NEW DELHI – As Bangladesh confirms its first Covid-19 death, fears are rising that the lethal virus may soon spread across the densely populated country, where health services are insufficient even in the best of times.

If and when that happens, the over one million Rohingya refugees now residing in overcrowded and unsanitary camps along the Bangladesh-Myanmar border will be among the most vulnerable.

It also likely means that any progress on repatriation of the refugees to Myanmar, already stuck for political and other reasons before the global coronavirus pandemic, will be out of question on health grounds for the foreseeable future.

Indeed, Myanmar has already closed many of its normally busy border crossings with Thailand and China, while India has halted all cross-border traffic with its western neighbor.

In the current global emergency environment, Asian diplomatic sources say any international pressure on Myanmar to take the refugees back would be futile and counterproductive.

On the same day as Bangladesh’s first Covid-19 death was recorded on March 17, a World Health Organization (WHO) spokesperson based in the country warned that the population density in the camps coupled with unsanitary conditions make the refugees prone to all kinds of communicable diseases.

Rohingya refugees at a protest against a disputed repatriation program at the Unchiprang refugee camp, Bangladesh, November 15, 2018. Photo: AFP/Dibyangshu Sarkar

According to official UN figures, there are around 1.1 million Rohingyas in Bangladesh, of whom over 630,000 live in Kutupalong, believed to be the world’s largest refugee camp.

While no Covid-19 infections have been detected in the camps so far, officials say, the Bangladesh Chronicle reported on March 18 that aid workers, especially foreigners, are being discouraged from going to the camps due to fears they could be carrying the virus.

It will, of course be impossible to completely stop interactions between refugees and outsiders as aid workers play a crucial role in supporting the refugee community, including through the dispensation of medical care and food deliveries.

Fewer international health workers in the camps could make the situation worse if the virus hits even a small number of refugees. Rohingya refugees are also known to leak out of the camps seek work in surrounding towns and villages, presenting another possible avenue of transmission.

In anticipation of a possible crisis in a crisis, the United Nations High Commissioner for Refugees has instructed camp authorities to hold suspected Covid-19 cases at the camps in temporary isolated areas until they can be transferred to specially designated isolation units.

But, as the Bangladesh Chronicle reported, “this is a very good initiative, if implemented properly — but how long will it take for the patient to be tested, given that the Institute of Epidemiology Disease Control and Research in Dhaka is at present the only healthcare facility in the country that can carry out testing?”

If a refugee tests positive, observers note, there are currently no facilities in the camps to handle it. The infected refugee, they note, would have to be transferred to a hospital in Cox’s Bazar, the nearest town, and that would immediately raise legal questions as the refugees are not allowed to leave the camps.

Rohingya children at the Kutupalong refugee camp in Bangladesh. Photo: AFP

The 630,000 refugees in Kutupalong are crowded into an area of approximately 13 square kilometers, a population density of more than 40,000 per square kilometer.

That makes it one of most densely populated human settlements on the planet; more than half of the refugees are children, many of whom are malnourished.

Sanitary conditions in the camps have improved since the massive influx of refugees in August and September 2017, but access to safe drinking water is still an issue and there are certainly not enough hygienic toilets.

The situation is grave even outside the camps, which is hardly surprising in a country of 160 million people squeezed into 147,570 square kilometer land area, or roughly the same size as the US state of Iowa.

The Bangladesh Chronicle quoted Saif Ullah Munshi, a local virology expert, as saying that “since the outbreak went out of control in China, we got more than two months for preparations. But we failed to understand the gravity of the situation.”

Saif noted that Bangladesh’s first major lapse was its failure to introduce proper screening of inbound passengers, including those arriving from Italy and Germany, both now Covid-19 transmission epicenters, at the country’s international airports.

Rohingya refugees shout slogans against a disputed repatriation program at the Unchiprang refugee camp in Bangladesh, November 2018. Photo: AFP/Dibyangshu Sarkar

With the monsoon season approaching, the already harsh living conditions in the camps are bound to get worse. Around the camps, rains destabilize the terrain which now have been deprived of forest coverage because the refugees have cut down trees for building and firewood.

Although Myanmar and Bangladesh have concluded a repatriation agreement, no refugees have so far returned through official channels.

Repatriation has been thwarted by conditions such as proof of prior residency set by Myanmar authorities, a demand that is almost impossible to comply with because most Rohingyas never had identification papers and those who did often left them behind when they fled to Bangladesh.

The refugees, on the other hand, are reluctant to return until authorities can guarantee their safety, the return of their homes and land lost in the conflict, and justice for the crimes they claim have been committed against them, among them charges of genocide.

With repatriation unlikely any time soon, Bangladesh authorities are known to be seeking places where the refugees could be relocated inside the country.

If and when that happens, it will open a potential Covid-19 transmission avenue between those integrated in the wider Bangladesh population with relatives and acquaintances still based in their original camps.

Bangladesh, and its Rohingya refugee camps in particular, could thus be a ticking Covid-19 time bomb, one that would devastate one of the world’s already most vulnerable populations.