Humanitarian disaster for Rohingya refugees: Impending natural hazards and worsening public health crises

Abstract

The Rohingya people are the world's largest stateless population.1UNHCR“This is our home”. Stateless minorities and their search for citizenship.http://www.unhcr.org/ibelong/stateless-minorities/Date: November, 2017Google Scholar Violence towards the Rohingya in Myanmar from late August, 2017, caused the mass displacement2The Office of the United Nations High Commissioner for Human Rights (OHCHR)Myanmar Rohingya abuses may be crimes against humanity, UN rights experts warn.http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=22196&LangID=EDate: 2017Google Scholar of 655 000 people from Rakhine State of Myanmar to the southeastern hilly region of Bangladesh, resulting in what UNOCHA describes as the “fastest growing refugee crisis in the world”.3UNOCHARohingya refugee crisis.https://www.unocha.org/rohingya-refugee-crisisGoogle Scholar The majority are residing in overcrowded temporary shelters, with Cox's Bazar and Bandarban hosting one of the densest concentrations of refugees; there are 954 500 people in total at the time of writing.4The office of the United Nations High Commissioner for Refugees (UNHCR)Operational update: Bangladesh (27 December 2017–7 January 2018).https://data2.unhcr.org/en/documents/download/61561Date: 2018Google Scholar Existing challenges in addressing poor access to health services, acute food shortages, and scarce shelter are compounding growing public health needs.5Pocock N Mahmood S Zimmerman C Orcutt M Imminent health crises among the Rohingya people of Myanmar.BMJ. 2017; 359: j5210Crossref PubMed Scopus (12) Google Scholar The likelihood of a public health emergency from infectious diseases is high in this vulnerable population, with already very low vaccination coverage, high prevalence of malnutrition,6UN Children's ReportMalnutrition rates among Rohingya refugee children in Bangladesh appear to be at least double earlier estimates.https://reliefweb.int/report/bangladesh/malnutrition-rates-among-rohingya-refugee-children-bangladesh-appear-be-leastDate: 2017Google Scholar and poor sanitation and water conditions. Vaccine-preventable diseases such as measles, polio, and tetanus are on the increase and diphtheria has recently re-emerged. As of Feb 14, 2018, there were 5710 suspected diphtheria cases and 35 deaths.7Bangladesh Humanitarian Situation Report No. 23 (Rohingya influx), UNICEF Report from 18 February. 2018.https://reliefweb.int/report/bangladesh/bangladesh-humanitarian-situation-report-no23-rohingya-influx-18-february-2018Google Scholar Against this background exists the further challenge of the approaching monsoon season, which runs from May to September. The refugee camps are highly susceptible to rainfall-triggered landslides, flash flooding, and cyclones.8Ahmed B Landslide susceptibility modelling applying user-defined weighting and data-driven statistical techniques in Cox's Bazar Municipality, Bangladesh.Nat Hazards. 2015; 79: 1707-1737Crossref Scopus (46) Google Scholar At their worst, cyclones can cause high mortality; for example, cyclone Nargis in the Bay of Bengal in 2008 killed an estimated 138 300 people.9The International Federation of Red Cross and Red Crescent Societies (IFRC)2011 Myanmar: Cyclone Nargis 2008 facts and figures.http://www.ifrc.org/en/news-and-media/news-stories/asia-pacific/myanmar/myanmar-cyclone-nargis-2008-facts-and-figures/Date: 2011Google Scholar The risk to the refugee population is high, as the camps are in predominantly low-lying areas vulnerable to flash flooding; the surrounding mud hillsides have been indiscriminately cut back to create rudimentary terraces for temporary shelters with no regard to the landslide hazard; and large areas of forest in the hills have been cut down to build makeshift shelters, further increasing the risk of landslides. The flooding will increase the risk of waterborne diseases and the landslides will cut road communications when transportation into the camps is already difficult. The overcrowded makeshift huts with poor sanitation and water supply, in the absence of multi-hazard alert systems and evacuation shelters, are also likely to contribute to an increase in disease incidence and demand on existing health-care facilities. Disaster risk reduction (DRR) measures are essential to reduce the likely mortality and morbidity. DRR addresses prevailing levels of vulnerability and formulates measures to prevent, mitigate, and prepare for disasters. Essential DRR activities include an urgent need to conduct a rapid multi-hazard risk mapping of the refugee camps and surrounding areas, with identification of evacuation routes and a safe zone during emergencies. An effective landslide and flash-flooding early warning system for the refugees and host communities should be developed, and hill-cutting and cutting down of the forests should be prevented, with the generation of a risk-sensitive land-use plan. The essential infrastructure needs to be examined for structural resilience in relation to h