Via MSF.org: Bangladesh: Emergence of diphtheria worsens situation of Rohingya refugees. Excerpt:
Diphtheria, a disease long forgotten in most parts of the world thanks to increasing rates of vaccination, is re-emerging in Bangladesh, where more than 655,000 Rohingya have sought refuge since 25 August, following increased violence in Myanmar. As of 21 December, Médecins Sans Frontières (MSF) has seen more than 2,000 suspected cases in its health facilities and the number is rising daily. The majority of patients are between five and 14 years old.
“I was very surprised when I got that first call from the doctor at the clinic telling me that he had a suspected case of diphtheria,” says Crystal VanLeeuwen, MSF emergency medical coordinator for Bangladesh.
“‘Diphtheria?’ I asked, ‘Are you sure?’ When working in a refugee setting you always have your eyes open for infectious, vaccine-preventable diseases such as tetanus, measles and polio, but diphtheria was not something that was on my radar.”
Diphtheria is a contagious bacterial infection that often causes the buildup of sticky grey-white membrane in the throat or nose. The infection is known to cause airway obstruction and damage to the heart and nervous system. The fatality rate increases without the diphtheria antitoxin (DAT). With global shortages of DAT and the limited quantity that arrived in Bangladesh just over a week ago, the likelihood of a public health emergency looms, threatening a population that has fled the threat of violence and is now faced with another: the outbreak of disease.
If patients don’t receive DAT early on in the progression of their illness, the toxin continues to circulate in the body. This can cause damage to the nervous, cardiac and renal systems weeks after the initial recovery period.
“The first suspected case we identified was a woman around 30 years old,” explains VanLeeuwen. “She came to our health facility in early November and we treated her with antibiotics. She left the clinic, only to return to us over five weeks later. Then she had numbness in her arms, could barely stand or walk and had difficulty swallowing. It is too late to give her DAT at this stage.”
As of today, there are only less than 5,000 vials of DAT globally. “There is not enough of the medication to treat all of the people in front of you who need it and we are forced to make extremely difficult decisions,” says VanLeeuwen. “It becomes an ethical and equity question.”
The emergence and the spread of diphtheria show how vulnerable Rohingya refugees are. The majority of them are not vaccinated against any diseases, as they had very limited access to routine healthcare, including vaccinations, back in Myanmar. Diphtheria is transmitted by droplets and spreads easily in the refugee settlements where people live in overcrowded conditions, with shelters squeezed up against each other and sometimes families with up to 10 people living in one very small space.
MSF has responded to the rapid spread of diphtheria by converting one of its mother and child inpatient facilities in Balukhali makeshift settlement, and the inpatient facility near Moynarghona – which was only days away from opening – into a diphtheria treatment centre.
