Health Services in Humanitarian Crises Bangladesh Sample

ESAM [Economic and Social Researches Center]

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ESAM PUBLICATIONS

HEALTH SERVICES IN HUMANITARIAN CRISES [Bangladesh Sample]

Publication Executive Dr. M. Eyyup HAZAR

Publication Consultant Atik AGDAG

Editorial Board

Prof. Dr. Mustafa KARAHOCAGIL

Prof. Dr. Secil OZKAN

Uzm. Dr. Muhammed Yasar SEVER

Dr. Huseyin MUTLU

Dr. Muhammed Fatih AKDEMIR

Assist Prof. Namaitijiang MAIMAITI

Prof. Dr. Mustafa Necmi ILHAN

Prof. Dr. Zeynep Aytül ÇAKMAK

Uzm. Dr. Mevlit YURTSEVEN

Uzm. Dr. Yunus Emre BULUT

Assist Prof. Mehmet Enes GOKLER

Merve AY

Reporter Mazlum AR

Editor Yusuf YALANIZ

Organizing Committee

Uzm. Dr. Muhammed Yasar SEVER

Uzm. Dr. Tayyibe SEVER

Dr. Ahmet Taher ALMOFTI

Dr. Muhammed Fatih AKDEMIR

Uzm. Dr. Songul HAZAR

Uzm. Dr. Yunus Emre BULUT

Assist Prof. Mehmet Enes GOKLER

Dr. Uzeyir ERDOGAN

Oguz ALTINOZ

Page Design Cover Design

ESAM Designer Yusuf KARAAGAC

ISBN

978-605-83736-3-1

ESAM [Economic and Social Researches Center]

Ziyabey Avenue 1416. Street No:22 Balgat/Cankaya - Ankara/Turkey

www.esam.org.tr

December 2018

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Contents

ABBREVIATIONS .................................................................................................. 5

PREFACE .............................................................................................................. 6

INTRODUCTON ................................................................................................... 7

THE OVERVIEW FOR ARAKANESE REGION ................................................... 10

HISTORICAL BACKGROUND............................................................................. 13

Arakan Genocide from the Past to the Present ..................................................... 15

Start of Arakan Massacre and 1942 Genocide ........................................................ 16

Burma Militia Massacre .......................................................................................... 17

The Break of Islamic Resistance and Restart of Genocide with 1962 Coup .......... 18

Arakan Genocide in 2012 and Afterwards ............................................................ 19

GENERAL SITUATION OF BANGLADESH HUMANITARIAN CRISIS ............. 21

General Features of the Camps ................................................................................ 21

Kutupalong Refugee Camp ................................................................................. 26

Nayapara Mülteci Kampı .................................................................................... 29

HEALTH SERVICES GIVEN TO BANGLADESHI REFUGEES ............................ 32

Public Health Risks at Camps, Needs and Intervention ........................................ 40

Infectious Diseases ............................................................................................... 40

Surveillance ..................................................................................................... 40

Preparation for Epidemics ............................................................................... 42

Water-Based Diseases ...................................................................................... 42

Acute Water Diarrhoea ............................................................................... 42

Acute Jaundice ............................................................................................ 42

Vector-borne Diseases ..................................................................................... 43

Diseases Preventable with Vaccines ................................................................ 43

Measles ....................................................................................................... 43

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Diphtheria .................................................................................................. 44

Sexual and Reproductive Health .................................................................... 45

Mental Health and Psycho-social Support ..................................................... 46

CRISIS MANAGEMENT IN EXTRAORDINARY SITUATIONS .......................... 46

Bangladesh Refugee Camps and Health System .................................................... 48

Management and Coordination .......................................................................... 48

Health Services and Control of Infectious Diseases ............................................. 56

Mother and Child Health Services ......................................................................... 61

CONCLUSION, RECOMMENDATIONS AND SOLUTIONS ............................. 64

REFERENCES ..................................................................................................... 70

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ABBREVIATIONS AFAD Disaster and Emergency Management Authority

AID Alliance of International Doctors

UN United Nations

BRAC Bangladesh Rural Advancement Committee

BSPP Burma Socialist Program Party

EWARS The Early Warning, Alert and Response System

IOM International Organization for Migration

ISCG Inter Sectoral Coordination Group

IHH Humanitarian Relief Foundation

MHPSS Mental Health and Psychosocial Support

MOAS Migrant Offshore Aid Station

MSF Médecins Sans Frontières

SAG Advisory Group

SCG Systems Consulting Group

SRH Sexual and Reproductive Health

NGO Non-Governmental Organization

SWOT Streghts, Weaknesses, Opportunities, Threats

TIKA Turkish Cooperation and Coordination Agency

UNFPA United Nations Population Fund

UNHCR The UN Refugee Agency

UNICEF United Nations International Children’s Emergency Fund

WHO World Health Organization

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PREFACE As the Directorate of Health Workers of ESAM, we have been carrying out various studies in order

to investigate, evaluate and find solution to problems both in national and international arena. In

this workshop, we discussed the issue of “Health Problems and Health Services” of Arakhan Muslims

taking a refugee in Bangladesh as they escaped from the oppression of Myanmar management and

having been exposed to serious health problems.

Starting with the year of 1937 and carried on after the Second World War, the genocide having been

experienced by Arakhan Muslims who have been exposed to big oppressions in recent years is still

going on currently. This humanitarian disaster which all the world stay silent but hundreds of thou-

sands of people were massacred, particularly faced by millions of Rohingya Muslims who turned

into refugees is gradually deepened.

Important problems are experienced in refugee camps where Arakanese Muslims escaping from the

oppression try hard to live in almost every field. Any individual and unplanned activity realised in

the Bangladeshi refugee camps where thousands of NGOs, institutions and departments carry out

their works affect any other fields, as well. As any wrong use in refugee camps where serious health

problems are seen would lead to important problems, it is necessary that all shareholder organiza-

tions be in coordination. Since the problems experienced particularly in the field of health is of

significance and could lead to non-recoverable results, any kind of intervention to be applied has to

be well planned in all senses.

This workshop report was examined in terms of health problems in humanitarian crises, organiza-

tional studies, health services and the relational dimensions between them in different ways and it

was concluded with the sample of Bangladesh.

We hope that our workshop of “Health Services at Humanitarian Crises: Bangladesh Sample” and

our report which we believe that it will help increase the quality of activities made for refugees will

be beneficial for the health organizations in the first place, all the organizations, official institutions

and department serving for the refugees in different regions of the world.

We are grateful for SASAM, AID giving any kind of support in the fulfilment of the workshop “Health

Services at Humanitarian Crises: Bangladesh”; Organization of Islamic Cooperation, Ministry of

Health, AFAD, IHH, SESRIC; ANSAR; ONSUR, Besir Dernegi, Turkiye Diyanet Vakfı, Saglık ve

Medeniyet Dernegi, Hudayi Vakfı for their participation and the Presidency of ESAM Health Workers

for their labour in the preparation of this report.

Dr. M. Eyyüp HAZAR

Director of ESAM Health Policies

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INTRODUCTON he world order formed in

line with the benefits of

global powers having a

worldly conflicting belief has been

pushing humanity towards a de-

struction and chaos. Bringing noth-

ing but blood, tear and misery, this

system destroys all good and useful

values and human life for the sake of

their benefits.

The imperialist order having caused

for the death of eighty million peo-

ple in the first and second world

wars and carrying on their existence

based on the absence and poverty of

1 www.unicef.org

the other is attacking with an ever-

lasting appetite.

The developed civilized world keep-

ing silent for these attacks is unfor-

tunately making the humanitarian

disaster deeper instead of offering

solutions for the problems and de-

structions.

In this tragedy where the concept of

justice means nothing but the will of

the powerful and the weakness of

the powerless,

10.9 million

children die of

hunger or mal-

nutrition before

they reach 5

years of age, 945

million people

live under hun-

ger limit.1

Because of the

negative effect of wars, millions of

people keep on losing their lives,

millions of other people become ref-

ugees, hundreds of thousands of

people die on the migration ways in

order to be able to hold on to life and

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thousands of small girls are exposed

to sexual abuse and rape.

Experienced as extraordinary cases,

these processes are basically the case

of crisis, namely, the period of de-

pression. For that reason, the activi-

ties to be carried out in these periods

differ from those of ordinary pro-

cesses. In other words, it will never

be possible to manage the period ex-

traordinary crises with the terms of

ordinary process, the methods of ad-

ministration.

The extraordinary periods that are

regarded as crisis periods are multi-

dimensional and multi-layer cases

comprised of multiple events. The

fact that they are multi-dimensional

and multi-layer requires that these

services must involve protective, cu-

rative and rehabilitative services.

Besides that, it is necessary to use

economical resources in a balanced

and effective way in the periods of

crisis and to manage not only na-

tional sources but also international

humanitarian and physical sources

within a system. As these sources

that are made up of any kind of ac-

tivity made to intervene the crisis re-

quire a very powerful correlation, in-

teraction and communication ser-

vices, it is necessary that all of the

organizations (NGOs, official insti-

tutions and departments) stay in

communication within a common

sense and system and carry out their

works with the coordination of this

system.

All the strategic planning, research-

ing, application and evaluation

works that are necessary in order to

cope with crises in extraordinary

times must be made beforehand, in

other words, preparation stage

which is the first stage be completed;

secondly, warning and intervention

stage and finally rehabilitation and

supervision stage must be carried

on. Any kind of step taken in ex-

traordinary situations which do not

bare this working discipline would

make the crises deeper.

Since the activities to be carried out

particularly in the health field in cri-

sis situations will affect the life of in-

dividual and community and will

bring about irreparable results, it is

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required that health organizations

plan and carry out their works in a

big care.

Purpose

The purpose of the current study is

to investigate the activities carried

out in the regions of crisis, working

principles, systems and organization

structures of health organizations in

particular and other organizations

related to this field in extraordinary

situations based on Bangladesh sam-

pling and to determine the ways of

solutions and offer recommenda-

tions.

In the first part of the report which

is made up of two main parts, an

evaluation was made. In this sense,

the data regarding the structural fea-

tures of Bangladeshi refugee camps,

basic dynamics with regard to refu-

gees, health services aiming at refu-

gees, health system coordinating

health services and the health prob-

lems experienced in refugee camps

was given.

