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transcript
Health Services in Humanitarian Crises Bangladesh Sample
ESAM [Economic and Social Researches Center]
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ESAM PUBLICATIONS
HEALTH SERVICES IN HUMANITARIAN CRISES [Bangladesh Sample]
Publication Executive Dr. M. Eyyup HAZAR
Publication Consultant Atik AGDAG
Editorial Board
Prof. Dr. Mustafa KARAHOCAGIL
Prof. Dr. Secil OZKAN
Uzm. Dr. Muhammed Yasar SEVER
Dr. Huseyin MUTLU
Dr. Muhammed Fatih AKDEMIR
Assist Prof. Namaitijiang MAIMAITI
Prof. Dr. Mustafa Necmi ILHAN
Prof. Dr. Zeynep Aytül ÇAKMAK
Uzm. Dr. Mevlit YURTSEVEN
Uzm. Dr. Yunus Emre BULUT
Assist Prof. Mehmet Enes GOKLER
Merve AY
Reporter Mazlum AR
Editor Yusuf YALANIZ
Organizing Committee
Uzm. Dr. Muhammed Yasar SEVER
Uzm. Dr. Tayyibe SEVER
Dr. Ahmet Taher ALMOFTI
Dr. Muhammed Fatih AKDEMIR
Uzm. Dr. Songul HAZAR
Uzm. Dr. Yunus Emre BULUT
Assist Prof. Mehmet Enes GOKLER
Dr. Uzeyir ERDOGAN
Oguz ALTINOZ
Page Design Cover Design
ESAM Designer Yusuf KARAAGAC
ISBN
978-605-83736-3-1
ESAM [Economic and Social Researches Center]
Ziyabey Avenue 1416. Street No:22 Balgat/Cankaya - Ankara/Turkey
www.esam.org.tr
December 2018
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Contents
ABBREVIATIONS .................................................................................................. 5
PREFACE .............................................................................................................. 6
INTRODUCTON ................................................................................................... 7
THE OVERVIEW FOR ARAKANESE REGION ................................................... 10
HISTORICAL BACKGROUND............................................................................. 13
Arakan Genocide from the Past to the Present ..................................................... 15
Start of Arakan Massacre and 1942 Genocide ........................................................ 16
Burma Militia Massacre .......................................................................................... 17
The Break of Islamic Resistance and Restart of Genocide with 1962 Coup .......... 18
Arakan Genocide in 2012 and Afterwards ............................................................ 19
GENERAL SITUATION OF BANGLADESH HUMANITARIAN CRISIS ............. 21
General Features of the Camps ................................................................................ 21
Kutupalong Refugee Camp ................................................................................. 26
Nayapara Mülteci Kampı .................................................................................... 29
HEALTH SERVICES GIVEN TO BANGLADESHI REFUGEES ............................ 32
Public Health Risks at Camps, Needs and Intervention ........................................ 40
Infectious Diseases ............................................................................................... 40
Surveillance ..................................................................................................... 40
Preparation for Epidemics ............................................................................... 42
Water-Based Diseases ...................................................................................... 42
Acute Water Diarrhoea ............................................................................... 42
Acute Jaundice ............................................................................................ 42
Vector-borne Diseases ..................................................................................... 43
Diseases Preventable with Vaccines ................................................................ 43
Measles ....................................................................................................... 43
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Diphtheria .................................................................................................. 44
Sexual and Reproductive Health .................................................................... 45
Mental Health and Psycho-social Support ..................................................... 46
CRISIS MANAGEMENT IN EXTRAORDINARY SITUATIONS .......................... 46
Bangladesh Refugee Camps and Health System .................................................... 48
Management and Coordination .......................................................................... 48
Health Services and Control of Infectious Diseases ............................................. 56
Mother and Child Health Services ......................................................................... 61
CONCLUSION, RECOMMENDATIONS AND SOLUTIONS ............................. 64
REFERENCES ..................................................................................................... 70
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ABBREVIATIONS AFAD Disaster and Emergency Management Authority
AID Alliance of International Doctors
UN United Nations
BRAC Bangladesh Rural Advancement Committee
BSPP Burma Socialist Program Party
EWARS The Early Warning, Alert and Response System
IOM International Organization for Migration
ISCG Inter Sectoral Coordination Group
IHH Humanitarian Relief Foundation
MHPSS Mental Health and Psychosocial Support
MOAS Migrant Offshore Aid Station
MSF Médecins Sans Frontières
SAG Advisory Group
SCG Systems Consulting Group
SRH Sexual and Reproductive Health
NGO Non-Governmental Organization
SWOT Streghts, Weaknesses, Opportunities, Threats
TIKA Turkish Cooperation and Coordination Agency
UNFPA United Nations Population Fund
UNHCR The UN Refugee Agency
UNICEF United Nations International Children’s Emergency Fund
WHO World Health Organization
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PREFACE As the Directorate of Health Workers of ESAM, we have been carrying out various studies in order
to investigate, evaluate and find solution to problems both in national and international arena. In
this workshop, we discussed the issue of “Health Problems and Health Services” of Arakhan Muslims
taking a refugee in Bangladesh as they escaped from the oppression of Myanmar management and
having been exposed to serious health problems.
Starting with the year of 1937 and carried on after the Second World War, the genocide having been
experienced by Arakhan Muslims who have been exposed to big oppressions in recent years is still
going on currently. This humanitarian disaster which all the world stay silent but hundreds of thou-
sands of people were massacred, particularly faced by millions of Rohingya Muslims who turned
into refugees is gradually deepened.
Important problems are experienced in refugee camps where Arakanese Muslims escaping from the
oppression try hard to live in almost every field. Any individual and unplanned activity realised in
the Bangladeshi refugee camps where thousands of NGOs, institutions and departments carry out
their works affect any other fields, as well. As any wrong use in refugee camps where serious health
problems are seen would lead to important problems, it is necessary that all shareholder organiza-
tions be in coordination. Since the problems experienced particularly in the field of health is of
significance and could lead to non-recoverable results, any kind of intervention to be applied has to
be well planned in all senses.
This workshop report was examined in terms of health problems in humanitarian crises, organiza-
tional studies, health services and the relational dimensions between them in different ways and it
was concluded with the sample of Bangladesh.
We hope that our workshop of “Health Services at Humanitarian Crises: Bangladesh Sample” and
our report which we believe that it will help increase the quality of activities made for refugees will
be beneficial for the health organizations in the first place, all the organizations, official institutions
and department serving for the refugees in different regions of the world.
We are grateful for SASAM, AID giving any kind of support in the fulfilment of the workshop “Health
Services at Humanitarian Crises: Bangladesh”; Organization of Islamic Cooperation, Ministry of
Health, AFAD, IHH, SESRIC; ANSAR; ONSUR, Besir Dernegi, Turkiye Diyanet Vakfı, Saglık ve
Medeniyet Dernegi, Hudayi Vakfı for their participation and the Presidency of ESAM Health Workers
for their labour in the preparation of this report.
Dr. M. Eyyüp HAZAR
Director of ESAM Health Policies
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INTRODUCTON he world order formed in
line with the benefits of
global powers having a
worldly conflicting belief has been
pushing humanity towards a de-
struction and chaos. Bringing noth-
ing but blood, tear and misery, this
system destroys all good and useful
values and human life for the sake of
their benefits.
The imperialist order having caused
for the death of eighty million peo-
ple in the first and second world
wars and carrying on their existence
based on the absence and poverty of
1 www.unicef.org
the other is attacking with an ever-
lasting appetite.
The developed civilized world keep-
ing silent for these attacks is unfor-
tunately making the humanitarian
disaster deeper instead of offering
solutions for the problems and de-
structions.
In this tragedy where the concept of
justice means nothing but the will of
the powerful and the weakness of
the powerless,
10.9 million
children die of
hunger or mal-
nutrition before
they reach 5
years of age, 945
million people
live under hun-
ger limit.1
Because of the
negative effect of wars, millions of
people keep on losing their lives,
millions of other people become ref-
ugees, hundreds of thousands of
people die on the migration ways in
order to be able to hold on to life and
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thousands of small girls are exposed
to sexual abuse and rape.
Experienced as extraordinary cases,
these processes are basically the case
of crisis, namely, the period of de-
pression. For that reason, the activi-
ties to be carried out in these periods
differ from those of ordinary pro-
cesses. In other words, it will never
be possible to manage the period ex-
traordinary crises with the terms of
ordinary process, the methods of ad-
ministration.
The extraordinary periods that are
regarded as crisis periods are multi-
dimensional and multi-layer cases
comprised of multiple events. The
fact that they are multi-dimensional
and multi-layer requires that these
services must involve protective, cu-
rative and rehabilitative services.
Besides that, it is necessary to use
economical resources in a balanced
and effective way in the periods of
crisis and to manage not only na-
tional sources but also international
humanitarian and physical sources
within a system. As these sources
that are made up of any kind of ac-
tivity made to intervene the crisis re-
quire a very powerful correlation, in-
teraction and communication ser-
vices, it is necessary that all of the
organizations (NGOs, official insti-
tutions and departments) stay in
communication within a common
sense and system and carry out their
works with the coordination of this
system.
All the strategic planning, research-
ing, application and evaluation
works that are necessary in order to
cope with crises in extraordinary
times must be made beforehand, in
other words, preparation stage
which is the first stage be completed;
secondly, warning and intervention
stage and finally rehabilitation and
supervision stage must be carried
on. Any kind of step taken in ex-
traordinary situations which do not
bare this working discipline would
make the crises deeper.
Since the activities to be carried out
particularly in the health field in cri-
sis situations will affect the life of in-
dividual and community and will
bring about irreparable results, it is
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required that health organizations
plan and carry out their works in a
big care.
Purpose
The purpose of the current study is
to investigate the activities carried
out in the regions of crisis, working
principles, systems and organization
structures of health organizations in
particular and other organizations
related to this field in extraordinary
situations based on Bangladesh sam-
pling and to determine the ways of
solutions and offer recommenda-
tions.
In the first part of the report which
is made up of two main parts, an
evaluation was made. In this sense,
the data regarding the structural fea-
tures of Bangladeshi refugee camps,
basic dynamics with regard to refu-
gees, health services aiming at refu-
gees, health system coordinating
health services and the health prob-
lems experienced in refugee camps
was given.
