Urgent invitation to prayer

Greetings to all!

I would simply like to use this blog to invite you to be praying for a few things.

First, our District (where both our offices and the refugee camp are located) has gone into a pretty draconian lockdown to attempt to stem the tide of new COVID-19 cases. This is good from a public health standpoint, but it has also meant that movement around the District is severely curtailed. This has also led to some vigilantism as some community members take their safeguarding from the virus into their own hands. It is difficult for our vehicles to move in order to pick up staff. At the same time we have concerns for staff who walk to our vehicles to be picked up as they might encounter such vigilantism. More and more NGO workers are being targeted as simply ignoring government regulations - and therefore fair game for vigilantes. Please pray for our duty to safeguard the well-being of our staff as well as our duty to serve the Rohingya in this difficult environment. 

Also pray for the sickness of team members and their extended families. We now have some field and base staff who are in quarantine due to either either having symptoms of the virus themselves, or having been in contact with persons who have tested positive. Please pray for protection from the virus and healing of staff members who test positive. 

Needless to say, we would invite prayer for the Rohingya. The number of infected refugees is now in double digits. And the rumor is running rampant through the camps that those refugees who test positive will be sent to this island off the coast, Basan Char, where the government has wanted to move refugees. So they don't want to go to health centers when they fall ill due to this fear.

At this very moment Christine is applying for her passport. We thought that she would get it today without any problem, but there is a minor obstacle - the government won't issue the passport until she pays for the repatriation flight that we took from Dhaka to the US! We have been told that the bills for those flights won't get to us for some time because of how many Americans took those flights.... But the person in the passport processing office is hoping that he will have an answer in the next hour allowing us to pay for this flight. Please pray for breakthrough in this situation!

We so value your support in prayer at this moment!

Phil & Christine

COVID-19 makes it to the camps - as well as a cyclone!

Quarantine unit at Medair Camp 20-Ext Health Clinic

You may have heard media reports two weeks ago confirming the first positive COVID-19 case in a Rohingya refugee in the camps. Yesterday's update confirmed 30 cases in the camps. These refugees  are in isolation facilities that were set up a few weeks ago.

It is nothing short of a miracle that the first case in the camp surfaced only recently which allowed time for preliminary preparation and a lot of awareness raising around COVID-19 prevention. We continue to pray for miraculous intervention for minimal community transmission and low mortality rates as cases are identified and tracking of contacts happens (this is being done by Rohingya volunteers). There are a number of factors that drive Rohingya to not want to report illness, including a history of disappearances of ill people in Myanmar. As you can imagine, this doesn't help the situation. And NGOs working at protection issues in the camps are really working to alleviate such fears. All such factors point to the devastating potential of the virus in the camps!

International NGOs started scrambling to put isolation units in place as soon as the COVID-19 outbreak started spreading around the world. There are a number of challenges to the implementation of such a plan, not least of which is simply finding space in the overcrowded camps. The capacity of the combined isolation facilities set up in different locations inside the refugee camp is somewhere between 500 and 1000 beds at this point. However, this will continue to grow. 

While a lot of preparation has been done to face the challenge of COVID-19 in the camps, challenges remain. There are NGO staff who are testing positive for the virus (amazingly few cases up to now). This past week was the Eid holiday (the end of the month of Ramadan fasting for Muslims), and there was very little testing going on in Bangladesh as a whole. And coordination can be a problem between different units and different organizations. 

Medair health activities are going like gangbusters. Apart from the normal (and now COVID-19) health services provided in the two health posts run by Medair, the team is assisting the International Office for Migration (IOM - the UN entity financing much of Medair's health work) in the creation of a quarantine center where refugees suspected of having the virus would be brought until their test results are conclusive (then refugees positive for the virus would be moved to the aforementioned isolation units). 