In the second part of the report, the

activities of the organizations carry-

ing out works in the field of health

in Bangladesh refugee camps, basic

problems they met in the crisis re-

gion, the effects of the organizations

acting in other fields on the field of

health and coordination between or-

ganizations were studied.

Method

Within the qualitative research

methods, this report was prepared in

a well-attended workshop with the

participation of academicians study-

ing in the fields of Public Health and

other health fields, various scien-

tists, the administrators of local and

international nongovernmental or-

ganizations.

In addition, the related reports were

examined, statistical data was col-

lected, the applications of national

and international organizations act-

ing in the refugee camps were ob-

served, some feasibility works were

carried out in place in Bangladesh

refugee camps and a true diagnosis

and ways of solutions were tried to

be found by combining all the data.

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Scope and Limitations

The population of this study was

made up of Bangladesh humanitar-

ian crisis hosting 1 million Ara-

kanese refugees. In this scope, the

limitations of the report within the

framework of the sampling of Ara-

kanese crisis and health problems of

the refugees with the health services

applied are as follows:

• Investigation of only Kutupalong

and Nayapara refugee camps, which

are official refugee camps,

• As for health applications, investi-

gation of management and coordina-

tion in the field health, preventive

health services and control of com-

municable diseases with mother and

child health.

Other refugee camps in Bangladesh

and other issues within the health

field were excluded from the scope

of this study.

2 www.bolgegundem.com, 2018

THE OVERVIEW FOR ARAKANESE REGION

he province of Arakan,

with the official name of

Rakhine State, is one of 7

states of the State of Myanmar. In the

region of Arakan, which has the

State of Chin in the North, Magwan,

Bago and Ayeyarwady regions in

East, Bengal Gulf in the West and

Chittagong region of Bangladesh in

the North-west, a great majority of

the population is made up of Muslim

Rohingyans and Buddhist

Rakhines.2

Arakan was an independent king-

dom throughout 18th century be-

cause of the advantages of its geo-

graphical location. Being an exten-

sion of Chittagong Lowland, Arakan

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is physically and geographically sep-

arated by the mountain ranges of

Arakan Yoma from the rest of the re-

gion known as Burma in the British

colonial period and called as

Myanmar in the

current time.

Being mountain-

ous and covered

with dense for-

ests, Arakan

opens to Indian

Ocean and outer

world with its

580 kilometre

coast lines stretching along the East-

ern coasts of Bengal Bay.

Since the two hundred and 285 kilo-

metre territorial and sea borders

with Bangladesh is so easily reacha-

ble, the Muslims departing the re-

gion because of the events experi-

enced mostly head to this border.

With this border, Arakan has the ti-

tle of the gate opening to Far East.

3 www.dusuncemektebi.com, 2018

It is prone to the effects likely to

come from the sea with its 360 kilo-

metre-mile coast line in its West. For

that reason, Buddhism appeared in

Arakan before it reached Burma.3

In addition, the people living the

two sides of the border between Ara-

kan and Bangladesh speak the same

language, believe in the same reli-

gion and have the same physiology.

In terms of population, Arakan re-

gion has a dense population as in

other regions in the south of the

continent. Among this population,

as Rohingyans are not regarded as

one of the official ethnic groups (but

as illegal Bangladeshi refugees) they

are not registered, do not have ID

FIGURE 1: MYANMAR LOCATION MAP

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cards and are not included in the

census.

Nevertheless, even though some of-

ficial population results belonging to

Myanmar are declared, it is difficult

to determine the real demographic

features of the Arakan region both

because Muslims abandoned the re-

gion intensively due to the massa-

cres upon Muslims and because of

the efforts of showing Muslim popu-

lation intensity smaller. However,

Arakan Muslims comprise 17% of

Myannam population of 51 million

when we consider over 1 million 850

thousand Arakan Muslims taking a

refuge in Bangladesh in first place, in

4 The Rohingya Refugee Crisis: Bangla-desh Seeks Solutions, (www. johnbri-anshannon.com)

Malaysia, Saudi Arabia, Pakistan and

Europe.

Arakan Muslims migrated by escap-

ing from Myanmar oppression, geo-

political proximity in the first place,

religious, cultural, ethnic etc. com-

ponents are effective on migration

tendency.

At this point, the

state of Bangla-

desh hosting

around 1 million

Arakenese refu-

gees is followed

by Pakistan with

350 thousand

refugees with

Saudi Arabia at

the third place hosting 200 thousand

refugees, and these countries are fol-

lowed by such countries as Malaysia

in close locations.4

FIGURE 2: THE NUMBER OF ARAKAN REFUGEES IN THE BASIS OF COUNTRIES

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HISTORICAL BACKGROUND

he historical development

of Arakan comprise a long

period and is closely re-

garded with Indian territory mostly.

This context is mostly considered

over the reign of Indian Chandra

Dynasty in Arakan in 7th and 10th

centuries.

The start of spreading Islam in these

lands was also in the era of Chandra

Dynasty. This spread was started by

Wakkas bin Malik (R.A) and a group

of Muslims. In addition, the spread

of Islam (with the effect of the con-

nections of Muslims to other regions

in line with the Hajj activities) accel-

erated by means of Muslim scientists

and travellers and an important part

of the people in the region converted

to Islam.

The spreading adventure of the reli-

gion of Islam in Arakan and other

fields of the region reigning in a pe-

riod over two hundred years started

to stagnate in the years of 960s.

There is no doubt that this stagna-

tion resulted from Mongolian inva-

sion ending a great many rulings in-

cluding Vesali Indian Kingdom com-

prising Arakan as well.

Significant changes happed in the re-

gion in more than 400 years and

Muslims started to live with another

ethnic group called Magh who lo-

cated in the region with the Mongo-

lian invasion and practicing Bud-

dhism culture having spread with

the activities of Magha Buddhists.

In the year 1406, the Burmese King

known as Myanmar today invaded

the region of Arakan and a great

many people, including the King of

Narameikhla, escaped, and taking a

refuge in Muslim Bangladesh.

In this period of refuge, the King of

Arakan who converted to İslam and

took the name of Suleiman Shah

took the control of the region again

with the other Arakanese Muslims

after the Bengali King had sent a big

troop to Arakan in the year 1430 and

threw Burmese invaders out of the

region.

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In the year 1784, the Burmese King

invaded Arakan again and forty

years later the region became the

colony of the British in 1824.

When it came to 1885, the British in-

vaded all Burma and colonized

there. This colonization period is

one of the reason why Myanmar

government and Buddhists external-

ize Arakanese Muslims today.

They believe that Arakanese Mus-

lims are those brought by the British

from other colonies to make them

work. For that reason, Myanmar

government do not regard Ara-

kanese Muslims as a citizen and de-

prive them of all rights Myanmarese

citizens have.

In 1937, the British gave autonomy

to Burma and left the region and

Burma declared its independence in

the year 1948.

Grapping the power in 1962, the

Burmese Army declared one party

Burma Socialist State in 1974. Divid-

ing the country into states, one party

regime made Arakan a state and

named Arakan Rakhine State. In

1988, even though National Democ-

racy front obtained a great success in

the general elections made after na-

tionwide riots, military dicta went

on keeping the power in reserve.

In the general elections made in

2010 after the adoption of the new

construction following the new ref-

erendum in 2008, Union Solidarity

and Development Party supported

by the army won the elections.

In Arakan, even though National

Democrat Party got the majority in

the state assembly, the state assem-

bly was formed with the support of

Union Solidarity and Development

Party.

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Arakan Genocide from the Past to the Present

he basis of any kind of

massive isolation, geno-

cide etc. to which Ara-

kanese Muslims were exposed de-

pends on pre Second World War. Be-

ing a British colony, Burma started

its struggle in cooperation with Ja-

pan in order to free itself from the

British colony totally after it became

autonomous in 1937. This struggle

was made by Thakin Party and its

members and they agreed with Ara-

kanese Bud-

dhist - Maghs

upon anti-In-

dian.

With the dis-

courses that

Muslims pose a

significant dan-

ger for Bud-

dhism and that

unless they are stopped they will

cause the extinction of Buddhists,

the leaders of Buddhist – Maghs try-

ing to provoke Arakanese Buddhist

Rakhines and Muslim Rohignyans

and the co-conspirators of Thakin

Party planted the seeds of hate in the

region.

In addition, they caused a religious

polarization which had never been

in the region with the falsified news

that Muslims were in collaboration

with the British against the Burmese

independence struggle.

In this sense, Buddhist-Maghs and

Takin Party co-conspirators agreed

to a great extent with conspiracy to

wipe out Arakanese Muslims and

put the Arakan region under Bur-

mese ruling. For that reason, they

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never put any demand of recogni-

tion or independence by other

groups on the agenda.

In the Burmese Round Table Confer-

ence in London in 1932, Rakhine-

Magh political leaders put a lobby

pressure upon the British to give

them independence while they kept

silence by putting no demand for-

ward for Arakan.

Furthermore, while all ethnic

groups made bargaining for the fu-

ture of their own regions after inde-

pendence in 1947 Panglong Confer-

ence made just before independ-

ence, the Rakhine-Magh leaders rep-

resenting Arakan people did not

even demand to be recognized as a

state and preferred to stay under he-

gemony of the Burmese and central

government. As a matter of fact,

granting “autonomy” or “the right to

withdraw after abiding Burmese

Unity for 10 years” had already been

adopted.

Start of Arakan Massacre and 1942 Genocide

fter Burma gained its in-

dependence, there be-

came conflicts among the

groups in Burma with the provoca-

tions of the Thakin Party leaders. In

particular, anti-Indian rebellions af-

fected Muslims.

In the wake of the Second World

War, after the bombing of Rangoon

in 23rd December, 1941 by Japan

following the Indians trying to mi-

grate to India through Arakan, both

Indian and British troops withdrew

from the region.

Having waited for the opportunity of

a massacre for a long time and al-

ready completed their preparation,

Thakin members ordered for a mas-

sacre and started the genocide on

28th March. Rakhine-Magh and

Thakin Party members who were

planning a genocide encountered

with an unexpected resistance in the

Buthidaung fight occurred between

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Rakhine – Magh members and sup-

porters and Arakanese Muslims

against the purpose of expelling

Muslims from the region com-

pletely.

