In Rohingya camps, COVID-19 challenges humanitarian effort to ‘do no harm’

MISSOULA, Mont./NEW YORK — Domestic flights from Cox’s Bazar, Bangladesh, had already been suspended, so Athena Rayburn drove 10 hours from the country’s southeastern coast — home to over 800,000 Rohingya refugees — to Dhaka before boarding the last international flight.

Now, the head of advocacy for Save the Children’s Rohingya response is in quarantine in an apartment in London.

Humanitarian organizations are making the choice to call expatriate staff home due to COVID-19 on a case-by-case basis, although these decisions became urgent in Bangladesh when the government announced a nationwide lockdown last week, suspending water, rail, and air travel.

Many aid workers who can do their jobs remotely have left due to the “real, legitimate concern that we don't add to the burden of health care systems that will already be at capacity,” said Rayburn, one of two expatriates among Save the Children’s approximately 700 full-time staffers based in Cox’s Bazar.

Operating under an established “do no harm” principle that encourages no further damage or suffering as a result of their actions, humanitarian organizations find themselves in an unprecedented situation where risks are tied to action and inaction alike. It’s one that requires making choices without policy guidance and with zero guarantees, Rayburn said.

“We're facing a new challenge every day. We’re balancing the safety of staff and refugees and host community all in one question and in a way that we’ve never had to do before,” Rayburn told Devex.

Bangladesh, which is among the world’s most densely populated countries, had 56 confirmed cases of COVID-19 as of Thursday.

At least one of those cases is in the town of Cox’s Bazar, an aid hub for organizations responding to the needs of nearly 1 million Rohingya refugees, including those who fled a brutal military offensive in Myanmar’s Rakhine state in August 2017. They now live in crowded camps, with limited access to water and health services and no internet connection — conditions that, aid groups warn, could lead to a devastating outbreak.

On March 25, Bangladeshi authorities ordered the suspension of all relief work, apart from essential services, in the Rohingya refugee camps. Ongoing services include those related to food distribution, nutrition, health, information hubs, and hygiene promotion, as well as some protection activities.

While communication about COVID-19 and the provision of extra soap for hand-washing ramp up, “nonessential” services such as schools and child-friendly centers have closed. For Oxfam, stepping up work on virus prevention means decreasing work in areas such as gender rights, according to Fatema Sumar, vice president of global programs.

Based on evidence from other epidemics, such as Ebola, prolonged quarantining could lead to an increase in domestic violence, among other risks.

“We have to do everything we can to reduce transmission. But I think that we have a real fear about the unintended consequences of COVID. So it's not just the direct impact of COVID-19 on this community; it's the sort of host of cascading impacts that are as a result of the suspension of these services,” Rayburn told Devex.

In the meantime, an interagency team is scrambling to identify new sites for COVID-19 isolation and treatment facilities, while preparing beds in existing hospitals and clinics that could treat cases of the disease, with the total number of planned beds at 1,900.

One of the poorest districts in Bangladesh, Cox’s Bazar has limited intensive care capacity, and the provision of medical supplies and the training of health workers are also top priorities. There is currently no capacity to test for COVID-19 in the camps, although the government is working to establish a lab in Cox's Bazar.

Oxfam is retraining some local staff in Bangladesh who do not normally work in water and sanitation, aiming to serve around 70,000 refugees in the camps and 5,000 Bangladeshi people with WASH prevention work.

Travel restrictions have impacted many of Oxfam’s employees, although most of the responding staffers in Bangladesh already live and work locally.

“It’s a huge impact for us globally with serious limitations of people. It is time for us to step up here with our local staff,” Sumar said. “It is a real opportunity to push local humanitarian leadership, in a way, for the response, given that worldwide we are all facing similar challenges on access and being able to mobilize.”

In other parts of the world, aid groups are turning to virtual tools and social media when in-person interaction is no longer feasible — options that aren’t currently available in Cox’s Bazar. A government-imposed internet blackout and phone restrictions in the camps are limiting the flow of information on health measures, movement restrictions, and other critical guidance, aid workers tell Devex.

“We should be supporting Rohingya to lead some of these programs themselves or to address cases of COVID, and in order to do that effectively, we need to have mechanisms to support distance learning and remote capacity building,” Rayburn said.

UNHCR, the U.N.’s refugee agency, has been petitioning the government, which has included Rohingya refugees in its national response plan, to restore internet connections in the camps to better facilitate communication about a potential outbreak.

“So far, they haven’t changed their position on that,” said Louise Donovan, a UNHCR communications officer.

The humanitarian relief agency Food for the Hungry, which has a team of more than 100 people offering primary health care in Cox’s Bazar, is bracing for an increase of COVID-19 cases.

“We are not currently seeing COVID cases yet, but statistically, we expect that to change,” said Matt Ellingson, director of relief and humanitarian affairs at Food for the Hungry.

The agency operates primarily with a staff of Bangladeshi nationals, who are considered essential personnel and continue to report to work in the camp. The risk of health workers becoming infected — or passing the infection on to their patients — is a top concern, Ellingson said.

“The scary thing is the whole scenario of the refugee camp is designed for an infusion of people coming to do their critical work — every time that happens, you create avenues and vectors for the virus to get in. And they are risking their lives to save people,” Ellingson said. “We are at risk as well as being a potential vector — that remains an enormous concern.”

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