The use of PPE at the Clinic

In addition to providing health services to the quarantine unit Medair is working to provide Isolation Kits for persons under quarantine or in home isolation. Designated health staff will be responsible for providing home-based care visits to those in home isolation in our catchment areas and will receive the isolation kits comprised of a washable cloth mask, a surgical mask, a bar of soap, household detergent (for disinfection), hand sanitizer, sanitary pads, a leaflet on home-based care, a bucket to put everything in and a bag into which the bucket and all supplier are put. 

We have a new Medair colleague who is a specialist in isolation who just entered Bangladesh a little over 2 weeks ago. He spent 14 days in self-isolation in Dhaka before coming overland to Cox's Bazar to join the team this past weekend. Stephen Chua is a Malaysian who gained expertise and experience in isolation techniques while fighting the Ebola virus in the DR Congo. He has been seconded to UNHCR by Medair and is focusing on the isolation units. There is another Medair staff with expertise in palliative care who will likely be seconded to IOM in the near future. She may work remotely for a time. 

We continue to have 4 international staff and around 200 national staff working in Bangladesh. Our national staff are mainly working from home (except for those providing the reduced essential services in the camps). Our international staff face the challenges of unrelenting work load combined with a pretty severe lockdown that limits their ability to get out of their rooms. The stress that both national and international staff feel, and the risk they run of contracting the virus, are constant prayer concerns for us. Comparatively speaking (even though many of our national staff express dismay at the fact that the US accounts for 1/3 of all coronavirus deaths in the world), we feel that we are living the life of a constant vacation compared to our colleagues in Bangladesh. We continue to work remotely with our teams from our home in Minneapolis. 

If the challenge of COVID-19 added to the stress of refugee life wasn't enough, 10 days ago a super cyclone (terminology for a hurricane in Asia) began to form in the Bay of Bengal off the shores of India and Bangladesh. As it approached landfall, it had wind speeds over 125 mph. Thankfully, it diminished in power a bit before hitting land on the 20th. It was still a devastating storm, and 6 persons lost their lives in Bangladesh.  The storm made landfall on the opposite side of Bangladesh from the refugee  camps, however it hit both India and Bangladesh and between the two countries around 4,000,000 people were evacuated from low lying coastlands and islands. The loss of life was minimal but the storm did significant damage. In the camps there were some landslides, and around 40 houses were destroyed. But it could have been worse. We thank God for His providence in again averting a direct hit on the camps. 

We want to thank those of you who gave to Medair in response to our last blog, those who have written to us expressing your concern and prayer support for the Rohingya, and those who have contacted us personally. All of these expressions of your support come straight from the heart of God who has loved the Rohingya since the beginning of time - and who desires a future with hope for them. We cannot thank you enough!

Praise for: 

• the fact that cyclone Amphan was not a direct hit on the camps
• the experience the Bangladeshi government has with cyclones - about 30-40 years ago a similarly devastating cyclone killed 100,000 people!
• the commitment of our international and national staff members in the face of COVID-19
• the situation in the camps being as good as it is! – even if we do now have confirmed cases

Prayer for: 

• COVID-19 preparation in the camps to continue to move forward and coordination to improve
• Stephen's adjustment to Bangladesh and his contribution to improving isolation units
• Christine getting a new passport and both of us getting Bangladeshi visas in order to return
• Opportunities to step back from the stress of work and get much needed breaks for our key international and national staff
• Protection from the virus for NGO staff serving the refugees - this is the front line of the front lines!

What is your COVID-19 prevention kit?

Greetings all,

Today is #GivingTuesday. We don't very often explicitly ask if you might consider giving to Medair. But today we would like to do just that!

As you know from previous blogs our nutrition activities in the Rohingya refugee camp have been severely restricted during the COVID-19 pandemic. We are now focusing our services on severely malnourished children as well as pregnant and lactating women. Instead of nutrition sites full to capacity seeing 300-500 children and women each day the nutrition sites are seeing 15-30 per day. We are continuing to provide double rations and soap, and have adapted our services to focus on the most vulnerable.