In the second part of the report, the
activities of the organizations carry-
ing out works in the field of health
in Bangladesh refugee camps, basic
problems they met in the crisis re-
gion, the effects of the organizations
acting in other fields on the field of
health and coordination between or-
ganizations were studied.
Method
Within the qualitative research
methods, this report was prepared in
a well-attended workshop with the
participation of academicians study-
ing in the fields of Public Health and
other health fields, various scien-
tists, the administrators of local and
international nongovernmental or-
ganizations.
In addition, the related reports were
examined, statistical data was col-
lected, the applications of national
and international organizations act-
ing in the refugee camps were ob-
served, some feasibility works were
carried out in place in Bangladesh
refugee camps and a true diagnosis
and ways of solutions were tried to
be found by combining all the data.
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Scope and Limitations
The population of this study was
made up of Bangladesh humanitar-
ian crisis hosting 1 million Ara-
kanese refugees. In this scope, the
limitations of the report within the
framework of the sampling of Ara-
kanese crisis and health problems of
the refugees with the health services
applied are as follows:
• Investigation of only Kutupalong
and Nayapara refugee camps, which
are official refugee camps,
• As for health applications, investi-
gation of management and coordina-
tion in the field health, preventive
health services and control of com-
municable diseases with mother and
child health.
Other refugee camps in Bangladesh
and other issues within the health
field were excluded from the scope
of this study.
2 www.bolgegundem.com, 2018
THE OVERVIEW FOR ARAKANESE REGION
he province of Arakan,
with the official name of
Rakhine State, is one of 7
states of the State of Myanmar. In the
region of Arakan, which has the
State of Chin in the North, Magwan,
Bago and Ayeyarwady regions in
East, Bengal Gulf in the West and
Chittagong region of Bangladesh in
the North-west, a great majority of
the population is made up of Muslim
Rohingyans and Buddhist
Rakhines.2
Arakan was an independent king-
dom throughout 18th century be-
cause of the advantages of its geo-
graphical location. Being an exten-
sion of Chittagong Lowland, Arakan
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is physically and geographically sep-
arated by the mountain ranges of
Arakan Yoma from the rest of the re-
gion known as Burma in the British
colonial period and called as
Myanmar in the
current time.
Being mountain-
ous and covered
with dense for-
ests, Arakan
opens to Indian
Ocean and outer
world with its
580 kilometre
coast lines stretching along the East-
ern coasts of Bengal Bay.
Since the two hundred and 285 kilo-
metre territorial and sea borders
with Bangladesh is so easily reacha-
ble, the Muslims departing the re-
gion because of the events experi-
enced mostly head to this border.
With this border, Arakan has the ti-
tle of the gate opening to Far East.
3 www.dusuncemektebi.com, 2018
It is prone to the effects likely to
come from the sea with its 360 kilo-
metre-mile coast line in its West. For
that reason, Buddhism appeared in
Arakan before it reached Burma.3
In addition, the people living the
two sides of the border between Ara-
kan and Bangladesh speak the same
language, believe in the same reli-
gion and have the same physiology.
In terms of population, Arakan re-
gion has a dense population as in
other regions in the south of the
continent. Among this population,
as Rohingyans are not regarded as
one of the official ethnic groups (but
as illegal Bangladeshi refugees) they
are not registered, do not have ID
FIGURE 1: MYANMAR LOCATION MAP
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cards and are not included in the
census.
Nevertheless, even though some of-
ficial population results belonging to
Myanmar are declared, it is difficult
to determine the real demographic
features of the Arakan region both
because Muslims abandoned the re-
gion intensively due to the massa-
cres upon Muslims and because of
the efforts of showing Muslim popu-
lation intensity smaller. However,
Arakan Muslims comprise 17% of
Myannam population of 51 million
when we consider over 1 million 850
thousand Arakan Muslims taking a
refuge in Bangladesh in first place, in
4 The Rohingya Refugee Crisis: Bangla-desh Seeks Solutions, (www. johnbri-anshannon.com)
Malaysia, Saudi Arabia, Pakistan and
Europe.
Arakan Muslims migrated by escap-
ing from Myanmar oppression, geo-
political proximity in the first place,
religious, cultural, ethnic etc. com-
ponents are effective on migration
tendency.
At this point, the
state of Bangla-
desh hosting
around 1 million
Arakenese refu-
gees is followed
by Pakistan with
350 thousand
refugees with
Saudi Arabia at
the third place hosting 200 thousand
refugees, and these countries are fol-
lowed by such countries as Malaysia
in close locations.4
FIGURE 2: THE NUMBER OF ARAKAN REFUGEES IN THE BASIS OF COUNTRIES
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HISTORICAL BACKGROUND
he historical development
of Arakan comprise a long
period and is closely re-
garded with Indian territory mostly.
This context is mostly considered
over the reign of Indian Chandra
Dynasty in Arakan in 7th and 10th
centuries.
The start of spreading Islam in these
lands was also in the era of Chandra
Dynasty. This spread was started by
Wakkas bin Malik (R.A) and a group
of Muslims. In addition, the spread
of Islam (with the effect of the con-
nections of Muslims to other regions
in line with the Hajj activities) accel-
erated by means of Muslim scientists
and travellers and an important part
of the people in the region converted
to Islam.
The spreading adventure of the reli-
gion of Islam in Arakan and other
fields of the region reigning in a pe-
riod over two hundred years started
to stagnate in the years of 960s.
There is no doubt that this stagna-
tion resulted from Mongolian inva-
sion ending a great many rulings in-
cluding Vesali Indian Kingdom com-
prising Arakan as well.
Significant changes happed in the re-
gion in more than 400 years and
Muslims started to live with another
ethnic group called Magh who lo-
cated in the region with the Mongo-
lian invasion and practicing Bud-
dhism culture having spread with
the activities of Magha Buddhists.
In the year 1406, the Burmese King
known as Myanmar today invaded
the region of Arakan and a great
many people, including the King of
Narameikhla, escaped, and taking a
refuge in Muslim Bangladesh.
In this period of refuge, the King of
Arakan who converted to İslam and
took the name of Suleiman Shah
took the control of the region again
with the other Arakanese Muslims
after the Bengali King had sent a big
troop to Arakan in the year 1430 and
threw Burmese invaders out of the
region.
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In the year 1784, the Burmese King
invaded Arakan again and forty
years later the region became the
colony of the British in 1824.
When it came to 1885, the British in-
vaded all Burma and colonized
there. This colonization period is
one of the reason why Myanmar
government and Buddhists external-
ize Arakanese Muslims today.
They believe that Arakanese Mus-
lims are those brought by the British
from other colonies to make them
work. For that reason, Myanmar
government do not regard Ara-
kanese Muslims as a citizen and de-
prive them of all rights Myanmarese
citizens have.
In 1937, the British gave autonomy
to Burma and left the region and
Burma declared its independence in
the year 1948.
Grapping the power in 1962, the
Burmese Army declared one party
Burma Socialist State in 1974. Divid-
ing the country into states, one party
regime made Arakan a state and
named Arakan Rakhine State. In
1988, even though National Democ-
racy front obtained a great success in
the general elections made after na-
tionwide riots, military dicta went
on keeping the power in reserve.
In the general elections made in
2010 after the adoption of the new
construction following the new ref-
erendum in 2008, Union Solidarity
and Development Party supported
by the army won the elections.
In Arakan, even though National
Democrat Party got the majority in
the state assembly, the state assem-
bly was formed with the support of
Union Solidarity and Development
Party.
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Arakan Genocide from the Past to the Present
he basis of any kind of
massive isolation, geno-
cide etc. to which Ara-
kanese Muslims were exposed de-
pends on pre Second World War. Be-
ing a British colony, Burma started
its struggle in cooperation with Ja-
pan in order to free itself from the
British colony totally after it became
autonomous in 1937. This struggle
was made by Thakin Party and its
members and they agreed with Ara-
kanese Bud-
dhist - Maghs
upon anti-In-
dian.
With the dis-
courses that
Muslims pose a
significant dan-
ger for Bud-
dhism and that
unless they are stopped they will
cause the extinction of Buddhists,
the leaders of Buddhist – Maghs try-
ing to provoke Arakanese Buddhist
Rakhines and Muslim Rohignyans
and the co-conspirators of Thakin
Party planted the seeds of hate in the
region.
In addition, they caused a religious
polarization which had never been
in the region with the falsified news
that Muslims were in collaboration
with the British against the Burmese
independence struggle.
In this sense, Buddhist-Maghs and
Takin Party co-conspirators agreed
to a great extent with conspiracy to
wipe out Arakanese Muslims and
put the Arakan region under Bur-
mese ruling. For that reason, they
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never put any demand of recogni-
tion or independence by other
groups on the agenda.
In the Burmese Round Table Confer-
ence in London in 1932, Rakhine-
Magh political leaders put a lobby
pressure upon the British to give
them independence while they kept
silence by putting no demand for-
ward for Arakan.
Furthermore, while all ethnic
groups made bargaining for the fu-
ture of their own regions after inde-
pendence in 1947 Panglong Confer-
ence made just before independ-
ence, the Rakhine-Magh leaders rep-
resenting Arakan people did not
even demand to be recognized as a
state and preferred to stay under he-
gemony of the Burmese and central
government. As a matter of fact,
granting “autonomy” or “the right to
withdraw after abiding Burmese
Unity for 10 years” had already been
adopted.
Start of Arakan Massacre and 1942 Genocide
fter Burma gained its in-
dependence, there be-
came conflicts among the
groups in Burma with the provoca-
tions of the Thakin Party leaders. In
particular, anti-Indian rebellions af-
fected Muslims.
In the wake of the Second World
War, after the bombing of Rangoon
in 23rd December, 1941 by Japan
following the Indians trying to mi-
grate to India through Arakan, both
Indian and British troops withdrew
from the region.
Having waited for the opportunity of
a massacre for a long time and al-
ready completed their preparation,
Thakin members ordered for a mas-
sacre and started the genocide on
28th March. Rakhine-Magh and
Thakin Party members who were
planning a genocide encountered
with an unexpected resistance in the
Buthidaung fight occurred between
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Rakhine – Magh members and sup-
porters and Arakanese Muslims
against the purpose of expelling
Muslims from the region com-
pletely.
