Kutupalong is a village on the road linking Chittagong, Cox’s Bazar and Teknaf, at the southernmost tip of eastern Bangladesh. It is a small place, with a market and shops on both sides of the road, surrounded by paddy fields. MSF’s hospital is on the side of the road, surrounded by a bamboo fence.
This is where I spend almost all of my time. The road itself is chaos, with little regard for traffic rules. The sides of the road are mud, and when it rains (as it has done most days since I arrived more than five weeks ago), it becomes a real mess. But this is civilisation compared to the camp, to the west of the road, where successive waves of refugees have settled, and where more than 600,000 refugees are now living.
The area to the west of the village was rolling, wooded countryside, a national park with wild elephants, before the government of Bangladesh earmarked 3,000 acres of this land for the refugees. Now it has been stripped of vegetation and every small patch of ground has some makeshift structure built on it. The basic building material is bamboo and plastic sheeting.
Squalid living conditions
The camp is massive. I went with MSF’s map maker to walk over a small section of the camp one morning. It was amazing, totally unlike anything I had ever seen before. Everyone seems to be busy, building, making, digging. People’s living conditions are unbelievably squalid. Filthy streams, polluted by human waste, are crossed by rickety bamboo bridges. Our nurse, Chris, saved a little girl from falling into one of these streams when she slipped between two long poles of bamboo on a bridge.
And when it rains, it becomes a quagmire. Some latrines have been constructed close to wells (not by MSF’s water and sanitation teams, of course), and if the pit latrines have not been dug deeply enough, they fill up with waste. The children seem to cope best of all. I didn’t see any formal schools (though they are being set up), so when it is sunny, they are playing and enjoying life. Rain dampens their spirits a bit, but it is warm and they splash about and have fun. In some areas of the camp, people have become entrepreneurial, setting up little shops selling essentials such as batteries, snacks, food.
The children seem to cope best of all. I didn’t see any formal schools (though they are being set up), so when it is sunny, they are playing and enjoying life. Rain dampens their spirits a bit, but it is warm and they splash about and have fun.
People seem to arrive in waves. I understand that there are an estimated 5,000 waiting to cross the border from Myanmar now. The conditions are appalling, with people living on the ridges between paddy fields, and grim when it rains. When they arrive at the camp, some people look thin, tired and impoverished, but they are safe. They want to get on with building their shacks, finding a place to sleep, getting food, water and cooking utensils. Healthcare comes later.
Others are unwell, especially small babies and the elderly. We see quite a few old people who have been carried by their families across Myanmar to the border on makeshift stretchers or chairs hung from long bamboo poles. They are often at the end of their lives, suffering from chest diseases or cardiovascular problems. Sometimes, they have fallen in their haste to escape, so they have broken bones.
Struck dumb by the horror
Mental health services are essential. Some patients are literally struck dumb by the horror of what they have witnessed or what has been done to them. What really sticks in my mind are the drawings the children do in the hospital’s mental health unit. Helicopters firing on people, homes on fire, people being killed. What these children must have witnessed is horrendous. One young boy has deformed feet. He couldn’t run away from the soldiers because of this. He told me a soldier shot him in his club foot. Why would anyone do such a thing? I signed up for this, I knew what I was letting myself in for, but having four very ill people die on my first day was a bit of a shock.
I signed up for this, I knew what I was letting myself in for, but having four very ill people die on my first day was a bit of a shock.
Most of the children in the ward suffer from severe acute malnutrition. They have very little strength to resist serious infections and, despite us pulling out all the stops with antibiotics, nutritional support, oxygen etc, they often succumb. I flit from one urgent problem to another. The hospital sees about 100 emergency cases and over 400 more routine cases every day. The main problems are respiratory infections, acute watery diarrhoea, skin problems and musculoskeletal problems.
Initially, we saw acute gunshot wounds, blast injuries and burns. Now, we see more road traffic accidents (the children are not used to coping with busy roads). I also see the patients who have had unsuccessful treatment for violent injuries – joints smashed to smithereens by bullets, paralysed by spinal cord injuries or with infected bones.
We knew what was required
I was dismayed to find that hardly any refugee children had received standard vaccinations. Measles is a dreadful disease and has killed two children since I have been working here. I am very concerned about the potential risk of a full-on measles epidemic here. Our lab is very basic, we can’t do X-rays or ultrasound examinations on site, there is no proper operating theatre and we are running low on some essential drugs.
But morale is sky high among the health workers. It’s very rewarding to be making people better, helping them return to health, reducing their pain and suffering. My favourite patient (are we meant to avoid having favourite patients?) is a little girl who is paralysed from the waist down. Before she came to the hospital, she developed dreadful bedsores which became infected. She copes bravely with the dressings and has made real progress over the past six weeks. We have arranged for her to have a special mattress to avoid further sores developing. And now she is able to sit in a chair and draw pictures.
MSF already had a presence in the area before the massive influx of refugees at the end of August. Because of our experience and our independent funding, we were able to scale up our work effectively and mount a fantastic response to the crisis in days.
We knew what was required and did it. Without MSF, there would be a gaping hole in health provision. If we were not here, I think it would be much worse for the refugees.