Because outbreaks are frequently characterized by uncertainty, early detection and timely response mechanisms to break the chains of transmission are critical to protect vulnerable and most-at-risk populations. In health emergencies, the mission of the World Health Organization is to support countries to coordinate actions to prevent, prepare for, detect, rapidly respond to, and recover from outbreaks and emergencies.
In Cox’s Bazar, after three years successfully averting disease outbreaks such as Measles, Diphtheria and Cholera, the public health imperative is to control COVID-19 as quickly as possible in order to minimize morbidity, mortality and other social and economic impacts that may compromise important health outcomes.
Under the overall supervision and coordination from WHO, camp-wise Rapid Investigation and Response Teams (RIRT) have been responding to alerts within 24 hours and referring COVID-19 patients to SARI ITCs with the help of the Dispatch and Referral Unit (DRU), in an effort that has been instrumental to slow down the spread of the virus in the world’s largest refugee camp.
Dr Morshad Ahmad, a WHO Camp Health and Disease Surveillance Officer (CHDSO) verifying with the mother of a confirmed COVID-19 patient the family members who have been in contact with the patient. WHO Bangladesh/Tatiana Almeida
A WHO Camp Health and Disease Surveillance Officer (CHDSO), Dr Morshad Ahmad was deployed to Cox’s Bazar to reinforce outbreak investigation and disease surveillance activities in the Rohingya refugee camps. As part of the rapid investigation and response teams, he is responding to COVID-19 alerts and ensuring that WHO guidelines and recommendations, such as voluntary isolation of patients and quarantine for contacts, are followed.
“Last night I received the alert of a 19-year-old male who had tested positive for COVID-19. I immediately called our colleague at the IOM sentinel site where the patient had given the sample to verify all details, including about his health condition. In the morning, I contacted the RIRT coordinator and the camp health focal point to activate case investigation, contact tracing, call IOM DRU and arrange the ambulance to transport the patient to a SARI ITC with an available bed. Our goal is to ensure voluntary participation of both patient and respective contacts”, explains Dr Morshad.
Camp-wise Rapid Investigation and Response Teams (RIRTs) include one coordinator, one site management focal person and one contact tracing supervisor. Today, accompanying Dr Morshad are the Contact Tracing Supervisor Mina Akter and Community Health Worker Sangita Rudra, both from the NGO Mukti Cox’s Bazar.
Acting as a Contact Tracing Supervisor from NGO Mukti Cox’s Bazar, Mina Akter is working at the Rohingya refugee camps since the onset of the COVID-19 outbreak. WHO Bangladesh/Tatiana Almeida
“The biggest challenge we face is to make the patients’ families understand the reasons why we recommend quarantine, especially in densely populated areas such as the refugee camps. We are confronted with fears of stigma and discrimination and also rumours about this new virus that is changing daily life as we used to know it”, tells Mina Akter.
Mohammed Naser, now a COVID-19 positive patient and a Rohingya volunteer in the camps, hesitates when confronted with the perspective of going to one of the Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centres (ITC). Such facilities were conceptualized by WHO and established by health partners at the refugee camps in the months prior to the first COVID-19 Rohingya patient.
“I have an English test this week which I can’t miss”, he says at first.
Then his phone rings, and he shows the text message written in English: <<Mohammad Naser, 19 Male from Cox’s Bazar tested positive on 2020.10.11, sample received on 2020.10.12. Please contact 16263 for further advice if needed. Directorate General of Health Services>>.
“Alright, I will do as you recommend. Let me get my books so I can study at the SARI ITC”, finally decides the 19-year-old.
Mohammad Naser, a Rohingya patient who tested positive for COVID-19, talking with WHO Camp Health and Disease Surveillance Officer (CHDSO), Dr Morshad Ahmad, about his admission at a SARI ITC. WHO Bangladesh/Tatiana Almeida
Mohammad Naser plans to study English during the isolation period at the SARI ITC. As many young men his age, Naser has a passion for football and big plans for the future. Learning English is the first step. WHO Bangladesh/Tatiana Almeida
The Contact Tracing network at the Rohingya refugee camps is comprised by 34 supervisors and 311 volunteers and closely facilitated by seven Camp Health and Disease Surveillance Officers (CHDSOs) from WHO. After coordinating the transport for the COVID-19 patient, it is time to refer his family to a quarantine facility or plan the follow up during the period of at-home quarantine in coordination with other sectors and camp administration. Naser’s family opts for quarantine at home where they feel more comfortable.
“Those living in the camps are particularly vulnerable to outbreaks of communicable diseases, due to high population densities, poor WASH conditions and low immunization. WHO supported the establishment of a disease surveillance system and Rapid Response Teams for outbreak investigation to ensure a meaningful integration of facility and community-based disease surveillance systems to enhance early detection of epidemical potential diseases in Cox’s Bazar. Additionally, in response to the COVID-19 pandemic, WHO deployed seven CHDSOs for further enhanced disease surveillance, outbreak investigation and appropriate response”, says Dr Muhammad Khan, WHO Disease Surveillance and Epidemiology Team Lead.
Currently there are 25 sample collection sites at the refugee camps, and since April 2020 samples are being tested at the IEDCR field laboratory at the Cox’s Bazar Medical College. To date, 342 Rohingya refugees and 4948 host communities have tested positive for COVID-19. Go.data has been used to collect detailed information on cases and contacts. All Contact Tracing Supervisors and SARI ITC focal persons have been trained on Go.Data and equipped with a tablet. The activity is supervised by WHO Epidemiology Unit & Surveillance Network (CHDSOs).
Over the past three years, disease surveillance and outbreak investigation has been paramount to enhance early detection and treatment and to collect information on mortality and morbidity with an acceptable degree of precision and accuracy for the effective planning, monitoring and evaluation of disease control programmes in Cox’s Bazar.