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July 2004 |
 The
Chittagong Hill Tracts in South-East Bangladesh are scarcely accessible and have
been plagued by conflicts for years. Médecins Sans Frontières provides
basic medical care in the area, with a focus on treating malaria. Annette Peters,
who has been Head of Mission in Bangladesh for a year, explains how the teams
support people who live in remote areas.
In Bangladesh, Médecins Sans Frontières is working in
the so-called Chittagong Hill Tracts near the border with Myanmar (Burma) and
India. What kind of region is it?
While Muslim Bengalis account for the majority of the population in Bangladesh,
the Hill Tracts are inhabited by an additional thirteen different minority groups
with different religious beliefs. These people are of Burmese or Tibetan origin
whose religious backgrounds are Buddhist, Hindu, Christian or animistic. Bangladesh
is one of the most densely populated countries in the world, with 130 million
inhabitants. By way of contrast, the Chittagong Hill Tracts are sparsely populated
with people living in very remote areas. The region is mountainous, unlike the
rest of Bangladesh, which is very flat.
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© Stephan Grosse Rüschkamp
Kalendra healthcare unit in Khagrachari District is only accessible by foot or
boat. |
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Why is Médecins Sans Frontières working in this
region in particular? There is a great need for medical aid as there
are no adequate public healthcare services available, and few NGOs present in
the area. On the one hand, the infrastructure is very poor, which makes it difficult
to reach the people in many remote areas. On the other hand, the region has been
torn by conflicts for decades. In the 60s, the construction of a huge dam deprived
many farmers of their arable land, causing thousands to flee to India. Another
50,000 people fled when violent clashes between the government and the region’s
autonomy movement began in the early 70s. |
In 1997, the conflict was officially resolved by means of a peace treaty. Since
then, refugees have returned from India, only to find that Bengali settlers are
now living on their land. These settlers have been given incentives by the government
to settle in the Chittagong Hill Tracts in order to alleviate population pressure
in the rest of Bangladesh. Both past and current conflicts centre on the issue
of autonomy and land rights held by various ethnic groups and unfortunately remain
because of non implementation of the peace treaty.
What projects is Médecins Sans Frontières running in
the Chittagong Hill Tracts?
We have two health centres and several mobile clinics in the Khagrachari District,
where we provide the population with basic healthcare. We have started setting
up a second project in the Bandarban District based on the same principle. Both
projects focus on treating malaria. Unlike the rest of Bangladesh, the Chittagong
Hill Tracts are hard hit by malaria – 90 per cent of people suffering from
malaria are living in this region, causing high morbidity and mortality amongst
the population. Besides treating patients with malaria Médecins Sans Frontières
is also committed to research the effectiveness of treatment regimes. Our studies
revealed that 40 per cent of the patients were resistant to the drug Chloroquine,
which is still the first line drug for treating patients with falciparum malaria
in Bangladesh. Therefore, we lay great importance in achieving a change of the
treatment protocol in Bangladesh. Médecins Sans Frontières is already
treating its patients with the effective artemisinin-based combination therapy
(ACT).
What exactly does working in the remote areas involve?
We provide basic healthcare for the population in our health centres, which are
open six days a week. In addition to these fixed clinics, our medical teams also
leave the tracks to offer consultations in remote areas. Some areas however are
so remote that they cannot be reached by a four-wheel drive vehicle. The team
then needs to abandon the vehicle and ventures up into the mountains by foot.
The hike usually takes one to two hours, but occasionally even as long as five.
When the hike is very long, the team will remain in the village overnight in order
to have enough time to treat the patients.
What challenges will the work there face in the future?
Our aim is to reduce the mortality rate caused by malaria as well as to respond
to outbreaks of infectious diseases. The challenge remains working in a crisis-hit
area with a virtually non-existing infrastructure. We want to reach out to people
in remote areas in order to provide them with good health care services.
Interview by Gaby Frank
| Improving care for malaria patients
MSF’s work in Bangladesh takes place in three districts that make up the Chittagong Hill Tracts region, an isolated area near the country’s borders with Myanmar and India, in which the need for medical aid is tremendous. Government policies and insurgent groups have inflicted discrimination, deprivation and marginalization on the region’s indigenous people, resulting in decades of conflict and massive displacement. Moreover, public health care services are scarce, and few other NGOs are present. Since 1999, MSF has a wide network of clinics, malaria-treatment sites and health education outreach posts in the northern part of Khagrachari district. Recently, the organization extended its activities to the neighboring Rangamati district. The Chittagong Hill Tracts, unlike other parts of Bangladesh, are hard hit by malaria, which produces high rates of illness and death. MSF treats people with malaria using highly effective artemisinin-based combination therapy (ACT). » More | | COUNTRY PROFILE Bangladesh
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