From ... in Health — Apr 29, 2020

Bangladesh: Covid-19 Aid Limits Imperil Rohingya

Expand Rohingya refugees place empty jars in a line while waiting to collect water in Cox's Bazar, Bangladesh on April, 20, 2020. © 2020 Mohammad Hussain (Bangkok) – The Bangladesh government’s new Covid-19 restrictions on access to aid put Rohingya refugees at greater risk, Human Rights Watch said today.

The lockdown measures cut humanitarian workers in refugee camps by 80 percent and put the refugees at severe risk of food and water shortages and disease outbreak. Rohingya refugees place empty jars in a line while waiting to collect water in Cox's Bazar, Bangladesh on April, 20, 2020. Bangladesh authorities should ensure that any pandemic containment measures do not hinder aid groups’ ability to provide food, water, and health care, or prevent them from protecting refugees most at risk, including women and girls facing violence and domestic abuse. “Bangladesh authorities need to protect against the spread of Covid-19 in the Rohingya refugee camps, but every effort should be made to limit the harm from lockdown measures,” said Brad Adams, Asia director. “Any Covid-19-related restrictions shouldn’t significantly hinder aid groups’ ability to provide food, water, health care, and protection.” On April 8, 2020, the Bangladesh refugee relief and repatriation commissioner issued a directive that restricts services and facilities in the Rohingya refugee camps to those termed “critical” and reduces access for humanitarian aid staff by 80 percent. While these measures were adopted to avoid an outbreak of Covid-19 in the camps, 14 aid workers interviewed by Human Rights Watch said that the drastic reduction in operations capacity has affected their ability to perform even those services deemed “critical.” Health workers said that these interruptions could impede a prompt medical response to the virus and have long-term health consequences. Over 900,000 Rohingya refugees are living in refugee camps in southern Bangladesh after fleeing mass atrocities in neighboring Myanmar.

The extremely cramped conditions make the camps vulnerable to rapid spread of the Covid-19 virus if an outbreak occurred there.

The government’s new directive protects “critical” services including health, nutrition, water, food, gas, hygiene, sanitation, waste treatment, identification of new arrivals, and “ensuring quarantine.” But aid workers said that the staff restrictions and an internet blackout are obstructing their efforts to provide even these core services and to effectively respond to the Covid-19 threat. Staff reductions have also halted some vaccination programs such as the measles vaccine.

The camps have previously had outbreaks of measles and other infectious diseases. A health care worker said: Because of the restrictions and manpower shortage, the supply of the vaccination to the health posts or clinic has been interrupted. I cannot stress how important it is to maintain the vaccination coverage. Dealing with the Covid-19 outbreak should not mean we stop measures to prevent other diseases. Otherwise the refugee camps could be hit by a secondary outbreak like cholera or the measles. Some camps are facing serious food and water shortages. Seventeen refugees from 4 settlements – camps 7, 9, 11, and 18 – told Human Rights Watch that food rations haven’t been replenished and are dwindling and that some areas have no drinking water. Aid workers said the restrictions have led to disruptions in water and sanitation, which the World Health Organization (WHO) has said are essential to protecting human health during the Covid-19 outbreak. One aid official reported receiving complaints about overflowing latrines in some areas because there are not enough staff members to address these issues. Shortages of water and sanitation failures also increase the risk for older people and those with disabilities who cannot easily reach or wait in lines for functioning toilets and washing facilities. Without safe and private hygiene spaces, women and girls may be forced to choose between using the toilet and risking assault or harassment. Violence against women and girls has been a widespread problem in the camps. However, the recent lockdown measures cease all protection activities including access to “child and woman-friendly spaces” and gender-based violence case management. Women’s rights activists said that since the lockdown began, they have had increasing domestic violence and sexual abuse reports. But because of restrictions on communications, aid workers are unable to remotely coordinate support and protection services. One protection team member said that without officers working in the camps, “now if a woman is raped, that news will not reach me and she will not get any support from us.” The United Nations refugee agency, UNHCR, has urged governments to ensure that “critical services for survivors of gender-based violence are designated as essential and are accessible to those forcibly displaced.” Some aid workers allowed to enter the camps have had to postpone critical services because they lack personal protective equipment to guard against Covid-19.

The UN and donors should work with the Bangladesh government to ensure that all those performing critical services, including Rohingya volunteers, have sufficient equipment. Aid workers also reported harassment at checkpoints entering the camps and stigma in Cox’s Bazar for working in the camps during the pandemic. “We have heard several cases from our staff of being intimidated by the police at the checkpoints,” an aid worker told HRW. “Some of our staffs have been evicted by their landlords for being health workers at the camps. This is a disaster because these are the only people who can save us from this outbreak.” Restrictions on the internet and phone services have facilitated the spread of misinformation, deterring refugees from seeking urgent medical care. Refugees have expressed concern that they will be “taken away” if they report Covid-19 symptoms. One refugee said “There is a widespread rumor here that if anyone has any coronavirus symptoms, he or she is taken somewhere and killed.” The humanitarian aid group Médecins Sans Frontières (MSF) reported that the number of patients coming to clinics has dropped significantly and they fear this could lead to a serious outbreak of other illnesses in the camps. “When people have symptoms, they are purposely not coming to the health facilities because they are afraid that they will be taken away,” one aid worker said. “We have seen a decline in respiratory infection patients coming into our clinic.” Several refugees said that after local clinics turned them away for lack of capacity or referred them to MSF, security forces stopped them at checkpoints and prevented them from reaching MSF clinics on camp outskirts. Other refugees seeking medical care outside the camps said they were deterred by officers questioning them about their illnesses or hostility from local community members. People with HIV, for example, said they stopped taking their medication because traveling to obtain it required explaining their status. “There are not many health workers now available inside the camp, but I fear going outside to get my medicine because it feels like they [local residents] hate us and will beat us if they find us outside,” one refugee said. “The security checkpoints are another obstacle to cross.” Women and girls in the camps already faced serious obstacles to safe reproductive health care, and Bangladesh authorities should heed calls from aid groups and activists to safeguard access in the Covid-19 response. Any measures taken to restrict movement for public health or national emergency reasons must be lawful, necessary, and proportionate, as well as nondiscriminatory. Bangladesh authorities should use best practice guidance on scaling up Covid-19 readiness in crowded camps. “Bangladesh is in a race against time to contain the spread of Covid-19 in the Rohingya refugee camps, but the government’s new restrictions could make things worse,” Adams said. “Instead of shutting down the internet and severely curtailing basic services, the government should work with humanitarian groups to ensure aid and protection reaches those in need.”.

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