Since mid-March, when the entire nation is consumed with the fear of COVID-19, about 10 Jumma children are killed and another 200 are infected from a measles outbreak in the CHT. Nabangsu Chakma writes about the negligence of the health authority that caused the outbreak
While the pandemic Covid-19 is at the center of concern for everyone in our country, an ‘unknown disease’ wreaking havoc in the hills. The media that first reported this outbreak termed it as an ‘unknown disease’ as if it is an alien disease, perhaps a new disease that nobody recognises. When you say an unknown disease there’s nobody to take responsibility, right? Perhaps, nobody has to answer for deaths with an unknown cause. At first the health officials simply said that the children died of an unknown disease.
However, later on, the disease was confirmed as Measles. So far, it has taken 10 lives (from February 26 to April 1), and all of them are Jumma children, age between 1 to 10 years. It has been found that the affected children are suffering from serious malnutrition as well. The death of 10 Jumma children however didn't create a nationwide outcry. While many may argue that it is because of the COVID-19 outbreak, but in reality, it is because of the same negligence that caused the deaths itself. Hill peoples and their lives have never mattered, always neglected, and always left out.
Measles isn’t a harmless disease that can be taken lightly. Measles is an airborne disease and it can quickly spread through coughs, and sneezes of infected people. It is extremely contagious, and has a reproduction rate of 12 to 18 people for every person it infects. An infected person can easily infect the people living within his surroundings. Most importantly, measles carries real risks: permanent brain damage, blindness, and hearing loss for some, death for others. Everyday more than 300 people die from measles around the world, most of whom are children. Infants and very young children are at the greatest risk from measles infection, with potential complications like pneumonia and encephalitis (a swelling of the brain).
This time around, the first death reports came from Lama upazilla, then subsequently from Sajek union of Baghaichari upazilla and Dighinala upazilla and the death toll is rising. The affected areas are: Lallyapara under Lama upazilla, Arunpara, Longthian Para, Kamlapur Chakma Para, Nwthang Para, Hayicchapara under Sajek union of Baghaichari upazilla, Rati Chandra Tripura Para, and Jerok Tripura Para under Dighinala upazilla. The deaths from this measles outbreak are a glaring proof to sad and sorry state of the public healthcare service in the Chittagong Hill Tracts.
In this day and age, when measles vaccines are available, it is unfortunate that Jumma children are dying of the disease. The village chiefs are saying that nobody went to vaccinate the children in their villages. They further alleged that neither doctors nor community health service providers ever visit there on the flimsy excuse that the areas are hard to reach. Villagers also alleged that no government healthcare service and health workers have reached there. The government therefore cannot deny their failure.
It is the job of the health workers to vaccinate the children nationwide, and the officials are supposed to monitor the vaccination campaign, and ensure that no child is left behind, as it is pledged in the preamble of ‘Transforming our world: the 2030 Agenda for Sustainable Development’ that ‘... no one will be left behind’, resolution adopted by the UN General Assembly and subscribed by our government. However, unfortunately in this case more than 200 children have been left behind. The onus of such negligence is on the shoulders of both the health workers and the officials. Instead of negligence, special attention should have been given to hard-to-reach areas. It cannot be an excuse for non-vaccination.
According to the Article 16 of our Constitution, ‘The State shall adopt effective measures to bring about a radical transformation… in the improvement of… public health… so as to remove disparity in the standards of living between the urban and rural areas.’ Article 18 also reads, ‘The State shall regard the rising of the level of nutrition and the improvement of public health as among its primary duties.’ Although, right to health isn’t an explicit constitutional fundamental right, however, in the cases of Dr. Mohiuddin Farooque Vs Bangladesh and Professor Nurul Islam Vs Bangladesh, the Supreme Court of Bangladesh has held that right to life means, and includes right to health. According to Vision 2021 of the government ‘The government seeks to create conditions whereby the peoples of Bangladesh have the opportunity to reach and maintain the highest attainable level of health. It is a vision that recognises health as a fundamental human right.’ Therefore, death of 10 Jumma children and more than 200 children being measles infected are a substantial proof of gross violation of fundamental human right.
According to Seventh Five Year Plan FY2016-FY2020, it is said, hard-to-reach areas such as the CHT, ‘requires a different set of strategies for health service delivery,’ and the plan further adds that ‘policy introducing both financial, and non-financial incentives for hard to reach areas has been developed’. If that’s the case, then why hasn’t the health service reached these measles affected areas? Why has it devastatingly failed? May be because of policy failure or implementation failure or both. Either way it has cost lives.
Earlier, in 2017, in Sonaichari village under Sitakunda upazilla, nine Tripura children died from measles outbreak. Similarly, the health workers, doctors and the officials never went to vaccinate the children there too. Later on, six health workers were transferred to Sandwip upazilla for their negligence. Clearly, there’s a pattern, the indigenous children are always affected, because of the negligence of the healthcare authority.
It is important to mention, while the overall health scenario in Bangladesh has improved, the condition of Jumma people in the CHT remains relatively worse off than elsewhere in the country. The maternal and infant mortality rates in CHT remain higher than the rest of the country. Both women and children tend to suffer from anemia.
The condition of the health sector in CHT is due to lack of awareness of primary health care issues and services and lack of actual health care facilities. In CHT, around 50 per cent health service providers’ posts are vacant. There are also many instances where both upazilla doctors and health workers don’t go to their workplaces regularly, only two or three times a month, and yet they take their monthly salary in due time.
Although recently medical teams have reached the infected areas and medical services have been provided to the affected patients, but the lack of timely health service has already gone against the conventional saying that ‘prevention is better than cure.’ The recent medical intervention is also inadequate; several medical teams were formed to tackle the crisis but the grim reality is that the health workers are just working in a single team by taking turns. Every team was supposed to have an MBBS doctor, but instead a paramedic is present. Needless to say, had the proper health services reached those areas in due course, long before the crisis, such a crisis wouldn’t have occurred in the first place.
The deaths and suffering of Jumma children from measles is not an ordinary event. It was preventable. It is because of the concerned authority’s discriminatory attitude towards the community that these children were denied of their right to access to vaccination. No compensation can undo the harm. The government should investigate negligence of the local health authority and bring the health workers, doctors and officials responsible for their unforgivable negligence to justice. It should also take adequate policy measures and make suitable policy adjustments (if necessary) so that in future such outbreaks are prevented.
Nabangsu Chakma is studying LLB (Hons.) at University of Dhaka
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