UNICEF and IPs Total Results. Target 11,876 3,020 7, , , , , , , ,000 27, ,000 26,924

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1 UNICEF/2017/LeMoyne Bangladesh Humanitarian Situation report No.6 (Rohingya influx) REPORTING PERIOD: 6 12 OCTOBER 2017 Highlights The humanitarian situation for Rohingya refugees in Bangladesh remains dire, with some 537,000 newly arrived refugees since 25 August 2017 of which 58 per cent are children and 60 per cent are women. With the new influx since 25 August, the current total number of Rohingyas who have fled from Myanmar into Bangladesh, coupled with the affected population in communities, has reached a staggering 1.2 million, including 720,000 children. With fears growing around the dismal water and sanitation conditions and amidst a rapidly growing number of reported cases of acute watery diarrhoea; UNICEF successfully launched a cholera prevention campaign on 10 October. This reached over 167,000 men, women and children with the Oral Cholera Vaccine in the first two days. UNICEF is encountering significant challenges, including lack of funding and physical access to some of the geographical locations due to lack of access roads and rainy weather conditions. UNICEF has received only 7 per cent of the US$76.1 million requested to provide immediate life-saving humanitarian assistance to affected children and women over the period of six months. UNICEF s Response with Partners SITUATION IN NUMBERS 15 October ,000 children in need of humanitarian assistance 1,200,000 people in need (HRP ) 311,600 children (arrived since 25 August) in need of humanitarian assistance (based on ISCG SitRep 12 Oct 2017) 537,000 new arrivals since 25 August (ISCG SitRep, 15 Oct 2017) UNICEF Appeal US$ 76.1 million* Children 0-59 months treated for Severe Acute Malnutrition (SAM) Children 6 months 15 years received MR vaccine People with access to safe drinking water Children who received psychosocial support Children (4-14) enrolled in emergency non-formal education Sector UNICEF and IPs 11,876 3,020 7, , , , , , , ,000 27, ,000 26, ,000 8, ,765 5,451 Funds Received: $5.4 M 2017 Funding Requirement $76.1M Funding Gap: $70.7 M * UNICEF s original 2017 Humanitarian Action for Children (HAC) regional appeal for South Asia required US$9.45 million for response in Bangladesh. The HAC is currently being revised to reflect the latest funding requirements of US$76.1M for the new influx of refugees since August

2 Situation Overview & Humanitarian Needs The influx of Rohingya refugees from northern parts of Myanmar Rakhine State into Bangladesh restarted following the attacks at Myanmar Border Guard Police posts on 25 August As of 15 October, the Inter-Sector Coordination Group (ISCG) reported that 537,000 1 Rohingya refugees have entered Bangladesh since the attacks. According to ISCG s rapid needs assessment, 58 per cent of new arrivals are children and 60 per cent are women including a high number of pregnant (3 per cent) and lactating women (7 per cent). There are currently 211,000 arrivals residing in extremely overcrowded makeshift settlements and official refugee camps, while 89,000 arrivals are in host communities. In addition, 162,000 arrivals are in sites that have spontaneously emerged, which are quickly expanding. With the new influx of 537,000 since 25 August 2017, the current total number of Rohingyas who have fled from Myanmar into Bangladesh, coupled with the affected population in the communities, has reached a staggering 1.2 million 2. There are 720,000 children, both from new arrivals, existing Rohingya populations and vulnerable host communities, who are affected and need urgent humanitarian assistance including critical life-saving interventions. The inter-agency Humanitarian Response Plan (HRP) identified the areas of WASH, health, nutrition and food security and shelter for immediate scale-up to save lives in both settlements and host communities. As per the HRP, the Rohingya population in Cox s Bazar is highly vulnerable, many having experienced severe trauma, and are now living in extremely difficult conditions. The limited WASH facilities in the refugee established settlements, put in place by WASH sector partners including UNICEF prior to the current influx, are over-stretched, with an average of 100 people per latrine. New arrivals also have limited access to bathing facilities, especially women, and urgently require WASH supplies including soap and buckets. Prior to the new influx in August, only 25 per cent of Rohingyas had access to safe water, and the situation is even worse in host communities, with only 10 per cent with access to safe water for drinking and personal hygiene. The entire 1.2 million affected population, including children and women, requires access to sufficient water of appropriate quality and quantity for drinking and personal hygiene. Given the current population density and poor sanitation and hygiene conditions, any