COVID-19: Projecting the impact in Rohingya refugee camps and beyond

Shaun A Truelove; Orit Abrahim; Chiara Altare; Andrew Azman; Paul B Spiegel

The health status of refugees has improved since 2017 but remains fragile. The latest crude and child mortality rates are below emergency levels, while global acute malnutrition remains high. 4 The site is served by five hospitals run by non-governmental organizations (NGOs) and foreign governments with a total of 340 hospital beds (5.7 beds per 10,000 population) and up to 630 hospital beds when needed (10.6 per 10,000 population). 5 There are 24 primary health care centers (1 PHC/25,000 persons) with numerous health posts, though the total number of functioning PHCs varies. 6, 7 Outside of the refugee site, there are 910 beds available in Cox's Bazar district, including government, private, and NGO facilities for both the host community and refugees. 8, 9 The district hospital, with a 250-bed capacity, typically treats between 400-600 inpatients daily; 50-60 of whom are estimated to be refugees. 9,10 It suffers from overcrowding with a bed occupancy rate over 200%, poor infection control, and inadequate hygiene protocol and waste management. 9, 10 While it has six intensive care unit (ICU) beds available, the ICU is reportedly not functional. 11 There are an estimated 0.31 physicians and 0.12 nurses per 1,000 population in Bangladesh, far below the 4.5 skilled health workers per 1,000 population recommended by WHO. 12, 13 In this study, we aim to understand how SARS-CoV-2 might impact refugee camp populations, using the Rohingya refugees living in the Kutupalong-Balukhali Expansion Site as a case study. The primary aims of this analysis are to: 1) develop a baseline expectation of the possible infection burden, speed, and hospitalization capacity needed to respond to a COVID-19 epidemic; 2) use these findings to provide some recommendations to support ongoing preparedness planning by the Bangladesh government, United Nations agencies and other actors for a COVID-19 outbreak; and 3) apply lessons from this case study to refugees and other forcibly displaced persons globally.