Even though the Arakanese Muslims
won this fight, more than 100.000
Muslims were massacred in the fight
which lasted one month. 294 Mus-
lim villages were completely cleared
out and 500.000 homeless people
had to migrate, and around 80.000
escaped to Bangladesh to stay there.
Muslims governed the region until
the British arrived in the region with
the name of “Peace Committee”, but
after the Second World War,
Rakhine – Magh and Thakin Party
members watched for an oppor-
tunity for a genocide once again.
Burma Militia Massacre
ollowing the declaration of
independence in Burma,
the position of the Ara-
kanese Muslims who were not called
for 1947 Panglong Conference and
were exposed to ethnic cleansing be-
came worse with the formation of a
border guard force out of Rakhine –
Maghs 90% of whom were already
the fierce enemy of Muslims in the
name of Burma Militia of the Bur-
mese regime.
Trying to turn the air to their side
particularly by taking the oppor-
tunity of the political turmoil in Pa-
kistan, Burmese Militia started a new
genocide and killed more than
10.000 Muslims. In this genocide
where more than 50.000 Muslims
escaping from the massacre to Paki-
stan, Burmese Militia killed the lead-
ing people of the community start-
ing with the religious leaders.
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The Break of Islamic Resistance and Restart of Genocide with 1962 Coup
he emergence of a serious
resistance among Ara-
kanese Muslims because
of the massacre became a problem in
terms of Burma and Buddhist repre-
sentatives. Trying to break the re-
sistance, Burmese rulers released a
manifest on 24th September 1954 in
order to break the synergy between
the public and declared that Ara-
kanese Muslims had the same rights
with other communities and that
Rohignyans were a local community
of Burma.
Upon this declaration, Muslim poli-
ticians in particular adopted the idea
that Muslim Arakanese must be in
cooperation with the state and
started to work for the disarmament
of rebels.
With such kind of promises by the
state, a significant part of the rebels
took away their weapons, however,
the government gave up their prom-
ises later on.
In particular, Revolutionist Com-
mand Council which took over the
regime with a bloody military coup
in 1962 increased the pressure upon
Arakanese Muslims and started any
kind of illegal activities (arrestment,
extortion, execution etc.) in order to
make the Muslims migrate to East-
ern Pakistan.
In 1974, the coup commission be-
coming a party with the name of
Burma Socialist Program Party
(BSPP) declared the Region of Ara-
kan a state and called it “Rakhine
State” representing Buddhists.
In 1982, BSPP regime enacted a new
constitution and denaturalized Ara-
kanese Muslims. In addition, not be-
ing able to stand the one party so-
cialist regime, BSPP, which lead the
country to poverty and decreased
Burma to the level of underdevel-
oped countries, the Burmese re-
belled with a spontaneous rebel
against one party socialist BSPP re-
gime in 1988. Calling an election to
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correct this situation but losing the
election against National Democracy
Party, the army did not leave the
government. Because of the in-
creased oppressions upon Rohing-
yans who were thought to be the cul-
prit, 300.000 Arakanese Muslims
had to migrate to Bangladesh.
However, new Bangladeshi govern-
ment coming after the death of
Sheikh Mujib tried to prevent the
passing of Arakanese refugees and
declared that they would not accept
new comers as a refugee anymore.
But people disposed of their rented
houses in addition to the new com-
ers started to live in slab huts built
along the banks of streams and in
muddy lands in big groups.
As a result of the insistence of some
humanitarian institutions, the gov-
ernment of Bangladesh had to allow
unofficial camps. Known as “Taal”,
these camps mean dump of houses
(just like dump of garbage) having
no basic comfort of life.
Such NGOs as CANSUYU, AID (Al-
liance of International Doctors),
IHH (The Foundation for Human
Rights and Freedoms and Humani-
tarian Relief), Islamic Relief and
Doctors Without Borders tried to
supply humanitarian aid and health
service to the region but the Bangla-
deshi government has prohibited to
reach the humanitarian aid over the
unregistered camps since 1910.
Arakan Genocide in 2012 and Afterwards
ecoming a more and more
desperate situation, Arakan
genocide and humanitarian
case turned out to be an unsolvable
situation depending on the develop-
ments in the region and in interna-
tional arena.
The changes in the administration of
Bangladesh which is one of the big-
gest protectors of Rohingyan Mus-
lims from the very beginning and
giving any kind of service and aid
gave a suitable ground for such ac-
tivities as any kind of genocide,
forced migration, assimilation etc.
B
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The political division of the Rohing-
yans, dispersal with no ability to in-
tervene the events, the separation in
the rebellion itself and structural in-
efficacy allowed the internal dynam-
ics of the region to move in an easy
way.
In addition, the perceptive tendency
of particularly the Islam Ummah and
the people in the region decreased
because of the Arab Spring starting
in 2010 and affecting a great many
Muslim countries, Tunisia in the
first place, and the political and so-
cial events occurring based on this
events.
Depending on the takeover of the
Arakan State Council by Rakhine-
Magh politically after 2010 general
elections, a new genocide was orga-
nized. With a conspiracy theory that
three Muslims raped a Buddhist
woman and killed her (which was
later confirmed that it was not true),
more than 200.000 people had to
leave their homes after the events
starting 3rd June, 2012.
In these events where more than 5
thousand people were killed, nearly
160.000 people had to escape to
Thailand and other near countries.
These events with which hundreds
of thousands of Arakanese Muslims
were exposed the oppression were
intensified with the emergence of a
rebellion group called Hareke el-Ya-
kin on October 2016 (a group of
which founders and the purpose are
not known and serving for the My-
anmar government and external
forces rather than being beneficial
for Muslims).
In 2017, because of the pressure
made depending on the actions by
Hareke el-Yakın group, nearly
436.000 Rohingyan Muslims es-
caped to Bangladeshi border and
313.000 of them were able to take
refuge in Cox’s Bazar refugee camp
but Muslims between 4 and 8 thou-
sand lost their lives
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GENERAL SITUATION OF BANGLADESH HUMANITARIAN CRISIS
General Features of the Camps
rakanese Muslims escap-
ing from the Myanmar ad-
ministration and Buddhist
Rakhine-Magh oppression mostly
head to Bangladesh because of vari-
ous reasons
such as geo-
political
neighbour-
hood, theo-
logical, soci-
ological and
ethnograph-
ical reasons.
Rohingyan
Muslims
mostly prefer valley grounds as a
course because of hard land and cli-
mate conditions in order to be in se-
cure and make a faster passing.
In this sense, Arakanese Muslims
who pass to the Cox’s Bazar region
of Bangladesh by passing Naf River
settle either in the camps where their
relatives had already settled or in the
nearest refugee camp to the passage.
All the camp places and settlements
in the Cox’s Bazar region of Bangla-
desh except for Kutupalong and Na-
yapara are not officially accepted as
refugee settlement by the Bangla-
desh government.
A
FIGURE 3: THE DIS TRIBUTION OF ARAKANESE REFUGEES SETTLED IN BANGLADESH
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Other unofficial camps are the camp
fields of Leda, Shamlapur, Un-
chiprang, Chakmarkul, Moynar-
ghona, Jamtoli, Hakimpara,
Thangkhali, Balukhali. In addition,
even though they are not officially
accepted, both health departments
and other official institutions divide
refugee fields into three and carry
out their works upon this structure.5
This division is made as:
• Kutupalong and Nayapara refugee
field as official refugee camp fields,
• Temporary settlement places com-
prising pre 2017
5 www.unocha.org
• Disorganized/
spontaneous set-
tlement field
comprising post
2017.
As seen in the
map, the majority
of the population
settled in
Kutupalong offi-
cial camp, Kutupalong Makeshift
camp (temporary settlement re-
gions) and in the region containing
Balukhali Makeshift camp with the
guidance of the government. This
place is also called as Kutupalong
Megacamp and the camp was di-
vided into smaller camps in it.
As of 2018 June, all the camps ex-
cept for Nayapara and Kutupalong
camp were replaced administratively
by enumerated smaller camps (total
33 camps). 85% of the refugees live
in the camps while 13% live with lo-
cal people together or in the villages.
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New disor-
ganized camps
where refugees
settled experi-
ence problems
in many senses
as they were set-
tled in hilly
places away
from residential
areas. Transportation problem to-
gether with the problem of infra-
structure is one of the most basic
problems in the settlement fields.
For that reason, refugees prefer the
fields which are easy to have an ac-
cess by walking.
The building material of the shelters
where refugees stay in this settle-
ment fields is bamboo trees. The rea-
son this material is preferred is that
it is cheap and easy to provide. Build
in the camp fields with the help of
local and international relief organi-
zations and increasing gradually,
these buildings are about 909.000
and 70% of them are deprived of hu-
manitarian conditions. Although the
shelter need of refugees was almost
met as of 25th August, 2017, they
need to be strengthened because of
intensive monsoon rains in April
and May every year.
In addition both national and inter-
national health and other relief or-
ganizations make preparations for
the risks of epidemics, flood and
landslide when the Monsoon season
starts.
Even though the water problem of
the Arakanese refugees recovered to
some extent, half of the population
in the 86% of all regions refugees live
can have an adequate access to wa-
ter. When the holes are filled with
water, toilets cannot be used. The
fact that toilets are close to the water
resources leads to serious problems
in terms of water and sanitation.
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The number of fields to have a
shower is limited and male and child
refugees have their showers in the
wells they dig.
There are not enough places for
women to have a shower. In some
regions, open sewage water channels
are built for the waste water other
than toilets.
Not being able to collect rubbish,
limited access to soap and hygienic
materials are the situations affecting
health negatively. Ninety-one per-
cent of the Arakanese refugees meet
their food needs only through hu-
manitarian aids. The diversity and
nutrition of the food distributed is
limited.
The rates of malnutrition are more
spread among adolescent, women
and children. Acute malnutrition
rate in unorganized camps is 19,3%
and it is 24% in Kutupalong Camp.
The number of
people in need
of nutrient sup-
port is over
564.000. Half
of the children
is anaemic and
240.000 chil-
dren need vita-
min A support.
The settlement of Arakanese Mus-
lims in the camp fields in the Cox’s
Bazar region of Bangladesh where
the number of Arakanese is getting
increased day by day is divided into
two periods.