outbreak of cholera or acute watery diarrhoea, which are endemic in Bangladesh, could kill thousands of people residing in temporary settlements. Urgent nutrition needs have been prioritized for under-five children (including infants), pregnant and lactating women and adolescent girls. These include close to 17,000 children under five suffering from severe acute malnutrition (SAM) to be supported over the next six months. Nutrition sector partners plan to cover 70 per cent of the identified needs in the makeshift and new settlements, host communities and official camps. Moreover, children, adolescents and women in both the Rohingya and host communities are exposed to high levels of violence, abuse and exploitation including sexual harassment, child labour and child marriage and are at high risk of being trafficked. Finally, an estimated 450,000 total Rohingya children aged 4-18 years old are in need of education services. Estimated Population in Need of Humanitarian Assistance: Male Female Population in Need 1,200, , ,000 Children (Under 18) 696, , ,880 Children Under Five 348, , ,440 Pregnant and lactating women 120, ,000 Adolescents 204,000 95, ,120 Source: Calculated based on the Needs and Population Monitoring, IOM, September 2017 Humanitarian Leadership and Coordination The overall humanitarian response for the Rohingya refugee crisis is facilitated by a sector-based coordination mechanism, the Inter-Sectoral Coordination Group (ISCG), established for refugee response in Cox s Bazar. On the government side, a National Task Force (NTF) established by the Ministry of Foreign Affairs (MoFA) leads the coordination of the overall Rohingya crisis. However, after the recent influx since August 2017, the Ministry of Disaster Management and Relief (MoDMR) has been assigned to coordinate the Rohingya response with support from the Bangladesh Army and Border Guard Bangladesh (BGB). In this structure, the roles of the Refugee, Relief and Repatriation (RRRC) Commissioner and the Deputy Commissioner (DC) of Cox's Bazar district are critical for daily coordination and information sharing. UNICEF and all other humanitarian organizations operating from Cox s Bazar are required to provide daily updates to keep district authorities informed. At sub-national level, UNICEF continues to lead sectoral coordination in the nutrition sector and child protection sub-sector and co-leads education 1 Situation Update: Rohingya Crisis, Inter Sector Coordination Group (ISCG), October 15, The 1.2 million also includes 200,000 Rohingya before the new influx, 191,000 for contingency and 300,000 affected host communities. Prior to August this year, around 33,000 registered Rohingya refugees lived in two camps officially recognised by the Government located in Kutupalong and Nayapara in Ukhiya and Teknaf upazilas respectively, which have been functioning since 1992 under the care of UNHCR. In addition, more than 60,000 undocumented Rohingya resided in makeshift settlements (in Leda, Kutupalong, Shamlapur and Balukhali) and an estimated 300, ,000 lived scattered within the host communities through the district and across the country. 2

3 sector with Save the Children. UNICEF co-leads the WASH sector along with Action against Hunger (ACF). It is important to note that the cluster system has not been officially activated. Humanitarian Strategy UNICEF s comparative advantage is its ability to work simultaneously with the government, local and international NGOs and other civil society organizations, and coordinate and mobilize their support as appropriate. UNICEF is working in close coordination with all the humanitarian actors at national and sub-national level including government line ministries and departments, such as the Department of Public Health Engineering (DPHE), to effectively scale up WASH interventions, and with the Civil Surgeon s Office (Ministry of Health) to organize mass immunisation campaigns. Summary Analysis of Programme Response Nutrition As of 8 October, an estimated 288,400 people need nutrition assistance out of all the newly arrived refugees. 149,350 children under five and 51,500 pregnant and lactating women need malnutrition prevention and treatment support through nutritious supplementary food, 14,562 children with severe acute malnutrition (SAM) require inpatient and outpatient treatment and 87,550 adolescent girls need nutritional support. In response, UNICEF has triggered life-saving nutrition interventions for new arrivals in six new spontaneous settlements (Unchiprang, Mainarghona, Hakimpara, Burmapara, Thangkhali, Jamtali) and in two makeshift settlements (Balukhali and Shamlapur). UNICEF and partners operationalized four outpatient therapeutic programme (OTP) centres with the potential to treat over 1,000 cases of SAM each month. Since 25 August, a total of 36,083 children under five have been screened, and out of 1,217 children identified with SAM, 974 children received