Check out the video below that was made today by Rashed, our Site Supervisor in Camp 11 nutrition site. You will see examples of how we are implementing COVID-19 prevention at the site. Follow the steps of thermal screening, hand-washing, social distancing, only measuring MUAC (mid upper arm circumference) instead of weight and height, and COVID-19 messaging. And see how success is possible during COVID-19 in the life of one little girl.

Conversely, our two health clinics are scaling up their activities (as you might imagine)! And the need for PPE for our health workers is crucial (the logs team is both testing PPE we have purchased in country and working at importing PPE from Dubai). Besides carrying on their normal primary health care activities, they are also setting up isolation spaces for cases that they suspect could be COVID-19. They would not care for any such cases at the sites, but would refer those cases on to a isolation facility. In addition they will be providing health services to a quarantine unit. And they are needing to do similar screening of patients as what you see in the video with full PPE.

Giving Tuesday comes at a strange time for all in our world. We are, rightly so, focused on care for our families. Thank you for considering supporting the life-saving work of Medair for the most vulnerable around the world during this time as well! You can contribute to Medair (without leaving your contact details) here: https://www.globalgiving.org/fundraisers/medair/ 

Phil & Christine

Phil & Christine in Minnesota, USA

Christine & I just wanted to update you on what we are facing in this time of COVID-19. Our teams continue to work in Bangladesh. But shortly before the really serious lockdown began in Bangladesh, the international staff team asked Christine & I to take some R&R in Dhaka (the capital). So we ended up leaving Cox's Bazar on (what we didn't know at the time was) the last flight out of dodge (or out of Cox's). So we ended up getting stuck in Dhaka, and working remotely from there.

After the huge distribution, NUT work is scaled back

After having been there for 3 weeks, and having no hope that we would be able to get back to Cox's anytime soon (given the fact that all commercial flights are grounded into the month of May), we again consulted with our country director and international colleagues. From that discussion we decided to take a repatriation flight arranged by the US embassy in Dhaka to Washington DC on the 13th of this month. We arrived in Dulles on the 14th and drove to Minnesota from Dulles. So we have been quarantining in the basement airbnb of a young couple that live next to our son, Nathan, and his wife Anna.

The plan is that we will continue to work remotely (late in the evening and early in the morning when we can have contact) with our teams from here until we can return to BGD. After quarantine Christine will work at renewing her passport, and we will apply to renew our visas (which you remember were expiring on May 1) while we wait for international flights between BGD and the US to resume.

In a wonderful twist (that only God could orchestrate), our country director feels that it should be easier, because of the corona virus, for Christine and I to get visas for BGD because we both have our Master's in Public Heath (shout out to Tulane University!) and the government of BGD is more open to people with such degrees given the crisis.

I want to give you some resources that I have been collecting over the last month or so that you can look at if you want to find out more about how the refugees are facing the crisis (the first is a link to an interview that our country director gave to Tearfund New Zealand):

https://www.facebook.com/watch/?v=220079196103162 - you can follow this Medair FB page if you want to keep up with what Medair is doing around the world.

https://www.msf.org/rohingya-refugees-left-starve-sea

https://www.thedailystar.net/frontpage/news/virus-can-cause-havoc-rohingya-camps-1882162

Thank you so much for your support!

Praise:

1. Safe travel to Minneapolis
2. The understanding of our Bangladeshi colleagues as we took the decision to leave BGD for the time being. 

Prayer:

1. For the peace of mind of our colleagues, a few of whom have expressed dismay that we have left a country with a few hundred reported cases of the virus, to rejoin a country that has 3x more than any other country of the world.
2. For our visa application process.
3. For our world in the time of this crisis (this probably goes without saying).
4. For resolution of some existing health issues that Christine has been dealing with. 
5. For the Rohingya refugees who face a multitude of crises, including the corona virus. And that God would continue to operate this miracle of no confirmed cases in the camps. Divine intervention is the only hope of this remaining the case. 