The first period comprising the term
between 1942 and 2017 which is
also called as the early period con-
tains the period when over 300.000
Arakanese Muslims migrated. The
second period, which is the date
25th August, 2017 and afterwards, is
the fastest growing human crisis of
the world.
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This period contains the process
when a total sum of 671.500 Ara-
kanese Muslims migrated from Roh-
ingya to Cox’s Bazar region.
5% of Arakanese refugees the num-
ber of whom reaches to 866.000 to-
gether with the number of the refu-
gees taking a refuge in the period be-
fore 2017 was settled in Kutupalong
and Nayapara official camps that
were set up before the crisis, 13% of
them were settled in other 3 unoffi-
cial camps. 73% of the rest were set-
tled in the disorganized camps lo-
cated around these camps and 9%
were settled in villages temporarily.
Bangladesh Government expressed
that they made the biometric registry
of 1.040.000 refugees as of 27th Jan-
uary, 2018, IOM (International Or-
ganization of Migration) reported
that estimated number of refugees
was 898.000 in March 2018.
FIGURE 4: DISTRIBUTION OF REFUGEES IN TERMS OF AGE AND GENDER
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The fact that both Bangladesh gov-
ernment and International Organi-
zation of Migration released differ-
ent numbers results from the census
methodology rather than new com-
ing refugees.6
As given in Figure 4 showing the age
and gender distribution of Ara-
kanese refugees, females comprise
52% of the Arakanese refugee popu-
lation in the region and males com-
prise 48% of the rest.
The distribution of 18-59 age inter-
val with 42,1% where biggest accu-
mulation was formed was followed
by 5-10 age group with 22,5%, 0-5
6 www.humanitarianresponse.com, 2018
age group with 18,5%, 12-17 age
group with 13,7% and 60+ age group
with 3,4%.
Kutupalong Refugee Camp
eing the most intensive
camp in terms of areal in-
tensity, Kutupalong camp
is one of the two official refugee
camp in Bangladesh and was set up
with the settlement of the first refu-
gees coming to Bangladesh with the
start of Arakan events. The intensity
of the camp located in Cox’s Bazar
region decreases from the centre to-
wards circumference.
B
FIGURE 5: DISTRIBUTION OF REFUGEES IN KUTUPALONG
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In the camp region which is made up
of 20 different fields, 14th, 15th and
16th fields which are out of official
Kutupalong camp (other field out of
the central camp of Kutupalong was
excluded in the scope of the study)
are the unorganized/spontaneous
settlement regions formed by the ref-
ugees arriving after the events on
25th August 2017 and the other re-
gions are the temporary settlements
formed before 2017.
In the Kutupalong camp field having
6.374 shelters, there are 10.191 shel-
ters per km2. While 22% of the refu-
gees in Kutupalong camp live in
7 Post-Distribution Monitoring Bangla-desh Refugee Sıtuatıon, (UNHCR, Post-
bamboo and plastic shelters, the rest
lives in divided and shared shelters.7
Official and central Kutupalong
camp covering 0,5 km2 hosts 21.000
refugees and 4.600 families with 69
people per m2. Besides that, total
population of the unorganized/spon-
taneous settlement camps after 2017
with the temporary settlement
camps before 2017 that were in-
cluded in the central camp and are
not regarded as official refugee
camps is 626.000. Fifty-one percent
Distribution Monitoring Bangladesh Refugee Sıtuatıon, 2018)
FIGURE 6: GENDER DISTRIBUTION OF THE REFUGEES IN KUTUPALONG CAMP
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28
of the camp population is under 18
and the number of individuals per
person is 5.8
The camp area where seventy-eight
percent of the population is made up
of women and children are in danger
of serious problems in a great many
fields such as health, food, security
etc. As for the facing of refugees with
problems, there appears an increase
from the central camp areas towards
unorganized camp fields.
The problem of accommodation is in
the first place in Kutupalong camp
field and it is followed by such
problems as food, fuel material,
8 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee
utensils, drinkable water, health ser-
vices, clothing, income activities,
toilet and education.
Almost all drinking water in
Kutupalong camp is supplied from
the wells. As the water sanitation is
so low, a lot of health problems are
experienced because of contamina-
tion of the water.
Even though the problem of accom-
modation is partly solved, there be-
comes serious periodical water
floods because of the climate condi-
tions in the region and monsoon
rains.
Crısıs Camp Settlement and Protection Profiling, 2018)
FIGURE 7: THE DISTRIBUTION OF THE NEEDS OF KUTUPALONG CAMP REFUGEES
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This case leads to the increase the
existing problems from accommoda-
tion to the need for clean water.9
Nayapara Mülteci Kampı
ayapara refugee camp,
which is the nearest one
for Arakanese Rohi-
gnyans is the second official camp
9 Camp Settlement and Protection Profil-ing, (UNHCR, Post-Distribution Monitor-ing Bangladesh Refugee Sıtuatıon, 2018)
set up for the refugees in Bangla-
desh.
Located within the borders of Cox’s
Bazar region, Nayapara camp has
less density and areal extent com-
pared to Kutupalong camp and addi-
tional regions.
N
FIGURE 8: DISTRIBUTION OF NAYAPARA CAMP REFUGEES
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The main reason for this is that the
place is not suitable for settlement
because of floods and that there is a
problem of security.
The field of Nayapara official camp
were added 24th, 25th and 26th
fields as disorganized/spontaneous
settlements with the refugees set-
tling after 2017. There are 1.487
shelters in the central camp field lo-
cated on 1.072 km2.10
In the camp field where the accumu-
lation of population is a bit higher,
26.783 refugees and 5.720 families.
Nayapara refugee camp where the
number of individual per family is
4,7 is comprised of 54% women and
10 Post-Distribution Monitoring Bangla-desh Refugee Sıtuatıon, (UNHCR, Rohıngya Refugee Crısıs Camp Settle-ment and Protection Profiling, 2018)
46% men. The population of women
and children is 80% and it is higher
than the rate of Kutupalong refugee
camp. The highest accumulation is
between the ages of 18-59 in terms
of age index in the camp field where
the rate of population under 18 is
51%.11
As Nayapara camp is located near
rich water sources, it has more op-
portunity to have an access to water.
While all of the water in Kutupalong
camp is provided from water wells,
76% of water in Nayapara camp is
supplied from pipe lines, 15% from
well water and 9% from tankers.
11 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee Crısıs Camp Settlement and Protection Profiling, 2018)
FIGURE 9: GENDER DISTRIBUTION OF REFUGEES IN NAYAPARA CAMP
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In the Kutupalong refugee camp
where access to water is limited and
unhealthy, 9% of the refugees have
various health problems because of
the contaminated water while only
1% of the ones in Nayapara camp has
health problems. Even though ac-
cess to water is easy in Nayapara ref-
ugee camp, different problems are
12 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee
experienced in terms of water sanita-
tion.12
As the camp field is in a near posi-
tion to the countryside, food among
primary needs is in the first place as
69%. Although access to water do
not pose a problem because of irreg-
ular and extreme rainfalls, the prox-
imity of the camp field to the valley
Crısıs Camp Settlement and Protection Profiling, 2018)
FIGURE 11: DRINKING WATER SUPPLY IN NAYAPARA CAMP
FIGURE 10: THE DISTRIBUTION OF NEEDS OF NAYAPARA CAMP REFUGEES
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floor, there happen some problems
with clean water access. Shelter
problems are mostly seasonal be-
cause of monsoon rains as in other
camp fields. A great majority of the
health problems are experienced at
children under 5 years of age de-
pending on the access to food. In ad-
dition, a lot of health problems that
could be overcome with palliative
health services, particularly preg-
nancy increase because of such cul-
tural and cognitive factors.13
13 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee
HEALTH SERVICES GIVEN TO BANGLADESHI REFUGEES
n order to give protective and
preventive health services to
Arakanese refugees, a great
number of departments and institu-
tions from different regions of the
Crısıs Camp Settlement and Protection Profiling, 2018)
I
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world act in Bangladesh. These
health institutions and NGOs carry-
ing out their works in an effort to of-
fer health services suitable for their
expertise fields are either included in
the health organization system de-
termined Bangladesh government
and international institutions or
carry out their works by means of in-
dividual connections.
It is necessary that the health organ-
izations working in the field of
health make a short, middle and
long term working discipline within
a certain plan and program.
In addition, it is essential that the
health organizations giving primary,
secondary and tertiary level health
services should act in a determined
coordination
system for the
functionality of
a problem - and
solution- fo-
cused working
system. Some-
times, NGOs
which do
not/cannot con-
nect with others coming from the
same region or same country try to
carry on their services in the field by
mean of the health institutions they
set up.
These kind of activities that are real-
ized without making a connection
with the organizations acting in a
certain system in the refugee camp
regions lead to waste of time and
cost in terms of sustainable health
services and more serious problems
come out.
WHO acting under United Nations
in order to overcome these kind of
activities and make faster and more
productive works carry out services
with 107 national and international
partners in the health sector which
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is coordinated with Bangladesh gov-
ernment. Setting up static and mo-
bile health facilities and wide-rang-
ing worker’s network for public
health, the sector tries to meet the
needs in health.
Cooperation network organizes and
coordinates the health services by
means of health labour force and ob-
servation system as a whole.
In other words, all the partners in
health sector are coordinated in the
leadership of Cox’s Bazar Civil Sur-
geon Office, The Directorate of Gen-
eral Health Services Coordination
Centre and World Health Organiza-
tion.
All the institutions working in
health sector could participate in
weekly sector meetings made under
the guidance of World Health Or-
ganization.
In the meetings,
the latest situa-
tions such as gen-
eral socio-demog-
raphy, epidemiol-
ogy of diseases
and vaccination
are put on the
agenda and
works of sub-
groups realized in
the field are presented.
The meetings are held with average
65-70 participants. Health depart-
ments such as UNICEF (The United
Nations International Children’s
Emergency Fund), IOM (Interna-
tional Organization for Migration),
Field Hospital Malaysia, Save the
Children, WHO (World Health Or-
ganization), MOAS (Migrant Off-
shore Aid Station), UNFPA (United
Nations Population Fund), EIDDRB,
MI, PEP, Penny Appeal UK, Aggra-
jatya, PHD, MDM, CSBD, RISDA-
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Bangladesh, Medicalteams Interna-
tional, HOPE, LOU, Moonlight,
Wethe Dreamers, UNHCR (The UN
Refugee Agency), DGHS, GK, Prot-
tyashi, Turkish Relief, MSF, RI,
Mercy Malaysia, ISCG, CARE, FHM,
IMARET, FHMTI, IRC (Interna-
tional Rescue Committee), HAEFA,
WVI (World Vision International),
SAM participate in these meetings.