treatment. With UNICEF support, approximately 69,000 children aged 6-59 months received Vitamin A supplementation during the supplementary immunization campaign for Rohingya children. To date, 4,326 pregnant and lactating women (PLW) received infant and young child feeding (IYCF) counselling, information critical to reducing undernutrition in infants and young children. In addition, 20 frontline community workers received training on community management of acute malnutrition (CMAM). As part of the nutrition sector wide response, in the reporting period (since 8 October) a total of 39,311 children under five were screened for malnutrition, and 1,006 were identified as having SAM and admitted to in- and outpatient settings for treatment. 257 children aged 6-59 months were identified as having moderately acute malnutrition (MAM) and were admitted for treatment, 329 children aged 6-59 months were admitted to malnutrition prevention programmes, 1,639 PLW received counseling on IYCF, 379 PLW were admitted to malnutrition prevention programmes and 167 children aged 6-59 months received Vitamin A supplementation. Despite the progress being made, significant challenges remain, including the lack of inpatient treatment services for children with SAM. In addition, caregivers are often afraid to access existing centers that are placed far from their settlements, and there is a lack of breastfeeding spaces in the settlements to ensure promotion and protection of breastfeeding. There is also an urgent need to establish mobile community nutrition centres to ensure treatment for children under five and pregnant and lactating women. Moreover, there are significant physical challenges, with rain and muddy roads affecting the mobility of outreach volunteers. Health Health needs on the ground remain overwhelming, with an estimated 42,000 pregnant women, 72,000 lactating mothers and 240,000 under-five children requiring assistance. The risk of communicable disease outbreak including cholera - is very high given the crowded living conditions and severe lack of adequate water and sanitation. In response, in support of the cholera prevention campaign that was launched on 10 October, UNICEF provided 900,000 doses of the Oral Cholera Vaccine (OCV) and supported microplanning at the district and upazila level. Social mobilization activities were conducted through mobile teams, megaphones and mosques and house-to-house mobilization by majhis, or local community leaders. In the first seven days, 565,000 men, women and children were vaccinated against cholera. In collaboration with WHO, UNICEF has supported the Ministry of Health to roll out a vaccination campaign targeting Rohingya children for polio, measles and rubella and vitamin A supplementation, reaching 135,519 children aged 9 months-15 years, 72,334 children under five with the polio vaccine, and 72,064 children aged 6 months-5 years with Vitamin A supplementation. To ensure continuity of primary health care, in collaboration with the Ministry of Health and Family Welfare and Partners in Health and Development, UNICEF supported 17 health care centres catering for primary care, immunization, antenatal care, postnatal care and Oral Rehydration Therapy. During the reporting period, a total of 7,796 cases of respiratory illness and 5,853 cases of diarrhoea were treated, 765 pregnant women were provided with antenatal care and 85 lactating mothers were provided with 3

4 postnatal care services. With UNICEF support, 326 sick newborns received treatment in the Special Care Newborn Unit (SCANU) of the district hospital - out of which 47 were from the refugee population. However, UNICEF continues to encounter significant challenges in rolling out health activities on the ground. The constant influx of new refugees means that the number of unvaccinated persons remains high, thus adding to the risk of transmission of measles, rubella and cholera. The mass shifting of the population by Bangladeshi security forces from one relief camp to another hinders planning for health care services. Finally, due to the non-availability of health records of the refugees, the status of health services already received or ongoing cannot be verified. WASH A significant number of Rohinyga refugees still do not have access to WASH services. Out of the 1.2 million people in need of WASH services, thus far the sector has only been able to reach 333,649 persons, or 28 per cent. The increasing number of new arrivals continues to further aggravate the situation, over-stretching existing WASH facilities. The fast filling of latrines due to overcrowding in the refugee settlements remains a major challenge and the increasing incidence of diarrhoeal diseases among children is a growing concern. The poor hygiene and sanitation conditions in the camps, combined with the increased population, has greatly increased the risk of outbreaks of water borne diseases, representing a potential