Bangladesh: Urgent response needed for scabies outbreak in Cox’s Bazar refugee camps

An estimated 40 per cent of people in the overcrowded camps currently have scabies, with a recent report by the World Health Organisation (WHO) suggesting that prevalence in some camps is as high as 70 per cent.

Scabies is easy to treat but can cause severe physical and mental effects if left untreated. The usual treatment involves drugs applied to patients’ skin, clothes and home environments to eliminate the parasite that causes the infestation. However, in this case Médecins Sans Frontières/Doctors Without Borders (MSF) warns that drugs will not be enough as the source of the outbreak needs to be tackled.  

“There have been recurrent discussions about a mass distribution of drugs within the camps to tackle the current outbreak, but drugs alone will not prevent reinfections if they are not accompanied by measures addressing the unsanitary conditions which have caused the outbreak,” says Karsten Noko, Head of Mission of MSF in Bangladesh.  

MSF teams in the camps have treated increasing numbers of patients with skin diseases in recent years. In March 2022, they started to see unusually high numbers of patients with scabies, since then the numbers have increased further. Between January and May this year, MSF teams treated almost 70,000 patients for scabies – nearly double that of the same period in 2022.  

“Some days we have reached peaks of 700 patients” says Pankaj Paul, Deputy Medical Coordinator of MSF Bangladesh. The situation remained the same until January 2023. Our teams have been alerting about the changing situation while completing a huge workload to respond to this increase. 

Our teams were already seeing an increased number of patients and from February 2023 they decided to redirect patients to the health facilities close to their respective camps.

"At the moment, we cannot treat everyone who comes in with scabies – we just don’t have the capacity” says Paul.  

“Our four-year-old son has had scabies since last December,” says Ajmot Ullah, a member of the Rohingya community living in the camps. “He started having rashes on his hands and then on his whole body. We spent money on doctors and pharmacies and eventually he got better, but he was reinfected with scabies very quickly. He doesn’t sleep much, his whole-body itches, especially at night, and he cries a lot from the pain. My other two sons also have scabies, and my wife and I have symptoms too. It has become a nightmare for my family."

MSF teams in Bangladesh conducted a study on water and sanitation conditions in the Rohingya refugee camps last year and it shows the situation is concerning. 

Teams found there is lack of proper sanitation and insufficient availability of water. While a considerable amount of water and sanitation infrastructure improvements have been made over the last two years (installation of water networks, chlorination), there is degradation in the maintenance, resulting in fewer functioning latrines than previously. In some areas, people have access to water for just two hours per day. This is due to poorly functioning water systems but also linked to water rationing under the misconception that groundwater resources are being depleted by the refugee population, which has been refuted by specialised monitoring and modelling of these water sources. In addition to this, basic hygiene rations are also limited. Last month, refugees’ soap rations were cut from two bars per month to just one bar. 

 “We do not have enough space,” says Taher, an 18-year-old refugee living in Jamtoli camp. “I have tried my best to maintain hygiene standards, but it is hard. We share bedding, we share clothes, we share everything. Now we share scabies too.”  

This out-of-control scabies outbreak is happening in a context of reduced funding for Rohingya refugees in Bangladesh, including cuts to their food rations. Even before the reduction in funding, the level of services provided by aid agencies within the camps did not meet the refugees’ needs. 

Of particular concern to MSF is people’s lack of access to health facilities in the camps that are fully staffed and supplied with sufficient medicine.  

“A 40 per cent positivity rate for scabies is the ‘canary in the coal mine’ moment, telling us that the underlying health and sanitation response in the camp is not functioning and that it risks further threats to the wellbeing of the Rohingya people and the local community in Cox’s Bazar,” says Noko.