Health

Current condition of the diphtheria infection in case of the Rohingya refugee

Introduction

Rohingya is referred as the worlds most persecuted as well as a minority population, in which majority of the people are Muslims. As per the report published by Advisory Commission on Rakhine State, Myanmar, Rohingya is the ethnic minority Muslim group that is situated in the Rakhine state of Myanmar. It is estimated in these reports, that nearly 90-95% of this Rohingya group live in the northern region of the Rakhine state of Myanmar. It is estimated that 10% of the world’s stateless and shelterless population live in Myanmar, and Rohingya is considered as one of the biggest stateless community in Myanmar.

However, the community has faced severe restrictions and discrimination in Rakhine state in terms of getting their individual rights and legal opportunities. As per the recent report published by United Nation on the migration of the Rohingya community, more than 604,000 Rohingya people have already fled to Bangladesh until 25th August 2017. In the past three decades, Rohingya community faces a high level of ethnic violence and brutal approaches of the country leaders which makes them forced to move out into Bangladesh for getting a better advantage in terms of gaining proper educational, nutritional, economic and legal rights. As stated by Chan et al. (2018)., from the recent report published by Myanmar’s Ministry of Labor, Immigration and Population, it is stated that it is virtually impossible for making the employment, the opportunity for the Rohingya community people, due to a huge number of stateless community in Myanmar. ActionAid, Bangladesh has shown their concern about the impacts as well as the influence of the brutal approach of the stated leaders on the women and girls. The government of Myanmar restricts the humanitarian access in Rakhine state. On the UN report on the Rohingya community, it has been stated that UN agencies, as well as NGOs, are unable for providing the immediate relief and aid to the civilians of this deprived community. As per the report by ActionAid, Bangladesh, approximately 80% of the Rohingya community is unable to get the proper food, shelter, sanitation, hygiene and water. Al, these discriminations and violations make the Rohingya community forced to move from Myanmar to Burma.

Diphtheria is referred as the acute infection affecting the upper respiratory tract as well as the skin and throat caused by the bacteria Corynebacterium diphtheria and sometimes by the Corynebacterium pseudotuberculosis. As stated by Islam et al. (2018), it is a highly contagious disease that can be spread by person-to-person through respiratory droplets. When the bacterium entered into the respiratory tract it discharges a type of harmful toxin that is associated with weakness, fever, swollen lymph nodes and sore throats. It is reported by the WHO, that if the toxin of the bacteria enters the bloodstream of the affected person it affects the normal functioning of the heart, kidney and nervous system. From the report published by UNICEF, it can be found that Rohingya refuge experiences this deadly disease due to malnutrition, poor access to the hygiene, sanitation, nutritious foods and shelter, and low immunization coverage. The report publishes Ministry of Health of Bangladesh and UNICEF has stated nearly 2536 suspected Diphtheria cases are encountered in the Bangladesh in which majority of the affected people are Rohingya. This bacterial transmission could be prevented by applying proper vaccination and diphtheria antitoxin (DAT).

Findings

The current condition of the diphtheria infection in case of the Rohingya refugee:

As per the recent report by the UNICEF on the health status of Rohingya, thousands of the Rohingya refugees who fled from the Rakhine state to Bangladesh are highly prevalent to the possible outbreak deadly disease, Diphtheria. As stated in the report published by the WHO, the weekly roundup of the illness of all the Rohingya people in Cox Bazar of Bangladesh, reveals the fact that, about 820,000 people of this community are at high risk of Diphtheria disease due to their malnutrition, low immunisation ability and unhygienic lifestyle. As per Hossain and Purohit (2018), WHO (World Health Organisation) has stated that Diphtheria is one of the most contagious diseases that can be transmitted people-to-people through contact. By making the coordinated healthcare initiatives taken by the UNICEF and the Bangladesh government, nearly 655,000 Rohingya people are given proper vaccination which makes it possible for the Bangladesh government to eradicate the disease (doctorswithoutborders.org, 2017).

