Friendship Rohingya Response
Friendship started its operation based on its analysis on needs and as per the Refugee joint response plan. Friendship’s intervene includes the following locations in Ukhia sub-district of Cox’s Bazar:
The settlements are divided into individual camps and zones within camps.
The following emergency interventions by Friendship are in operation in those zones.
1. Emergency healthcare support
2. Water, Sanitation, and Hygiene support (WASH)
3. Lighting solutions (for the safety and security of women and children)
4. Recreation and socialization centers for helping people overcome the aftermath of trauma
5. Ensure geographical connectivity and linkage
6. Reforestation pilot project
1. Emergency healthcare support: Friendship, over the years, has built a reputation as a reliable healthcare provider during major emergencies, such as floods and cyclones. Friendship’s innovative healthcare system and integrated service approach, coupled with a strong healthcare team both in the Head Office and Field Offices, can provide timely delivery of reliable primary and secondary care services in the remotest of locations during major disasters (including in coastal areas, where the Rohingyas are taking shelter)
Friendship is serving around 3,000 patients a day with its current interventions with Rohingyas. The healthcare services for Rohingya community include:
a) Basic clinics:
Friendship has 8 such clinics up and running, whereas 5 more are under construction and will be operational by mid-May. Characteristics of basic clinics:
– There are 2 paramedics, 1 Friendship Community Medic-Aide, 1 organizer, one locally based cleaner, one security guard working from each of the basic clinics.
– The clinics are based out of the makeshift settlements so that these can be accessed by the most vulnerable of the Rohingya populace.
– The clinics run from temporary sheds.
– Business hours: from 9 AM- 4 PM.
– Serves approx. 100 patients a day.
– Provides primary healthcare, consultation, medicine, and referral services.
– There is one tube-well and two latrines in each of the clinics.
– A solar panel power source has been installed.
b) Comprehensive Maternity Clinics: Friendship has constructed a comprehensive maternity clinic in order to serve child birth delivery cases (including cesarean). The clinic is envisaged to serve 150 delivery cases per month with 3000 beneficiaries receiving maternal and neonatal care services per month. Characteristics of the comprehensive maternity clinic:
– Operating from fixed facilities.
– There are a counseling room, Doctor’s consultation room, labor room (normal delivery), pre-operative, operation theatre (OT), post-operative, ward, pathology room, sterilization room and store room
– The entire structure is being made of prefabricated materials
– Open 24/7. There is enough staff to provide services throughout the day.
– There will be 2 medical officers, 3 paramedics, 3 nurses, 3 community based skilled birth attendants, 2 pathology technicians, 2 pharmacists, 1 counselor.
– Full-time gynecologist and on-call anaesthetist are going to be involved.
– There is an MoU with government hospitals so that referred beneficiaries from maternity clinic are provided with immediate health management services
– Service delivery: The following services are being delivered from the comprehensive maternity clinics:
- ANC and PNC checkup
- Normal and Elective caesarian delivery
- Screening, treatment, and referral for Sexually Transmitted Infections and Reproductive Tract Infections.
- Behavioral change communication.
- Nutrition of pregnant mothers and new-borns.
- Limited curative care for women and their husbands
- Basic neonatal care and Healthcare for under-5 children
c) Birthing center: Since beginning of December,Friendship is operating a birthing center within the Rohingya camps. In terms of service delivery, the basic birthing center has all characteristics of comprehensive maternity clinic except for the fact that the basic birthing center does not serve caesarian cases. Instead, such cases will be referred to the comprehensive maternity clinic.
d) Health Outreach: Friendship has all its operation in the hilly areas of the camp sites to provide services to the people settling deeper into the camps. The basic clinics have been established in strategically selected locations. However, given the hilly areas in the sites, it is sometimes difficult for pregnant and lactating women, children, people with disability, and elderly to walk such long distances to come to the clinics. To mitigate such problems, Friendship is currently implementing an extensive health outreach project in the Rohingya zone, which includes 24 satellite clinic teams at this moment. Each of the teams comprises one paramedic, one community medic-aide, and one organizer. The basic primary healthcare services along with ANC and PNC check-up, health education and patient referrals are provided by the satellite clinics.
e) mHealth: Friendship, with the fund from ECHO (via ACF), has initiated the first and the only mHealth project till date in the Rohingya camp.
