David Nash was in Bangladesh for six months as head of mission, from July 2015 until February 2016. There are many health needs to address in this country, and a new security context to manage following a series of attacks of foreign workers. Médecins Sans Frontières focuses on sexual and gender-based violence and occupational health in Kamrangirchar, a large slum in Dhaka, and on a protracted refugee situation on the border with Myanmar.
“Following several waves of intercommunal violence since 1992, the most recent of which was in 2014, and ongoing restrictions on access to healthcare and protection, it is estimated that between 200,000 and 500,000 ethnic Rohingya people have crossed the border from Myanmar to find refuge in Bangladesh. While Bangladesh is developing fast, many refugees have settled in a less developed area, making it complicated to provide assistance to them. The Rohingya people are mostly dispersed amongst the population, but there are several makeshift camps where there are approximately 300,000 undocumented Rohingyas living with very little assistance.
"While Bangladesh is developing fast, many refugees have settled in a less developed area, making it complicated to provide assistance to them."
In 2009 Médecins Sans Frontières set-up a clinic close to the numerous makeshift camp in Cox’s Bazaar in an area called Kutupalong, facilitating healthcare access to residents there and the local host population - approximately half of those treated in our clinic in the area are Bangladeshis from the host community. We have an average of 8,000 consultations monthly in that clinic and 100 deliveries a month in the birthing unit. There is also a 42 bed in-patient department that is generally close to full. The main pathologies we are dealing with are seasonal low respiratory tract infections. We see some malnutrition on which we work with another international NGO; they do the ambulatory and we have a stabilisation unit in the hospital.
Our other project is in the city of Dhaka, the capital of the country, with almost the same population in a single city as the whole of Australia... It’s a very densely populated area and is facing pollution issues. We run a project in Kamrangirchar located in the South West of the city along the Buriganga River. This slum is hosting around half a million people most of whom are migrants from rural areas seeking a better life in the city. It’s a centre for small scale recycling of plastics, car batteries, zinc and tanneries, but there is almost no regulation of waste disposal from these small scale industries or any service provision, including healthcare, in what is an extremely densely populated area. These factors make it incredible that people would choose to come here.
"there is almost no regulation of waste disposal from these small scale industries or any service provision, including healthcare, in what is an extremely densely populated area"
We focus on several issues in Kamrangirchar, including running five clinics concentrating on occupational health. To develop this we approached the owners of these workshops and reached an agreement to register their workers at our clinic. They mainly suffer from skin and respiratory problems relating to their work environment, and there are some traumas as well. But we are not yet seeing conditions resulting from long-term exposure to such an environment. We are working with an anthropologist and an environmental health specialist to better understand the issues in particular these workers are facing and better address the health needs of the slum population. This analysis will also help us find the best way to provide health care to people migrating there from rural areas.
The Kamrangirchar project also focuses on reproductive health and sexual violence. This last component is very important and showing great results. Sexual violence is a substantial problem, especially intimate partner violence. Options for survivors are limited. In 2015 Médecins Sans Frontières handled over a thousand cases of sexual violence in this clinic, focusing on providing medical and psychological support to the survivors. Last year we introduced a new decentralized outreach model to reduce the obstacles people face seeking care and support, and saw the number of people seeking help in our clinic double. The program also provides care for adolescent sexual and reproductive health.
To allow as many people as possible to access our services we focus on the well-being of survivors, not prosecution of perpetrators. With intimate partner violence, such prosecution can stop a lot of woman from seeking support.”