When included in the e-mail lists of
the sector, the participants are in-
formed about the announcements
regarding meeting notes, general no-
tices and reports arranged. WHO
also delivers the demands for reports
by Inter Sectoral Coordination
Group – ISCG and other announce-
ments to the health sector partners.
A detailed organiza-
tion network was
formed for Bangla-
deshi refugees in
the content of
health sector under
the guidance of
WHO.
As there are lots of
departments work-
ing in the field of
health, A Strategic
Advisory Group
(SAG) was set up
with the participa-
tion of IOM (Inter-
national Organiza-
tion for Migration),
FIGURE 12: WHO HEALTH SECTOR ORGANIZATION STRUCTURE
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UNFPA (United Nations Population
Fund), UNICEF (The United Na-
tions International Children’s Emer-
gency Fund), UNHCR (The UN Ref-
ugee Agency), MSF, BRAC (Bangla-
desh Rural Advancement Commit-
tee), Save the Children, IFRC / Bang-
ladesh Red Crescent and supervisors
from other sectors under the guid-
ance of WHO.
Made up of
basic health
sector part-
ners and
making guid-
ance and con-
sultancy for
other sector
partners in
such fields as
making plans,
adaptation to
quality standards, surveillance,
emergency action in coordination
with the Ministry of Health, SAG
carries out the task of consultancy
for Health Sector Coordinator in
health works in Bangladesh to meet
the needs primarily.
Health Sector Field coordinators
work for the connection between the
activities to be made between health
sector coordination and camps at the
level of Upazila. Camp Health Focal
Points that are defined under Health
Sector Field coordinators works as
the sub-unit of Health Sector Field
coordinators to make the determina-
tion of health aids needed in the
light of data obtained from the camp
fields and necessary interventions.
Camp Health Focal Points obtain the
data regarding health conditions
from Health Posts in the camp fields
and serving as a sub-unit.
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WHO which is located in many re-
gions of the camps spread around
and making the health organization
over this system make the regular
flow of information with the report-
ing system of EWARS (Early Warn-
ing and Response System) and 4W
(Who does What, Where and
When).
In the system
set up for the
surveillance
and early inter-
vention for the
diseases with a
risk of epi-
demic, the re-
ports taken
from all the
shareholder
partners by WHO and Bangladesh
General Directorate of Health Ser-
vices of the Ministry of Health and
Family Welfare are analysed, the
data is shared and necessary precau-
tions are taken.
14 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018
Bangladesh Ministry of Health set up
an online system of surveillance
other than EWARS. With this sys-
tem, daily reports are asked from all
health departments.14
In addition, there are a lot of active
working groups representing health
sector partners in the Health Sector
Coordination. These groups are
formed depending on the current
situations with priority and gathered
in various times to solve primary
problems needed.
The groups acting in Bangladesh are
the working groups of:
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• MHPSS (Mental Health and Psy-
chosocial Support),
• SRH (Sexual and Reproductive
Health),
• Community Health,
• Health Sector Emergency Prepar-
edness and Response,
• Acute Watery Diarrhoea,
• Vector Borne Diseases,
SAG system formed in Bangladesh
by World Health Organization
(WHO) acting under United Nations
have some problems because of both
the activities of shareholder institu-
tions and unanticipated complica-
tions at the times of crisis. The
causes of these kinds of unexpected
problems are examined and the sys-
tem is revised when necessary.
Official departments, institutions
and NGOs which are not included in
the health system organized by
United Nations and other interna-
tional relief organizations collabo-
rate with local partners on work de-
sign and try to solve the health prob-
lems experienced in the refugee
camps.
These structures are divided into
three groups in terms of working
principles and working fields. Offi-
cial departments, institutions and/or
NGOs making a short-term work
generally come to the field in crisis
times. They evaluate the aids they
provide in their location and the
health workers they organize over
the principle of volunteerism in a lo-
cation determined by a local partner
agreed beforehand. These are the
structures either having no experi-
ence regarding disaster or having
worked partially.
The structures that are likely to be
defined as the secondary group are
the ones having a mid-term working
principle. Having more experience
and qualitative partner compared to
the first group, these structures carry
out works for basic health needs. In
addition, the structures that observe
the field for which they provide ser-
vices by means of partners carry out
their works with the sense of preven-
tive health.
As for the organizations comprising
the third group and making long-
term organizations have a larger
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partner network. Other than health
service, meeting any kind of need
such as shelter, water suppliance, se-
curity etc. and establishing and man-
aging the camp fields of the refugees
in a certain plan, these organizations
try to for a sustainable service net-
work through the system they set
up.
The number of health organizations
of both UN and others increased
more after the humanitarian crises
in 2017. As of the year 2018, 129 pri-
mary health points, 56 secondary
health points and 10 hospitals serve
in the refugee camps.
Besides 150 partners organized by
WHO, and 178 other independent
partners, 328 partners in total serve
for Bangladeshi refugees. One of the
most important problems these or-
ganizations meet in the field is work-
ing permit.
At the start of the crisis, a great many
institutions, both national and inter-
national, carried out their activities
with short term working permits
and temporary medical camps and
mobile teams.
Short term permits are generally
taken from the representatives of the
army in the field authorized by the
government.
In addition, in
order to work of-
ficially in the
field according
to the official
procedure of
Bangladesh, it is
necessary to be
either registered
(a procedure of
at least one year) or cooperate with
the registered local NGOs (interna-
tional organization takes places as a
donor – local partner is operator).
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In the form named FD7 prepared by
NGO Affairs Bureau, project details
are written and the consent is taken.
The consents are given as three
months. After getting FD7 for the
Health Sector, it is necessary to take
the consent from Civil Surgeon.
ISCG (Information Systems Con-
sulting Group) in Bangladesh con-
ducting the task of consultancy de-
mands to make advocacy in order to
facilitate the consents in these pro-
cesses and share the data they obtain
regarding the field from NGOs.
Public Health Risks at Camps, Needs and Intervention
Infectious Diseases
Surveillance
Even though the rate of vaccination
increases with vaccination cam-
paigns, unhealthy life conditions, in-
adequate drinking water quality and
malnutrition case carry on increas-
ing the current public health risks.
Including malaria, dang and
chikungunya, AWD, Shigella, Ty-
phoid and Hepatitis A and E, it is
worried about vectors and water
borne diseases.
There are serious concerns with re-
gard to the presence of the diseases
such as measles and diphtheria that
are preventable with vaccination.
Many cases are observed with
EWARS which is an online, inte-
grated data collection, analytic
warning and automatic reporting
system. A total 155 registered health
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organizations for indicator based
and case based surveillance make re-
ports weekly. 1.127 warnings in to-
tal that were verified at 99% rate and
evaluated by a common Ministry of
Health and intervention unit was
formed between 1st January - 31st
March 2018.
As given in the table, the health is-
sues mostly needed for their services
are the application for temperature,
acute respiratory passage infection,
acute watery diarrhoea, bloody diar-
rhoea and other diarrhoeas. These
problems that happen depending on
various reasons such as water sanita-
tion increase or decrease seasonally
based on climatic and geographic
conditions.
15 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018
Surveillance system is completed
with a project that will increase the
diagnosis of diphtheria and the la-
boratory capacity for other key tests
depending the proximity to health
care centre for the refugees affected
from the infectious diseases.
This laboratory that was designed as
comprising molecular diagnostic
test capacity including DNA extrac-
tion and PCR amplification and of
which instalment was completed
was organized in Cox’s Bazar Medi-
cal College with the support of
health sector. The basic purpose of
the laboratory is to detect epidemics
in Cox’s Bazar and take preventive
precautions.15
FIGURE 13: BASIC MORBIDITE NUMBERS OF THE EWARS IN 2018
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Preparation for Epidemics
The case of preparedness for the ep-
idemics which is an important
health situation for the monsoon
rains that are very effective particu-
larly in the months of April and May
is one of the most critical processes
for Bangladeshi refugees.
A group was appointed in coordina-
tion with the emergency case prepar-
edness working group in order to
observe this procedure and reduce
possible risks. Necessary reports are
prepared by the appointed emer-
gency case preparedness working
group for such natural disaster situ-
ations as background profile data for
infectious disease risks, load estima-
tions, warning and verifying brinks,
case definitions etc. and some stud-
ies are carried out to take the preven-
tive precautions.
In addition, the standard working
procedures and education packages
for the Quick Response Teams to be
assigned in the cases of Cholera,
Hepatitis A/E, Malaria and Dang are
developed and are revised all the
time.
Water-Based Diseases
The data for following the water
quality both in the source of water
and at home shows that there is
highly contaminated and poses an
important risk for public health. In
order to follow this case, the surveil-
lance process for water quality that
is managed by health sector partners
is going on.
Acute Water Diarrhoea
One of the most spread disease types
in refugee camps is acute watery di-
arrhoea. The acute diarrhoea case re-
ported in the 1st and 13th weeks of
the year 2018 is 63.497. AWD stocks
are prepared by the partners carry-
ing out the task in the field for the
most critical epidemic cases in the
refugee camps where there are 20
planned diarrhoea treatment cen-
tres.
Acute Jaundice
Another water-based disease that is
encountered widely in the camps is
Acute Jaundice. In the camp field
where 1.591 cases were determined
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between 1st and 13th weeks of the
year 2018, weekly 90-170 Acute
Jaundice cases are reported to
EWARS system. Acute Jaundices
mostly poses a risk for the pregnant
women in the camps. In particular,
as there is no special treatment for
Hepatitis A, refugees try to get rid of
the disease depending on their life
standards and immunization situa-
tions.
Vector-borne Diseases
As biotic (host) abiotic (climate,
ecology) factors and the immune
systems of the hosts are effective in
the formation of the vector-borne
diseases caused by disease functions
reaching by means of such organ-
isms as ticks, flies, fleas (because of
geographical features of Bangla-
desh), health organizations meet se-
rious problems. Increasing depend-
ing on environmental effects and
changes especially increases in the
periods when the rains are more.
