Social Impact of COVID-19 on Rohingya Refugees in Bangladesh and India’s Policy Stand: An Analytical Study

Aims: The Paper will explore about the COVID19 social challenges confronted by the Rohingya refugees in Cox’s Bazar of Bangladesh and will also discuss the role of India in providing medical assistance to Rohingyas in Bangladesh and further will explain a set of policy recommendations designed to improve the life chances of the Rohingya community both now and in the future. Study Design: Descriptive Study. Methodology: A detailed and related Review of literature of the previous work has been collected in order to extract the information about the vulnerable conditions of Rohingyas refugees in Bangladesh amid novel coronavirus. The paper is based on qualitative research design and the Mini-review Article Puri and Akhouri; JPRI, 33(47A): 773-785, 2021; Article no.JPRI.73961 774 data has been collected from official reports, documents, newspaper, journal articles, books based on Rohingyas refugees in Bangladesh. Results: The COVID-19 pandemic represents a grave social threat to the Rohingya refugees in the camps of Bangladesh. Having fled decades of persecution by the Burmese military, the majority of Rohingya currently live in densely populated refugee camps in Bangladesh. Most are denied access to the internet, mobile phones, humanitarian aid, and sanitary conditions and living in congested camps—all of which heighten the risk of infection and contamination. Currently in 2021, Government of India and International Organization are providing COVID19 vaccines and medical assistance to Rohingyas in Bangladesh. Conclusion: Despite facing social impact from COVID19, Government of India are taking imperative steps, both to protect the Rohingya from widespread infection and to create the conditions whereby future tragedy can be preempted.


INTRODUCTION
Amongst the world's most heavily persecuted minority communities are the Rohingya people who fled from Myanmar over the decades and are currently living in Cox's Bazar (a small town on the southeast coast) in Bangladesh [1]. About 600,000 Rohingyas left Myanmar in 2017 and joined the previously fled 200,000-300,000 Rohingya refugees, making the overall 1 million [2] Around 65% of them live in a very overcrowded camps in 5 square miles. According to various sources, presently this is the world's largest and most densely populated (120,000 people per square miles) refugee camp (World vision, 2020). The living condition in the camps is woefully inadequate and un-healthy. The average number of people per household is 4.5. Almost all of them are living in modest temporary shelters of 14 m 2 size built through bamboo and tarpaulins. They have limited access to clean water and sanitation [3]]. The majority of Rohingyas sleep on a plastic paper spread over the muddy floor in their tents. In these situations, keeping even minimum hygiene is difficult, and any contagious virus outbreak has the potential to kill thousands of people [4].
In March 2020, COVID-19 outbreak has substantially affected all over the world, including Bangladesh, where an aggregate of 12,425 confirmed cases was documented as of May 07, 2021.(Worldmeter, 2020). On May 14, 2020 the first case of COVID-19 Pandemic was reported in Rohingya refugee camps [5]. As the COVID-19 cases are growing rapidly, the nation state is facing increasing challenges to safeguard its citizens. Recently in July 2021, the spread of new COVID-19 delta variant in Bangladesh has exponentially increase the number of conformed cases and death ratio in the country, like what we had observed in the last year in China, Italy, and some other countries [6].
In July 2021, a sharp increase in cases among Rohingya refugees was observed. Since July 14, 2021 a total of 2147 confirmed COVID-19 cases was reported and 20 deaths was reported from the Rohingya refugee camps and approx. 60% female was suffering from COVID-19. By the first week of July 2021, more than 100 cases had been reported. The Rohingya's suffering from COVID-19 belongs to median age of 22 years (range 0-107) with approx. 50% of them are male. More than 80% of Rohingyas belongs to 40 years of old age persons. In terms of disease severity, 15% of patients had moderate and 26% severe disease, which included fever, cough, headache and sore throat. At the hospitalization admission 55% of the patients who died had severity conditions. Moreover, 20% patients who died from COVID-19 were below the age of 30 years. (Table 1). In addition to the deaths reported from COVID-19 cases, more than 100 suspected acute respiratory infection among Rohingyas was suspected [7][8][9].  [10] but the COVID-19 breakout in the current year of 2021 shows that the Rohingya camps may be worsened in the coming days. As such, people all over the world are being advised to stay home, to practice "social distancing", and to make hygiene a priority. Such measures are definitely not possible to put into practice in a refugee camp. Importantly, the Rohingya refugees and the Bangladeshi local community are living across the camps and even it is restricted for local people to enter the camps, and for Rohingya people to exit the camp, although by law they are not permitted to do so. Thus, refugee people are in a dire state of stress, many of them have a range of underlying health conditions and nutritional inadequacies. All these threat considerations may suppress their immune systems to fight against COVID-19, and as a result, the current community-level transmission of COVID-19 puts them at risk of getting infected.
However, if a single case of COVID-19 is detected at Rohingya camps, any interventions aiming to prevent further infection and manage the infected cases would be a "mission impossible" as the number of cases might rise to thousands within a insignificant period of time due to close-proximity in the camps and high virulence of COVID-19. So, to handle the dire situation as well as to control new variant of COVID-19 at the Rohingya refugee camps, the Government of India and various international organization are providing adequate aid as well as medical assistance to Rohingya refugees in Bangladesh and ensuring them with the comprehensive strategy and immediate provision of vaccines and medical drugs against COVID-19.
This paper is based on Review of Literature. The title and abstract were screened carefully and studies that are related to the paper were included. Initially, 80 articles were selected, some of them were found unrelated and some were duplicates. Hence, then excluded from the study. The authors reviewed only full text articles and finally 32 articles were selected for this study. Against this backdrop, the study aims to explore and explain about the social impact of COVID 19 on Rohingya immigrants in Bangladesh and the role of India and international organizations in providing medical assistance to Rohingyas in Bangladesh amid COVID-19 Pandemic.