Even though the Arakanese Muslims

won this fight, more than 100.000

Muslims were massacred in the fight

which lasted one month. 294 Mus-

lim villages were completely cleared

out and 500.000 homeless people

had to migrate, and around 80.000

escaped to Bangladesh to stay there.

Muslims governed the region until

the British arrived in the region with

the name of “Peace Committee”, but

after the Second World War,

Rakhine – Magh and Thakin Party

members watched for an oppor-

tunity for a genocide once again.

Burma Militia Massacre

ollowing the declaration of

independence in Burma,

the position of the Ara-

kanese Muslims who were not called

for 1947 Panglong Conference and

were exposed to ethnic cleansing be-

came worse with the formation of a

border guard force out of Rakhine –

Maghs 90% of whom were already

the fierce enemy of Muslims in the

name of Burma Militia of the Bur-

mese regime.

Trying to turn the air to their side

particularly by taking the oppor-

tunity of the political turmoil in Pa-

kistan, Burmese Militia started a new

genocide and killed more than

10.000 Muslims. In this genocide

where more than 50.000 Muslims

escaping from the massacre to Paki-

stan, Burmese Militia killed the lead-

ing people of the community start-

ing with the religious leaders.

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The Break of Islamic Resistance and Restart of Genocide with 1962 Coup

he emergence of a serious

resistance among Ara-

kanese Muslims because

of the massacre became a problem in

terms of Burma and Buddhist repre-

sentatives. Trying to break the re-

sistance, Burmese rulers released a

manifest on 24th September 1954 in

order to break the synergy between

the public and declared that Ara-

kanese Muslims had the same rights

with other communities and that

Rohignyans were a local community

of Burma.

Upon this declaration, Muslim poli-

ticians in particular adopted the idea

that Muslim Arakanese must be in

cooperation with the state and

started to work for the disarmament

of rebels.

With such kind of promises by the

state, a significant part of the rebels

took away their weapons, however,

the government gave up their prom-

ises later on.

In particular, Revolutionist Com-

mand Council which took over the

regime with a bloody military coup

in 1962 increased the pressure upon

Arakanese Muslims and started any

kind of illegal activities (arrestment,

extortion, execution etc.) in order to

make the Muslims migrate to East-

ern Pakistan.

In 1974, the coup commission be-

coming a party with the name of

Burma Socialist Program Party

(BSPP) declared the Region of Ara-

kan a state and called it “Rakhine

State” representing Buddhists.

In 1982, BSPP regime enacted a new

constitution and denaturalized Ara-

kanese Muslims. In addition, not be-

ing able to stand the one party so-

cialist regime, BSPP, which lead the

country to poverty and decreased

Burma to the level of underdevel-

oped countries, the Burmese re-

belled with a spontaneous rebel

against one party socialist BSPP re-

gime in 1988. Calling an election to

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correct this situation but losing the

election against National Democracy

Party, the army did not leave the

government. Because of the in-

creased oppressions upon Rohing-

yans who were thought to be the cul-

prit, 300.000 Arakanese Muslims

had to migrate to Bangladesh.

However, new Bangladeshi govern-

ment coming after the death of

Sheikh Mujib tried to prevent the

passing of Arakanese refugees and

declared that they would not accept

new comers as a refugee anymore.

But people disposed of their rented

houses in addition to the new com-

ers started to live in slab huts built

along the banks of streams and in

muddy lands in big groups.

As a result of the insistence of some

humanitarian institutions, the gov-

ernment of Bangladesh had to allow

unofficial camps. Known as “Taal”,

these camps mean dump of houses

(just like dump of garbage) having

no basic comfort of life.

Such NGOs as CANSUYU, AID (Al-

liance of International Doctors),

IHH (The Foundation for Human

Rights and Freedoms and Humani-

tarian Relief), Islamic Relief and

Doctors Without Borders tried to

supply humanitarian aid and health

service to the region but the Bangla-

deshi government has prohibited to

reach the humanitarian aid over the

unregistered camps since 1910.

Arakan Genocide in 2012 and Afterwards

ecoming a more and more

desperate situation, Arakan

genocide and humanitarian

case turned out to be an unsolvable

situation depending on the develop-

ments in the region and in interna-

tional arena.

The changes in the administration of

Bangladesh which is one of the big-

gest protectors of Rohingyan Mus-

lims from the very beginning and

giving any kind of service and aid

gave a suitable ground for such ac-

tivities as any kind of genocide,

forced migration, assimilation etc.

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The political division of the Rohing-

yans, dispersal with no ability to in-

tervene the events, the separation in

the rebellion itself and structural in-

efficacy allowed the internal dynam-

ics of the region to move in an easy

way.

In addition, the perceptive tendency

of particularly the Islam Ummah and

the people in the region decreased

because of the Arab Spring starting

in 2010 and affecting a great many

Muslim countries, Tunisia in the

first place, and the political and so-

cial events occurring based on this

events.

Depending on the takeover of the

Arakan State Council by Rakhine-

Magh politically after 2010 general

elections, a new genocide was orga-

nized. With a conspiracy theory that

three Muslims raped a Buddhist

woman and killed her (which was

later confirmed that it was not true),

more than 200.000 people had to

leave their homes after the events

starting 3rd June, 2012.

In these events where more than 5

thousand people were killed, nearly

160.000 people had to escape to

Thailand and other near countries.

These events with which hundreds

of thousands of Arakanese Muslims

were exposed the oppression were

intensified with the emergence of a

rebellion group called Hareke el-Ya-

kin on October 2016 (a group of

which founders and the purpose are

not known and serving for the My-

anmar government and external

forces rather than being beneficial

for Muslims).

In 2017, because of the pressure

made depending on the actions by

Hareke el-Yakın group, nearly

436.000 Rohingyan Muslims es-

caped to Bangladeshi border and

313.000 of them were able to take

refuge in Cox’s Bazar refugee camp

but Muslims between 4 and 8 thou-

sand lost their lives

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GENERAL SITUATION OF BANGLADESH HUMANITARIAN CRISIS

General Features of the Camps

rakanese Muslims escap-

ing from the Myanmar ad-

ministration and Buddhist

Rakhine-Magh oppression mostly

head to Bangladesh because of vari-

ous reasons

such as geo-

political

neighbour-

hood, theo-

logical, soci-

ological and

ethnograph-

ical reasons.

Rohingyan

Muslims

mostly prefer valley grounds as a

course because of hard land and cli-

mate conditions in order to be in se-

cure and make a faster passing.

In this sense, Arakanese Muslims

who pass to the Cox’s Bazar region

of Bangladesh by passing Naf River

settle either in the camps where their

relatives had already settled or in the

nearest refugee camp to the passage.

All the camp places and settlements

in the Cox’s Bazar region of Bangla-

desh except for Kutupalong and Na-

yapara are not officially accepted as

refugee settlement by the Bangla-

desh government.

A

FIGURE 3: THE DIS TRIBUTION OF ARAKANESE REFUGEES SETTLED IN BANGLADESH

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Other unofficial camps are the camp

fields of Leda, Shamlapur, Un-

chiprang, Chakmarkul, Moynar-

ghona, Jamtoli, Hakimpara,

Thangkhali, Balukhali. In addition,

even though they are not officially

accepted, both health departments

and other official institutions divide

refugee fields into three and carry

out their works upon this structure.5

This division is made as:

• Kutupalong and Nayapara refugee

field as official refugee camp fields,

• Temporary settlement places com-

prising pre 2017

5 www.unocha.org

• Disorganized/

spontaneous set-

tlement field

comprising post

2017.

As seen in the

map, the majority

of the population

settled in

Kutupalong offi-

cial camp, Kutupalong Makeshift

camp (temporary settlement re-

gions) and in the region containing

Balukhali Makeshift camp with the

guidance of the government. This

place is also called as Kutupalong

Megacamp and the camp was di-

vided into smaller camps in it.

As of 2018 June, all the camps ex-

cept for Nayapara and Kutupalong

camp were replaced administratively

by enumerated smaller camps (total

33 camps). 85% of the refugees live

in the camps while 13% live with lo-

cal people together or in the villages.

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New disor-

ganized camps

where refugees

settled experi-

ence problems

in many senses

as they were set-

tled in hilly

places away

from residential

areas. Transportation problem to-

gether with the problem of infra-

structure is one of the most basic

problems in the settlement fields.

For that reason, refugees prefer the

fields which are easy to have an ac-

cess by walking.

The building material of the shelters

where refugees stay in this settle-

ment fields is bamboo trees. The rea-

son this material is preferred is that

it is cheap and easy to provide. Build

in the camp fields with the help of

local and international relief organi-

zations and increasing gradually,

these buildings are about 909.000

and 70% of them are deprived of hu-

manitarian conditions. Although the

shelter need of refugees was almost

met as of 25th August, 2017, they

need to be strengthened because of

intensive monsoon rains in April

and May every year.

In addition both national and inter-

national health and other relief or-

ganizations make preparations for

the risks of epidemics, flood and

landslide when the Monsoon season

starts.

Even though the water problem of

the Arakanese refugees recovered to

some extent, half of the population

in the 86% of all regions refugees live

can have an adequate access to wa-

ter. When the holes are filled with

water, toilets cannot be used. The

fact that toilets are close to the water

resources leads to serious problems

in terms of water and sanitation.

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The number of fields to have a

shower is limited and male and child

refugees have their showers in the

wells they dig.

There are not enough places for

women to have a shower. In some

regions, open sewage water channels

are built for the waste water other

than toilets.

Not being able to collect rubbish,

limited access to soap and hygienic

materials are the situations affecting

health negatively. Ninety-one per-

cent of the Arakanese refugees meet

their food needs only through hu-

manitarian aids. The diversity and

nutrition of the food distributed is

limited.

The rates of malnutrition are more

spread among adolescent, women

and children. Acute malnutrition

rate in unorganized camps is 19,3%

and it is 24% in Kutupalong Camp.

The number of

people in need

of nutrient sup-

port is over

564.000. Half

of the children

is anaemic and

240.000 chil-

dren need vita-

min A support.

The settlement of Arakanese Mus-

lims in the camp fields in the Cox’s

Bazar region of Bangladesh where

the number of Arakanese is getting

increased day by day is divided into

two periods.

The first period comprising the term

between 1942 and 2017 which is

also called as the early period con-

tains the period when over 300.000

Arakanese Muslims migrated. The

second period, which is the date

25th August, 2017 and afterwards, is

the fastest growing human crisis of

the world.

