Preventing COVID-19 in Rohingya camps

The coronavirus panic has gripped Rohingya refugees settled in the Cox's Bazar region of Bangladesh. Health officials said Rohingya refugee camps could be a ticking "time bomb" for coronavirus (Covid-19). The Rohingya refugees are highly vulnerable to Covid-19 in part because of the health risks associated with displacement, overcrowding, increased climatic exposure due to sub-standard shelter, and poor nutritional and health status among affected populations.

These conditions weaken refugees' immune systems, rendering them susceptible to a range of other infections. It is critical to invest in strategic preparedness and a response plan that outlines public health measures to prevent transmission of Covid-19 among the Rohingya refugees, and to mitigate the impact of the outbreak in greater Cox's Bazar district.

Two of the most effective precautionary measures against Covid-19 – social distancing and hand-washing – are extremely difficult to implement in camps and settlements, where space, shelter, soap, and clean water are often in short supply.

However, considering Rohingyas' specific needs and humanitarian situations, the Bangladesh government needs urgent initiatives for enhancing readiness and preparing a response plan that translates knowledge into strategic action to limit human-to-human transmission, communicate critical risks, and minimise the social and economic impact of Covid-19.

There is currently no vaccine to prevent Covid-19. The best way to prevent illness is to avoid exposure to this virus. Recognising the unique threat that the Covid-19 pandemic poses, the government must invest in scaling-up readiness and response operations for the Covid-19 outbreak through an effective multi-sectoral partnership.

An epidemiological risk assessment is crucial for scaling-up Covid-19 readiness and response operations. This assessment deals with the incidence, distribution, and control of Covid-19 in Rohingya camps. It needs to be conducted in refugee camps to determine the risk of Covid-19 introduction and propagation and the characteristics of these camps, which might act as amplifiers of coronavirus transmission.

This assessment should be undertaken to determine the areas most at risk: areas where people are living in particularly overcrowded conditions, with higher densities, with less space for expansion, more in contact with the population at risk, or with a higher proportion of the vulnerable population (aged Rohingyas). This identification helps to take measures including physical re-planning of the site to the extent possible, social distancing, crowd management, and preventing large gatherings of people.

Specific action has to be adopted in distributing food and other assistance, and enrolling for services like education and training, which avoid large masses and movement of Rohingyas. These measures assist in Covid-19 isolation and quarantine. Negotiation for additional space for potential isolation needs to be carried out as part of preparedness ahead of cases being identified.

Community engagement (and mobilisation) and risk communication are critical for various purposes. Identifying community leaders and local networks (women's groups, youth groups, traditional healers, etc.) is essential for carrying out consultations on risk assessment and identification of high-risk population groups.

These also help to determine trusted communication channels (formal and informal) and setting up of surveillance focal points per blocks and sections, as well as community task teams, etc. Community mobilisation serves for social and behaviour change approaches to ensure preventive community and individual health and hygiene practices. It also facilitates the implementation of measures to reduce the risk of virus transmission during such an event.

Life-saving health interventions require rapid and effective communication. Risk communication needs special attention to health authorities ranging from national to the local level. Health authorities should prepare to communicate rapidly, regularly, and transparently with the refugees, employing existing public health communication networks, media, and community engagement staff.

It has to be done by taking into account languages understood, literacy levels, and access to communication channels and existing barriers for prevention. In this regard, authorities have to address several issues like gender norms, roles, and relations that influence women's and men's differential vulnerabilities and status among the Rohingya people. Multi-stakeholders support and coordination are significant in communicating risks and implementation.

Anecdotal evidence indicates that without adopting aggressive disease containment measures, it is tough to defeat Covid-19. Fundamental to these measures is "proactive surveillance" to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and a high degree of population understanding and acceptance of these measures. Community-based surveillance should be encouraged whenever it is feasible.

The efficacy and effectiveness of surveillance measures are contingent on near-term readiness planning, which has to be embraced by the large-scale implementation of high-quality and non-pharmaceutical public health measures. Moreover, these measures must fully incorporate immediate case detection and isolation, rigorous close contact tracing and monitoring, and direct population (and community) engagement.

The outbreak rapid response team needs to be ensured for effective and efficient surveillance. The rapid-response teams should be trained and equipped for investigation of suspected Covid-19 cases and initial treatment where appropriate.

Meticulous planning is required for individual health screening. This screening might take place upon first arrival at the border or the campsite. This screening should take place whenever new residents come from a place where there is community transmission of Covid-19 or where exposure to the virus is likely.

It is significant to ensure that the screening process covers identification of signs and symptoms of Covid-19, as well as the risks of exposure, for example, observation of visual signs of respiratory illness, coupled with questions on the presence of fever or respiratory symptoms, and questions on the history of contact with a potential Covid-19 case. This screening process is fundamental for case investigation, diagnostics, and initial clinical management.

Laboratory facilities have to be available around the refugee camps. National protocols shall be followed for safe specimen collection and transportation. Public health efforts to limit spread and strengthen disease control in regions with imported cases depend critically on the ability to detect the pathogen.

Specimen collection techniques, viral transport medium, transport material should be made available at each campsite together with personal protection equipment (PPE). The government must work on ensuring the availability of tests and other facilities.

Infection prevention and control (IPC) strategies have to be deployed whenever Covid-19 is suspected. A dedicated and trained team for IPC is crucial. IPC measures need to be developed for households, as well as common spaces tailored to the characteristics of each camp. Rohingya people need to be engaged to ensure adherence to these measures.

Key IPC measures include ensuring triage, early recognition, and source control; applying standard precautions for all patients; and implementing additional empiric precautions (droplet and contact).

Health facilities must be available for providing clinical care for the suspect and confirmed cases of Covid-19 and the necessary coordination established for referral, treatment, and discharge. Management of suspected cases, isolation, and referral needs to be developed in alignment with the guidelines articulated by the Institute of Epidemiology, Disease Control and Research (IEDCR).

Medium-term measures are needed for ensuring routine health services available for a suspect and confirmed Covid-19 cases. The respected authorities, including Directorate of Health and Ministry of Health and Family Welfare, require detailed logistics, procurement, and supply chain management plans. These plans must be reviewed based-on updated epidemiological information.

The Rohingya refugees and Covid-19 are a tale of two crises. The government has taken some measures to reduce the risk of the spread of coronavirus inside the Rohingya camps. Based on the "National Preparedness and Response Plan for Covid-19, Bangladesh", more 'proactive'measuresare indispensable to avoid the great contagion in Cox's Bazar as well as in Bangladesh.

Dr Ranjan Roy, is Associate Professor of Agricultural Extension and Information System, Sher-e-Bangla Agricultural University.