Aim and Objectives
The research paper is based on secondary sources in order to review and explore the situations of Rohingya refugees in Bangladesh amid COVID-19 Pandemic. The specific objectives are:

Research Questions
The research intends to seek answers to the following research questions:  [15] explains the global outbreak of novel coronavirus and its impact of human health. He also included that Nutritional deficiencies are exceedingly predominant among Rohingya. Verma (2020) discusses about the largest persecuted community of the world. Rohingya's history is complex, as they are more exposed to the human rights violations.

METHODOLOGY
This study was carried out as a desk study to address the phenomenon under research as outlined in the reference list, which provides a detailed information of sources that were reviewed. A detailed Review of related Literature is utilised in order to collect current and topical data from the reports, journal and articles. Electronic media was also consulted to answer the objectives of the study. In addition, a wide range of additional sources of information from the websites were utilised. International, Regional and National frameworks also anchored this review. Tables and figures are also presented to highlight the issue. This study is focused mainly to elaborate literature written in 2020 and 2021 to ensure a detailed assessment of the vulnerable position of Rohingyas refugees in Bangladesh amid coronavirus pandemic. The current studies rely on the application of 'Qualitative analysis'. The paper is conducted in a systematic search across multiple sources of information with reference to the social, and health-related factors amongst Rohingya refugees were used.

This Research paper discusses as follows:
Section one introduces the topic of the paper and reviews the previous literature. Section two explains the methodology used in the paper. Section three explains the social challenges at Rohingya refugees camps and further discusses high vulnerability of COVID-19 transmission and it also elaborates about India's medical assistance to Bangladesh and lastly Section four of the paper explains recommendations to fight against COVID-19 Pandemic and followed by conclusion.

