Driving public health action among the Rohingya refugee population in Cox’s Bazar

Early warnings on disease outbreaks are helping guide WHO’s emergency response in Cox’s Bazar where nearly 1 million people remain vulnerable to disease outbreaks, mass casualties and disruption of basic services. Amid the humanitarian crisis, the Early Warning Alert and Response System (EWARS) became the driving force for public health action and two years on remains responsible for: investigate suspected outbreaks, targeting vaccination campaigns and avert excess mortality.

“EWARS is a very important component of this massive health response. In partnership with the Ministry of Health and Family Welfare, WHO has implemented EWARS across the Rohingya refugee camps with 99% of the population currently under surveillance and 160 health facilities generating lifesaving alerts. Our team is responding to each one of these alerts within 48h”, says Jennie Musto, WHO Epidemiology Team Lead.

EWARS is a web-based system and mobile application designed to strengthen disease surveillance and outbreak detection in emergency settings. The data is collected and submitted in real time by health staff working at the health facilities, allowing timely access by WHO and the Ministry of Health and Family Welfare who will take the necessary action to provide early response to relevant health events. 

As soon as the alert is generated the Joint Assessment Team (JAT), composed by Health, WASH and Laboratory personnel, have 48h to collect key information that will help understand the context and identify the source of the infection.

In the last week of October, a total of 7334 diarrhoeal diseases cases have been reported in EWARS. Among these, 4752 cases referred to acute watery diarrhoea (AWD), 384 cases with bloody diarrhoea and 2198 with ‘other’ diarrhoea. To ensure that clinical management is optimal and deaths are prevented, WHO and the Health sector recommended that: “all cases of AWD with any dehydration must be referred to diarrhea treatment centres (DTCs), or to PHCs with isolation facilities. Cases without dehydration can be managed as outpatients”.

According to Jennie Musto, WHO Epidemiology Team Lead, “diarrhoeal diseases showed an increasing trend in the last weeks in the Rohingya and host community, particularly in Teknaf. 83% of the cases were reported from Teknaf, 64% from the Rohingya camps, 41% of the patients are over 15 years and 57% are females.

Based on this information, in October, WHO and its partners conducted a campaign to prevent Acute Watery Diarrhoea by mobilizing Rohingya women and men to adopt simple measures that will keep their families safe.

“Please wash your hands with soap and water, especially after using the toilet”, “Do not allow your children to play in contaminated waters”, “Use clean water to wash your clothes and cooking utensils”, “eat your food while it is warm and protect it from flies” were some of the messages shared by the Refugee Relief and Repatriation Commission (RRC), Camp in Charge (CiC), Community Health Workers representatives and Rohingya leaders during the campaign. The awareness campaign also included household visits reaching 70,000 Rohingya people and 20,000 individuals in the host communities. Further to this, LifeStraw water filters were distributed in Teknaf and community members were trained in their use. 15 community and 47 family filters were established in health facilities, learning centres and mosques.

Additionally, in partnership with the International Centre for Diarrhoeal Disease Research in Bangladesh, WHO trained 85 health workers including physicians, nurses and health assistants from various health posts and PHC, on case-definition, diagnosis, stabilization and referral. Six more batches of ‘Training for Healthcare Workers on Acute Watery Diarrhea’ were conducted in November.

EWARS is a successful example of how innovative technology can have a positive impact in humanitarian response and crisis-affected populations. In Cox’s Bazar and across the world, EWARS has succeeded in disease monitoring, detecting outbreaks and driving public health action.

WHO is committed to strengthening health systems to sustain the achievements, mitigate impact on Rohingya and host communities and increase resilience.

With this in mind, WHO assisted the Government of Bangladesh to place a request to access the global oral cholera vaccination (OCV) stockpile. The vaccination campaign is being launched today in the refugee camps and host communities and is aimed to reach 635,000 people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.