Friendship has been implementing its own mobile app based healthcare project in the northern riverine islands for more than 5 years now. With the help of the mHealth app, Friendship’s already existing Community Medic-Aides (community based female health workers) in the north are able to provide with more reliable healthcare services.
In the first phase of the project with Rohingya, Friendship has customized the already existing mHealth app, keeping in mind the unique healthcare needs of the Rohingya coming to Bangladesh (particularly the possibility of malaria, diphtheria, and other communicable disease outbreaks, and difficult referral process). Family planning, Sexual, Reproductive, Maternal, and Child healthcare are important components of the mHeath project with Rohingya. The follow-up in regard to ANC, PNC, neonatal care and maternal care, nutrition status, etc. has been more convenient and real-time because of the existence of the mHealth project.
12 teams have been trained on mHealth project so far and deployed in the Rohingya camp. Each of the teams has one paramedic (medical assistant) and one program organizer. The paramedics have been provided with medical equipment, medicine, and mHealth enabled mobile tablet.
The project started from January 2018 and has already shown strong impact in the Rohingya camps, mainly in terms of identification, follow-up, and referral of cases. Based on this successful pilot project, Friendship is envisaging to expand the project in the Rohingya zone.
Some other specialized key services already provided or envisaged to be provided from the health outlets in the Rohingya camps:
a) Child immunization and deworming: Within all its health outlets, Friendship envisages to arrange providing logistical support for creating access to the Government-run Expanded Program on Immunization, deworming, and Vitamin A capsule distribution. Piloting is already going to be started with 5 clinics.
b) Special attention for prevention of a Malaria outbreak: Because of its being in a malaria-prone area, the location is at serious risk of a malaria outbreak. There is adequate medication and treatment available across all health outlets in regard to Malaria.
c) Nutrition support for Children, Pregnant women and Nursing mothers: Nutritious food packages are distributed among pregnant women and nursing mothers and children under 5 years of age. So far, 700 nutrition packs and 700 medicine packs have been distributed.
Friendship healthcare infrastructure and facilities in the Rohingya zone can be reached/ accessed by more than 100,000 Rohingya.
2. Water, Sanitation and Hygiene (WASH) support
Most latrines and tube-wells by other agencies have been constructed close to the Ukhia- Teknaf main road, whereas many of the inhabitants in the more remote locations are deprived of anything like adequate access to water and sanitation. As per our initial estimation, the total number of tube-wells and latrines already installed within the Rohingya camps needed to be increased at least 3 times the present number in order to create adequate access for everyone.
Friendship has taken initiative in this sector in the following areas:
- Tube-wells: 60 deep hand-operated tube-well have already been installed. Each tube-well is accessible by 300 individuals. The tube wells installed in the early days of the crisis were not deep enough, and have stopped working, as the water at those shallow levels has been exhausted. Friendship is installing deep-level tube wells which are bored to a level of 650 – 800 feet (200 – 250 meters).
The presence of such deep-level hand operated tube wells is particularly important in hilltop areas, so that long journeys just to fetch water are avoided, particularly for women and elderly.
- Sanitation: 180 gender-segregated latrines are already constructed. The superstructure is made of tin sheets in order to ensure proper hygiene and to ensure that no environmental hazard occurs.
- Bathing space: A total of 180 gender-segregated bathing spaces are constructed so far.
Bathing spaces and latrines (along with hand washing facilities) are constructed in clusters and thus the resources and spaces are maximized.