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This period contains the process

when a total sum of 671.500 Ara-

kanese Muslims migrated from Roh-

ingya to Cox’s Bazar region.

5% of Arakanese refugees the num-

ber of whom reaches to 866.000 to-

gether with the number of the refu-

gees taking a refuge in the period be-

fore 2017 was settled in Kutupalong

and Nayapara official camps that

were set up before the crisis, 13% of

them were settled in other 3 unoffi-

cial camps. 73% of the rest were set-

tled in the disorganized camps lo-

cated around these camps and 9%

were settled in villages temporarily.

Bangladesh Government expressed

that they made the biometric registry

of 1.040.000 refugees as of 27th Jan-

uary, 2018, IOM (International Or-

ganization of Migration) reported

that estimated number of refugees

was 898.000 in March 2018.

FIGURE 4: DISTRIBUTION OF REFUGEES IN TERMS OF AGE AND GENDER

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The fact that both Bangladesh gov-

ernment and International Organi-

zation of Migration released differ-

ent numbers results from the census

methodology rather than new com-

ing refugees.6

As given in Figure 4 showing the age

and gender distribution of Ara-

kanese refugees, females comprise

52% of the Arakanese refugee popu-

lation in the region and males com-

prise 48% of the rest.

The distribution of 18-59 age inter-

val with 42,1% where biggest accu-

mulation was formed was followed

by 5-10 age group with 22,5%, 0-5

6 www.humanitarianresponse.com, 2018

age group with 18,5%, 12-17 age

group with 13,7% and 60+ age group

with 3,4%.

Kutupalong Refugee Camp

eing the most intensive

camp in terms of areal in-

tensity, Kutupalong camp

is one of the two official refugee

camp in Bangladesh and was set up

with the settlement of the first refu-

gees coming to Bangladesh with the

start of Arakan events. The intensity

of the camp located in Cox’s Bazar

region decreases from the centre to-

wards circumference.

B

FIGURE 5: DISTRIBUTION OF REFUGEES IN KUTUPALONG

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In the camp region which is made up

of 20 different fields, 14th, 15th and

16th fields which are out of official

Kutupalong camp (other field out of

the central camp of Kutupalong was

excluded in the scope of the study)

are the unorganized/spontaneous

settlement regions formed by the ref-

ugees arriving after the events on

25th August 2017 and the other re-

gions are the temporary settlements

formed before 2017.

In the Kutupalong camp field having

6.374 shelters, there are 10.191 shel-

ters per km2. While 22% of the refu-

gees in Kutupalong camp live in

7 Post-Distribution Monitoring Bangla-desh Refugee Sıtuatıon, (UNHCR, Post-

bamboo and plastic shelters, the rest

lives in divided and shared shelters.7

Official and central Kutupalong

camp covering 0,5 km2 hosts 21.000

refugees and 4.600 families with 69

people per m2. Besides that, total

population of the unorganized/spon-

taneous settlement camps after 2017

with the temporary settlement

camps before 2017 that were in-

cluded in the central camp and are

not regarded as official refugee

camps is 626.000. Fifty-one percent

Distribution Monitoring Bangladesh Refugee Sıtuatıon, 2018)

FIGURE 6: GENDER DISTRIBUTION OF THE REFUGEES IN KUTUPALONG CAMP

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of the camp population is under 18

and the number of individuals per

person is 5.8

The camp area where seventy-eight

percent of the population is made up

of women and children are in danger

of serious problems in a great many

fields such as health, food, security

etc. As for the facing of refugees with

problems, there appears an increase

from the central camp areas towards

unorganized camp fields.

The problem of accommodation is in

the first place in Kutupalong camp

field and it is followed by such

problems as food, fuel material,

8 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee

utensils, drinkable water, health ser-

vices, clothing, income activities,

toilet and education.

Almost all drinking water in

Kutupalong camp is supplied from

the wells. As the water sanitation is

so low, a lot of health problems are

experienced because of contamina-

tion of the water.

Even though the problem of accom-

modation is partly solved, there be-

comes serious periodical water

floods because of the climate condi-

tions in the region and monsoon

rains.

Crısıs Camp Settlement and Protection Profiling, 2018)

FIGURE 7: THE DISTRIBUTION OF THE NEEDS OF KUTUPALONG CAMP REFUGEES

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This case leads to the increase the

existing problems from accommoda-

tion to the need for clean water.9

Nayapara Mülteci Kampı

ayapara refugee camp,

which is the nearest one

for Arakanese Rohi-

gnyans is the second official camp

9 Camp Settlement and Protection Profil-ing, (UNHCR, Post-Distribution Monitor-ing Bangladesh Refugee Sıtuatıon, 2018)

set up for the refugees in Bangla-

desh.

Located within the borders of Cox’s

Bazar region, Nayapara camp has

less density and areal extent com-

pared to Kutupalong camp and addi-

tional regions.

N

FIGURE 8: DISTRIBUTION OF NAYAPARA CAMP REFUGEES

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The main reason for this is that the

place is not suitable for settlement

because of floods and that there is a

problem of security.

The field of Nayapara official camp

were added 24th, 25th and 26th

fields as disorganized/spontaneous

settlements with the refugees set-

tling after 2017. There are 1.487

shelters in the central camp field lo-

cated on 1.072 km2.10

In the camp field where the accumu-

lation of population is a bit higher,

26.783 refugees and 5.720 families.

Nayapara refugee camp where the

number of individual per family is

4,7 is comprised of 54% women and

10 Post-Distribution Monitoring Bangla-desh Refugee Sıtuatıon, (UNHCR, Rohıngya Refugee Crısıs Camp Settle-ment and Protection Profiling, 2018)

46% men. The population of women

and children is 80% and it is higher

than the rate of Kutupalong refugee

camp. The highest accumulation is

between the ages of 18-59 in terms

of age index in the camp field where

the rate of population under 18 is

51%.11

As Nayapara camp is located near

rich water sources, it has more op-

portunity to have an access to water.

While all of the water in Kutupalong

camp is provided from water wells,

76% of water in Nayapara camp is

supplied from pipe lines, 15% from

well water and 9% from tankers.

11 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee Crısıs Camp Settlement and Protection Profiling, 2018)

FIGURE 9: GENDER DISTRIBUTION OF REFUGEES IN NAYAPARA CAMP

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In the Kutupalong refugee camp

where access to water is limited and

unhealthy, 9% of the refugees have

various health problems because of

the contaminated water while only

1% of the ones in Nayapara camp has

health problems. Even though ac-

cess to water is easy in Nayapara ref-

ugee camp, different problems are

12 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee

experienced in terms of water sanita-

tion.12

As the camp field is in a near posi-

tion to the countryside, food among

primary needs is in the first place as

69%. Although access to water do

not pose a problem because of irreg-

ular and extreme rainfalls, the prox-

imity of the camp field to the valley

Crısıs Camp Settlement and Protection Profiling, 2018)

FIGURE 11: DRINKING WATER SUPPLY IN NAYAPARA CAMP

FIGURE 10: THE DISTRIBUTION OF NEEDS OF NAYAPARA CAMP REFUGEES

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floor, there happen some problems

with clean water access. Shelter

problems are mostly seasonal be-

cause of monsoon rains as in other

camp fields. A great majority of the

health problems are experienced at

children under 5 years of age de-

pending on the access to food. In ad-

dition, a lot of health problems that

could be overcome with palliative

health services, particularly preg-

nancy increase because of such cul-

tural and cognitive factors.13

13 Camp Settlement and Protection Pro-filing, (UNHCR, Rohıngya Refugee

HEALTH SERVICES GIVEN TO BANGLADESHI REFUGEES

n order to give protective and

preventive health services to

Arakanese refugees, a great

number of departments and institu-

tions from different regions of the

Crısıs Camp Settlement and Protection Profiling, 2018)

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world act in Bangladesh. These

health institutions and NGOs carry-

ing out their works in an effort to of-

fer health services suitable for their

expertise fields are either included in

the health organization system de-

termined Bangladesh government

and international institutions or

carry out their works by means of in-

dividual connections.

It is necessary that the health organ-

izations working in the field of

health make a short, middle and

long term working discipline within

a certain plan and program.

In addition, it is essential that the

health organizations giving primary,

secondary and tertiary level health

services should act in a determined

coordination

system for the

functionality of

a problem - and

solution- fo-

cused working

system. Some-

times, NGOs

which do

not/cannot con-

nect with others coming from the

same region or same country try to

carry on their services in the field by

mean of the health institutions they

set up.

These kind of activities that are real-

ized without making a connection

with the organizations acting in a

certain system in the refugee camp

regions lead to waste of time and

cost in terms of sustainable health

services and more serious problems

come out.

WHO acting under United Nations

in order to overcome these kind of

activities and make faster and more

productive works carry out services

with 107 national and international

partners in the health sector which

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is coordinated with Bangladesh gov-

ernment. Setting up static and mo-

bile health facilities and wide-rang-

ing worker’s network for public

health, the sector tries to meet the

needs in health.

Cooperation network organizes and

coordinates the health services by

means of health labour force and ob-

servation system as a whole.

In other words, all the partners in

health sector are coordinated in the

leadership of Cox’s Bazar Civil Sur-

geon Office, The Directorate of Gen-

eral Health Services Coordination

Centre and World Health Organiza-

tion.

All the institutions working in

health sector could participate in

weekly sector meetings made under

the guidance of World Health Or-

ganization.

In the meetings,

the latest situa-

tions such as gen-

eral socio-demog-

raphy, epidemiol-

ogy of diseases

and vaccination

are put on the

agenda and

works of sub-

groups realized in

the field are presented.

The meetings are held with average

65-70 participants. Health depart-

ments such as UNICEF (The United

Nations International Children’s

Emergency Fund), IOM (Interna-

tional Organization for Migration),

Field Hospital Malaysia, Save the

Children, WHO (World Health Or-

ganization), MOAS (Migrant Off-

shore Aid Station), UNFPA (United

Nations Population Fund), EIDDRB,

MI, PEP, Penny Appeal UK, Aggra-

jatya, PHD, MDM, CSBD, RISDA-

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Bangladesh, Medicalteams Interna-

tional, HOPE, LOU, Moonlight,

Wethe Dreamers, UNHCR (The UN

Refugee Agency), DGHS, GK, Prot-

tyashi, Turkish Relief, MSF, RI,

Mercy Malaysia, ISCG, CARE, FHM,

IMARET, FHMTI, IRC (Interna-

tional Rescue Committee), HAEFA,

WVI (World Vision International),

SAM participate in these meetings.

