For more than two months, 20-year-old Jane Alam suffered from constant itching on his fingers, scalp, and elbows. The ointments and tablets prescribed by healthcare workers in the Rohingya refugee camp took weeks to relieve his symptoms.
Like most of his neighbours, Alam lives with his family in a house smaller than 200 square feet. The population density in the sprawling camp means that highly contagious ailments like scabies – caused by an infestation of a parasitic mite – spread like wildfire.
“We are all getting sick,” Alam said. “Five out of my seven-member family are infected with scabies. You will not find a single house where there are no scabies or skin disease patients,” he told The New Humanitarian in May, confirming in a recent phone call that the scabies situation in the camps was, if anything, getting worse.
Médecins Sans Frontières, which offers skin disease treatment at the camps, treated nearly 43,000 skin infections in 2019 and over 44,300 in 2020. But the number spiked to more than 73,300 in 2021, and infections continue to climb. This year, from 14 March until 8 May, MSF treated almost 20,700 individuals with scabies.
In May, the World Health Organization announced it had surveyed more than 100,000 households across the camps and discovered a scabies prevalence rate of 10.2 percent – crossing the threshold for a mass treatment campaign.
Scabies is a common dermatological condition that causes intense and relentless itching. Though treatable, its rapid spread in recent months highlights the severe overcrowding of the Rohingya refugee camps and lack of adequate medication, water, and sanitation facilities.
Rehana, 27, who goes by one name, shares a 150-square-foot home with six other family members. When The New Humanitarian spoke to her in May, she had suffered from scabies for three months but had been unable to access treatment.
“Healthcare workers suggest we should maintain distance from the healthy ones, but how can we do so in such a tiny place with a big family?"
“There is no medicine at the medical camp now,” said Rehana, who was turned away from her local health centre after they ran out of medicine following a huge spike in cases. “Healthcare workers suggest we should maintain distance from the healthy ones, but how can we do so in such a tiny place with a big family? Four of the members now share a room, and three others are in another room. When my situation gets worse, I live in the kitchen space.”
Tight spaces, rapid spread
Rehana and Alam are among nearly one million Rohingya Muslims living in the Bangladesh refugee camps. Most arrived in 2017, escaping violence in their homeland in Myanmar’s Rakhine state. Built to address an emergency crisis, the camps were never intended to house so many people for so long.
The sharp increase in scabies cases is directly linked to living conditions at the camps, humanitarian workers said. In addition to cramped living conditions, refugees lack adequate access to water and sanitation.
In the camps, up to 20 people share a single outdoor latrine where almost all have to wait in line for water for their washing, cooking, and bathing. Though refugees are given bars of soap for bathing and laundry by the World Food Programme, camp residents said neighbours regularly borrow soap from one another, possibly accelerating the spread of scabies.
Chief to tackling conditions like scabies is making sure there’s enough water not only for drinking or cooking food, but also for cleaning and maintaining personal hygiene at household levels in the community, noted Dr. Asish Kumar Das, deputy medical coordinator of MSF.
But given the difficulty fixing the entrenched issues of overcrowding and inadequate water and sanitation, Das said there should be at least three mass drug administration campaigns per year to cope with contagious diseases like scabies that can rapidly run through large populations living in small, confined spaces. The campaign would involve offering Ivermectin and anti-itch medications to large numbers of residents, while carrying out a baseline survey and periodic monitoring.
“However, all these activities require a coordinated effort of all the organisations active in the camp,” said Das. "I sincerely believe the existing health sector coordination can take the lead in this regard and should effectively involve the camp management too.”
Though the Bangladesh government runs the camp, officials said they were unaware of the surge in scabies cases.
Cox’s Bazar Civil Surgeon Dr. Mahbubur Rahman, who heads the healthcare facility, told The New Humanitarian mid-May that he had yet to receive any such situation report from his team.
State Minister for Disaster Management and Relief Dr. Enamur Rahman said he too was surprised to hear about such a spike in scabies cases.
"There is no way we can further improve the living conditions at the camps right now."
“If the prevalence rate is 10 percent, then it is of course alarming,” he said. “There is no way we can further improve the living conditions at the camps right now, but I can definitely speak to the health minister about taking necessary steps to combat the scabies outbreak, if found true.”
Reached by phone a month after his treatment began, Alam said he was slowly getting better. But despite the promised treatment rollout, he said scabies continues to spread fast through the camps. In the past week alone, his nephew, a neighbour, and his shopkeeper had all contracted it.
For those suffering from scabies, slow-moving mass responses have left them with little recourse other than itching, seeking treatment, and trying – and nearly always failing – to prevent the infestation from spreading to the rest of their family.
“We live in such a condition that the atmosphere does not allow us to remain safe from skin disease or infections like scabies,” said Rehana. “Since the living conditions cannot change overnight, the humanitarian workers along with the government should offer us soaps in a higher number along with offering adequate medicine so that at least the pain that we are having from the infection can be minimised, even if in a slow process.”
With reporting support from Anamur Rahman. Edited by Abby Seiff.