Global & Disaster Medicine

Archive for the ‘Rohingya’ Category

The upcoming monsoon season in Bangladesh could put tens of thousands of Rohingya refugees staying at the highly congested settlements in Cox’s Bazar district at serious risk.

UNHCR

  • At least 100,000 refugees could be in grave danger from landslides and floods.
  • Up to one third of the settlement area could be flooded
  • More than 85,000 refugees could lose their shelters.
  • Another 23,000 refugees living on steep slopes within the site could be at risk of landslides.
  • key services in the settlement are also at risk of being washed away, including latrines, washrooms, tube wells, and health centers.

 

 


Reports of 5 Rohingya mass graves


Rohingya: US diplomat resigns from international advisory board because it was a “whitewash” and he did not want to be part of a “cheerleading squad for the government [Myanmar]”.

BBC

 


The rape of Rohingya women by Myanmar’s security forces

Pulitzer

“…..The AP interviewed 29 women and girls who say they were raped by Myanmar’s armed forces, and found distinct patterns in their accounts, their assailants’ uniforms and the details of the rapes themselves. The most common attack involved groups of soldiers storming into a house, beating any children inside and then beating and gang raping the women. ….”


Rohingya: From 3 November 2017 through 12 December 2017, a total of 804 suspected diphtheria cases including 15 deaths were reported among the displaced Rohingya population in Cox’s Bazar.

WHO

Diphtheria – Cox’s Bazar in Bangladesh

Disease outbreak news
13 December 2017

From 3 November 2017 through 12 December 2017, a total of 804 suspected diphtheria cases including 15 deaths were reported among the displaced Rohingya population in Cox’s Bazar (Figure 1). The first suspected case was reported on 10 November 2017 by a clinic of Médecins Sans Frontières (MSF) in Cox’s Bazar.

Figure 1: Number of diphtheria cases among the displaced Rohingya population in Cox’s Bazar, Bangladesh reported by date of illness onset from 3 November 2017 through 12 December 20171

1Date of onset information is missing for 45 (5.6%) cases.

Source: Médecins Sans Frontières

Of the suspected cases, 73% are younger than 15 years of age and 60% females (the sex for one percent cases was not reported). Fourteen of 15 deaths reported among suspected diphtheria cases were children younger than 15 years of age. To date, no cases of diphtheria have been reported from local communities.

Public health response

Since August 2017, more than 646 000 people from neighbouring Myanmar have gathered in densely populated camps and temporary settlements with poor access to clean water, sanitation and health services. A multi-agency diphtheria task force, led by the Ministry of Health Family Welfare of Bangladesh, has been providing clinical and public health services to the displaced population. WHO has mobilized US$ 3 million from its Contingency Fund for Emergencies (CFE) to support essential health services in Bangladesh.

WHO is working with health authorities to provide tetanus diphtheria (Td) vaccines for children aged seven to 15 years, as well as pentavalent vaccines (diphtheria, pertussis, tetanus, Haemophilus influenzae type b, and hepatitis B) and pneumococcal conjugate vaccines (PCV) for children aged six weeks to six years. A list of essential medicines and required supplies to support the response is being finalized by WHO and partners.The Serum Institute of India has donated 300 000 doses of pentavalent vaccines for use in the response.

WHO risk assessment

The current outbreak in Cox’s Bazar is evolving rapidly. To date, all suspected cases have occurred among the displaced Rohingya population, who are living in temporary settlements with difficult and crowded conditions. The coverage of diphtheria toxoid containing vaccines among the displaced Rohingya population is difficult to estimate, although diphtheria outbreaks are an indication of low overall population vaccination coverage. Available vaccination data for Bangladesh indicates that the coverage of diphtheria toxoid containing vaccines is high. However, spillover into the local population cannot be ruled out. WHO considers the risk at the national level to be moderate and low at the regional and global levels.

WHO advice

WHO recommends timely clinical management of suspected diphtheria cases that is consistent with WHO guidelines consisting of diphtheria antitoxin, appropriate antibiotics and implementation of infection prevention and control measures. High-risk populations such as young children, close contacts of diphtheria cases, and health workers should be vaccinated on priority basis. A coordinated response and community engagement can reduce the risk of further transmission and help to control the outbreak.

For more information on diphtheria, please see the link below:


Doctors Without Borders: At least 6,700 Rohingya were killed in attacks during the first month of a military crackdown in Myanmar in late August

CNN

“…..[ Médecins Sans Frontières ] interviewed several thousand Rohingya refugees in four camps in Bangladesh in late October and early November, asking how many members of their families had died and how, both before and after the violence began.