When included in the e-mail lists of

the sector, the participants are in-

formed about the announcements

regarding meeting notes, general no-

tices and reports arranged. WHO

also delivers the demands for reports

by Inter Sectoral Coordination

Group – ISCG and other announce-

ments to the health sector partners.

A detailed organiza-

tion network was

formed for Bangla-

deshi refugees in

the content of

health sector under

the guidance of

WHO.

As there are lots of

departments work-

ing in the field of

health, A Strategic

Advisory Group

(SAG) was set up

with the participa-

tion of IOM (Inter-

national Organiza-

tion for Migration),

FIGURE 12: WHO HEALTH SECTOR ORGANIZATION STRUCTURE

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UNFPA (United Nations Population

Fund), UNICEF (The United Na-

tions International Children’s Emer-

gency Fund), UNHCR (The UN Ref-

ugee Agency), MSF, BRAC (Bangla-

desh Rural Advancement Commit-

tee), Save the Children, IFRC / Bang-

ladesh Red Crescent and supervisors

from other sectors under the guid-

ance of WHO.

Made up of

basic health

sector part-

ners and

making guid-

ance and con-

sultancy for

other sector

partners in

such fields as

making plans,

adaptation to

quality standards, surveillance,

emergency action in coordination

with the Ministry of Health, SAG

carries out the task of consultancy

for Health Sector Coordinator in

health works in Bangladesh to meet

the needs primarily.

Health Sector Field coordinators

work for the connection between the

activities to be made between health

sector coordination and camps at the

level of Upazila. Camp Health Focal

Points that are defined under Health

Sector Field coordinators works as

the sub-unit of Health Sector Field

coordinators to make the determina-

tion of health aids needed in the

light of data obtained from the camp

fields and necessary interventions.

Camp Health Focal Points obtain the

data regarding health conditions

from Health Posts in the camp fields

and serving as a sub-unit.

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WHO which is located in many re-

gions of the camps spread around

and making the health organization

over this system make the regular

flow of information with the report-

ing system of EWARS (Early Warn-

ing and Response System) and 4W

(Who does What, Where and

When).

In the system

set up for the

surveillance

and early inter-

vention for the

diseases with a

risk of epi-

demic, the re-

ports taken

from all the

shareholder

partners by WHO and Bangladesh

General Directorate of Health Ser-

vices of the Ministry of Health and

Family Welfare are analysed, the

data is shared and necessary precau-

tions are taken.

14 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018

Bangladesh Ministry of Health set up

an online system of surveillance

other than EWARS. With this sys-

tem, daily reports are asked from all

health departments.14

In addition, there are a lot of active

working groups representing health

sector partners in the Health Sector

Coordination. These groups are

formed depending on the current

situations with priority and gathered

in various times to solve primary

problems needed.

The groups acting in Bangladesh are

the working groups of:

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• MHPSS (Mental Health and Psy-

chosocial Support),

• SRH (Sexual and Reproductive

Health),

• Community Health,

• Health Sector Emergency Prepar-

edness and Response,

• Acute Watery Diarrhoea,

• Vector Borne Diseases,

SAG system formed in Bangladesh

by World Health Organization

(WHO) acting under United Nations

have some problems because of both

the activities of shareholder institu-

tions and unanticipated complica-

tions at the times of crisis. The

causes of these kinds of unexpected

problems are examined and the sys-

tem is revised when necessary.

Official departments, institutions

and NGOs which are not included in

the health system organized by

United Nations and other interna-

tional relief organizations collabo-

rate with local partners on work de-

sign and try to solve the health prob-

lems experienced in the refugee

camps.

These structures are divided into

three groups in terms of working

principles and working fields. Offi-

cial departments, institutions and/or

NGOs making a short-term work

generally come to the field in crisis

times. They evaluate the aids they

provide in their location and the

health workers they organize over

the principle of volunteerism in a lo-

cation determined by a local partner

agreed beforehand. These are the

structures either having no experi-

ence regarding disaster or having

worked partially.

The structures that are likely to be

defined as the secondary group are

the ones having a mid-term working

principle. Having more experience

and qualitative partner compared to

the first group, these structures carry

out works for basic health needs. In

addition, the structures that observe

the field for which they provide ser-

vices by means of partners carry out

their works with the sense of preven-

tive health.

As for the organizations comprising

the third group and making long-

term organizations have a larger

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partner network. Other than health

service, meeting any kind of need

such as shelter, water suppliance, se-

curity etc. and establishing and man-

aging the camp fields of the refugees

in a certain plan, these organizations

try to for a sustainable service net-

work through the system they set

up.

The number of health organizations

of both UN and others increased

more after the humanitarian crises

in 2017. As of the year 2018, 129 pri-

mary health points, 56 secondary

health points and 10 hospitals serve

in the refugee camps.

Besides 150 partners organized by

WHO, and 178 other independent

partners, 328 partners in total serve

for Bangladeshi refugees. One of the

most important problems these or-

ganizations meet in the field is work-

ing permit.

At the start of the crisis, a great many

institutions, both national and inter-

national, carried out their activities

with short term working permits

and temporary medical camps and

mobile teams.

Short term permits are generally

taken from the representatives of the

army in the field authorized by the

government.

In addition, in

order to work of-

ficially in the

field according

to the official

procedure of

Bangladesh, it is

necessary to be

either registered

(a procedure of

at least one year) or cooperate with

the registered local NGOs (interna-

tional organization takes places as a

donor – local partner is operator).

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In the form named FD7 prepared by

NGO Affairs Bureau, project details

are written and the consent is taken.

The consents are given as three

months. After getting FD7 for the

Health Sector, it is necessary to take

the consent from Civil Surgeon.

ISCG (Information Systems Con-

sulting Group) in Bangladesh con-

ducting the task of consultancy de-

mands to make advocacy in order to

facilitate the consents in these pro-

cesses and share the data they obtain

regarding the field from NGOs.

Public Health Risks at Camps, Needs and Intervention

Infectious Diseases

Surveillance

Even though the rate of vaccination

increases with vaccination cam-

paigns, unhealthy life conditions, in-

adequate drinking water quality and

malnutrition case carry on increas-

ing the current public health risks.

Including malaria, dang and

chikungunya, AWD, Shigella, Ty-

phoid and Hepatitis A and E, it is

worried about vectors and water

borne diseases.

There are serious concerns with re-

gard to the presence of the diseases

such as measles and diphtheria that

are preventable with vaccination.

Many cases are observed with

EWARS which is an online, inte-

grated data collection, analytic

warning and automatic reporting

system. A total 155 registered health

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organizations for indicator based

and case based surveillance make re-

ports weekly. 1.127 warnings in to-

tal that were verified at 99% rate and

evaluated by a common Ministry of

Health and intervention unit was

formed between 1st January - 31st

March 2018.

As given in the table, the health is-

sues mostly needed for their services

are the application for temperature,

acute respiratory passage infection,

acute watery diarrhoea, bloody diar-

rhoea and other diarrhoeas. These

problems that happen depending on

various reasons such as water sanita-

tion increase or decrease seasonally

based on climatic and geographic

conditions.

15 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018

Surveillance system is completed

with a project that will increase the

diagnosis of diphtheria and the la-

boratory capacity for other key tests

depending the proximity to health

care centre for the refugees affected

from the infectious diseases.

This laboratory that was designed as

comprising molecular diagnostic

test capacity including DNA extrac-

tion and PCR amplification and of

which instalment was completed

was organized in Cox’s Bazar Medi-

cal College with the support of

health sector. The basic purpose of

the laboratory is to detect epidemics

in Cox’s Bazar and take preventive

precautions.15

FIGURE 13: BASIC MORBIDITE NUMBERS OF THE EWARS IN 2018

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Preparation for Epidemics

The case of preparedness for the ep-

idemics which is an important

health situation for the monsoon

rains that are very effective particu-

larly in the months of April and May

is one of the most critical processes

for Bangladeshi refugees.

A group was appointed in coordina-

tion with the emergency case prepar-

edness working group in order to

observe this procedure and reduce

possible risks. Necessary reports are

prepared by the appointed emer-

gency case preparedness working

group for such natural disaster situ-

ations as background profile data for

infectious disease risks, load estima-

tions, warning and verifying brinks,

case definitions etc. and some stud-

ies are carried out to take the preven-

tive precautions.

In addition, the standard working

procedures and education packages

for the Quick Response Teams to be

assigned in the cases of Cholera,

Hepatitis A/E, Malaria and Dang are

developed and are revised all the

time.

Water-Based Diseases

The data for following the water

quality both in the source of water

and at home shows that there is

highly contaminated and poses an

important risk for public health. In

order to follow this case, the surveil-

lance process for water quality that

is managed by health sector partners

is going on.

Acute Water Diarrhoea

One of the most spread disease types

in refugee camps is acute watery di-

arrhoea. The acute diarrhoea case re-

ported in the 1st and 13th weeks of

the year 2018 is 63.497. AWD stocks

are prepared by the partners carry-

ing out the task in the field for the

most critical epidemic cases in the

refugee camps where there are 20

planned diarrhoea treatment cen-

tres.

Acute Jaundice

Another water-based disease that is

encountered widely in the camps is

Acute Jaundice. In the camp field

where 1.591 cases were determined

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between 1st and 13th weeks of the

year 2018, weekly 90-170 Acute

Jaundice cases are reported to

EWARS system. Acute Jaundices

mostly poses a risk for the pregnant

women in the camps. In particular,

as there is no special treatment for

Hepatitis A, refugees try to get rid of

the disease depending on their life

standards and immunization situa-

tions.

Vector-borne Diseases

As biotic (host) abiotic (climate,

ecology) factors and the immune

systems of the hosts are effective in

the formation of the vector-borne

diseases caused by disease functions

reaching by means of such organ-

isms as ticks, flies, fleas (because of

geographical features of Bangla-

desh), health organizations meet se-

rious problems. Increasing depend-

ing on environmental effects and

changes especially increases in the

periods when the rains are more.

