Rohingya refugees on frontline of fight to contain diphtheria

NAYAPARA CAMP, Bangladesh – A community health refugee volunteer, Zafor Hossein knew the signs and symptoms of diphtheria to look out for as he went from shelter to shelter in this sprawling refugee settlement - then one 17-year-old girl caught his eye.

“She had a very swollen neck and couldn’t eat. It matched the symptoms. I called a doctor and she was taken to a medical facility. It was confirmed as a diphtheria case,” said Zafor.

The 31-year-old is among 44 Rohingya refugees volunteering as community health workers in Nayapara and Kutupalong settlements in southeast Bangladesh. And his prompt action may have helped to save the girl’s life and those of others around her.

“When I went to do a follow up visit, four days later, she was back home and thanked me,” said Zafor, 31.

“It was God’s will that [saved] her. But I felt very good to have played a part in helping and making sure the family and neighbours were also safe. It gave me confidence about doing my job. I know I am making a difference.” 

“She had a very swollen neck and couldn’t eat. It matched the symptoms."

At least 688,000 Rohingya children, women and men have fled to Bangladesh since violence erupted in the Maungdaw area in the northern part of Rakhine State five months ago, most seeking shelter at the two crowded settlements near Cox’s Bazar.

At least 5,068 suspected cases of the highly infectious respiratory disease have been reported at the settlements.

Spotting the potential signs of the disease and referring cases to medical facilities, as well as tracing families and neighbours who may also have been infected, are just part of the workload of volunteer programme run by Food for the Hungry and Medical Teams International, in partnership with UNHCR, the UN Refugee Agency.

Outreach volunteers like Zafor are trained in health and hygiene promotion, as well as nutrition and sexual health. They carry out household visits, spreading information about hygiene practices and health messaging.

In addition to diphtheria, the teams have also been trained to spot symptoms of cholera and measles. As they make their household rounds, they carry a folder with pictures to give families graphic information of the danger signs to look for.

“The refugees often don’t know where to turn for help,” says Murad Amin, a programme officer for the project. “The volunteers can provide information and fill an important gap. They also distribute water purification tablets for families to ensure water collected by them is safe to drink,” he says.

Currently, there are 20 community health workers operating in Nayapara, about a third of whom are women. Most are registered refugees, some born in Cox’s Bazar, others like Zafor, who was brought here as a child in a previous wave of displacement in the 1990s. They receive a small stipend. 

“Community health workers have been key players in stopping diphtheria from spreading out of control."

Untreated, up to half of diphtheria cases can be fatal. Another volunteer, 17-year-old Shahina Akhter, said she was initially nervous when she first learnt about the disease appearing in the settlements. “We hadn’t come across this disease before and I was a bit scared at first.  But I knew we were doing important work, that it was a serious outbreak. I didn’t want to give up.”

According to the World Health Organization, the number of suspected diphtheria cases has now plateaued, to around 30-40 cases a day. Contact tracing and early identification of people suspected of having diphtheria symptoms has been key in helping to curb transmission.

And that is why the work of the volunteer community health workers -- together with UNHCR’s related Community Outreach Member initiative -- has been so important. In fact, the programme is soon set to expand. The plan is to have a total of 120 volunteer community health workers operating in Kutapalong and Nayapara.

“Their work on the ground is vital and binds all health activities together,” said UNHCR’s public health officer, Dr Amany Sadek. “Community health workers have been key players in stopping diphtheria from spreading out of control.

“These volunteers are the health system’s community messengers, helping to make sure no one falls through the net during the roughest of times.”

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