Besides that, a great many factors
such as the drainage of the water
used in the camp fields, waste stor-
age etc. lead to the increase in the ac-
cumulation of vector-borne diseases.
Diseases Preventable
with Vaccines
Even though the diseases that are
preventable with vaccines for the
Arakanese refugees in Bangladesh
are significantly controlled with the
controls made in the entrance of the
refugee camps, extreme masses in
the crisis fields and other diseases
encountered in the camps led health
organizations to put the issue of
spreading the content of vaccines in
the region on their priority.
Measles
Depending on the data obtained be-
tween 1st and 13th weeks of the year
2018 form the partners acting in the
refugee camps over 4W reporting
system and EWARS warning system,
it is likely to say that suspected mea-
sles cases are encountered in almost
all camps.
Even though 1.105 suspected mea-
sles cases were encountered in the
year 2018 and there became a de-
crease in the measles cases com-
pared to the year 2017, the fact that
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the reports come from different re-
gions and there was no information
flow from the same partner make the
general evaluation impossible.
The basic reason for the instability in
the number between the cases reach-
ing health partners is that camp
fields have different characteristics
such as location, accommodation,
clean water, environmental factors
etc.16
Diphtheria
As seen in the epidemiological curve
in terms of diphtheria disease, it is
likely to see that the number of cases
peaked in December 2017 and there
16 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018
became a constant decrease in the
cases reported from the first week of
the year 2018. In the period starting
from 8th November 2017 when the
diphtheria epidemics were first
heard up to 31st March 2018, 2.837
(44%) suspected, 3.422 (53%) possi-
ble diphtheria cases were reported to
EWARS system.
Health sector partners try to provide
health care from two active diphthe-
ria treatment centres in Bangladesh.
As the patients undergoing the dis-
ease could develop “late complica-
tions” a few days / weeks after the
first acute phase, those discharged
are observed in the follow up period
for 30 days.17
17 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018
FIGURE 14: THE NUMBER OF SUSPECTED MEASLES REPORTED TO EWARS SYSTEM BETWEEN 1ST AND 13TH WEEKS
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Sexual and
Reproductive Health
Fifty-two percent of Bangladeshi ref-
ugees are made up of women. The
majority of them are between the
ages 18-59. A great many institu-
tions, departments and NGOs acting
in the field provides a minimum
start-up service package for sexual
and reproductive health (SRH).
However, access to detailed repro-
duction, mother and new-born
health services pose a problem to a
great extent.
Because of lack of service or trans-
portation, 28% of refugee women
cannot benefit from prenatal care
services.
Due to many factors like cultural
factors, 36% of women cannot give a
birth in health facilities. One of the
important drawbacks in the camp
fields is that there are no incubator
health facilities to be used particu-
larly at night transportations for
7/24.
FIGURE 15: THE NUMBER OF SUSPECTED DIPHTHERIA CASES EXPERIENCED ACCORDING TO THE AGE GROUPS BETWEEN NOVEMBER 2017 AND MARCH 2018
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Mental Health and
Psycho-social Support
Psychological problems caused by
what refugees experienced such as
any kind of oppressions and tortures
they were exposed to, the traumatic
situations like losing many relatives
is another problem which health or-
ganizations acting in the field.
Among the psychological problems
defined in the camps are unemploy-
ment, lack of health care, shortage of
clean water and leaving from the
family.
In addition, the security problems in
the camp fields and other problems
such as unpreventable child loses
etc. make the psycho-social support
service by health organizations com-
pulsory.
CRISIS MANAGEMENT IN EXTRAORDINARY SITUATIONS
umanitarian crises that
requires different organ-
ization ability depend-
ing on the type of formation have a
feature where a great many fields are
interconnected. A wrong application
that will be made in any field affects
other fields, it is necessary that the
organizations acting in such fields as
health, food, accommodation, secu-
rity etc. should act in a certain disci-
pline.
In other words, the organizations
should manage crises in a certain
plan and program in order to over-
come the crises emerging suddenly
and/or at an unexpected time and
developing sometimes very fast and
sometimes very slowly at minimum
damage. So as to take these situa-
tions emerging suddenly and unex-
pectedly under control and get rid of
the negative effects, turning them
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into a positive case, crisis manage-
ment requires a detailed and strate-
gic planning.
In the crisis
management
where the
basic thing
should be de-
termined ac-
cording to the
worst sce-
nario, the
main purpose
is to provide
that organiza-
tions be ready
for the crises beforehand, they take
some precautions for the crisis and
produce a fast solution. Various
stages should be taken into consid-
eration to manage the crisis in an ef-
fective way. These stages could be
expressed as the process of crisis
management. Making preparations
by paying attention to crisis signals,
taking the crisis under control, mak-
ing plans to turn back to normal po-
sition by controlling the damage,
taking some lessons or benefitting
from the situation by evaluating the
crisis experienced could be ex-
plained as the processes of crisis
management.
Organizations have the opportunity
of obtaining the data. Early warning
system means anticipating, perceiv-
ing and evaluating the crisis.
When the crisis signals are taken,
necessary precautions could be
taken after preparations. An effective
early warning system and organiza-
tion network should be set up in this
purpose.
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Bangladesh Refugee Camps and Health System
Management and Coordination
There are humanitarian crises at dif-
ferent dimensions because of such
situations as war, hunger, lack of
food etc. in many parts of the World
such as Africa, Central Asia and
Southeast Asia, particularly in the
region of Middle East.
As for Bangladesh hosting 671.500
Arakanese who were exposed to gen-
ocide in the public eye, migrating
because of the events and more than
1 million refugees as of 2018, the ef-
fects humanitarian crisis are felt
more deeply.
In Bangladesh where intersectorial
organization is needed more, a lot of
national and international organiza-
tions, institutions and NGOs act. In
Bangladesh where 97 NGOs from
Turkey act, it is known that thou-
sands of organizations carry out
their works in many fields such as
accommodation, food, health etc.
when we take the number of the or-
ganizations working in the field of
humanitarian aids from other Mus-
lim countries into consideration.
In addition, even though there are
organizations serving in different
fields in Bangladesh where there
happen seasonal sudden complica-
tions and serious crisis situations are
experienced, the activities of health
organizations which carry out works
especially in health sector and have
sectoral relations with this field are
of crucial importance qualitatively.
In this sense, it is essential that or-
ganizations make intra-coordination
and interorganizational coordina-
tion and develop a sustainable sys-
tem in the field.
The functionality of the manage-
ment and organization system which
could be evaluated as the most im-
portant stage of the humanitarian
crises could be realized through a
qualitative planning.
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Besides that, the fact that the organ-
izations making activities particu-
larly in Bangladesh cannot be inte-
grated in international organization
systems (e.g. WHO) due to various
reasons and that such organizations
as OIC (Organization of Islamic Co-
operation) cannot form a well-at-
tended organization network for the
crises experienced in Muslim coun-
tries increase organizational prob-
lems with regard to both preventing
and rehabilitating them. These prob-
lems vary in many fields from the
process of preparation for crisis and
the stage of application in the field.
Crises happen in different geogra-
phies in different types and condi-
tions. Crises happening in one point
of the world are caused by natural
disasters while different crises and
situations appear in other regions
because of factors like war and hun-
ger. Due to this case, it is necessary
the process of preparation and activ-
ities to be applied in the fields of cri-
sis show a change.
In particular, the
organizations
coming to the
field of crisis in
order to carry
out various ac-
tivities both
from Turkey
and other coun-
tries as experi-
enced in the lo-
cality of Bangladesh have serious
drawbacks regarding intervention to
disaster cases.
Organizations do not take care of the
endemic conditions of the region
where they act and make regional
preparations depending on the par-
tial experience obtained from other
regions of crisis. While making these
preparations, there are many issues
to be paid attention.
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The basic reason for these issues and
other problems is that organizations
cannot coordinate the preparation
process in a planned way. As it is not
carried out with an agenda, a lot of
organizations coming from the same
region or country make similar ac-
tivities and interventions.
This case was observed in the two of-
ficial refugee camps of Kutupalong
and Nayapara in Bangladesh.
Kutupalong refugee camp is nearer
to the centre due to its geographical
location, where humanitarian aids
reach earlier and floods are experi-
enced less because of rough terrain
conditions.
As for Nayapara refugee camp, it is
the camp area where the majority of
the refugees coming in surges as it at
the Myanmar border are located
temporarily, far from the centre and
humanitarian aids and having more
serious floods as the terrain is
smooth and it is near to the river
Naf.
Because of
these kinds of
differences, the
crisis cases and
dimension of
the two camps
differ. Due to
the fact that or-
ganizations
plan their pre-
paredness pro-
cess before crisis do not take into
consideration and cannot act sys-
tematically, there are significant
problems between the fields of the
two camps (Kutupalong and Naya-
para) in terms of humanitarian aids.
The crisis that such humanitarian
aids as urgent intervention, medi-
cine, inoculation, food etc. do not
reach the camp area where they
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must primarily go but go to where
there is no need, instead is deepened
and causes loss of time and labour.
In Bangladesh where one million ref-
ugees spread in a large area and there
is a fast population circulation, the
increasing negative attitude of the
political authority towards refugees
as well as arrival of organizations in
the field without having enough
preparations and lack of theoretical
and practical experiences to a great
extent do not have an effective influ-
ence in long term even though it has
palliative effects in short term.
One of the most important applica-
tions to be made in crisis cases and
process is that information and data
management should be made func-
tional affectively. Lack of a common
network where
particularly
health organiza-
tions in Bangla-
desh could trans-
fer a lot of data
such as what kind
of activities they
carry out in local
fields, which
health problems they encounter and
what are the basic reasons for them
etc. and the organizations other than
health sector working in other fields
could be integrated causes a great
many problems.
This case leads to the disruption of
health services, inability of making a
short, medium and long term sus-
tainable planning and carrying out
works triggering each other in a neg-
ative way. For that reason, organiza-
tions give the priority to therapeutic
health services which are easy meth-
ods.
In addition, the works of organiza-
tions which are unaware of health
data of the region where they act and
are deprived of being informed with
regard to what kind of complications
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are experienced and what kind of
precautions should be taken for
these complications cause serious
problems.
