Double rations and preparedness in the nutrition program

With all of us focusing on the COVID-19 crisis, I wanted to update you a bit on the implications for our lives and COVID-19 preparedness in the Nutrition program of Medair.

(c) Medair / Hailey Sadler

As an overview, from the beginning of 2020 we moved into 4 different camp locations and have been providing food rations to all children under 5, children from 5-9 years and elderly (>60 years) with severe malnutrition, and Pregnant and Lactating Women (PLWs). I have described these services a bit in the past but for a brief recap children and elderly with severe acute malnutrition (SAM) come weekly for their food and follow-up visit. Children with moderate acute malnutrition (MAM) come biweekly. PLWs come biweekly, and all healthy children come once a month. In total we serve around 18,000 beneficiaries monthly.

Porters unloading double rations
from truck

As an organization that is used to working in emergency settings we started our COVID-19 preparedness plans in January. The first confirmed cases were recognized by the Bangladeshi government on March 9. Leading up to this time we trained staff on messaging to share with beneficiaries and in the communities and basic COVID-19 understanding. We worked to get our sites ready with extra masks, soap, hand-washing stations, and alcohol based hand rubs. And we encouraged the nutrition sector, the organization that brings together all the nutrition actors to start working on their preparedness plans. Finally at a nutrition sector meeting on March 16 I shared our own proposal for preparedness with a imminent restriction on movement into the camps. Our proposal was to begin serving all beneficiaries a double ration immediately and continue until all were served. This would make sure that everyone had food for at least 2 weeks (SAM cases), 1 month (MAM and PLWs) and 2 months (all healthy children) respectively. This proposal was agreed to immediately by the UN agencies. All NGOs were told to try to distribute double rations to all beneficiaries beginning March 22 and end by March 31.

Rohingya in the camps waiting for extra rations

The first step in doing this was to order the additional food that we'd need to distribute during this time period. I put in an order with WFP (World Food Programme) - which provides most of our food for the nutrition services - for 220 metric tons (MT) of food. Yes, that's 220,000 kg of food. This would be added to what we already had in stock. On a monthly basis we distribute around 115 MT which means we needed double that amount of food. All of this food  would need to be loaded onto trucks at the WFP warehouse and trucked either directly out to the camps or to our warehouse (from where it would then be trucked to the camps). In the camps it would be hand carried by Rohingya porters to each of our nutrition sites where it would then distributed. This process is all handled by our logistics department - it may have been one of their biggest challenges yet given the time constraints.

On March 19 we visited all 4 nutrition sites and discussed setup with the site supervisors. Rather than receiving 3-400 beneficiaries/day we would need to plan for around 1000. We had to look at how we could best protect staff and beneficiaries by considering social distancing, handwashing for all beneficiaries, and managing this number of people in a 6 hour day. At the end of the day we again met with all the site supervisors to go over plans. Not once did any of the staff say it wasn't possible, rather they were all focused on the lifesaving need to get all beneficiaries food in case camp access was shut down due to virus cases in the camps.

Rohingya taking the extra rations home

March 22 our staff began distributing to their beneficiaries. Each camp had its own challenges but overall the day went well. The following day they kept up the pace of serving beneficiaries; each sub block (as you remember, camps are divided into blocks) was called at a different time to try and manage flow and keep distance between people. The third day we were informed that rather than having another 5 days to distribute we should try and finish in the next two days. After that Bangladesh would be going on lockdown for the next two weeks and access to the camps would be limited. All of a sudden we were facing increasing numbers served to 2000+/day rather than 1000. Imagine serving double rations to 18,000 people in 4 nutrition sites over 4 days. I am so proud of our nutrition staff for working so hard. In Medair we talk about going the extra mile. This is a true example of staff going the extra mile.

We don't know what the next weeks and months will hold. Our health staff are already experiencing difficulty getting into the camp to work. Movement is restricted to protect people in the camps as some COVID-19 cases have been detected outside of the camps in the Cox's Bazar area where some staff live. With the lockdown in place our office staff will be working from home this next week. Nutrition will see when it can get back out to the sites with skeleton staff to follow up on the children with SAM and MAM. We will see how we can use our Rohingya volunteers to support the ongoing work as they live, and work, in these communities that we are trying to serve in spite of the COVID-19 crisis.