RESULTS AND DISCUSSION
In August 2017, Bangladesh saw a massive influx of Rohingya refugees into its territory in Cox's Bazar from Rakhine state, following their violent persecution by the Myanmar authorities, (Fig. 1) and the United Nations described it as a textbook example of "ethnic cleansing"(UN REPORT, 2020).
Since then, the district of Cox's Bazar has been home to nearly 900,000 Rohingya refugees living in extremely harsh, overcrowded and unhygienic conditions [13]. They continue to survive and live under clouds of distress, constantly burdened with the helplessness of being ripped off their identity, the agony of being stateless, the sadness of having no home to call their own and the anguish of losing their loved ones. Four years into their exodus and yet no agreement has been reached on their peaceful repatriation to send back to their homeland.
However, since early 2020, governments across all over the nations have imposed lockdowns [6], shut down businesses, closed down all the universities and schools, banned all recreational activities and social gatherings, in an attempt to curb the spread of COVID-19 [14]. In addition to these, Government of Bangladesh (GoB) has also enforced mandatory measures like use of thermal scanners in workplaces, prohibition of domestic and international travel, and quarantine period for incoming travelers as well as Government had also imposed strict COVID-19 protocols in Cox Bazaar, where numerous Rohingya refugees are residing. A specialized lockdown was levied in Cox's Bazar which restricted entry into or exit from the district, except for emergency of food and medical supplies [16].
Public toilets and bathing facilities are installed at various points in the camps. These are to be shared by almost everyone living in the camp. Residents of different tents/households have to share the same facilities as there is one latrine for every 19 persons and one bathing facility for every individual [27]. While some have soaps and water points installed, while most of the Rohingya refugees have no provision for any sort of handwashing facilities. To collect water for drinking and daily chores, refugees are gathering around water points. To access these facilities, one must walk a few meters, thus making it difficult for women and children to access at night for security reasons. These facilities are being shared by everyone and it is serving as a hotspot for the transmission of the coronavirus in the camps [17].

High Vulnerability of COVID-19 Transmission
The literacy level of the Rohingya population is very low. Despite being educated by the various aid agencies, they are not able to maintain basic personal hygiene as they have limited access to soaps and water. Handwashing and use of facemasks is not a common practice among this high-risk group of population [18]. During the eruption of COVID-19 virus many of them was not aware about its consequences [18]. In 2020, Humanitarian organizations was facing difficulty to spread information regarding COVID-19 protocols due to the internet ban enforced by the Government of Bangladesh (GoB), since September 2019, there was limited access to mobile data and communications in the refugee camps [19]. This blackout has prevented the dissemination of vital information and delivery of updated knowledge on COVID-19 inside the camps, eventually leading to the spread of misinformation and misinterpretation of facts.

Source: worldvision
However, due to the lack of social distancing measures in the camp [12] the Rohingya refugee continues to be at highest risk for exposure to COVID-19. The present infrastructure of the camps is unsuitable for maintaining "social distance" and the lack of hygiene practice is creating the virus to spread in the Rohingya camps [10]. (Fig. 2).
Besides, the low level of literacy and lack of awareness among the population makes these camps a potential breeding ground for COVID-19 transmission as a result, most of the Rohingyas was found COVID positive in September 2020 and October 2020. (Fig. 3).
All in all, we are awaiting the mini pandemic within the Rohingya refugee camps, especially in Cox's Bazar of Bangladesh [7][8][9].
Apart from COVID-19 disease, Rohingya refugees in Bangladesh are suffering from other such diseases. According to WHO 2021 data, nearly 54% Rohingya refugees children, 60% Rohingya refugees women and 10% Rohingya refugees pregnant women's are residing in Bangladesh. According to a study, the major health problems prevailing among Rohingya refugees are unexplained fever (2,27,928), acute respiratory infection (2,23,651) and diarrhea (1,92,560). In August 2021, the Rohingya refugees camps located in Cox Bazaar are experiencing a sudden outbreak of diphtheria and measles that were spread among the community. (Table 2).
In Bangladesh, the cases of tuberculosis (TB) in Rohingya refugees camps are highly prevalent among the vulnerable Refugees, considering the fact that Myanmar is one of the top 30 countries with the highest TB ridden country. According to a report of January 2021, it is estimated that in Bangladesh approx. 51.5 % had hypertension and 14.2% had diabetes. Additionally, 36,930 refugees were suffering from injuries. Most of the Rohingya refugees in the congested camps are addicted to alcohol, tobacco etc. Nutritional deficiencies are exceedingly predominant among Rohingya refugees, particularly among children. In Rohingya refugees camps, children aged among six to 59 months are anemic and onefourth had Global Acute Malnutrition (GAM [7-9].   and 47% women were suffering from the virus. From July-September, 2021, a comparison level model (Fig. 5) is explaining the comparison level of death among Rohingya men and women effected due to the outbreak of COVID-19 in the camps.

