The World Health Organization (WHO), in collaboration with the Government of Bangladesh (GoB) and health partners, initiated an Antimicrobial Resistance (AMR) Surveillance program in the Rohingya camps on September 25, 2024. This program aligns with the national AMR surveillance program in Bangladesh and aims to monitor AMR among selected microbial pathogens affecting both the Rohingya population and the adjacent host communities.
WHO recognises AMR as a major threat to global public health and development. In 2019, bacterial AMR was directly responsible for 1.27 million deaths worldwide and contributed to 4.95 million deaths[i]. Economically, AMR could lead to an additional US$ 1 trillion in healthcare costs by 2050 and cause GDP losses ranging from US$ 1 trillion to US$ 3.4 trillion per year by 2030, according to the World Bank[ii].
Antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics, are essential for treating infections in humans, animals, and plants. However, AMR occurs when these pathogens adapt to withstand the medications that once effectively treated them, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
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Global Deaths Attributable to AMR Every Year (Review on antimicrobial resistance by Jioneinn, 2016).
Quoted in National AMR Surveillance in Bangladesh: 2016-2023, 2023, p. 24.
“The lack of awareness and education, along with the influence of the pharmaceutical industry and government policies, are direct causes of antimicrobial resistance (AMR). Our surveillance efforts will provide crucial insights for the future. Anything that affects the Rohingya community inevitably impacts the people of Bangladesh.”- Mr Mohammed Mizanur Rahman, Refugee Relief and Repatriation Commissioner, Cox’s Bazar.
The Rohingya population is particularly vulnerable to infectious diseases due to overcrowding and poor hygiene. The causes, resistance patterns, and outcomes of infections in this population may differ from those in the host community, underscoring the need for targeted AMR surveillance to ensure appropriate treatment.
Bangladesh’s national AMR surveillance program, with its eleven sentinel sites, has enhanced the understanding of AMR patterns. However, the unique conditions in the camps and the distinct ethnicity of the Rohingya population necessitate additional surveillance to understand evolving resistance patterns as well as the most used antibiotics for effective management.
A report published in the National Antimicrobial Resistance (AMR) Surveillance Bangladesh: 2016-2023[iii], on page 109, details the most used antibiotics across various sentinel sites, including Cox’s Bazar as shown below.
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“Bangladesh is a pacesetter in AMR surveillance in Asia. While discussions in a side event at the ongoing United Nations General Assembly highlighted the need for AMR in refugee and migrant populations, Bangladesh has already initiated AMR surveillance in the Rohingya population. The findings from this population will be invaluable not only to Bangladesh but to the global community as well.” - Dr Anthony Eshophonie, Team Leader, Health Security and Emergency Response, WHO, Bangladesh.
The Institute of Epidemiology Disease Control and Research (IEDCR), supported by WHO, will extend its nationwide AMR surveillance to include the Rohingya population. Cox’s Bazar Medical College, a sentinel site since 2019, will play a key role in this initiative. The college’s microbiology department will conduct laboratory testing under the supervision of the National Reference Laboratory (NRL) at IEDCR, with technical support from WHO. The AMR draft Standard Operating Procedures (SOP) were distributed, during the launch, to ensure a proper understanding of the approach.
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WHO technical staff and government representatives stand united at the AMR launch in Cox’s Bazar, driving forward the fight against antimicrobial resistance.
Photo Credit: WHO/MANZUR Mehnaz
“Antibiotics are easily accessible in shops, and we all bear responsibility for purchasing them, thereby worsening the issue. We must discipline ourselves and return to fundamental practices. Physicians should guide their patients. This is a collaborative effort in a community heavily reliant on humanitarian aid. Additionally, we need to extend any support to the host community.” - Dr Jorge Martinez, Head of WHO Sub Office in Cox’s Bazar.
The launch of the AMR surveillance programme represents a major step toward enhancing public health within the Rohingya camps. This initiative underscores the commitment of health authorities and partners to combating antimicrobial resistance and ensuring the well-being of one of the world’s most vulnerable populations. Continued cooperation, funding, and community engagement are crucial for the success of this vital programme.
For more information on this publication, please contact Terence Ngwabe Che External Communications Officer, Cox’s Bazar office at chet@who.int.
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[i] Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet; 399(10325): P629-655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
[ii] Drug-Resistant Infections: A Threat to Our Economic future (March 2027) https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
[iii] National AMR Surveillance in Bangladesh: 2016-2023. https://dashboard.iedcr.gov.bd/amr/uploads/amr_report_2016-23.pdf