- Provide hygiene support in the form of soap, bleaching powder, sanitary napkins, slippers, dustbins, etc.
3. Lighting solution: Friendship plans to have all its operation equipped with fully functional lighting solutions powered by solar energy. The lighting solution is functional at all basic clinics, maternity and birthing centers, child and mother friendly spaces. Lighting for WASH projects are underway.
In order to ensure safe and secure movement at night, particularly for women, children and the elderly, Friendship has selected location and worked on design to install solar powered street lights. Implementation of the lighting solution is underway and will be expanded subject to availability of more funds.
4. Child and Mother Friendly space:
Friendship wants to initiate one “comprehensive child friendly space” close to each of the 13 basic clinics, in order to ensure that both physical and mental health are taken care of simultaneously for the Rohingya communities. Indeed, Child Friendly Spaces are safe spaces where communities create nurturing environments in which children can be provided with psychosocial support, through an access to free and structured play, recreation, leisure and learning activities. Along with education, these activities provide structure, normalizing activities, safety, socialization, and adult supervision which strengthen children resilience and promote their well-being. These spaces prevent children from developing more serious psychosocial problems. CFS’s also provide a venue for monitoring protection or any other issues that may affect children, and ensure relevant referral to other services.
In each of the spaces, there are in total 3 batches of children and adolescents (depending on the needs and number of children, the number of batches may vary). Each batch of sessions span over two hours. Each of the batches has 50 children on an average, thus serving 150 children from each of the child friendly spaces. However, the number can vary depending on the number of children around the spaces.
On the other hand, there is only one group each day for pregnant and lactating women and adolescent girls.
The major characteristics of the activities targeted toward the children are:
- The children are provided basic education such as alphabets and counting via playing activities.
- Children learn rhymes and short poems to engage their creative side. The languages used will be mostly their native language Arakanese (Rohingya volunteer), coupled with English.
- Drawing and Art competition are held to help facilitate their education and sharpen their mental skills
- Games such as Kabaddi, Skipping, Running Races and some cultural games are arranged to keep them physically active and introduce the element of healthy competitiveness.
- The children are integrated with Friendship’s regular dignity program through story telling activities. Lessons on dignity are shared with them and they are encouraged to come up and share the dignity stories from their lives. Friendship recognizes that many of those children lost everything back in Myanmar and dignity is one thing that should be nurtured among them at an early age.
- There are Community Medic-Aides visiting the spaces on regular interval, providing hygiene lessons to the children, and checking the basic nutrition indicators for the children. As and when required, the children are referred to the clinics.
There are child friendly toilets and washing spaces for the children in each of the CFS’s. Children’s convenient access and usage will be ensured at those points.
5. Ensure geographical connectivity and linkage: The settlements are based mostly within areas of small hills. Sometimes it takes 1-2 hours to travel only 500 meters between hills, since there is no walkable way. Friendship has constructed, with the support of local community members, 5 bamboo bridges in order to ensure connectivity between the hills. In addition, this has made it possible for many of the inhabitants to travel and seek healthcare and other services (both from Friendship and other agencies) which they would otherwise find extremely difficult or even impossible.
6. Other initiatives
Apart from the above mentioned, following additional activities have been implemented by Friendship as of now:
- In total 700 food packs have been distributed among Rohingya families. Each of the packs included Rice, Lentil, Salt, Sugar, Oil etc.
- We have distributed 700 medical kits (consisting of antiseptic solution, orsaline, menthol, hygiene soap, shampoo, etc.) among the families so far.
- In total, 2,000 comprehensive hygiene packs for Rohingya families have been distributed.
Envisaged activities with the host communities
During the initial stages of the influx when humanitarian actors had not yet arrived and were not ready to render services, the communities in Ukhia have had an active and remarkable role in hosting the massive influx of Rohingyas, letting them share their land, sometimes providing food and other support. However most of the preexisting local people in Ukhia are themselves impoverished. With one of the highest SAM and MAM rates in Bangladesh and weak healthcare and WASH infrastructure, the local communities in Ukhia were already requiring extensive interventions in healthcare, nutrition, WASH, education, livelihood, etc.