Thanks for:

• the incredible support provided by the logistics teams in procuring our personal protective equipment (PPE) supplies and trucking all this extra food
• the hard work of all the nutrition teams to serve as many beneficiaries as they were able before the shutdown
• the courage of our health teams to serve on the front lines (logs erected a tent for isolating potential COVID-19 cases at one of the Medair health clinics)

Pray for:

• the ongoing setting up of isolation and treatment centers both in the camps and in the broader community
• the relationships between the host community and the Rohingya refugees - with fear and suspicions rampant right now about who is to blame for COVID-19
• protection against the virus - particularly in the camp setting where the population density is higher than a cruise ship
• our Medair team as we work to protect staff and volunteers as much as possible in their work
• Phil and I who are taking a week of much needed rest in Dhaka. We are on lockdown here, like everyone else in the country. We've never experienced such quiet in Dhaka before! Pray for me, Christine, in particular, as I've been struggling with feeling worn down for a couple of months.

Night life in the camps and a new resouce - Medair Lives

I wonder what the title of this post evoked for you? Were you wondering about night clubs in the camps (there are none)? Were you thinking about violence that happens at night (unfortunately, that is part of the reality of refugees as drug gangs and the Rohingya rebel group sometimes make life difficult for people)? I often wonder how people deal with the rats at night (particularly securing the food commodities they get from the nutrition clinics from the rats)? Or have you heard reports of Christians being persecuted in the camp in the last month (this took place at night)?

Actually those realities had nothing to do with the title of this blog post. It has to do with a refugee who documents night life in the camps through his photography. Check it out here: https://asiatimes.com/2020/02/the-nightlife-of-rohingya-refugees/.

I think that this article gives a glimpse into the lives of the Rohingya. They are discouraged by the lack of a future. They continually retell the stories of horrors that they faced in Myanmar. They like to be social. In the absence of school, people like this young man seek to train themselves in other things (like photography) as a coping mechanism. The horror of their stories cannot erase the creative impulse that drives poets, musicians and photographers, like this young man. And the case brought against the government of Myanmar in the International Court of Justice (ICJ) gave at least momentary hope to a people who seem to have so little.

If you are wondering how this young man gets gets his photos out to the Asia Times, your thoughts are going where mine went. There is no network for data in the camp (it was cut off a few months ago). But refugees are also nothing if not resourceful and resilient. They find a way to do the things they want (and need) to do!

The last two months have been super intense for Christine and I. The number of international staff has dwindled to between 4-5. This means that we are constantly covering for each other. It has become more and more difficult to get visas for international staff - for all international NGOs, not simply ours. The Covid-19 situation around the world will not make this any easier. But just when I was beginning to despair of us getting our visas renewed in May, today we had a Nepali consultant get a work permit! Thanks be to the conventional-wisdom-tables-turning God that we serve!

I find myself more at peace with life in Bangladesh and more drawn to this country and the people we work with (those people, for me, are all Bangladeshi). I think this is my heart giving itself to this place and these people. I don't know exactly what that means.

Something that might tell you about the rhythm of our life here is that yesterday I found the time to watch a video that I no longer remember how long ago I opened in my browser.... It was as if I found it anew (except that it was already open on my browser).... It is this video: youtube.com/watch?v=bAB1iyexxRo&feature=youtu.be. Check it out! For those of you who are interested in knowing more about the lives of people connected to Medair (local and international workers, refugees etc), you can write and email to florian.ecuyer@medair.org and ask more about this. My understanding is that you would get content specifically related to the different types of lives connected to Medair.

Thanks for your prayers -- they really are what keeps us going!

Praise for:

1. A new visa for one of our international staff members - woohoo!
2. God's grace in the midst of a reality that often seems to be spiraling out of control!
3. Amazing Medair staff - at the base, in the camps and at HQ
4. Christine & I finding our place here in Medair Bangladesh - God confirms His call over and over
5. Thanks that, in the face of dwindling supplies and rising prices, we were able to procure the personal protection equipment that we needed if we would need to face caring for people with Covid-19 in our clinics - this was no small feat!

Prayer for: 

1. Our visa application which will be made early in May (if the world as we know it doesn't cease to exist before that time....)
2. Covid-19 to NOT make it to the camps - this would be an unmitigated disaster (for which we are, nonetheless, preparing)
3. Covid-19 to be a reminder that we are not in control of our lives (that is a delusion), and that we need the One who created this world and who also will walk with us day-to-day through the suffering and the triumph!