Jamtoli spontaneous settlement in Cox’s Bazar District, Bangladesh, is a temporary home to nearly 50,000 Rohingya refugees seeking protection from ongoing violence in northern Rakhine State, Myanmar. Since August 25, 2017, more than 650,000 refugees have crossed the border into Bangladesh, and more continue to arrive each day. The great majority of refugees are women, children (including newborns) and the elderly.
As existing refugee camps and makeshift settlements rapidly became overwhelmed by the thousands of refugees pouring across the border each day, new arrivals have formed new settlements wherever they could find space and shelter.
The refugees in Jamtoli arrived with nothing except the few items that they were able to salvage in the chaos of flight, and could carry with them on the often dangerous journey on foot across the border. They arrived exhausted, traumatized, malnourished, sick and sometimes wounded. Without any shelter available, they camped in the open, scattered across the fields and hills.
As aid began to arrive, families received bamboo and tarpaulins to build basic shelters. Now these flimsy and densely packed shelters blanket the fields and hillsides, often perched precariously on steep slopes. With aid agencies struggling to cope with the overwhelming number of new arrivals in Cox’s Bazar, it is taking time for essential services to reach those in need.
The poor public health conditions present a serious threat in such a densely packed community where services are limited. Latrines are filling up more quickly than they can be constructed. Wells have been hastily dug but in many cases concerns remain about the quality of construction, the safety of the water they provide, and their ability to continue supplying water as the dry season approaches. Health services are beginning to arrive, but continue to be patchy and struggle to meet demand.
In the midst of this emergency, the first CPI-supported Health Post opened its doors on November 1, 2017. The Health Post was established and is led by CPI local partner Prottyashi, a woman-led organization with more than 30 years of experience providing social services to communities in southern Bangladesh.
The Health Post offers primary health care services to a population of approximately 6,000 refugees in the surrounding area. The Health Post provides both facility-based and outreach health services with a particular focus on pregnant women, newborns and young children. Open six days a week, the Health Post is led by a local female physician supported by three medical assistants. A team of three Community Health Workers provide outreach services, going from house to house to map households and spread the word about the prenatal and postnatal care, malnutrition screening, and general medical services available at the Health Post.
When the Health Post first opened, Prottyashi anticipated about 30 patients per day. In November alone, 2,500 people visited the Health Post - nearly triple the expected patient volume. The most common illnesses treated in the first month include fevers of unknown origin, acute respiratory infection, diarrhea, and skin infections. In a worrying recent development, a diphtheria outbreak is beginning to spread through refugee communities in Cox’s Bazar. Twenty cases have been reported in Jamtoli in the last few days.
On any given day, a broad cross-section of the Jamtoli community comes to the Health Post: a grandmother visits with her 11-day old granddaughter who is suffering from suspected measles; a father brings in his two daughters who have skin infections on their feet; an elderly man revisits the clinic a few days after treatment to report that he is feeling much improved.
The refugees of Jamtoli, and those throughout Cox’s Bazar, have experienced great trauma and hardship. In this time of adversity, the Health Post is part of a wider web of essential services supporting them to live in dignity and begin the process of rebuilding their lives and communities.
CPI is continuing to work closely with Prottyashi, providing support and training to improve and scale up the services that the Health Post provides. This includes the recruitment of additional Community Health Workers, the purchase of more diagnostic equipment, and the procurement of a wider range and increased levels of medicines and medical supplies.
The Health Post in Jamtoli is one component of CPI’s wider response to the refugee crisis in Cox’s Bazar. Staying true to our founding principles, we are focusing our efforts on supporting local partners to deliver essential services. In the coming months, we are planning to support the establishment of additional Health Posts and mobile health teams, the construction of deep tube wells, and respond to other emergency relief needs as they arise.