Your resiliency during a time of COVID-19

I was recently led to re-read these questions that I posed to you in our post of the 23rd of November:

• How would you respond if you were forced from your home? 
• Would you be able to find joy? 
• How would you combat creeping despair? 
• What would be your strategies for resilience?

Rather than being forced from your homes, most of you have confined to your homes. But I think those questions are quite pertinent for all of us in this time!

This article by NT Wright helped me to crystallize some of the lament in our hearts in this time: https://time.com/5808495/coronavirus-christianity/?fbclid=IwAR3zPKoEDoQBYVsPE4uGsOzAKEPmFx9SK_YCqGBv8BUCG9_fnGeFGBVe9Ss

I have these laments (among others):

1. That a people so marginalized already are only marginalized more by COVID-19;
2. That we are separated from our biological extended and nuclear family during this time;
3. That I find it so difficult to see past my own inconveniences caused by COVID-19 to be able to perceive the dire consequences for others;
4. That Christine has not been able to shake illness for the last month or so;
5.  That this illness could be what forces us to leave this place where we feel called to work, and this people with whom we feel called to walk;
6. That the poor are made poorer by such circumstances. 

I have been drawn to the biblical laments for some time (those of you from Emmanuel Mennonite in Minneapolis might remember us bringing our laments to the altar some years back). These writers cry out to God because they know him as He who acts on behalf of His people. So their lament is an act of faith, not an act of despair! In fact, the flip side of the coin bearing the image of lament is an image of faith! The Biblical writers didn't write out of abject despair wondering whether God even exists - they rather wrote out of their relationship with a God who they existentially knew and experienced.

Jesus, in the very travails of death on the cross, quotes from one of these Biblical songs of lament - Psalm 22 - when "...about the ninth hour Jesus cried out with a loud voice, saying, 'Eli, Eli, lema sabachthani?' that is, 'My God, my God, why have you forsaken me?'" Maybe you feel a bit like the psalmist, who continues on by saying, "Why are you so far from saving me, from the words of my groaning?"

I am certainly not smart enough to understand what God is doing, or allowing to happen, through COVID-19. NT Wright suggests (to those of us so influenced by the Enlightenment) that we may find no rational answer to to this question. In Stanley Hauerwas' book Naming the Silences, he suggests that the question we would be asking ourselves is whether or not we have a community surrounding us when we suffer, rather than why God allows suffering.

Psalm 46 is a place where I have sought comfort in these nearly unprecedented days:

1 ¶  God is our refuge and strength, a very present help in trouble.

2  Therefore we will not fear, though the earth should change, though the mountains shake in the heart of the sea;

3  though its waters roar and foam, though the mountains tremble with its tumult. Selah

4  There is a river whose streams make glad the city of God, the holy habitation of the Most High.

5  God is in the midst of the city; it shall not be moved; God will help it when the morning dawns.

6 ¶  The nations are in an uproar, the kingdoms totter; he utters his voice, the earth melts.

7  The LORD of hosts is with us; the God of Jacob is our refuge. Selah

8  Come, behold the works of the LORD; see what desolations he has brought on the earth.

9  He makes wars cease to the end of the earth; he breaks the bow, and shatters the spear; he burns the shields with fire.

10  "Be still, and know that I am God! I am exalted among the nations, I am exalted in the earth."

11  The LORD of hosts is with us; the God of Jacob is our refuge. Selah

So I come back to my questions: 

• Are we able to find joy in these difficult circumstances? 
• Do you have strategies for combating creeping despair? 
• What are your strategies for resilience?

We would love to hear what your strategies for resilience are as you yourself - and all people around our globe - face these cataclysmic changes to our daily existence. What ways are you finding to love your neighbors (next door or around the world) at this time?

My prayer is that the God of all comfort will share His with you - that you, in turn, can share this comfort with others!

(c) Medair / Hailey Sadler

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!