The survey showed that a minimum of 6,700 Rohingya — including 730 children — were killed by shooting and other violence between August 25 and September 24, and that at least 2,700 others died from disease and malnutrition…..”

 


“There is no such thing as Rohingya,” said U Kyaw San Hla, an officer in Rakhine’s state security ministry. “It is fake news.”

NY Times

  • “….human rights watchdogs warn that much of the evidence of the Rohingya’s history in Myanmar is in danger of being eradicated by a military campaign….”
  • “….Since late August, more than 620,000 Rohingya Muslims, about two-thirds of the population that lived in Myanmar in 2016, have fled to Bangladesh,……”

UN

Brutal attacks on Rohingya meant to make their return almost impossible – UN human rights report

GENEVA (11 October 2017) – Brutal attacks against Rohingya in northern Rakhine State have been well-organised, coordinated and systematic, with the intent of not only driving the population out of Myanmar but preventing them from returning to their homes, a new UN report based on interviews conducted in Bangladesh has found.

The report by a team from the UN Human Rights Office, who met with the newly arrived Rohingya in Cox’s Bazar from 14 to 24 September 2017, states that human rights violations committed against the Rohingya population were carried out by Myanmar security forces often in concert with armed Rakhine Buddhist individuals. The report, released on Wednesday, is based on some 65 interviews with individuals and groups.

It also highlights a strategy to “instil deep and widespread fear and trauma – physical, emotional and psychological” among the Rohingya population.

More than 500,000 Rohingya have fled to Bangladesh since the Myanmar security forces launched an operation in response to alleged attacks by militants on 25 August against 30 police posts and a regimental headquarters. The report states the “clearance operations” started before 25 August 2017, and as early as the beginning of August.

The UN Human Rights Office is gravely concerned for the safety of hundreds of thousands of Rohingya who remain in northern Rakhine State amid reports the violence is still ongoing, and calls on authorities to immediately allow humanitarian and human rights actors unfettered access to the stricken areas.

The report cites testimony from witnesses that security forces scorched dwellings and entire villages, were responsible for extrajudicial and summary executions, rape and other forms of sexual violence, torture and attacks on places of worship. Eyewitnesses reported numerous killings, saying some victims were deliberately targeted and others were killed through explosions, fire and stray bullets.

A 12-year old girl from Rathedaung township described how “the [Myanmar security forces and Rakhine Buddhist individuals] surrounded our house and started to shoot. It was a situation of panic – they shot my sister in front of me, she was only seven years old. She cried and told me to run. I tried to protect her and care for her, but we had no medical assistance on the hillside and she was bleeding so much that after one day she died. I buried her myself.

The report states that in some cases, before and during the attacks, megaphones were used to announce: “You do not belong here – go to Bangladesh. If you do not leave, we will torch your houses and kill you.

Credible information indicates that the Myanmar security forces purposely destroyed the property of the Rohingyas, targeting their houses, fields, food-stocks, crops, livestock and even trees, to render the possibility of the Rohingya returning to normal lives and livelihoods in the future in northern Rakhine almost impossible.

UN Human Rights chief Zeid Ra’ad Al Hussein, who has described the Government operations in northern Rakhine State as “a textbook example of ethnic cleansing,” has also urged the Government to immediately end its “cruel” security operation. By denying the Rohingya population their political, civil, economic and cultural rights, including the right to citizenship, he said, the Government’s actions appear to be “a cynical ploy to forcibly transfer large numbers of people without possibility of return.”

The report indicates that efforts were taken to effectively erase signs of memorable landmarks in the geography of the Rohingya landscape and memory in such a way that a return to their lands would yield nothing but a desolate and unrecognizable terrain.

Information received also indicates that the Myanmar security forces targeted teachers, the cultural and religious leadership, and other people of influence of the Rohingya community in an effort to diminish Rohingya history, culture and knowledge.

ENDS

To read the full report, see: http://www.ohchr.org/Documents/Countries/MM/CXBMissionSummaryFindingsOctober2017.pdf

For more information and media requests, please contact:Rupert Colville – + 41 22 917 9767 / rcolville@ohchr.orgLiz Throssell – + 41 22 917 9466  / ethrossell@ohchr.org  Jeremy Laurence – + 41 22 917 9383 / jlaurence@ohchr.org

 


WHO: Hundreds of thousands of Rohingya refugees who fled from Myanmar into Bangladesh are at risk from a possible outbreak of diphtheria

Reuters

“…..The WHO describes diphtheria as a widespread, severe infectious disease that has the potential for epidemics, with a mortality rate of up to 10 percent…..”