Analysis of the health needs of the community by using the different relevant epidemiological database:

From the epidemiological database, it can be stated that diphtheria is spreading day-by-day among the Rohingya refugee in the Cox Bazar of Bangladesh, in spite of providing a high dose of vaccination and antibiotics. As per the recent report represented by WHO, there are more than 110 suspected cases of diphtheria with 6 deaths that are clinically diagnosed by the Médecins Sans Frontières (MSF). As stated by Merchant (2014), the report stated by the WHO and UNICEF reveal the fact that, there are 804 suspected cases of this deadly disease with nearly 15 official deaths among the displaced as well as the deprived Rohingya population in the Cox Bazaar. In the suspected cases, 73% of the people are younger than 15 years and 60% of the suspected population is female. UNICEF and WHO are working together with the Ministry of Health and Family Welfare for vaccinating nearly 350,000 women and children in Rohingya camp. As stated by Hunter (2016), WHO reports on the health of Rohingya community has shown that, Government of Bangladesh in support with WHO as well as UNICEF focuses on the conduction of vaccination campaigning for eradicating the bacteria. As per the report publishes by ActionAid Bangladesh, it can be stated that Rohingya children, who are suffering from Diphtheria, are from 6 weeks to 6 years. According to, as per the commitments and strategies took up by the Bangladesh government with UNICEF and WHO, the immunization system of the Rohingya would be accelerated in the Rohingya community by providing timely food, better education, and hygienic shelter and life standard. Initiates taken by the Bangladesh government to provide better health and education would cover nearly 12 Rohingya camps and 250,000 children in the Teknaf and Ukhiya sub-district in Cox Bazaar. On the 3523 cases of diphtheria in Rohingya community reported in January 2018, there are 59 laboratory-confirmed cases (doctorswithoutborders.org, 2017).

Evaluation of the various public health approaches for describing the diphtheria infection:

Different approaches are taken up by the Bangladesh government with the assistance of GAVI, the Vaccine Alliance and World Health Organisation, to eradicate the occurrence of Diphtheria among the Rohingya. On 12th December 2017, Bangladesh government, WHO and Gavi have launched a vaccination campaign against all the preventable diseases with social consideration to Diphtheria. As stated by van den Ent et al. (2017), the campaign has covered nearly all the Rohingya children lived in Myanmar border and Bangladesh ranges from 6 weeks to 6 years. In Tekhnaf and Ukhiya sub-districts of Cox Bazaar, the immunization acceleration program has been conducted by UNICEF and Government of Bangladesh which cover nearly 155,000 children in the Rohingya community. According to van den Ent et al. (2017), WHO and Bangladesh government has conducted awareness campaign thereby sponsoring free health check and vaccination for all the Rohingya for providing increases support and treatment of the Diphtheria. World Health Organisation (WHO) is going to procure 2000 doses of the tetanus-diphtheria (Td) vaccines and the diphtheria anti-toxins to all the children and young people of Rohingya community. According to Sornbundit et al. (2017), a recent report published by the WHO shows that nearly 345 doses of the anti-toxins are carried by WHO (World Health Organisation) from India to Cox Bazaar in Bangladesh. As per the health report published by WHO and UNICEF, 3 rounds of the tetanus-diphtheria (Td) vaccines have been provided to all the Rohingya children with an age range from 7 – 16 years, by 10,000 high skilled health workers appointed by UNICEF and Bangladesh government. Awareness campaigns are conducted by the WHO and UNICEF in Bangladesh to make the Rohingya community aware of different cause and symptoms of the Diphtheria, thereby making them able to take proper precautions to eradicate the risk of diphtheria. On the contrary, Haenssgen (2017) argued that, in spite of providing proper vaccination and anti-toxins, 31 children Rohingya individuals are infected as well as killed by the respiratory diocese including Diphtheria as per the health report publishes by WHO till 2016, November. However, ActionAid, Bangladesh has already vaccinated near half a million Rohingya people in Cox Bazaar in assisting them to get rid of diphtheria. Bangladesh government has appointed health staffs in each camp that would take care of the health of the Rohingya people within the camp by conducting regular health checkup, providing timely medications and offering nutritious as well as medicated foods (Padilla and Trujillo, 2015). For making proper environmental controlling against the diphtheria transmission, the UK Emergency Medical Team (EMT) has been deployed into the Rohingya camps in the Cox Bazaar. The 1st round vaccination has been completed and ensures that more than 350,000 children with an age group between 6 weeks to 15 years are highly protected from the occurrence of the Diphtheria (doctorswithoutborders.org, 2017).