public health emergency. In response to the increasing number of refugees, in collaboration with its WASH partners, UNICEF installed more than 2,000 tube wells in the highly populated camps, while the government counterpart, the Department of Public Health and Engineering, was supported to deliver more than 60,000 liters of water on a daily basis through water trucking and treatment in areas with limited or no alternative sources of water. In addition, UNICEF has constructed 419 water points benefiting 135,000 people. Overall, more than 100,000 people have gained access to safe drinking water. A major achievement registered during the reporting period is the installation of an emergency water treatment and supply system in Unchiprang camp as an alternative solution to the poor hydrogeological conditions of the area. Over 130,000 people gained access to sanitation through the construction of 3,741 latrines supported by UNICEF, while some 17,000 people have received hygiene kits and essential behavior messaging. Finally, to scale up sanitation interventions, UNICEF has signed an agreement with the Ministry of Disaster Management and Relief (MoDMR) for the construction of 10,000 latrines. The WASH sector has identified congestion as a key factor hindering adequate WASH coverage in the sites as well as appropriate site planning in newly developed areas. Initial indicative analysis suggests that up to 60 per cent of constructed latrines may already be full, compounded by a lack of space for new constructions, and a lack of desludging capacity and treatment. With Global WASH Cluster support, WASH infrastructure mapping is ongoing with the first round expected to be completed by next week. This will clarify gaps on the ground and factor in the functionality of infrastructures and their geographic distribution. WASH site focal points are currently being selected amongst partner agencies to oversee WASH implementation, provide a local link to the sector and better identify and address WASH issues and gaps. Despite the progress made, some major gaps need to be addressed. A number of camps and spontaneous settlements have not yet been reached with sufficient WASH services, and some of the health, nutrition, education and child protection centres are yet to be provided with WASH facilities. WASH needs continue to grow and physical access to some of the geographical locations is an issue due to lack of access roads to transport WASH supplies and equipment. Finally, hygiene promotion is lagging behind despite being an urgent and critical intervention to contribute to the prevention of possible outbreaks. Child Protection The situation of many children, the elderly and vulnerable women remains very volatile. The number of female single-headed households, separated children and the need for GBV-related services is high. Identification, referral, psychosocial support and counseling services (as well as medical follow-up) must be scaled up, as well as tracing and family reunification. Many children are in need of safe spaces to engage in recreational activities and receive psychosocial support services. Children and adolescents arriving in Cox s Bazar show signs of exhaustion and distress from their experiences. Most of the new arrivals are young children with their parents or caregivers (mostly women). Many parents are occupied by the tedious registration processes in addition to securing food, shelter and water as soon as they arrive and as a result, many children are left unattended. In the reporting period, UNICEF signed a new partnership to reach 16,200 children with and without disabilities with psychosocial support through sports, culture, and arts activities including their referral to protection services. Two additional mobile child friendly spaces (CFS) were set up in the Kutupalong extension for new arrivals to provide psychosocial support, and registration of approximately 600 unaccompanied and separated children (UASC). Mobile CFSs have also been deployed to the new settlements to provide comprehensive protection services, including conducting rapid assessments to identify unaccompanied and separated children. Capacity building of six frontline staff working with partners has been organized on comprehensive response planning for the UASC. UNICEF and the Ministry of Social Welfare drafted a Memorandum of Understanding to support unaccompanied and separated children including children without parental care with emphasis on family-based care to ensure the best interests of the child. 4

