Humanitarian disaster for Rohingya refugees: impending natural hazards and worsening public health crises
Authors: Bayes Ahmed, Miriam Orcutt, Peter Sammonds, Rachel Burns, Rita Issa, Ibrahim Abubakar, Delan Devakumar
Journal: The Lancet Global Health (2018)

The Rohingya people are the world's largest stateless population.1UNHCR"This is our home". Stateless minorities and their search for citizenship.http://www.unhcr.org/ibelong/stateless-minorities/Date: November, 2017Google Scholar Violence towards the Rohingya in Myanmar from late August, 2017, caused the mass displacement2The Office of the United Nations High Commissioner for Human Rights (OHCHR)Myanmar Rohingya abuses may be crimes against humanity, UN rights experts warn.http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=22196&LangID=EDate: 2017Google Scholar of 655 000 people from Rakhine State of Myanmar to the southeastern hilly region of Bangladesh, resulting in what UNOCHA describes as the "fastest growing refugee crisis in the world".3UNOCHARohingya refugee crisis.https://www.unocha.org/rohingya-refugee-crisisGoogle Scholar The majority are residing in overcrowded temporary shelters, with Cox's Bazar and Bandarban hosting one of the densest concentrations of refugees; there are 954 500 people in total at the time of writing.4The office of the United Nations High Commissioner for Refugees (UNHCR)Operational update: Bangladesh (27 December 2017–7 January 2018).https://data2.unhcr.org/en/documents/download/61561Date: 2018Google Scholar Existing challenges in addressing poor access to health services, acute food shortages, and scarce shelter are compounding growing public health needs.5Pocock N Mahmood S Zimmerman C Orcutt M Imminent health crises among the Rohingya people of Myanmar.BMJ. 2017; 359: j5210Crossref PubMed Scopus (12) Google Scholar The likelihood of a public health emergency from infectious diseases is high in this vulnerable population, with already very low vaccination coverage, high prevalence of malnutrition,6UN Children's ReportMalnutrition rates among Rohingya refugee children in Bangladesh appear to be at least double earlier estimates.https://reliefweb.int/report/bangladesh/malnutrition-rates-among-rohingya-refugee-children-bangladesh-appear-be-leastDate: 2017Google Scholar and poor sanitation and water conditions. Vaccine-preventable diseases such as measles, polio, and tetanus are on the increase and diphtheria has recently re-emerged. As of Feb 14, 2018, there were 5710 suspected diphtheria cases and 35 deaths.7Bangladesh Humanitarian Situation Report No. 23 (Rohingya influx), UNICEF Report from 18 February. 2018.https://reliefweb.int/report/bangladesh/bangladesh-humanitarian-situation-report-no23-rohingya-influx-18-february-2018Google Scholar Against this background exists the further challenge of the approaching monsoon season, which runs from May to September. The refugee camps are highly susceptible to rainfall-triggered landslides, flash flooding, and cyclones.8Ahmed B Landslide susceptibility modelling applying user-defined weighting and data-driven statistical techniques in Cox's Bazar Municipality, Bangladesh.Nat Hazards. 2015; 79: 1707-1737Crossref Scopus (46) Google Scholar At their worst, cyclones can cause high mortality; for example, cyclone Nargis in the Bay of Bengal in 2008 killed an estimated 138 300 people.9The International Federation of Red Cross and Red Crescent Societies (IFRC)2011 Myanmar: Cyclone Nargis 2008 facts and figures.http://www.ifrc.org/en/news-and-media/news-stories/asia-pacific/myanmar/myanmar-cyclone-nargis-2008-facts-and-figures/Date: 2011Google Scholar The risk to the refugee population is high, as the camps are in predominantly low-lying areas vulnerable to flash flooding; the surrounding mud hillsides have been indiscriminately cut back to create rudimentary terraces for temporary shelters with no regard to the landslide hazard; and large areas of forest in the hills have been cut down to build makeshift shelters, further increasing the risk of landslides. The flooding will increase the risk of waterborne diseases and the landslides will cut road communications when transportation into the camps is already difficult. The overcrowded makeshift huts with poor sanitation and water supply, in the absence of multi-hazard alert systems and evacuation shelters, are also likely to contribute to an increase in disease incidence and demand on existing health-care facilities. Disaster risk reduction (DRR) measures are essential to reduce the likely mortality and morbidity. DRR addresses prevailing levels of vulnerability and formulates measures to prevent, mitigate, and prepare for disasters. Essential DRR activities include an urgent need to conduct a rapid multi-hazard risk mapping of the refugee camps and surrounding areas, with identification of evacuation routes and a safe zone during emergencies. An effective landslide and flash-flooding early warning system for the refugees and host communities should be developed, and hill-cutting and cutting down of the forests should be prevented, with the generation of a risk-sensitive land-use plan. The essential infrastructure needs to be examined for structural resilience in relation to health-care, education, services, and relief facilities. Alongside this, adequate training needs to be provided for community volunteers and risk information disseminated amongst the refugees. No disaster is natural. Vulnerability—a complex blending of social, economic, physical, cultural, environmental, and institutional aspects at local or community scale—is considered the primary component of DRR.10Wisner B Blaikie P Cannon T Davis I At risk: natural hazards, people's vulnerability and disasters. Routledge, Oxon2004Google Scholar In this context, any decision to put the Rohingya refugees in greater risk has the potential to increase disaster vulnerability and the consequent effects on societal wellbeing. For example, two long-term solutions to the Rohingya crisis have been proposed. One is the return of refugees to Myanmar following governmental agreement with Bangladesh; however, this prospect seems remote. The second is to move refugees to an uninhabited low-lying island (Bhashan Char) off the coast of Bangladesh, but without adequate cyclone shelters or evacuation procedures and livelihood opportunities, this will probably lead to high mortality. It is apparent that any environmental hazard in the region would profoundly affect the humanitarian response and would pose grave challenges to sufficient provision for health needs. An effective public health emergency response that integrates DRR with assessment of the immediate health needs, mortality and morbidity surveillance, and the implications of the destruction of the health, water, and sanitation infrastructure is essential. The Government of Bangladesh plus the Inter-Sector Coordination Group, led by the International Organization for Migration, have a responsibility to act to prevent a worsening public health crisis in the region, as a result of natural hazards. By developing and strengthening the DRR components of the humanitarian response to the Rohingya refugee crisis, the severity of a disaster from a natural hazard can be mitigated and preventable life loss minimised. We declare no competing interests. This work was in part funded by the UCL Humanitarian Institute as part of their project "The Rohingya Exodus: Issues and Implications for Stability, Security and Peace in South Asia" (British Academy Award Reference: IC2\100178). DD and IA (SRF-2011-04-001; NF-SI-0616-10037) receive salary support from National Institute for Health Research (NIHR). This article presents independent research funded by NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. #VaccinesWork… don't they?One hundred years ago in April 1918, as American soldiers landed on European soil in the final months of World War I, so did a virus detected a month earlier at an army training facility in Kansas, USA, accelerating what would be the first wave of the 1918 flu pandemic. The exact origin of the pandemic is not known, but the culprit is: it was an influenza A(H1N1) virus, the kind that would again emerge and spread worldwide in 2009, causing this time a reported (and probably underestimated) 19 000 deaths. Full-Text PDF Open Access