Besides that, a great many factors

such as the drainage of the water

used in the camp fields, waste stor-

age etc. lead to the increase in the ac-

cumulation of vector-borne diseases.

Diseases Preventable

with Vaccines

Even though the diseases that are

preventable with vaccines for the

Arakanese refugees in Bangladesh

are significantly controlled with the

controls made in the entrance of the

refugee camps, extreme masses in

the crisis fields and other diseases

encountered in the camps led health

organizations to put the issue of

spreading the content of vaccines in

the region on their priority.

Measles

Depending on the data obtained be-

tween 1st and 13th weeks of the year

2018 form the partners acting in the

refugee camps over 4W reporting

system and EWARS warning system,

it is likely to say that suspected mea-

sles cases are encountered in almost

all camps.

Even though 1.105 suspected mea-

sles cases were encountered in the

year 2018 and there became a de-

crease in the measles cases com-

pared to the year 2017, the fact that

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the reports come from different re-

gions and there was no information

flow from the same partner make the

general evaluation impossible.

The basic reason for the instability in

the number between the cases reach-

ing health partners is that camp

fields have different characteristics

such as location, accommodation,

clean water, environmental factors

etc.16

Diphtheria

As seen in the epidemiological curve

in terms of diphtheria disease, it is

likely to see that the number of cases

peaked in December 2017 and there

16 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018

became a constant decrease in the

cases reported from the first week of

the year 2018. In the period starting

from 8th November 2017 when the

diphtheria epidemics were first

heard up to 31st March 2018, 2.837

(44%) suspected, 3.422 (53%) possi-

ble diphtheria cases were reported to

EWARS system.

Health sector partners try to provide

health care from two active diphthe-

ria treatment centres in Bangladesh.

As the patients undergoing the dis-

ease could develop “late complica-

tions” a few days / weeks after the

first acute phase, those discharged

are observed in the follow up period

for 30 days.17

17 Rohingya Crisis in Cox’s Bazar, Bang-ladesh: Health Sector Bulletin, 2018

FIGURE 14: THE NUMBER OF SUSPECTED MEASLES REPORTED TO EWARS SYSTEM BETWEEN 1ST AND 13TH WEEKS

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Sexual and

Reproductive Health

Fifty-two percent of Bangladeshi ref-

ugees are made up of women. The

majority of them are between the

ages 18-59. A great many institu-

tions, departments and NGOs acting

in the field provides a minimum

start-up service package for sexual

and reproductive health (SRH).

However, access to detailed repro-

duction, mother and new-born

health services pose a problem to a

great extent.

Because of lack of service or trans-

portation, 28% of refugee women

cannot benefit from prenatal care

services.

Due to many factors like cultural

factors, 36% of women cannot give a

birth in health facilities. One of the

important drawbacks in the camp

fields is that there are no incubator

health facilities to be used particu-

larly at night transportations for

7/24.

FIGURE 15: THE NUMBER OF SUSPECTED DIPHTHERIA CASES EXPERIENCED ACCORDING TO THE AGE GROUPS BETWEEN NOVEMBER 2017 AND MARCH 2018

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Mental Health and

Psycho-social Support

Psychological problems caused by

what refugees experienced such as

any kind of oppressions and tortures

they were exposed to, the traumatic

situations like losing many relatives

is another problem which health or-

ganizations acting in the field.

Among the psychological problems

defined in the camps are unemploy-

ment, lack of health care, shortage of

clean water and leaving from the

family.

In addition, the security problems in

the camp fields and other problems

such as unpreventable child loses

etc. make the psycho-social support

service by health organizations com-

pulsory.

CRISIS MANAGEMENT IN EXTRAORDINARY SITUATIONS

umanitarian crises that

requires different organ-

ization ability depend-

ing on the type of formation have a

feature where a great many fields are

interconnected. A wrong application

that will be made in any field affects

other fields, it is necessary that the

organizations acting in such fields as

health, food, accommodation, secu-

rity etc. should act in a certain disci-

pline.

In other words, the organizations

should manage crises in a certain

plan and program in order to over-

come the crises emerging suddenly

and/or at an unexpected time and

developing sometimes very fast and

sometimes very slowly at minimum

damage. So as to take these situa-

tions emerging suddenly and unex-

pectedly under control and get rid of

the negative effects, turning them

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into a positive case, crisis manage-

ment requires a detailed and strate-

gic planning.

In the crisis

management

where the

basic thing

should be de-

termined ac-

cording to the

worst sce-

nario, the

main purpose

is to provide

that organiza-

tions be ready

for the crises beforehand, they take

some precautions for the crisis and

produce a fast solution. Various

stages should be taken into consid-

eration to manage the crisis in an ef-

fective way. These stages could be

expressed as the process of crisis

management. Making preparations

by paying attention to crisis signals,

taking the crisis under control, mak-

ing plans to turn back to normal po-

sition by controlling the damage,

taking some lessons or benefitting

from the situation by evaluating the

crisis experienced could be ex-

plained as the processes of crisis

management.

Organizations have the opportunity

of obtaining the data. Early warning

system means anticipating, perceiv-

ing and evaluating the crisis.

When the crisis signals are taken,

necessary precautions could be

taken after preparations. An effective

early warning system and organiza-

tion network should be set up in this

purpose.

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Bangladesh Refugee Camps and Health System

Management and Coordination

There are humanitarian crises at dif-

ferent dimensions because of such

situations as war, hunger, lack of

food etc. in many parts of the World

such as Africa, Central Asia and

Southeast Asia, particularly in the

region of Middle East.

As for Bangladesh hosting 671.500

Arakanese who were exposed to gen-

ocide in the public eye, migrating

because of the events and more than

1 million refugees as of 2018, the ef-

fects humanitarian crisis are felt

more deeply.

In Bangladesh where intersectorial

organization is needed more, a lot of

national and international organiza-

tions, institutions and NGOs act. In

Bangladesh where 97 NGOs from

Turkey act, it is known that thou-

sands of organizations carry out

their works in many fields such as

accommodation, food, health etc.

when we take the number of the or-

ganizations working in the field of

humanitarian aids from other Mus-

lim countries into consideration.

In addition, even though there are

organizations serving in different

fields in Bangladesh where there

happen seasonal sudden complica-

tions and serious crisis situations are

experienced, the activities of health

organizations which carry out works

especially in health sector and have

sectoral relations with this field are

of crucial importance qualitatively.

In this sense, it is essential that or-

ganizations make intra-coordination

and interorganizational coordina-

tion and develop a sustainable sys-

tem in the field.

The functionality of the manage-

ment and organization system which

could be evaluated as the most im-

portant stage of the humanitarian

crises could be realized through a

qualitative planning.

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Besides that, the fact that the organ-

izations making activities particu-

larly in Bangladesh cannot be inte-

grated in international organization

systems (e.g. WHO) due to various

reasons and that such organizations

as OIC (Organization of Islamic Co-

operation) cannot form a well-at-

tended organization network for the

crises experienced in Muslim coun-

tries increase organizational prob-

lems with regard to both preventing

and rehabilitating them. These prob-

lems vary in many fields from the

process of preparation for crisis and

the stage of application in the field.

Crises happen in different geogra-

phies in different types and condi-

tions. Crises happening in one point

of the world are caused by natural

disasters while different crises and

situations appear in other regions

because of factors like war and hun-

ger. Due to this case, it is necessary

the process of preparation and activ-

ities to be applied in the fields of cri-

sis show a change.

In particular, the

organizations

coming to the

field of crisis in

order to carry

out various ac-

tivities both

from Turkey

and other coun-

tries as experi-

enced in the lo-

cality of Bangladesh have serious

drawbacks regarding intervention to

disaster cases.

Organizations do not take care of the

endemic conditions of the region

where they act and make regional

preparations depending on the par-

tial experience obtained from other

regions of crisis. While making these

preparations, there are many issues

to be paid attention.

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The basic reason for these issues and

other problems is that organizations

cannot coordinate the preparation

process in a planned way. As it is not

carried out with an agenda, a lot of

organizations coming from the same

region or country make similar ac-

tivities and interventions.

This case was observed in the two of-

ficial refugee camps of Kutupalong

and Nayapara in Bangladesh.

Kutupalong refugee camp is nearer

to the centre due to its geographical

location, where humanitarian aids

reach earlier and floods are experi-

enced less because of rough terrain

conditions.

As for Nayapara refugee camp, it is

the camp area where the majority of

the refugees coming in surges as it at

the Myanmar border are located

temporarily, far from the centre and

humanitarian aids and having more

serious floods as the terrain is

smooth and it is near to the river

Naf.

Because of

these kinds of

differences, the

crisis cases and

dimension of

the two camps

differ. Due to

the fact that or-

ganizations

plan their pre-

paredness pro-

cess before crisis do not take into

consideration and cannot act sys-

tematically, there are significant

problems between the fields of the

two camps (Kutupalong and Naya-

para) in terms of humanitarian aids.

The crisis that such humanitarian

aids as urgent intervention, medi-

cine, inoculation, food etc. do not

reach the camp area where they

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must primarily go but go to where

there is no need, instead is deepened

and causes loss of time and labour.

In Bangladesh where one million ref-

ugees spread in a large area and there

is a fast population circulation, the

increasing negative attitude of the

political authority towards refugees

as well as arrival of organizations in

the field without having enough

preparations and lack of theoretical

and practical experiences to a great

extent do not have an effective influ-

ence in long term even though it has

palliative effects in short term.

One of the most important applica-

tions to be made in crisis cases and

process is that information and data

management should be made func-

tional affectively. Lack of a common

network where

particularly

health organiza-

tions in Bangla-

desh could trans-

fer a lot of data

such as what kind

of activities they

carry out in local

fields, which

health problems they encounter and

what are the basic reasons for them

etc. and the organizations other than

health sector working in other fields

could be integrated causes a great

many problems.

This case leads to the disruption of

health services, inability of making a

short, medium and long term sus-

tainable planning and carrying out

works triggering each other in a neg-

ative way. For that reason, organiza-

tions give the priority to therapeutic

health services which are easy meth-

ods.

In addition, the works of organiza-

tions which are unaware of health

data of the region where they act and

are deprived of being informed with

regard to what kind of complications

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are experienced and what kind of

precautions should be taken for

these complications cause serious

problems.

