In 2019 nearly 5 million outpatient consultations took place in the world’s largest refugee camp in Cox’s Bazaar, Bangladesh. Each month about 1500 babies were born in healthcare facilities. While many Rohingyas still prefer home delivery, the number of women delivering in 2019 at a health facility improved from 32% in January to 53% in December.
The COVID19 pandemic threatens to undo the gains in healthcare seeking behavior amongst the almost one million Rohingya refugees but the healthcare workers in the camps remain undeterred to provide the best possible care.
Almost 1200 doctors, nurses, midwives and paramedical staff are working in the Rohingya camps during the COVID19 pandemic, serving both the Rohingyas and host communities.
WHO Bangladesh
Hope Foundation’s Midwife supervisor Susama has been working in Camp 15 (Red Cross, BDRCS, UNFPA) for 2 years, ensuring safe pregnancy and deliveries and helping dozens of children to come into the world.
“I am not fearful”, she says of the pandemic.
She proudly wears her pink jacket, the color of midwives in Bangladesh and despite the risks for health workers she is motivated not to give up. However, COVID-19’s mark is visible:
“The number of women delivering at the hospital is down because of this coronavirus crisis” she says, claiming that fewer women are coming for routine reproductive health care.
The COVID19 pandemic has affected the overall utilization of healthcare services in the Rohingya camps. Compared to April 2019 there was a 73% decrease in the total outpatient consultations reported from the camps in April 2020.
“We need to encourage women to continue seeking reproductive health services during COVID-19. While, to date, women and infants are generally not experiencing the worst outcomes of the infection, they are more likely to suffer the consequences of the pandemic because of access of care issues for obstetric emergencies” says Diana Garde, WHO project officer for Sexual and Reproductive Health (SRH) under the Global Health Cluster in Cox’s Bazar.
WHO Bangladesh
Meanwhile, supported by WHO healthcare facilities are strengthening the infection prevention and control (IPC) measures to prevent transmission of coronavirus. In 2020, WHO initiated IPC trainings helped over 1500 health staff in Cox’s Bazar district to enhance safety for patients and health workers.
Infection prevention and control (IPC) training
WHO Bangladesh
Midwife Katija works at the Union Health and Family Welfare Center in Palonkhali (Hope Foundation, UNFPA). When asked about her challenges during COVID-19, she responded that she is not afraid of the infection, but feels the difficulties lie in the prolonged use of PPE during deliveries.
WHO Bangladesh
“It’s very hot” says Katija, referring to the summer temperature in the camps that can reach up to 40 degree Celsius. Wearing the personal protective equipment while working in the non-air conditioned delivery room can add 5-7 degrees to the room temperature. The glasses meant to shield the healthcare workers from infection end up foggy, often disrupting the vision.
But Katja continues to be present for women coming to the facility for antenatal care, deliveries, post-natal care and other reproductive care services.
How many babies has she delivered? “Too many to count”.
To further increase protection of health staff and patients, all obstetric patients are screened for coronavirus symptoms at the entrance to the facility and suspected cases are transferred to isolation and treatment units.
However, some emergency cases at SRH clinics cannot wait to be transferred to isolation units. To ensure the safety and timely care of such patients, several healthcare facilities have created a maternity “red zone” to stabilize obstetric emergencies and allow deliveries for women with symptoms of COVID19.
Furthermore, based on the WHO guidelines additional midwives and medical officers will be additionally trained to be more familiar with referral to isolation and where to safely stabilize emergencies for symptomatic patients to ensure that access to care is not affected.
Family planning training
WHO Bangladesh
“We continue to closely work with Government and humanitarian partners to improve access to safe SRH services, increase staff capacity and also to keep mothers and their newborns safe during the challenging times of coronavirus pandemic”, says Diana Garde.
For scaling up the Sexual and Reproductive health care among Rohingyas and host communities, WHO and health partners have been providing medical equipment, supplies, essential commodities and guidelines for maternity services in the camps, to ensure that patients and staff are protected, and that women have access to emergency stabilization during COVID-19.
In the international year of the nurse and the midwife, more than 4000 midwives in Bangladesh are working in the frontlines of the COVID19 pandemic. As of early June, 24 have tested positive for coronavirus; 18 of them have recovered.
WHO remains committed to collaborating closely with the Government and health partners to further accelerate fighting against COVID-19 through capacity building with evidence based practice in maternal and neonatal care and in contributing to give all women in Bangladesh, including from the Rohingya communities their right to Safe Motherhood.