Understanding India 's Assistance to Rohingya Refugees in Bangladesh
India has received Refugees from Pakistan, Bangladesh, Afghanistan, Sri Lanka and Tibet etc. from South Asian region and other nations. Rohingya refugees crisis have become one of the prominent issues for India. India's will and direct competition with Chinese investment in Myanmar have kept India's leadership absent from making decisions with Myanmar. Nations around the world, in spite of having recognized the Rohingya issues, have amplified no big support to Bangladesh. In spite of the fact that India's help with the arrangement of relief materials in the form of drain powder, dried fish, infant food, raincoats and gumboots etc. are provided to Rohingyas in Bangladesh [24]. In 2021, India has provided medical aid and COVID-19 vaccination assistance to Bangladesh. (Table 4).
India gave 1.2 million free doses of the AstraZeneca coronavirus vaccine to Bangladesh, in March 2021. Dhaka also asked New Delhi to maintain a regular supply of shots to battle the pandemic. All this initiative by India can leads to maintain innovative opportunities to promote India's foreign policy and diplomatic relations between nations in its neighborhood and across globe.
India had also supplied hydroxychloroquine, Remdesivir and paracetamol tablets, as well as diagnostic kits, ventilators, masks, gloves and other medical supplies to a large number of countries including Bangladesh, to help them to deal with the COVID-19 pandemic. Both countries are in active discussion regarding cooperation in the field of COVID-19 vaccine, including phase 3 testing, vaccine distribution and co-production. (Ministry of External Affairs, 2021). By financing shipments from India's assistance program for cash-strapped neighboring countries desperately needing such assistance, India shall earn the long-term goodwill of its immediate neighbors and across Indian ocean countries. Early shipment from India to Bangladesh could help counter China's vaccine and mask diplomacy in its neighbourhood. India always follows India's neighhbourhood first policy. Though, in all this initiative a provision provided to Rohingya refuges was also mentioned [25].

RECOMMENDATION
Based on the above discussion and availability of reports to the authors, some recommendations should be undertaken to prevent COVID-19 among Rohingya refugees camps in Bangladesh. Such as in the camps Rohingyas refugees have limited access to TV, radio and the internet. So, to collect the accurate information, Government and other humanitarian organization have become the only last source. So, to gather a well-defined data, an evidence-based source from refugees needs to be expanded. An effective Health education should be provided to Rohingyas refugees in the camps. So that they might not get confused with symptoms of common illness already present amongst the refugees (TB, diarrhoea, flu). Therefore, a careful attention must be paid to detailed health education related to COVID-19. It is also important to focus on non-pharmaceutical interventions (face mask, medical gloves, alcohol-based sanitizer, social distancing) to be adopted as a preventive measure to reduce the spread of COVID-19. Due to the huge population of Rohingya refugees in the camps, a more large-scale testing sites and testing facilities should be increased so that it can easily mitigate the spread of COVID-19. The Government of Bangladesh, NGOs, and foreign health organizations should need to undertake a further and future initiative to achieve containment of the spread of COVID-19 pandemic in the Rohingya refugee camps in Bangladesh. Electronic billboards can be installed to provide static and full motion texts, images, and videos related to COVID-19. The contents on the billboards can guide refugees on how to keep social distances, wash hands, use masks, and other basic hygienic behaviours to prevent and control COVID-19. The recommendations at the Rohingya camps can contribute in controlling the spread of COVID-19 and will further protect the health of refugees. This recommendation can also influence around 26 million vulnerable refugees living across the worldwide.

LIMITATIONS AND STUDY FORWARD
The major limitations of the present study are the constant change in facts and figures in terms of data available for the research. Since, it is an evolving crisis, it was difficult to analyse the data available at a given point of time due to their dynamic nature. Second, limitation of the research was lack of access to the Rohingya refugees' settlement for collection of empirical data on the ground. So, due to the outbreak of the virus the authors were heavily dependent on secondary sources. Thirdly, the research was mainly confined to Bangladesh, whereas in the pandemic phase the Rohingyas faced adverse conditions in other parts of Asia as well. This deprives the research of its comparative analysis dimension.
The study opens avenues for researchers, policymakers, and scientists to further investigate the extent and impact of novel coronavirus on Rohingya refugees in Bangladesh and in other parts of the country.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
It is no applicable.

ETHICAL APPROVAL
It is no applicable.