As an example, the fact that NGOs

coming to Cox’s Bazar refugee

camps to dig a well only and being

unaware of the works of other or-

ganizations do not pay attention to

terrain conditions and camp condi-

tions and do not dig the well deep

enough in suitable standards in-

creased the cases of cholera, diar-

rhoea and skin problems.

Besides that, as they are deprived of

information and data network, the

organizations have troubles in the

preparation for crisis. This case leads

to the problems of which inventories

would be taken to the crisis field,

what kind of medicine would be

supplied, in which field health staff

is needed and it also causes the prob-

lems of failure in such issues as nu-

trition, food,

shelter, hy-

giene etc.

The conditions

experienced in

the temporary

settlement field

where refugees

arrive after Na-

yapara refugee

camp in Bangladesh in this sense

show how humanitarian crisis turns

into an inextricable stage in the case

of lacking from this data.

Because of the fact that a great many

health organizations which carry out

their works in Nayapara refugee

camp also work in similar fields,

both significant drawbacks appeared

in 1st and 2nd health services and

unexpected situations developed be-

cause of the inadequacy in coordina-

tion.

As an example, a great many organi-

zations acting over such diseases as

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cholera, measles etc. failed behind

and those coming to the same refu-

gee camp encountered with the same

problems since they were not

informed about these drawbacks.

Owing to the fact that the organiza-

tions working in other sectors can-

not/do not get the basic information

or data regarding the field from the

organizations working in the field,

there become a great many problems

in providing the needed materials in

many fields in urgent situations.

In the region where monsoon rains

and floods related to them are expe-

rienced more, there are big problems

in reaching mostly needed products

because of the problem of coordina-

tion and wrong applications made

before the process.

As seen in the example of Bangla-

desh, lack of information / data flow

and any kind of

drawback re-

sulting from it

brings forward

the problem of

using the funds

effectively in

many fields, par-

ticularly in the

field of health.

Besides the

funds allocated by international offi-

cial institutions for crisis situations,

a great many other organizations al-

locate significant amount of sources

in order to intervene humanitarian

situations. It is necessary to utilize

from the sources national and inter-

national departments and institu-

tions allocate for humanitarian situ-

ations as well as the donations col-

lected over the principle of volun-

teerism in time and in place. It is es-

sential for the organizations which

will work in order to realize it have

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full knowledge of crisis field, work

with professional partners or be in

cooperation with other organiza-

tions experienced in the field, carry-

ing out their works.

This case that is called Reliable Part-

ner Cooperation affects not only the

quality of works and also the effec-

tive use of funds forming a basis for

all situations such as supplying se-

cure and reliable materials, fast de-

tection of problems, true interven-

tion in time, reaching experienced

human source etc.

When it comes to Bangladesh in par-

ticular, it is true that there are signif-

icant problems over the fact that

there is a Reliable Partner Coopera-

tion for a great many organizations

working in the field for both Turkey

and other countries. There are also

some other problem resulting from

the lack of this cooperation and from

relevant using of the aids which are

supplied by lots

of organizations

having no expe-

rience in the

field by means

of being in co-

operation with

their unreliable

partners.

Besides that,

many organiza-

tions deliver these aids to their unre-

liable partners. Many of the organi-

zations working with unreliable

partners leave the crisis field without

getting any feedback about whether

the aids achieved their aims. This

case requires the necessity to review

the status of establishment, supervi-

sion etc. of the organizations work-

ing in international arena.

Another issue related to the lack of a

common working network which

plays a role in the formation of part-

ner security problem or not being

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able to be integrated in this kind of

system is the provision of profes-

sional human source suitable for the

crisis situation.

In particular, the organizations and

institutions working in health sector

are in an important position at this

point. As health organizations hav-

ing structures like NGOs work on

the principle of volunteerism, it is

necessary for health staff working in

health sector to be experienced in

terms of intervention in humanitar-

ian situations and be made up of in-

dividuals trained for the needs in cri-

sis fields.

The fact that health organizations

working in Bangladesh refugee

camps do not plan the process of

preparedness for crisis in a good way

brings about the lack of personnel

who will work in the fields of infec-

tious diseases, obstetrics and gynae-

cology.

Similar cases are encountered in the

institutions working for a long time

in the fields where there are refu-

gees. Instead of forming such struc-

tures as personnel, hospital etc. vi-

tally needed primarily, secondary ac-

tivities are given priority.

There are important problems which

the organizations in Bangladesh

have regarding management and co-

ordination as well as social, political,

cultural etc. ones both nationally

and internationally:

The problems that organizations en-

counter in the camp fields are as fol-

lows:

• Not being able get necessary visas

to work and significant handicaps in

getting a visa,

• Short term visas given by Bangla-

desh government,

• Bangladesh government doesn’t

not give a work permit and prevents

the entrance in the camp fields,

• Bangladesh governments offers the

chance working with limited num-

ber of local partners,

• Significant problem regarding ac-

creditation,

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• Not being able to make necessary

coordination with official institu-

tions working in the field like Turk-

ish Cooperation and Coordination

Agency (TIKA) and Disaster and

Emergency Management Agency

(AFAD),

• Problem of communication be-

tween organizations and institutions

at every stage,

• Connection and communication

problems resulting from Bangladesh

domestic politics,

• Muslim women refugees stay away

from male health staff and do not

want any examination in terms of

health organizations,

• Important

problems in

the fields of

nutrition,

hygiene etc.

culturally.

Health Services and Control of Infectious Diseases

reventive health services

are of wide range of con-

tent affecting therapeutic

health services as well. In this sense,

it is known that preventive health

services have a roof task in the sys-

tem of health service.

Preventive health services are a so-

cial approach comprising such situ-

ations as taking any kind of precau-

tions to prevent diseases, preventing

infectious diseases, surveillance of

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the process after disease, social

awareness raising and training over

diseases and health issues and aim-

ing at preventing diseases rather

than treating them.

In this sense, the basic purpose is to

serve for community, determining

risks, reducing risks and preventing

mistakes, taking responsibilities in

terms of society and making behav-

ioural and social interventions at the

point of clinic.

Therapeutic services emerge with

the emergence of diseases despite all

these things. For that reason, both

preventive services and therapeutic

services are interconnected in health

sector. Giving the opportunity of re-

covering the health conditions of

more people with less effort, in

cheaper price, preventive health ser-

vices approach is much more supe-

rior than therapeutic services and

has a social and humanitarian ap-

proach. In other words, preventive

health services has a larger content

than other fields with its preventive

position.

Such works as planning, revising

and increasing the quality manage-

ment of preventive health services in

ordinary situation could be done

regularly. However, preventive

health services cannot keep its im-

portance among urgent intervention

stages in extraordinary and crisis sit-

uations.

In particular, it is almost impossible

to work over preventive health crisis

without overcoming first interven-

tion in crisis times when clinical in-

terventions are more, there is an ac-

cumulation of refugees. For that rea-

son, it is necessary to put much

more effort in terms of the preven-

tive health risks in order to prevent

disease risks likely to emerge for dif-

ferent reasons with the stabilization

of crisis situation in the fields partic-

ularly in Bangladesh where 1 million

refugees live.

Since these works that will be real-

ized within a work schedule and a

plan comprise such important cases

that they are community based ra-

ther than individual based, they con-

tain a long period, they need a large

human source, they have a regular

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flow of data etc., the organization

acting in the field of humanitarian

aid is a hard working platform in

terms of institutions and depart-

ments.

Yet, a great many health organiza-

tions try to offer preventive health

services in Bangladesh refugee

camps even though they are not so

planned. In offering these health ser-

vices, many political and institu-

tional problems come out and there

appear problems resulting from im-

portant drawbacks such as given ser-

vice, planning and application etc.

One of the important problems in

terms of political handicaps is that

Bangladesh bureaucratic structure

and state departments do not allow

preventive health works for women

and make limitations in this sense.

This limitation that causes im-

portant problems in terms of mother

health particularly poses a handicap

for the works to prevent infectious

diseases, increas-

ing the rate of

morbidity among

women.

In addition, the

working permits

given to the or-

ganizations work-

ing in the field by

the Bangladesh

government is of short period affects

the activities of the organizations. In

this sense, many of the organizations

prefer the treatment of urgent com-

plications but do fewer activities

with regard to providing preventive

health services and preventing infec-

tious diseases.

Besides the work permit problem

limiting the activities of the organi-

zations, deprivation of the organiza-

tions from basic education and

working abilities for preventive

health services, the fact that thera-

peutic services require less effort for

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organizations and getting feedbacks

very fast in a concrete way push pre-

ventive health service work to a sec-

ond place.

Preventing infectious diseases in the

system of preventive health services

and providing the coordination to

reduce the disease risks and report-

ing the health data (type and num-

ber of the cases etc.) obtained from

planned organizational work are the

most critical processes.

Disease risks could be overcome

with a qualitative reporting system

and a more planned preventive

health service could be given.

In this sense, even though World

Health Organization (WHO) try to

subsidize this with the reporting sys-

tem of Early Warning and Response

System (EWARS) and 4W they es-

tablished in Bangladesh Health Sec-

tor Organization in the refugee

camps, the fact that the organiza-

tions cannot / do not be integrated in

this system and that particularly the

organizations, departments and in-

stitutions coming from Muslim

countries cannot set up a coordina-

tion network prevents healthy data

flow.

In addition, the

lack of a coor-

dination net-

work where all

activity fields

(health, food,

nutrition etc.)

could be in-

cluded besides

general coordi-

nation increases the problems in

terms of preventive health services

and causes the emergence of infec-

tious diseases.

In Bangladesh refugee camps where

the level underground water is high

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and floods are frequently experi-

enced with the monsoon rains, be-

cause of the fact that the cesspools

which the organizations working in

the sheltering field opened for waste

water do not have the necessary

standards and are not deep enough,

waste water (toilet water) is accumu-

lated in the living spaces of the refu-

gees during floods.

In addition, as the water wells are

dug near cesspools, they pose a seri-

ous risk for infectious diseases. Be-

sides that, many cases such as build-

ing the shelters by the organizations

in the flooding areas during the first

refugee surges and the increase in

the chronic lung cases because of

building the chimneys which are

used to cook inside the houses show

that organizations in the health field

are far from a lot of basic health ed-

ucation ability.

Since the majority of Bangladeshi

refugees are under 18 years of age,

high risk percentage of such diseases

as measles and diphtheria, particu-

larly water-borne and vector borne

diseases, surveillance opportunities

requires being ready for urgent

cases.

There are some important problems

in the preservation of vaccines

stocked in order to apply in the case

of an emergence of diseases apart

from preventing infectious diseases

in Bangladesh refugee camps where

preventive health services fail.

Given the fact that the vaccine

should carry necessary standards of

storing and preserving condition in

cold chain system, the problems ex-

perienced both in supplying electric-

ity which provides the heat condi-

tions that will prevent the spoilage of

the vaccine and in storing the vac-

cine in certain conditions cause big

problems in the provision of the vac-

cine during an epidemic.

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Mother and Child Health Services

emales comprise 52% of

the Bangladesh refugee

camps which are the fastest

growing and spreading camps of the

world. At this rate the majority of

which is comprised of children,

there became a sudden and im-

portant increase after 2017.

While 16% of the population is only

women, the rate of children sepa-

rated from their parents is 2%. This

table leads to possible secondary

problems.

In the refugee

camps in the

Cox’s Bazar re-

gion of Bangla-

desh where 60

babies are born

in a day, more

than 16.000 ba-

bies were born

in only last 9 months of the year

2018.

Affected from the current crises,

Bangladeshi refugee women chil-

dren have serious health problems

with the risks of being a

women/child as well as the natural

problem of being an immigrant.

Women in the refugee camps cannot

be supported mostly in the issues of

woman health in general, hygiene

and birth. Pregnant women have

very little chance for the access to

health services. Furthermore, the

women at the period of giving a birth

have to give their birth at home.

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The demand for the health services

which are not at adequate number is

less because birth at home is cultur-

ally spread. The majority of the

births given at home are made even

in the absence of such basic materi-

als as sterile suture to knot umbilical

cord, clean cloth to control bleeding,

soap etc. For that reason, immuniza-

tion of mothers in terms of neonatal

tetanus should be given importance.

Also, the difficulty of transferring

patients to health facilities for secure

births goes on being a problem. Par-

ticularly, an incubator or health fa-

cilities serving for 7/24 for night

transfers should be established in

the camps. As there is no service like

that or hard to achieve, 28% of the

women are reported to have prob-

lems in having an access to prenatal

care services.

A great many

mother who can-

not achieve

health services in

postpartum pe-

riod could be lost

because of pre-

ventable condi-

tions. These con-

ditions increase

the risk of infection of disease like

ADS that could lead to deaths and

the risk of miscarriage in insecure

conditions.

Frequent experience of the sexually

transmitted diseases and that mis-

carriage threatens the health of

women are other problems that

should be taken into consideration.

In this sense, the presentation and

information activities for family

planning is of great importance in

the region. Spreading the family

planning services in the region,

given routine prenatal services,

making the birth in accompany with

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a health personnel and also giving

health support for the mother in

postpartum period could prevent

maternal and infant mortality.

Another factor that would increase

the success in reducing maternal and

mortality is trained health staff and

equipped health system.

In particular, basic problems en-

countered in reaching these health

services could be given as follows:

• Lack of awareness and experience

at health workers for the special

needs of refugees,

• Language and communication

problem,

• Cultural differences,

• Not being able to adapt to a foreign

health system,

• Not being informed about the

health service if any,

• Timidity in explaining such cases

as abuse, rape etc.

• In the camps where child abuse

and rapes are encountered, escaping

girls at the age of a child in the refu-

gee camps by prostitution gangs is

another significant problem.

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CONCLUSION, RECOMMENDATIONS AND SOLUTIONS

umanitarian situations

and humanitarian crisis

which is one of the most

important problems of our age has

an immanence affecting human life

in a massive way.

Besides humanitarian crises devel-

oping naturally (earthquake, flood

etc.), the humanitarian crises result-

ing from wars in many regions, par-

ticularly in Muslim geographies,

threatening the life of millions of

people directly and the problem of

intervention to these situations are

going on at serious levels. many or-

ganizational, political, cultural etc.

problems encountered from the pre-

paredness process to crisis manage-

ment and wrong application made

with regard to solve these problems

do not solve the problems and re-

sults in appearance of different prob-

lems in long term.

In this sense, recommendations,

precautions and solutions compris-

ing all structural activities, both

qualitatively and quantitatively,

within the crisis intervention system

could be given with these dynamics:

United Nations is unable to in-

tervene political crisis in many

regions of the world and human-

itarian situations caused by

them.

Because of factors of the fact that

decision making resulting from

the structural case of the United

Nations takes a long time, it is

late in putting the steps to be

taken in a fast way etc., it is nec-

essary to establish a more effec-

tive international organization

network and that:

• This system should provide the

integration of the organization,

official institutions and depart-

ments working in different field

no matter which country they

are from to the system,

• The system where all share-

holders are included and orga-

nized by a common sense should

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have a transparent and reliable

identity,

• The organizations should be

made to work in this system in

every field not only in crisis

times, but also from the prepar-

edness process for crisis other

process, some steps should be

taken between the system and

organizations in order to

strengthen the communication,

management mechanisms such

as education to make SWOT

analyses, supervision, authoriz-

ing etc. should be formed,

• The internal coordination of

the organizations working in the

same sector together with inter-

sectorial coordination should be

made, providing a the active,

productive and sustainable use

of sources which are limited in

the field,

• Inclusion of the organizations

acting in similar fields in the sys-

tem will make them move faster

in the crisis time and prevent the

accumulation of activities in a

certain field,

• An information network

should be established in order to

guide the organizational activi-

ties before and after the disaster

in an active way, organize them,

form preventive services and

make early diagnosis for dis-

eases, and active use of this

structure should be provided by

the organizations.

The laws and regulations provid-

ing the institutional formation of

the organizations established to

intervene humanitarian situa-

tions whichever field they are,

supervising the works of organi-

zations should be made to be

qualitative.

It is necessary that organizations

should act depending on any

kind of social feature of the field

where any work will be made ac-

cording to the types of the crisis

for the organizations.

It is necessary that the prepared-

ness for a crisis which is the most

important stage of the crisis

should be evaluated well by the

organizations. In this context, it

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is essential that the personnel to

work in the crisis field should

plan standard educations and au-

thorize the organization having

minimum number of trained

personnel should be authorized.

One of the important problems

encountered during the inter-

vention to humanitarian situa-

tions is the problem of contact

with reliable partner. Mostly the

organizations having no field ex-

perience encounter with this

problem and in this way, some

troubles come out in the process

of using sources adequately in

many senses. Setting up an or-

ganization where the organiza-

tions could be accredited might

overcome the problems in this

sense.

All organizations working in the

crisis field should be given con-

cessions in order to solve the visa

problem which is one of the most

important handicaps affecting

the field works and long term

plans of the organizations in cri-

sis time,

An organization tries to serve in

more than one field even though

it doesn’t have enough capacity

and equipment. This case causes

unexpected results in terms of

preventive health services and

sustainable work services. For

that reason, a certification sys-

tem which determines the work-

ing limitations and working

competencies of all NGOs, offi-

cial departments and institutions

should be applied and organiza-

tions should carry out their

works in this system,

It is necessary that students com-

ing from crisis regions to other

countries, particularly to Tur-

key, should be evaluated accord-

ing to their point of interests and

the organizations working in the

field should be communication

with these students. In this

sense, it is of importance that

students complete related certifi-

cate programs throughout their

education life.

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It is of importance that the NGOs

being dynamic in terms of hu-

manitarian aids and intervention

to crisis and affecting the result

directly should be included in

the organization network. Mak-

ing this integration will over-

come negative cases and trends

such as:

• The interest of search and res-

cue by NGOs, having the com-

peting coming forefront in this

kind of issues,

• Reluctance of NGOs in work-

ing with official departments and

having no obligation of account-

ability,

• The increase in the unskilled

volunteers in NGOs which can-

not/do not institutionalize,

• Lack of supervising mechanism

in NGOs and having no clear ac-

creditation criteria,

• Unprepared arrival of NGOs in

the disaster area and being a bur-

den for the disaster management,

• Language problem of the work-

ers in NGOs

The fact that preventive health

services are of more extensive

identity compared to other fields

and that the visibility of these

service is less than other services

will lead to not being able to ex-

pertise and serve in the field for

an organization.

This problem could be solved

with the formation of a common

and well-participated system.

In order to apply preventive

health services in an active way,

it is required that all NGOs, offi-

cial departments and institutions

acting in the crisis fields get a

certification education with re-

gard to this field.

The most critical case in terms of

preventive health services is

gathering numerical data of the

crisis field and surveillance of

this data. Setting up a surveil-

lance system will prepare the

necessary environment for the

detection of health risks and for

an active fight with diseases. For

that reason, as well as the work-

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ing performance of the organiza-

tions, obtaining the data of the

working field in a healthy way

and transferring it to the related

unit is a must.

In order to solve mother morbid-

ity, which is one of the common

problems happening in refugee

camps:

• Early detection surveillance of

the pregnant

• Application of antenatal care

protocols to all pregnant women

and realizing them in standards

for the first stage health services,

• Giving the births in a health fa-

cility, if possible in accompany

with a health worker, paying at-

tention to the quality of the per-

sonnel helping for the birth and

supporting them with educa-

tions,

• Determining and following up

of the puerperants,

• Raising the awareness of

women at the reproductive age

through home visits and encour-

aging pregnant follow-up and

birth in the centre in particular,

should be made regularly.

In order to minimize the health

problems encountered in crisis

fields and particularly at 0-14 age

group, it is necessary to give im-

munization services.

Sanitation educations should be

given for the diarrhoea based dis-

eases met in crisis fields exten-

sively and the distribution of the

necessary materials should be

made and they should made to

be used,

Mother milk should be encour-

aged in the crisis fields and chil-

dren with malnutrition should

be supported and children

should be followed regularly,

A transfer system which will

work regularly within the con-

tent of maternal and child health

should be set up. There should

be a mapping, 7/24 transfer sys-

tem and free ambulance system

with a mapping from the centres

making pregnant follow-up

works to the hospitals giving

caesarean birth.

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Precautions should be taken

against abusing, organ and child

trafficking and training and

warnings should be given re-

garding these issues.

In addition, some centres giving

services for sexual violence and a

transfer system should be set up.

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