5 UNICEF and partners are working to address the challenges of limited space to establish new CFS. Alternatives are being sought to identify spaces to operate mobile child friendly spaces. Following up on cases remains a challenge for case management teams due to the constant movement and fluidity of the population within settlements. Education A total of 453,000 Rohingya and Bangladeshi host community affected children aged 4 18 years urgently need access to education, including 270,000 newly arrived Rohingya children. In response, UNICEF aims to reach at least 201,765 children aged 4 14 years in the next six months. In the reporting period, with UNICEF support, an additional 2,374 Rohingya children aged 4 14 years old gained access to early learning and non-formal basic education through 228 learning centres in four makeshift and two spontaneous settlements. As of 14 October, UNICEF has reached 19,400 children, of whom 5,451 are newly arrived. 20 transitional learning spaces have been established in the reporting week and preparatory work has started for the establishment of transitional learning spaces in three new spontaneous settlements. Through local NGO partner CODEC, UNICEF reached 31,500 children with 350 school-in-a-box kits, 65 early childhood development (ECD) kits and 31,500 school bags, and through partner Mukti, UNICEF reached 28,500 children with 300 school-in-a-box kits, 35 ECD kits and 15,000 school bags. The education sector is in the process of developing a sector strategy for a 12-month period to define the way forward after the acute emergency phase to enable more sustainable solutions for girls, boys and youth. At the same time, new education partners are arriving in Cox s Bazar and are contacting the sector for a coordinated and standardized approach. The sector is also looking into developing its own monitoring tool as the 4Ws developed by the Information Management Working Group to facilitate data collection. UNICEF continues to face major challenges including finding spaces for learning centres, staff and teacher dropout, limited attendance of learners due to relief collection, lack of WASH facilities in learning centres and a lack of appropriate pedagogy and materials to address immediate psychosocial needs due to the huge influx. Communication for Development (C4D), Community Engagement and Accountability With around 1,126 local partner staff on the ground, UNICEF ensured that messaging on the oral cholera vaccination (OCV) campaign reached approximately 650,000 people in the makeshift camps of Teknaf and Ukhiya. Over 1,000 community leaders were sensitized to scale up message dissemination efforts, public service announcements (PSA) have been broadcast at least six times a day from Bangladesh Betar Regional Station and Community Radio Naf, with a population coverage of more than 200,000 listeners. 120 radios have been distributed to key stakeholders, and a new information and feedback centre was established in Maynerghonna with another underway in Kutupalong extension. 891 people in Unichprang, Balukhali and Maynerghonna were reached with information about service points and delivery. At the same time, in light of the high risk of communicable diseases, UNICEF is currently developing hygiene materials with key messages that are being translated to Burmese and shared with the WASH sector for feedback. There is however a need to build the capacity of newly recruited information service providers at new information and feedback centres to refer communities to relevant services as well as receive and respond to feedback. In addition, rain and muddy roads affect the mobility of outreach volunteers trying to provide life-saving information in distant communities. Supply and Logistics UNICEF s finalized six-month supply plan has been translated into staggered procurement orders. Local and offshore (by sea and air) supplies will start to arrive in Cox s Bazar by 20 October. Thus far, total procurement is above US$4 million for critical supplies for WASH, Health, Education, Nutrition, Child Protection and C4D. A second round of distribution of WASH and Child Protection supplies was finalized by 12 October. Media and External Communication The media highlight for the reporting period was the cholera vaccination campaign. The campaign launch was covered by Reuters, APTN, AFP, Sky News and Al-Jazeera through interviews at the vaccination sites in the camps. A news note prior to the campaign and a press release were issued. Footage of Rohingyas crossing the border will be used for the upcoming Child Alert report. The Facebook page is updated on a regular basis since 25 August, the number of followers has jumped from 860,000 to 12.3 million, or 370,000 in under two months, demonstrating a rapidly growing interest. Security The overall security situation reflects an escalating trend with increased risks of violence, abuse, exploitation and trafficking of children, adolescents and women. Bangladesh security forces, including the army, border guards and police, are deployed in the camp locations to combat crime; provide safety and security; and support the humanitarian response operations. Road traffic 5