The influx has cost the host community in environmental degradation, rising food, fuel and transport costs and increased competition for scarce employment. The Global Humanitarian response plans take into account that the host population is just as underprivileged as the Rohingya and thus the services take into account host population numbers. In the absence of such support, increasing competition and conflict between the host communities and the newly arriving Rohingya will be unavoidable.
Certain of the Friendship infrastructures, and in particular the maternity centers, are beneficial equally to the host community and to the Rohingya (all other infrastructures are also open for use to the host community but in practice less likely to be used by, for being located in the remoter areas of the camps).
In addition, Friendship is in the process of developing and initiating livelihood and WASH projects specifically targeted toward host communities.
Dignity and respect in giving
In all of its interventions, Friendship is ensuring that the beneficiaries are treated with dignity, respect and compassion. Awareness of these values will also be promoted throughout Friendship’s working areas.
Friendship currently employs more than 190 staff on a full-time basis for Rohingya work. In addition, staff from the Head Office and other field offices also regularly travel for supervision, monitoring, and assisting in carrying out specialized works.
It is sometimes easy to forget that those who work intensively to provide relief to others in such difficult conditions may become traumatized by the experience. Friendship however ensures that attention is paid to the wellbeing of its staff by making available adequate recreation time as well as regular medical and psychological care.
Should the newly recruited staff for work with Rohingya no longer be required for this work, Friendship should be in a position to continue to employ most of them in regular healthcare projects, in particular in the Syamnagar Friendship Hospital, which is planned to open mid-2018, and in new hospital ships which are planned to go into operation early 2019 in the context of a project funded by the Islamic Development Bank from early 2019.
Friendship is coordinating with the relevant Government ministries (Ministry of Disaster Management and Relief, Ministry of Finance, Ministry of Health and Family Welfare, Ministry of Public Administration, etc.), with the Army, with local level authorities and other NGOs working in the area, as well as with Rohingya community leaders, in order to identify gaps and develop the most appropriate action plan for filling in those gaps. A central coordination mechanism has been set up locally by the Army and is operating effectively.
As a Bangladeshi NGO with local knowledge of the area and the language, Friendship is able to operate quickly and effectively. Following are some of the key points in terms of coordination:
- Friendship is a part of ISCG (Inter Sectorial Coordination Group), which consists of different international and national development agencies working with Rohingya. The effort is led by UNHCR & IOM.
- Friendship participates every week in the ISCG organized coordination meetings at the district level for different sectors such as child protection, WASH, and health.
- Friendship collaborates with WHO and the Government of Bangladesh (Director General of Health Services) through regular daily reporting system.
- Friendship participates and contributes in coordination meetings organized by local Government authorities (Health, WASH, etc.)
- The sites, logistics, and services are coordinated in collaboration with NGOB, DC, RRRC and the Army in order to avoid duplication with other stakeholders and simultaneously ensure optimum outputs.
- The Friendship project sites are incorporated within the map developed by UNFPA, in partnership with other development agencies. This allows to coordinate and avoid duplication of services.
- Friendship is part of different clusters and sub-sectors active in Cox’s Bazar- which comprise all major international and national agencies working with Rohingya. Friendship also participates regularly in the cluster and sub-sector weekly meetings.
Friendship has been appointed as the child protection focal point in one of the zones.
- Friendship receives technical and advisory support and shares resources with ACF and Secours Islamique France (SIF) for its projects with Rohingya. Secours Islamique France sends experts on WASH, Health and Child related matters, in order to assist Friendship in program design, site selection, curriculum development, program implementation, and monitoring. Cooperation with ACF is in particular, but not only, on nutrition matters on which ACF has particular expertise. Attachments: