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As Covid-19 Gains a Foothold, a Q&A with the Director of a Rohingya Camp Field Hospital

Dr. Iftikher Mahmood runs a field hospital in the Rohingya settlement in Cox's Bazar, Bangladesh. In an interview with Direct Relief, he discussed the discovery of Covid-19 in the camp, and what's being done to contain and prevent it.



A health worker consults with a colleague at the HOPE for Women and Children of Bangladesh's field hospital. (Photo courtesy of Dr. Iftikher Mahmood)

Facing the specter of Covid-19, a recent cyclone, and an impending monsoon season, Dr. Iftikher Mahmood is worried – but hopeful.

The Miami-based pediatrician oversees a field hospital in the refugee camp in Cox’s Bazar, Bangladesh, where more than 1 million Rohingya people live in makeshift structures clustered closely together. Most arrived in 2017, but some have been there for as long as 30 years, Dr. Mahmood said.

On May 14, the first two confirmed cases of Covid-19 within the Rohingya camp were announced. Since then, there have been more – but not many, thanks in part to measures taken to prevent movement both into and within the camp.

Cyclone Amphan, which posed a devastating threat to the refugee settlement, caused some flooding, but vented the worst of its fury elsewhere. (While more than 100 have been killed, and hundreds of thousands displaced, the full impact of the storm is not yet fully understood.)

During a recent interview with Direct Relief, the physician spoke about the collaborative work being done to keep Covid-19 at bay and treat those affected; the continuation of medical services after the cyclone; and his concerns looking ahead to a season of heavy rains.

Direct Relief: Covid-19 was recently detected in the Rohingya camp in Cox’s Bazar. Tell me a little bit about the conditions in the camp and how they might intersect with Covid-19.

Dr. Mahmood: The camp is in the southern part of Bangladesh, and it’s a very small area, and currently, over a million refugees live there.

And they live in makeshift structures. There is no permanent, solid structure for them. There are the same issues with structure, and the same issues with hygiene, same issues with space. Their condition has not much changed since the time they came.

So that makes the Covid-19 issue a little bit difficult for them. But luckily, fortunately, the first case was diagnosed inside the camp long after cases had been diagnosed in the country. It took time to reach the camp.

It was primarily because the local administration has taken some strict measures in terms of people’s movement. There were a lot of restrictions [around] going inside the camp or going outside.

And also, the numbers are not yet that high. The first case was diagnosed about a week ago. So far, I think they have fewer than 20 cases. There is no case fatality. For some reason, so far it has been very slow.

But the tension is extremely high. They live very close to each other, the Rohingya people. So if there is a bad strain or people get seriously ill, that can spread very quickly.

Direct Relief: What did people who live in the camp and take care of the camp start doing differently when Covid-19 appeared?

Dr. Mahmood: As soon as this thing happened, people got engaged in the discussion about it in Bangladesh itself. Everywhere, there were high tensions and people trying to figure out what to do. And especially in the Rohingya camp, tension was highest because we knew that this could be a very bad situation if it comes here.

So along with other organizations that are involved, including the health sector [and] the World Health Organization, we did the best we could in terms of [establishing] handwashing practices and social distancing practices – within the limitations – and using masks for the people. All the common public health measures, we have been practicing even a long time before Covid came there.

The camp is divided into small subcamps. In every subcamp, there are some offices or there are some organizations that were working there for the past two or three years, and they know that community.

As I said, they restricted movement in and out of the camp. Also, they restricted movement inside the camp. [People] cannot go from one subcamp to another subcamp just like that.

A health worker passes medication to a patient. (Photo courtesy of Iftikher Mahmood)
A health worker passes medication to a patient. (Photo courtesy of Iftikher Mahmood)

As soon as the first case was diagnosed, and they tried to find that case, and contact tracing and all of this, some of the areas inside the camp were locked down.

[The health sector, working with a number of different organizations] has a plan to set up a number of isolation units. I was told, I’m not 100% sure, [there would be] at least 1,000 beds inside the camp so they can take care of those patients.

[Camp residents] are pretty worried about it themselves as well.

Direct Relief: What is their access to running water? How much are they able to maintain social distancing?

Dr. Mahmood: Limited. The scope is limited.

We have set up, in our hospital and around our hospital, some handwashing stations. Soap, water’s available, also sanitizers. And inside the camp also, they have set up different handwashing places. But it’s limited.

It’s like a small village, but a lot of people.

Say I have a family of five, six people. They’re staying within themselves, not doing things with others, going around to the shops or to gatherings or things like that. These are the best they can do. And they’re using masks.

Direct Relief: You run a field hospital in the camp that particularly focuses on women’s health. Can you talk about the services that you provide and how those will be affected by Covid-19?

Dr. Mahmood: We have a 50-bed hospital for women and babies. We have an outpatient department. We have a labor and delivery room. We have a maternity unit to admit patients after delivery or any maternal health conditions. We have an operation theater.

We have an isolation unit inside the hospital, so if they have an infectious disease, we isolate them. We also have the pediatric unit, and we have a neonatal unit. We provide around-the-clock emergency obstetric care.

The impact of Covid-19 is that, first of all, we have seen a decrease in the number of patients. Now that [there is] social distancing, they are not coming for minor things. They’re coming for major things, of course, important things.

Before, we used to have a lot of field workers who would go from home to home to follow up on patients. That has reduced because of the limited movement and also staff issues, of bringing staff from outside the camp.

But our deliveries and the emergency C-sections remain pretty much the same. And caseloads are still there.

We started a fever and flu corner, so people don’t come directly to the hospital, because upper respiratory infection is very common in the camp, because of the close proximity and hygienic issues.

Our staff, they have protective equipment themselves, so they don’t get infected. We have conducted many trainings for our staff so they know what to do. And we have put together a team of doctors, nurses, and midwives specifically to treat patients with suspected infection.

The field hospital's new Covid-19 isolation unit, under construction. (Photo courtesy of Dr. Iftikher Mahmood)
The field hospital’s new Covid-19 isolation unit, under construction. (Photo courtesy of Dr. Iftikher Mahmood)

We have a plan to set up a special unit, a separate unit of 50 beds to treat patients with Covid or suspected Covid, because it seems like the infection is going to be with us for a long time. We want to make sure that we prepare for it. And we are a part of that 1,000-bed plan.

Direct Relief: So you’ve doubled your beds and taken on a whole new area of medicine – from maternal and child health to infectious disease. What did you have to do to make that happen?

Dr. Mahmood: We did it even before we got any funding support because we knew that it was important and necessary. I knew support would be coming.

I have been following this since it started, and I did a lot of studying of how to set up a unit like this. I spent a lot of time to understand the mechanics, the setups.

I consulted a lot of top-level infectious disease specialists. And I have involved many Bangladeshi specialists that worked in the U.S. on infectious disease and pulmonary care and Covid infections, and sought their help and guidance.

The information is out there. It’s been happening since November [in other countries]. So we had all this time to prepare and understand the disease, the process for response.

Health workers prepare to respond to Cyclone Amphan. (Photo courtesy of Dr. Iftikher Mahmood)
Health workers prepare to respond to Cyclone Amphan. (Photo courtesy of Dr. Iftikher Mahmood)

I want to mention that Direct Relief, we already had several training sessions, discussions, consultations, and support. The Covid supplies [donated by Direct Relief] already arrived.

Direct Relief: Cyclone Amphan recently made landfall in Bangladesh, and it wasn’t as bad in Cox’s Bazar as people were fearing it would be, but it did cause flooding. Has the cyclone complicated Covid-19 response or medical care in the camp?

Dr. Mahmood: Honestly, very little. We were ready to respond, but the cyclone kind of diverted and went to northern Bangladesh and India. So we had very little happen, luckily, because this kind of hurricane can devastate a camp like the Rohingya camp.

Direct Relief: Are you concerned about any other consequences related to Covid-19 or the cyclone?

Dr. Mahmood: I’m very concerned because of the monsoon time.

Next June, July, August, these are high times for monsoon. Lots of rain, lots of floods, can happen. And now Covid, where you have to keep people separate. Whenever you evacuate people, you have to be together, right?

I mean, this is a mess. Hopefully we don’t have to be subjected to natural calamities. And hopefully, the Covid situation will be mild. We are hoping for a lot of things, but we are worried.

Direct Relief has provided Dr. Mahmood’s organization, HOPE Foundation Hospital for Women and Children of Bangladesh, with financial support and medical aid, including protective gear, to equip workers responding to the pandemic and cyclone. The latest shipment arrived last week.

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