Across Bangladesh, the number of people suffering from COVID-19 has climbed persistently since March, with more than 149,000 cases reported.
For patients in the paediatric ward at Goyalmara, Médecins Sans Frontières/Doctors Without Borders (MSF)’s mother and child hospital in the Cox’s Bazar refugee camps, COVID-19 is causing significant issues with accessing routine health care.
Noor Haba, a young mother in Bangladesh, pulls her headscarf close around her face with one hand. With the other hand, she strokes the back of her seven-year-old daughter, Shahara, who lies semi-conscious on the hospital bed. Shahara is being treated for thalassaemia, a genetic blood disorder.
Sharaha is the second of Noor Haba’s five children to suffer from thalassaemia, and Noor Haba has to bring them both to hospital every two months for blood transfusions. As there is no blood bank, she relies on people coming to the hospital voluntarily to give blood—usually a simple matter. Because of the pandemic, they’ve been waiting for a blood donor for three days now. Many people are scared to come to a medical facility for fear of catching the virus, while lockdown measures have made travel difficult.
“We’re searching everywhere,” Noor Haba says. “Normally we can easily find someone to give blood. But this time I can’t find any blood donors due to the COVID-19 situation. No one wants to come to the hospital because they feel afraid.”
The MSF nurse inserts a needle into Shahara’s arm and draws blood into a syringe. As the child cries out and squirms on the bed, her mother soothes her. Shahara’s legs and arms are stick thin; her belly is extended from the swollen spleen caused by her condition and exacerbated by malnutrition. Thalassaemia causes decreased haemoglobin levels and can be fatal if not treated with regular blood transfusions.
Normally we can easily find someone to give blood. But this time I can’t find any blood donors due to the COVID-19 situation. No one wants to come to the hospital because they feel afraid.
Prior to the arrival of COVID-19 in Bangladesh, MSF had finalised arrangements to send thalassaemia patients to a nearby surgical facility for splenectomies, reducing their need for regular blood transfusions and improving their quality of life, while also making it easier for struggling families like Noor Haba’s. But due to COVID-19, the facility is now unable to offer this service.
Facing shortages of staff and a lack of essential medical supplies and personal protective equipment, many health facilities, including those run by MSF, have had to make the distressing decision to reduce or close services. Across Cox’s Bazar district and in Dhaka, MSF has reduced its medical services to focus on lifesaving activities only. The outpatient department of Goyalmara hospital is currently closed. MSF paediatrician Ferdyoli Porcel believes pandemic-related closures could have devastating effects.
“For me, the most problematic thing is that people will start dying not from COVID-19, but from other diseases—normal diseases that we could treat,” Porcel says.
Noor Haba and her family face a bleak dilemma. Noor Haba’s husband has lost his job as a daily labourer because of the COVID-19 restrictions. To keep her daughters alive, she has to regularly make the 90-minute journey to the hospital, even though the family can barely afford to eat. Prices for public transport have tripled. On this occasion, she had to take a loan of 300 taka [$AU3] to pay their bus fare.
“It’s so hard,” Noor Haba says. “I have no money to go home. We have five children and I don’t know how we’ll feed them.
“I’m afraid all the time. I worry for my children and for my family. I pray that they will get better and this situation will improve.”
The most problematic thing is that people will start dying not from COVID-19, but from other diseases—normal diseases that we could treat.
The harmful stigma of COVID-19
Mohammad, a Rohingya father living in one of the many refugee camps in Cox’s Bazar district, was diagnosed with COVID-19 and taken to MSF’s Kutupalong field hospital, where he was isolated and received treatment.
Like many others, Mohammad faced the dual challenge of tackling the virus while enduring the social consequences of being diagnosed positive. Although global health guidelines state that close contacts of a COVID-19 patient can safely quarantine at home, Mohammad’s family were put under pressure by the community to leave their home and quarantine in a remote location. Mohammad was terrified that his family would be taken from their home against their will.
"People were threatening, saying they would burn our house down if my family didn’t go into quarantine,” he says. “It was so shameful for my family. They felt extremely frightened.”
Trust is central to a public health response—something MSF has seen in infectious disease outbreaks across the world, from Ebola to diphtheria. People must trust that any medical treatment they receive will be respectful and humane, and that they and their families will be safe if they seek medical care.
The breakdown of this trust can have severe consequences—in Bangladesh, patients with COVID-19 have told MSF staff of families being taken to quarantine centres against their will; of being threatened with eviction from their homes; and of being subjected to aggressive and threatening language. Such experiences can prevent people with symptoms from seeking testing or treatment, further exacerbating the spread of the virus.
Hopes for the future
Life goes on, even in the midst of a pandemic. Mothers give birth, families make plans for their future. MSF continues to run reproductive health services in all its facilities in Bangladesh, supporting women and children in need. However, the COVID-19 pandemic has affected these services too.
New mother Syeda was recently admitted to the isolation ward in Goyalmara hospital. All visitors have to don full personal protective gear—gown, face mask, and plastic face shield. Syeda herself wears a surgical mask; her eyes above the mask are frightened. Her baby son, just a few days old, is breathing with the help of a plastic tube attached to an oxygen canister.
“I’m so scared, for my baby and myself,” she says. “I worry about when we will be able to go home.”
Right now I can’t think about our future at all. Once my baby is well, then I can think about it.
After collapsing during labour, Syeda was rushed to a clinic for an emergency caesarean. Soon after, both she and her newborn were diagnosed with COVID-19. They were referred to MSF’s Goyalmara hospital, where they are now receiving treatment.
“This is my first baby,” says Syeda. “But right now I can’t think about our future at all. Once my baby is well, then I can think about it.”
Several miles away, in MSF’s Jamtoli clinic, Rohingya refugee Shokutara sits beside her newborn son, born hours earlier. Unable to hold back delight, she beams a huge smile. But the spectre of COVID hangs over her family too.
“People tell us to maintain space, but that isn’t possible to do because we live close together, Shaokutara says. “But still we try as best we can.
“In Myanmar we faced so many hardships and were so afraid. They tortured us. So I am happy here. I want my son and my daughter to both become educated so they can have a good future.”
Names have been changed to protect patients’ identities.
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