As an example, the fact that NGOs
coming to Cox’s Bazar refugee
camps to dig a well only and being
unaware of the works of other or-
ganizations do not pay attention to
terrain conditions and camp condi-
tions and do not dig the well deep
enough in suitable standards in-
creased the cases of cholera, diar-
rhoea and skin problems.
Besides that, as they are deprived of
information and data network, the
organizations have troubles in the
preparation for crisis. This case leads
to the problems of which inventories
would be taken to the crisis field,
what kind of medicine would be
supplied, in which field health staff
is needed and it also causes the prob-
lems of failure in such issues as nu-
trition, food,
shelter, hy-
giene etc.
The conditions
experienced in
the temporary
settlement field
where refugees
arrive after Na-
yapara refugee
camp in Bangladesh in this sense
show how humanitarian crisis turns
into an inextricable stage in the case
of lacking from this data.
Because of the fact that a great many
health organizations which carry out
their works in Nayapara refugee
camp also work in similar fields,
both significant drawbacks appeared
in 1st and 2nd health services and
unexpected situations developed be-
cause of the inadequacy in coordina-
tion.
As an example, a great many organi-
zations acting over such diseases as
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cholera, measles etc. failed behind
and those coming to the same refu-
gee camp encountered with the same
problems since they were not
informed about these drawbacks.
Owing to the fact that the organiza-
tions working in other sectors can-
not/do not get the basic information
or data regarding the field from the
organizations working in the field,
there become a great many problems
in providing the needed materials in
many fields in urgent situations.
In the region where monsoon rains
and floods related to them are expe-
rienced more, there are big problems
in reaching mostly needed products
because of the problem of coordina-
tion and wrong applications made
before the process.
As seen in the example of Bangla-
desh, lack of information / data flow
and any kind of
drawback re-
sulting from it
brings forward
the problem of
using the funds
effectively in
many fields, par-
ticularly in the
field of health.
Besides the
funds allocated by international offi-
cial institutions for crisis situations,
a great many other organizations al-
locate significant amount of sources
in order to intervene humanitarian
situations. It is necessary to utilize
from the sources national and inter-
national departments and institu-
tions allocate for humanitarian situ-
ations as well as the donations col-
lected over the principle of volun-
teerism in time and in place. It is es-
sential for the organizations which
will work in order to realize it have
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full knowledge of crisis field, work
with professional partners or be in
cooperation with other organiza-
tions experienced in the field, carry-
ing out their works.
This case that is called Reliable Part-
ner Cooperation affects not only the
quality of works and also the effec-
tive use of funds forming a basis for
all situations such as supplying se-
cure and reliable materials, fast de-
tection of problems, true interven-
tion in time, reaching experienced
human source etc.
When it comes to Bangladesh in par-
ticular, it is true that there are signif-
icant problems over the fact that
there is a Reliable Partner Coopera-
tion for a great many organizations
working in the field for both Turkey
and other countries. There are also
some other problem resulting from
the lack of this cooperation and from
relevant using of the aids which are
supplied by lots
of organizations
having no expe-
rience in the
field by means
of being in co-
operation with
their unreliable
partners.
Besides that,
many organiza-
tions deliver these aids to their unre-
liable partners. Many of the organi-
zations working with unreliable
partners leave the crisis field without
getting any feedback about whether
the aids achieved their aims. This
case requires the necessity to review
the status of establishment, supervi-
sion etc. of the organizations work-
ing in international arena.
Another issue related to the lack of a
common working network which
plays a role in the formation of part-
ner security problem or not being
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able to be integrated in this kind of
system is the provision of profes-
sional human source suitable for the
crisis situation.
In particular, the organizations and
institutions working in health sector
are in an important position at this
point. As health organizations hav-
ing structures like NGOs work on
the principle of volunteerism, it is
necessary for health staff working in
health sector to be experienced in
terms of intervention in humanitar-
ian situations and be made up of in-
dividuals trained for the needs in cri-
sis fields.
The fact that health organizations
working in Bangladesh refugee
camps do not plan the process of
preparedness for crisis in a good way
brings about the lack of personnel
who will work in the fields of infec-
tious diseases, obstetrics and gynae-
cology.
Similar cases are encountered in the
institutions working for a long time
in the fields where there are refu-
gees. Instead of forming such struc-
tures as personnel, hospital etc. vi-
tally needed primarily, secondary ac-
tivities are given priority.
There are important problems which
the organizations in Bangladesh
have regarding management and co-
ordination as well as social, political,
cultural etc. ones both nationally
and internationally:
The problems that organizations en-
counter in the camp fields are as fol-
lows:
• Not being able get necessary visas
to work and significant handicaps in
getting a visa,
• Short term visas given by Bangla-
desh government,
• Bangladesh government doesn’t
not give a work permit and prevents
the entrance in the camp fields,
• Bangladesh governments offers the
chance working with limited num-
ber of local partners,
• Significant problem regarding ac-
creditation,
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• Not being able to make necessary
coordination with official institu-
tions working in the field like Turk-
ish Cooperation and Coordination
Agency (TIKA) and Disaster and
Emergency Management Agency
(AFAD),
• Problem of communication be-
tween organizations and institutions
at every stage,
• Connection and communication
problems resulting from Bangladesh
domestic politics,
• Muslim women refugees stay away
from male health staff and do not
want any examination in terms of
health organizations,
• Important
problems in
the fields of
nutrition,
hygiene etc.
culturally.
Health Services and Control of Infectious Diseases
reventive health services
are of wide range of con-
tent affecting therapeutic
health services as well. In this sense,
it is known that preventive health
services have a roof task in the sys-
tem of health service.
Preventive health services are a so-
cial approach comprising such situ-
ations as taking any kind of precau-
tions to prevent diseases, preventing
infectious diseases, surveillance of
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the process after disease, social
awareness raising and training over
diseases and health issues and aim-
ing at preventing diseases rather
than treating them.
In this sense, the basic purpose is to
serve for community, determining
risks, reducing risks and preventing
mistakes, taking responsibilities in
terms of society and making behav-
ioural and social interventions at the
point of clinic.
Therapeutic services emerge with
the emergence of diseases despite all
these things. For that reason, both
preventive services and therapeutic
services are interconnected in health
sector. Giving the opportunity of re-
covering the health conditions of
more people with less effort, in
cheaper price, preventive health ser-
vices approach is much more supe-
rior than therapeutic services and
has a social and humanitarian ap-
proach. In other words, preventive
health services has a larger content
than other fields with its preventive
position.
Such works as planning, revising
and increasing the quality manage-
ment of preventive health services in
ordinary situation could be done
regularly. However, preventive
health services cannot keep its im-
portance among urgent intervention
stages in extraordinary and crisis sit-
uations.
In particular, it is almost impossible
to work over preventive health crisis
without overcoming first interven-
tion in crisis times when clinical in-
terventions are more, there is an ac-
cumulation of refugees. For that rea-
son, it is necessary to put much
more effort in terms of the preven-
tive health risks in order to prevent
disease risks likely to emerge for dif-
ferent reasons with the stabilization
of crisis situation in the fields partic-
ularly in Bangladesh where 1 million
refugees live.
Since these works that will be real-
ized within a work schedule and a
plan comprise such important cases
that they are community based ra-
ther than individual based, they con-
tain a long period, they need a large
human source, they have a regular
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flow of data etc., the organization
acting in the field of humanitarian
aid is a hard working platform in
terms of institutions and depart-
ments.
Yet, a great many health organiza-
tions try to offer preventive health
services in Bangladesh refugee
camps even though they are not so
planned. In offering these health ser-
vices, many political and institu-
tional problems come out and there
appear problems resulting from im-
portant drawbacks such as given ser-
vice, planning and application etc.
One of the important problems in
terms of political handicaps is that
Bangladesh bureaucratic structure
and state departments do not allow
preventive health works for women
and make limitations in this sense.
This limitation that causes im-
portant problems in terms of mother
health particularly poses a handicap
for the works to prevent infectious
diseases, increas-
ing the rate of
morbidity among
women.
In addition, the
working permits
given to the or-
ganizations work-
ing in the field by
the Bangladesh
government is of short period affects
the activities of the organizations. In
this sense, many of the organizations
prefer the treatment of urgent com-
plications but do fewer activities
with regard to providing preventive
health services and preventing infec-
tious diseases.
Besides the work permit problem
limiting the activities of the organi-
zations, deprivation of the organiza-
tions from basic education and
working abilities for preventive
health services, the fact that thera-
peutic services require less effort for
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organizations and getting feedbacks
very fast in a concrete way push pre-
ventive health service work to a sec-
ond place.
Preventing infectious diseases in the
system of preventive health services
and providing the coordination to
reduce the disease risks and report-
ing the health data (type and num-
ber of the cases etc.) obtained from
planned organizational work are the
most critical processes.
Disease risks could be overcome
with a qualitative reporting system
and a more planned preventive
health service could be given.
In this sense, even though World
Health Organization (WHO) try to
subsidize this with the reporting sys-
tem of Early Warning and Response
System (EWARS) and 4W they es-
tablished in Bangladesh Health Sec-
tor Organization in the refugee
camps, the fact that the organiza-
tions cannot / do not be integrated in
this system and that particularly the
organizations, departments and in-
stitutions coming from Muslim
countries cannot set up a coordina-
tion network prevents healthy data
flow.
In addition, the
lack of a coor-
dination net-
work where all
activity fields
(health, food,
nutrition etc.)
could be in-
cluded besides
general coordi-
nation increases the problems in
terms of preventive health services
and causes the emergence of infec-
tious diseases.
In Bangladesh refugee camps where
the level underground water is high
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and floods are frequently experi-
enced with the monsoon rains, be-
cause of the fact that the cesspools
which the organizations working in
the sheltering field opened for waste
water do not have the necessary
standards and are not deep enough,
waste water (toilet water) is accumu-
lated in the living spaces of the refu-
gees during floods.
In addition, as the water wells are
dug near cesspools, they pose a seri-
ous risk for infectious diseases. Be-
sides that, many cases such as build-
ing the shelters by the organizations
in the flooding areas during the first
refugee surges and the increase in
the chronic lung cases because of
building the chimneys which are
used to cook inside the houses show
that organizations in the health field
are far from a lot of basic health ed-
ucation ability.