Analysis of various intervention strategies for controlling the infections and the consequences if the infection is not controlled:

As stated by Anya et al. (2016) WHO had described that Diphtheria is highly contagious as well as an infectious disease which affects the majority of the Rohingya people in their community due to lower access to treatment, proper medications, knowledge and education. In assistance with WHO and GIVA, the Vaccine Alliance, Government of Bangladesh has supplied nearly 300,000 doses of the pneumococcal conjugate vaccines (PCV) and pentavalent vaccines (PV) against Diphtheria over the entire Rohingya community in Bangladesh as well as in the Burma Borders. According to Kwon et al. (2017), high dose of vaccination to the Rohingya is not sufficient until they are provided with the better quality of life including nutritious foods, healthcare service, education, awareness about the various contagious disease and proper job opportunities. In this context, it can be stated that, Australian government has made valuable assistance to the Bangladesh government by contributing $1.5 million to International Organisation for Migration for supplying proper life savings medications, conducting awareness campaign against Diphtheria and providing training to the local health staffs and boosting proper awareness to community activities for enhancing the concern of the society against this deadly disease. As per Sagiv et al. (2018), Australia’s activities in providing proper assistance such as food, nutrition, sanitation, clean water, shelter, trauma counselling and providing proper healthcare, are important in improving the way of providing healthcare service to Rohingya community in Bangladesh. In the strategic move taken up by the alliance of British government and the Bangladesh government, the Bangladesh medical council become able to get the medical health from a British medical team of 40 British doctors, fire-fighters and nurses. UK Emergency Medical Team that is working with their high level of commitment and efforts in offering proper education, healthcare service and disease awareness makes possible improvements in the living standard and nutritional status of the Rohingya community. On the contrary Basavaraja et al. (2016) argued that, although the clinical intervention set by the Bangladesh and UK government, 160 new cases of Diphtheria are reported on the daily basis in the Cox bazaar area of Bangladesh. However, from analysing the cases of diphtheria among Rohingya community in Myanmar and Bangladesh, it can be stated that severity of the infections and prevalence to contagious disease has been reduced in Cox bazaar after the initiatives taken up by the federal and local government against diphtheria (cdc.gov, 2017). Therefore, it can be stated that service provided to the Rohingya people are used to their health and welfare thereby making them able to combat the future health challenges.

Conclusion and recommendation:

• By analysing the above findings and analysis some recommendation can be represented in terms of eradicating the chances of diphtheria outbreak among the Rohingya community:
• Although the medical board of Bangladesh and UK Emergency Medical Team supply proper antitoxins to the Rohingya people to discard their chances of deteriorating their health due to the attack of Diphtheria. The health professionals can use proper antibiotics such as Erythromycin as well as Penicillium for the eradication of the bacteria causing diphtheria and its spreading.
• As the Bangladesh government is yet not able to provide proper treatment by admitting the majority of the Rohingya people, suffering from diphtheria, into the hospitals, it is high time, that UK government and WHO should assist Bangladesh government to cover all the Rohingya people in Cox bazaar as well as Burma under the proper treatment process in Intense Care Unit (ICU) in reputed hospitals.
• Bangladesh should assist Burma to conduct awareness campaign not only in Cox bazaar as well as in another part of Bangladesh but also in the Rakhine state of Burma to make people aware of cause, symptoms, diagnosis process and precautions of diphtheria.
• Healthcare staffs appointed for each Rohingya camp must be well trained to deal with the several medical tests of the patient, regular health assessment, accurate data entry of patient's health and mental status.

Conclusion

From the above discussion, it can be stated that Diphtheria is the contagious infectious disease that is transmitted from person to person through various possible contacts. Rohingya community is one of the most ethnic, minorities and deprived community in Burma, who suffers from malnutrition, poor lifestyle, poor hygiene and sanitation facility and low-quality foods, thereby are more prevalent to diphtheria. Therefore, this report concludes that Bangladesh government, in assistance with WHO (World Health Organisation) and UNICEF has taken up effective healthcare strategies against diphtheria among Rohingya community. Further improvement in this healthcare framework can be conducted for getting better outcomes.

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