Preparedness planning for potential outbreak scenarios of COVID-19 in the Rohingya refugee camps, in Cox's Bazar, Bangladesh (the largest refugee camp in the world) commenced in early February 2020. WHO rapidly engaged partners in preparations for specialized COVID-19 Isolation and Treatment centres and targeted clinical treatment practices to mount an effective response while leveraging local capacity.
By March 2020, WHO developed a concept of operations to establish dedicated Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centres (ITCs) within and around the camps in Ukhiya and Teknaf. WHO worked closely with technical experts (e.g., in engineering, disaster preparedness, public health, infectious diseases, etc.) from the health sector and various NGOs and UN agencies throughout the phases of site selection, land allocation, design, construction and implementation of SARI ITCs.
In WHO-led coordination meetings, which serve as a platform where partners confer on the required response, needs such as in bed capacity, medical oxygen, and security of the would-be SARI facilities (among many others) were identified. To efficiently address these demands and the eventual health capacity needs predicted by early research studies, WHO and its partners designed SARI ITCs to use locally available materials (e.g., bamboo and clay bricks) while ensuring adequate ventilation, security, water supply and water storage, wastewater management and drainage, sanitation and hygiene, dead body management, waste management and cyclone resistance.
Different partners expressed interest in operating SARI facilities, and in record time, 14 SARI ITCs were established across the camps and nearby host community, with the first SARI ITCs being ready to provide specialist clinical management of COVID-19 patients to host community and refugees ready in May 2020, just in time to provide quality care for the first Rohingya COVID-19 patient. Additional facilities were added, reaching a total bed capacity of 1200 beds by November 2020.
In addition to establishing the SARI ITC network, WHO also developed standard operating procedures and quality assurance tools for SARI facilities and holds regular trainings for infection prevention and control (IPC), clinical case management, case alert and surveillance, laboratory, operational leadership, risk communication, and many others. WHO also rolled out trainings in the form of "Training of Trainers", ensuring that each organization operating one of the facilities had at least two trainers for improved and continued capacity building among the rest of the team in the facilities. Before receiving patients at each SARI ITC, WHO facilitated “dry runs” with different cadres of staff, from doctors to cleaners and waste handlers, on how their typical day with COVID-19 patients would look, with strong emphasis on adherence to IPC measures at all times.
To ensure acceptability and use of SARI facilities, WHO encouraged engagement with the communities . This involved encouraging facilities to invite community and religious leaders of refugees and host communities to visit the SARI ITCs to better understand the layout and operations and interact with the management and staff working at the facilities.
To date, WHO conducts regular supervision visits and reinforces capacity building through coaching and individual case reviews (offered by a case management team) to the ICU and SARI ITC staff.
WHO continues to coordinate weekly online forums, each with a multidisciplinary panel of health care providers (experienced in managing patients with COVID-19 and other viral infections) and infectious disease experts. These forums serve as a foundation for optimized clinical care to ensure patients' best chance for survival in Cox's Bazar and to foster peer to peer support and knowledge exchange. The forums also promote awareness and implementation of national protocols and WHO guidance on clinical case management of COVID-19 in the SARI ITCs.
Early modelling projections had suggested that infection rates could be alarming in the Rohingya Camps, with up to 90% of the population at risk of becoming infected within the first three months of the virus entering the camps. It was projected that the daily numbers of patients requiring hospitalization could quickly reach the thousands, with over 2000 deaths projected within 12 months, even under the best-case scenarios. This would have hugely overwhelmed the existing health services' capacity and compromised important health outcomes achieved since the onset of the humanitarian response in these camps three years ago. However, by promoting coordinated health action and best practices in Cox's Bazar, WHO and its partners have been instrumental in preventing excess morbidity and mortality due to an infection with COVID-19. As of Mid-March, some 430 cases and just ten deaths among Rohingya refugees have been reported from the 34 camps. No increase in all-cause mortality has been observed, and the cumulative share of positive tests in the district is 2.1%, suggesting robust and sufficient COVID-19 testing capacity in the district.
A year without precedent globally, 2020 has brought short and long-term social and economic disruptions whilst COVID-19 infections and deaths soared worldwide. The rapid spread and impact of the pandemic have propelled the WHO Emergency Sub-Office in Cox's Bazar to promptly implement decisive preparedness measures to slow the spread of the virus and mitigate its impact on mortality and morbidity, hospitalizations, and demand for health care goods and services. By doing so, WHO has helped to protect vulnerable groups, minimize economic and social disturbance for healthcare and when the time comes - and it will come - to enable a quick return to normal conditions.
Photo caption: In response to COVID-19 pandemic, in 2020 WHO initiated and coordinated the establishment of 14 Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centres (ITCs) in Cox’s Bazar with a capacity of nearly 1200 beds.
Photo credit: WHO/T. Almeida