CDC

Diphtheria once was a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly due to the widespread use of vaccines. Between 2004 and 2015, 2 cases of diphtheria were recorded in the United States. However, the disease continues to cause illness globally. In 2014, 7,321 cases of diphtheria were reported worldwide to the World Health Organization, but many more cases likely go unreported.

The case-fatality rate for diphtheria has changed very little during the last 50 years. The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. Before there was treatment for diphtheria, the disease was fatal in up to half of cases.

Clinical Features

The incubation period of diphtheria is 2–5 days (range: 1–10 days). Diphtheria can involve almost any mucous membrane. For clinical purposes, it is convenient to classify diphtheria into a number of manifestations, depending on the site of disease:

  • Respiratory diphtheria
    • Nasal diphtheria
    • Pharyngeal and tonsillar diphtheria
    • Laryngeal diphtheria
  • Cutaneous diphtheria

Medical Management

After the provisional clinical diagnosis is made and appropriate cultures are obtained, persons with suspected diphtheria should be given antitoxin and antibiotics in adequate dosage and placed in isolation. Respiratory support and airway maintenance should also be administered as needed.

Diphtheria Antitoxin

In the United States, diphtheria antitoxin can be obtained from CDC on request. Learn more about diphtheria antitoxin and how to request it(https://www.cdc.gov/diphtheria/dat.html).

Antibiotics

The recommended antibiotic treatment for diphtheria is erythromycin orally or by injection (40 mg/kg/day; maximum, 2 gm/day) for 14 days, or procaine penicillin G daily, intramuscularly (300,000 units every 12 hours for those weighing 10 kg or less, and 600,000 units every 12 hours for those weighing more than 10 kg) for 14 days. Oral penicillin V 250 mg 4 times daily is given instead of injections to persons who can swallow. The disease is usually not contagious 48 hours after antibiotics are instituted. Elimination of the organism should be documented by two consecutive negative cultures after therapy is completed.

Preventive Measures

Doctor examining adult male patient

For close contacts, especially household contacts, a diphtheria toxoid booster, appropriate for age, should be given. Contacts should also receive antibiotics—a 7- to 10-day course of oral erythromycin (40 mg/kg/day for children and 1 g/day for adults). For compliance reasons, if surveillance of contacts cannot be maintained, they should receive benzathine penicillin (600,000 units for persons younger than 6 years old and 1,200,000 units for those 6 years and older). Identified carriers in the community should also receive antibiotics. Contacts should be closely monitored and antitoxin given at the first sign(s) of illness.

Contacts of cutaneous diphtheria should be treated as described above; however, if the strain is shown to be nontoxigenic, investigation of contacts can be discontinued.

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Challenges

Circulation of the bacteria appears to continue in some settings, even in populations with more than 80% childhood immunization rates. An asymptomatic carrier state can exist even among immune individuals.

Immunity wanes over time and a booster dose of vaccine should be administered every 10 years to maintain protective antibody levels. Large populations of older adults may be susceptible to diphtheria, in both developed as well as in developing countries.

In countries with low disease incidence, the diagnosis may not be considered by clinicians and laboratory scientists. Prior antibiotic treatment can prevent recovery of the organism. Because the disease is rarely seen in developed countries, most physicians will never have seen a case of diphtheria in their lifetime. There is limited epidemiologic, clinical, and laboratory expertise on diphtheria.

Surveillance

National surveillance is conducted through the National Notifiable Diseases Surveillance System. Cases are also identified by requests for diphtheria antitoxin (DAT); since 1997, DAT is available for U.S. healthcare professionals only through CDC.

 


Pope Francis studiously avoided using the name of Myanmar’s persecuted Rohingya minority or directly addressing their situation

NY Times


Senior Gen. Min Aung Hlaing: The methods his forces used in 2009 have all been on display this year as the military has driven more than 620,000 Rohingya Muslims out of Myanmar

NY Times

“….General Min Aung Hlaing has effectively sidelined Ms. Aung San Suu Kyi, whose electoral landslide in 2015 blocked a potential path for him to become president of Myanmar, also known as Burma. She is barred in the Constitution from becoming president and heads the government under the title she created, “state counselor.”

She and the general rarely meet or speak to each other. And as his military offensive continues, it is deeply undermining Ms. Aung San Suu Kyi’s international standing.

“Aung San Suu Kyi and her government are a human shield for the military against international and domestic criticism,” said Mark Farmaner, director of the London-based Burma Campaign U.K…..General Min Aung Hlaing’s power includes appointing three key cabinet members, overseeing the police and border guards, and presiding over two large business conglomerates. He fills a quarter of Parliament’s seats, enough to block any constitutional amendment that would limit his authority………”


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