Since the majority of Bangladeshi
refugees are under 18 years of age,
high risk percentage of such diseases
as measles and diphtheria, particu-
larly water-borne and vector borne
diseases, surveillance opportunities
requires being ready for urgent
cases.
There are some important problems
in the preservation of vaccines
stocked in order to apply in the case
of an emergence of diseases apart
from preventing infectious diseases
in Bangladesh refugee camps where
preventive health services fail.
Given the fact that the vaccine
should carry necessary standards of
storing and preserving condition in
cold chain system, the problems ex-
perienced both in supplying electric-
ity which provides the heat condi-
tions that will prevent the spoilage of
the vaccine and in storing the vac-
cine in certain conditions cause big
problems in the provision of the vac-
cine during an epidemic.
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Mother and Child Health Services
emales comprise 52% of
the Bangladesh refugee
camps which are the fastest
growing and spreading camps of the
world. At this rate the majority of
which is comprised of children,
there became a sudden and im-
portant increase after 2017.
While 16% of the population is only
women, the rate of children sepa-
rated from their parents is 2%. This
table leads to possible secondary
problems.
In the refugee
camps in the
Cox’s Bazar re-
gion of Bangla-
desh where 60
babies are born
in a day, more
than 16.000 ba-
bies were born
in only last 9 months of the year
2018.
Affected from the current crises,
Bangladeshi refugee women chil-
dren have serious health problems
with the risks of being a
women/child as well as the natural
problem of being an immigrant.
Women in the refugee camps cannot
be supported mostly in the issues of
woman health in general, hygiene
and birth. Pregnant women have
very little chance for the access to
health services. Furthermore, the
women at the period of giving a birth
have to give their birth at home.
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The demand for the health services
which are not at adequate number is
less because birth at home is cultur-
ally spread. The majority of the
births given at home are made even
in the absence of such basic materi-
als as sterile suture to knot umbilical
cord, clean cloth to control bleeding,
soap etc. For that reason, immuniza-
tion of mothers in terms of neonatal
tetanus should be given importance.
Also, the difficulty of transferring
patients to health facilities for secure
births goes on being a problem. Par-
ticularly, an incubator or health fa-
cilities serving for 7/24 for night
transfers should be established in
the camps. As there is no service like
that or hard to achieve, 28% of the
women are reported to have prob-
lems in having an access to prenatal
care services.
A great many
mother who can-
not achieve
health services in
postpartum pe-
riod could be lost
because of pre-
ventable condi-
tions. These con-
ditions increase
the risk of infection of disease like
ADS that could lead to deaths and
the risk of miscarriage in insecure
conditions.
Frequent experience of the sexually
transmitted diseases and that mis-
carriage threatens the health of
women are other problems that
should be taken into consideration.
In this sense, the presentation and
information activities for family
planning is of great importance in
the region. Spreading the family
planning services in the region,
given routine prenatal services,
making the birth in accompany with
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a health personnel and also giving
health support for the mother in
postpartum period could prevent
maternal and infant mortality.
Another factor that would increase
the success in reducing maternal and
mortality is trained health staff and
equipped health system.
In particular, basic problems en-
countered in reaching these health
services could be given as follows:
• Lack of awareness and experience
at health workers for the special
needs of refugees,
• Language and communication
problem,
• Cultural differences,
• Not being able to adapt to a foreign
health system,
• Not being informed about the
health service if any,
• Timidity in explaining such cases
as abuse, rape etc.
• In the camps where child abuse
and rapes are encountered, escaping
girls at the age of a child in the refu-
gee camps by prostitution gangs is
another significant problem.
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CONCLUSION, RECOMMENDATIONS AND SOLUTIONS
umanitarian situations
and humanitarian crisis
which is one of the most
important problems of our age has
an immanence affecting human life
in a massive way.
Besides humanitarian crises devel-
oping naturally (earthquake, flood
etc.), the humanitarian crises result-
ing from wars in many regions, par-
ticularly in Muslim geographies,
threatening the life of millions of
people directly and the problem of
intervention to these situations are
going on at serious levels. many or-
ganizational, political, cultural etc.
problems encountered from the pre-
paredness process to crisis manage-
ment and wrong application made
with regard to solve these problems
do not solve the problems and re-
sults in appearance of different prob-
lems in long term.
In this sense, recommendations,
precautions and solutions compris-
ing all structural activities, both
qualitatively and quantitatively,
within the crisis intervention system
could be given with these dynamics:
United Nations is unable to in-
tervene political crisis in many
regions of the world and human-
itarian situations caused by
them.
Because of factors of the fact that
decision making resulting from
the structural case of the United
Nations takes a long time, it is
late in putting the steps to be
taken in a fast way etc., it is nec-
essary to establish a more effec-
tive international organization
network and that:
• This system should provide the
integration of the organization,
official institutions and depart-
ments working in different field
no matter which country they
are from to the system,
• The system where all share-
holders are included and orga-
nized by a common sense should
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have a transparent and reliable
identity,
• The organizations should be
made to work in this system in
every field not only in crisis
times, but also from the prepar-
edness process for crisis other
process, some steps should be
taken between the system and
organizations in order to
strengthen the communication,
management mechanisms such
as education to make SWOT
analyses, supervision, authoriz-
ing etc. should be formed,
• The internal coordination of
the organizations working in the
same sector together with inter-
sectorial coordination should be
made, providing a the active,
productive and sustainable use
of sources which are limited in
the field,
• Inclusion of the organizations
acting in similar fields in the sys-
tem will make them move faster
in the crisis time and prevent the
accumulation of activities in a
certain field,
• An information network
should be established in order to
guide the organizational activi-
ties before and after the disaster
in an active way, organize them,
form preventive services and
make early diagnosis for dis-
eases, and active use of this
structure should be provided by
the organizations.
The laws and regulations provid-
ing the institutional formation of
the organizations established to
intervene humanitarian situa-
tions whichever field they are,
supervising the works of organi-
zations should be made to be
qualitative.
It is necessary that organizations
should act depending on any
kind of social feature of the field
where any work will be made ac-
cording to the types of the crisis
for the organizations.
It is necessary that the prepared-
ness for a crisis which is the most
important stage of the crisis
should be evaluated well by the
organizations. In this context, it
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is essential that the personnel to
work in the crisis field should
plan standard educations and au-
thorize the organization having
minimum number of trained
personnel should be authorized.
One of the important problems
encountered during the inter-
vention to humanitarian situa-
tions is the problem of contact
with reliable partner. Mostly the
organizations having no field ex-
perience encounter with this
problem and in this way, some
troubles come out in the process
of using sources adequately in
many senses. Setting up an or-
ganization where the organiza-
tions could be accredited might
overcome the problems in this
sense.
All organizations working in the
crisis field should be given con-
cessions in order to solve the visa
problem which is one of the most
important handicaps affecting
the field works and long term
plans of the organizations in cri-
sis time,
An organization tries to serve in
more than one field even though
it doesn’t have enough capacity
and equipment. This case causes
unexpected results in terms of
preventive health services and
sustainable work services. For
that reason, a certification sys-
tem which determines the work-
ing limitations and working
competencies of all NGOs, offi-
cial departments and institutions
should be applied and organiza-
tions should carry out their
works in this system,
It is necessary that students com-
ing from crisis regions to other
countries, particularly to Tur-
key, should be evaluated accord-
ing to their point of interests and
the organizations working in the
field should be communication
with these students. In this
sense, it is of importance that
students complete related certifi-
cate programs throughout their
education life.
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It is of importance that the NGOs
being dynamic in terms of hu-
manitarian aids and intervention
to crisis and affecting the result
directly should be included in
the organization network. Mak-
ing this integration will over-
come negative cases and trends
such as:
• The interest of search and res-
cue by NGOs, having the com-
peting coming forefront in this
kind of issues,
• Reluctance of NGOs in work-
ing with official departments and
having no obligation of account-
ability,
• The increase in the unskilled
volunteers in NGOs which can-
not/do not institutionalize,
• Lack of supervising mechanism
in NGOs and having no clear ac-
creditation criteria,
• Unprepared arrival of NGOs in
the disaster area and being a bur-
den for the disaster management,
• Language problem of the work-
ers in NGOs
The fact that preventive health
services are of more extensive
identity compared to other fields
and that the visibility of these
service is less than other services
will lead to not being able to ex-
pertise and serve in the field for
an organization.
This problem could be solved
with the formation of a common
and well-participated system.
In order to apply preventive
health services in an active way,
it is required that all NGOs, offi-
cial departments and institutions
acting in the crisis fields get a
certification education with re-
gard to this field.
The most critical case in terms of
preventive health services is
gathering numerical data of the
crisis field and surveillance of
this data. Setting up a surveil-
lance system will prepare the
necessary environment for the
detection of health risks and for
an active fight with diseases. For
that reason, as well as the work-
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ing performance of the organiza-
tions, obtaining the data of the
working field in a healthy way
and transferring it to the related
unit is a must.
In order to solve mother morbid-
ity, which is one of the common
problems happening in refugee
camps:
• Early detection surveillance of
the pregnant
• Application of antenatal care
protocols to all pregnant women
and realizing them in standards
for the first stage health services,
• Giving the births in a health fa-
cility, if possible in accompany
with a health worker, paying at-
tention to the quality of the per-
sonnel helping for the birth and
supporting them with educa-
tions,
• Determining and following up
of the puerperants,
• Raising the awareness of
women at the reproductive age
through home visits and encour-
aging pregnant follow-up and
birth in the centre in particular,
should be made regularly.
In order to minimize the health
problems encountered in crisis
fields and particularly at 0-14 age
group, it is necessary to give im-
munization services.
Sanitation educations should be
given for the diarrhoea based dis-
eases met in crisis fields exten-
sively and the distribution of the
necessary materials should be
made and they should made to
be used,
Mother milk should be encour-
aged in the crisis fields and chil-
dren with malnutrition should
be supported and children
should be followed regularly,
A transfer system which will
work regularly within the con-
tent of maternal and child health
should be set up. There should
be a mapping, 7/24 transfer sys-
tem and free ambulance system
with a mapping from the centres
making pregnant follow-up
works to the hospitals giving
caesarean birth.
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Precautions should be taken
against abusing, organ and child
trafficking and training and
warnings should be given re-
garding these issues.
In addition, some centres giving
services for sexual violence and a
transfer system should be set up.
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