“I have been involved in humanitarian work for about 26 years now, and this last mission was definitely one of the most rewarding, and one of the most unusual.”
UK-Med arrived in Bangladesh in early May responding to the urgent health needs of the Rohingya refugees living in and around Cox’s Bazar. Former UNICEF UK CEO and UK EMT Lead Mike Penrose paints a picture of the challenges of taking on COVID-19 in one of the most densely populated places on earth:
I am halfway through my two weeks quarantine having just returned from Bangladesh on a UK-Med/UK EMT deployment to help the UN scale up to deal with the effects of COVID-19. I have been involved in humanitarian work for about 26 years now and this last mission was definitely one of the most rewarding, and one of the most unusual.
The objective of the mission was fairly simple: to help the UN agency IOM (the International Organization for Migration), who manage many of the critical services provided in the world’s biggest refugee settlement, plan and deliver the services needed to effectively treat a widespread COVID-19 outbreak.
This involved helping IOM assess the status of the health facilities they already had, plan for additional capacity to deal with a high number of COVID-19 patients with serious complications, and look at the pathways of care, from sentinel testing for COVID 19, to quarantine, to treatment in specialist Severe Acute Respiratory Infection Treatment Centres (SARI ITC’s), as well as ambulatory services, discharge and rehabilitation and home-based palliative care.
To understand the complexity here, it is important to know the context. This is the largest refugee settlement in the world by a considerable extent. There are nearly one million refugees in the east of a country which is smaller than the UK in landmass and which already has a population of about 160 million. In addition, the population density in the camps is enormous; several times that of the most crowded cities on earth.
As I said earlier, this was an unusual mission, as whilst the pre-departure preparation had all the normal momentum you associate with a humanitarian deployment, arrival involved locking down in a semi-closed hotel for two weeks, not immediately becoming operational.
Now, on the one hand that gave us plenty of time to prepare, discuss with the teams already in place, start developing standard operating procedures, and gain a better understanding of the context and the challenges. It did, however, mean that all the initial adrenaline and preparation did dip slightly, before restarting again two weeks after arrival.
Getting myself and the team into a healthy rhythm which ensured we used the time appropriately wasn’t hard as it was an exceptional group of professionals, but it did feel a little strange.
COVID-19 is already widespread in the Rohingya population, although we didn’t really know how widespread, as there is very minimal testing. All we knew was that wherever testing was (and is) conducted, they find cases, and there are a steadily increasing number of deaths at home.
Other than that, the data is patchy and impossible to rely on meaning all of the planning that is being done is based on projections and estimations, so is very theoretical. This didn’t always make planning easy.
Once we were in Cox’s Bazar (the closest town to the camps, where the UN and NGOs all have bases), we were warmly welcomed and very quickly became part of the IOM team. The UK Med/UK EMT Health lead Sarah quickly established herself as the key partner of the IOM Doctor in charge of this response. Our ITC Coordinator Mel and Rehabilitation coordinator Gaelle (who was working remotely) rapidly integrated into the health teams led by Sarah and the IOM Doctor, and in coordination with sister agencies like WHO, MSF, Save the Children and UNHCR, the planning for medical services got underway.
In addition to preparing for direct care delivery, our Water, Sanitation and Hygiene (WASH) Manager Alex was swiftly assessing issues such as water supply, waste management and decontamination, and our Logs and Training lead Rory was helping IOM look at everything from managing ambulatory services through to drugs and equipment supply chain.
The context within the country was not always an easy one to work in as the health services received by the local population, who are also struggling with COVID-19 and a strict lock down, are often not as good as those being developed for the refugees, which does cause resentment that can sometime bubble over into tensions and some hostility.
The Rohingya are also a population that have been brutalised for generations, and who have an inherent mistrust of official structures and authority (for very valid reasons), so getting them to participate and engage with the services that were being established is an ongoing issue, and one for which there is no simple answer.
As an experienced mission and humanitarian leader, it was both a pleasure and a somewhat humbling experience to work with such a professional team, as the team rapidly became embedded in the IOM infrastructure so my role swiftly moved away from direct management to looking at how the EMT system can be better adapted to complex epidemics and health systems support in the future.
Once the team were up and running, the crisis and security plans were in place, we knew how and where they would operate, and the structure of the mission was in place – my job was done.
The rest of the team are just starting the hard stuff, however. Now the SARI ITCs are starting to open, and the local medical teams are being recruited, the planning and preparation they have done will quickly become the provision of critical healthcare to very vulnerable people. They couldn’t be in better hands however, and I consider myself very lucky to have worked with such an excellent group of professionals.
Mike Penrose
29/06/2020
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