6 accidents due to poor road conditions and travels after dark is a major safety risk that the UN/UNICEF personnel are exposed to and appropriate preventive mitigation measures are being put in place. Poor mobile phone network in the camp locations remains a challenge in emergency communication, which is being mitigated by extending VHF radio coverage and allocating additional radios to the staff. While UNHCR and IOM have already deployed international Field Security Officers on surge in Cox s Bazar, UNICEF is in the process of deploying one. Funding As part of UNICEF s original 2017 Humanitarian Action for Children (HAC) regional appeal for South Asia launched in January 2017, US$9.45 million was required to respond to the humanitarian needs in Bangladesh. Following the recent influx of Rohingya and to deliver immediate life-saving humanitarian assistance, UNICEF s revised response plan requires US$76.1 million to provide lifesaving and other services to over half a million children, which includes both the existing, new influx and the vulnerable host community children. UNICEF wishes to express its sincere gratitude to UN OCHA, Japan, Canada, Sweden, Denmark, the United States, the UK and various National Committees who have contributed generously to the humanitarian response in Continued and timely donor support is critical to scaling up the response in Bangladesh. Funding Requirements * Funds available** Funding gap Appeal Sector Requirements Funds Received Carry-Over $ % Current Year Nutrition 7,721,373 1,708, ,969 5,500,553 71% Health 10,436,113 1,767,820 8,668,293 83% WASH 27,328,698 4,753, ,323 22,270,364 81% Child Protection 3,003,626 1,548, ,873 1,347,509 45% Education 13,406,412 1,327,988 12,078,424 90% Communication for development 1,056, , ,576 71% Social Policy/Social Protection 13,150,632 4,631 13,146, % 76,103,391 11,412,507* 925,165 63,765,719 84% *US$76.1 million is a provisional requirement pending release of the HAC for Bangladesh. ** Funds available includes funding received against the current appeal as well as carry-forward from the previous year. Out of total funding received this year, US$4.5 million was received for Rohingya before 25 August and US$1.5 million for other emergencies in the country. Against the latest funding requirement of U$76.1 million for Rohingya response post 25 August, UNICEF has received only US$ 5.37 million and the current funding gap is 93% for that response. Next SitRep: 22 October 2017 HAC: Facebook: Bangladesh Humanitarian Response Plan 2017: Who to contact for further information: Edouard Beigbeder Representative Tel: ebeigbeder@unicef.org Sheema Sen Gupta Deputy Representative Mob: ssengupta@unicef.org Sara Bordas Eddy Chief Field Services Tel: sbordaseddy@unicef.org Jean-Jacques Simon Chief of Communication Mob: jsimon@unicef.org 6

7 Annex A SUMMARY OF PROGRAMME RESULTS NUTRITION Number of children 0-59 months treated for Severe Acute Malnutrition (SAM) Number of pregnant and lactating women (PLW) reached with counselling on infant and young child feeding (IYCF) practices Number of children 6-59 months, adolescents and PLW in the affected areas receiving multimicronutrient supplementation. HEALTH Number of children 6 months 15 years who received MR vaccine Number of doses of OCV administered to population (reaching 650,000 people over 1 year)* Number of children under five accessing basic health care Number of pregnant women who received at least one ANC consultation WATER, SANITATION & HYGIENE Number of people with access to safe drinking water Number of people provided access to cultural and gender appropriate latrines and washing facilities Number of people received key messages on improved hygiene practices CHILD PROTECTION Number of children receiving psychosocial support and community based child protection services Number of unaccompanied and separated children identified and receiving case management services Number of adolescent boys and girls receiving life skills including information on GBV EDUCATION Number of children (4-14) enrolled in emergency non-formal education including early learning Overall needs Sector/Cluster Response ( ) UNICEF and IPs ( ) 2017 Revised since 25 August Change since last report 2017 Revised since 25 August Change since last report 16,965 11,876 3,020 1,006 7, ,000 84,000 8,080 1,639 43,000 4,326 1, , ,000 69, ,000 69, , , , , , , , ,000 79,800 3,244 42,000 7,000 1,617 1,200, , ,000 88, , ,100 7,800 1,200, , , , , ,950 37,000 1,200,000 1,200,000 31,000 31, ,000 17,360 5, , ,000 27,656 5, ,000 26,924 5,075 5,000 5,000 1, , , ,000 2, ,800 2, , ,000 8,742 3, ,765 5,451 2,374 Number of teachers recruited and trained 7, , C4D/ ACCOUNTABILITY MECHANISMS Number of people reached through information dissemination and community engagement efforts on life saving behaviors and available services* Number of community/opinion leaders sensitized to provide life-saving information and referral** *650,000 in 1st round (>1 year age) and 250,000 in 2nd round (1-5 years age) ** results for C4D indicators are point-in-time coverage 180, , ,000 3,000 1,050 1,050 7