ADDITIONAL FINANCING TO HEALTH SECTOR SUPPORT PROJECT ADDRESSING ESSENTIAL HEALTH NEEDS OF ROHINGYA POPULATION APPROVAL DATE: END DATE: TOTAL COMMITMENT: IMPLEMENTING AGENCIES: BASIC INFORMATION February 21 February 20 $41.67 million grant through the WHO, UNFPA, UNICEF and 2019 2022 IDA18 Regional Sub-Window for Refugees IOM will jointly support and Host Communities and $8.33 million the Ministry of Health and from the Government of Canada Family Welfare OVERVIEW Since August 2017, more than 745,000 Rohingya fled violence in Myanmar and took shelter in the Teknaf and Ukhia Upazila of Cox’s Bazar district, according to UN estimates. This has been the largest refugee influx in modern times. More than half of them are women and are children. They live in extremely congested conditions in 34 camps; the mega camps are currently the world’s largest refugee settlements. They have outnumbered the local population by almost three times. The speed and scale of the influx resulted in a critical humanitarian emergency. Bangladesh has ably coordinated humanitarian support and provided for basic needs and humanitarian partners, both international and national, have responded rapidly to the needs of the displaced population. Due to the poor immunization status of the Rohingya, an outbreak of diphtheria occurred shortly after arrival, and sporadic outbreaks of measles subsequently. A quick response by health agencies contained the outbreaks with low fatalities and raised immunization coverage among Rohngya children. The World Bank is helping Bangladesh respond to the health, nutrition, and family planning needs of the displaced Rohingya population as well as strengthen the healthcare services in the Cox’s Bazar. 122 CHALLENGE Health, nutrition and population (HNP) services are being provided through 190 health facilities in the camp areas with varying service provisions. Field hospitals in camps make referrals to the Ukhia and Teknaf Upazilla Health Complexes (UZHC) or District Hospital in Cox’s Bazar. Despite these efforts, significant challenges remain: • Risks of communicable diseases are very high in congested camps and so risks from physical, sexual and gender-based violence are substantial. • Low exposure and lack of trust to health services in Myanmar led to less demand for services like immunization, contraceptives, antenatal care, safe delivery etc. • Coordination among the four implementing UN agencies with the two government departments and across the levels of the government – ministry, directorates, district, upazillas and camps. • Working with other agencies for ensuring other necessary requirements which determine health outcomes like water, sanitation, hygiene, waste management, environment, female empowerment etc. TOWARDS • Managing host population expectations. THE FUTURE The World Bank is exploring Cox’s Bazar APPROACH district-wide health The first of a series of assistance from the World Bank to help Bangladesh deal with the crisis, the grant to the ongoing Health Sector system improvement Support Project will help provide essential health and nutrition services to the Rohingya people. initiative to benefit both the refugees and host The support follows the following principles: (1) Help strengthen the government’s capacity to respond to HNP service needs of the communities. Rohingya, (2) not replacing the existing humanitarian assistance for the refugees, (3) HNP services to Rohingya population will focus on essential services package and mental health including gender-based violence and (4) medium-term planning. The government signed agreements with four UN agencies – WHO, UNICEF, UNFPA and IOM for the implementation. The services will be delivered within the camps through community health volunteers, Health and Family Welfare Posts for outpatient services, Primary Health and Family Welfare Centers for basic emergency obstetrics care and outpatient services, and Women Friendly Spaces for counseling for sexual and gender-based violence. It will also improve the capacity of the existing government facilities adjacent to the camps, including community clinics, Health and Family Welfare Centers, Union Sub-centers and Upazilla Health Complexes. The ongoing project will continue to serve the local population. EXPECTED RESULTS 86,571 19,005 19 facilities 22 facilities 187,500 Rohingya women and Build government Rohingya births providing an providing adolescent girls received information capacity for resilience and children (ages delivered appropriate mix emergency on sexual and reproductive health mitigate risks for localized 0-11 months) in an HNP of family planning obstetric care rights and gender-based violence in outbreaks in Cox’s Bazar immunized facility methods to the each year for 3 years Rohingya THE WORLD BANK IN BANGLADESH | 123