1. Context

In response to the rapid influx of the massive population fled from the northern Rakhine State, Myanmar to Bangladesh, the humanitarian assistance has simultaneously scaled up in Cox’s Bazar from August, 2017. The Japanese Red Cross Society (JRCS) is one of the organization providing the humanitarian assistance to the people in need in close partnership with the Bangladesh Red Crescent Society (BDRCS). JRCS has accommodated the request for Basic Health Care Emergency Response Unit (BHC ERU) as a joint deployment with PNSs such as Danish RC, Hong Kong RC and Italian RC. For grasping a overall picture of the population movement, please refer to the map below.

BDRCS is a strong national society which has a capacity not only to respond to major disasters and disaster risk reduction within the county but also to train many youth and volunteers to be stationed by the people at all times. It also provides medical services to the local communities through hospitals in normal times. Due to those activities, BDRCS enjoys a good reputation and acceptance from the local people, but it is not often the case for BDRCS to respond to a massive population movement in the country. Thus, the level of perception and acceptance from the people newly arrived at camps was not confirmed at the initial stage. On ERU commencement, JRCS has taken a flexible stand and supported BDRCS’s medical activity on the ground in respect for its capacity and reputation. This stand actually resolved medical license issue of international delegates.

The 1st rotation of BHC ERU team has started by the end of September, 2017. The camp situation was quite fluid with many people coming day by day, which initially led the team to operate in mobile configuration. Two mobile medical teams were activated at Camp12/Katupalong Balukhali and Camp14/Hakimpara respectively in Ukhia sub-district. The main ERU activities initially consist of emergency medical clinic, mother and child health (MCH) and psycho-social support (PSS), in which home visit, community health program and contact tracing of diphtheria were added later. As the number of people arriving from Myanmar decreased, the team shifted the mode of configuration into one mobile team plus one fixed emergency clinic which could also function as an epidemic treatment unit from December, 2017. Given the green light for land usage by the Bangladeshi authority, the clinic was set up along the main road in the light of easier access for the camp communities as well as for the host communities living outside the camp.

 I’ve been basically involved in the operation as a security officer at JRCS HQ in Tokyo from Sep, 2017 till now, and deployed to the field as a part of administration body from Dec, 2017 to Jan, 2018.

When the 6th rotation of ERU team completed its operation in the field by the end of April 2018, it has been taken over as a bilateral project with a focus on capacity building for local medical staff together with promotion of community health through BDRCS staff, BDRCS volunteers and community volunteers. This project aims at reinforcing positive perception and acceptance of BDRCS through quality improvement of medical services as well as enhancement of community resilience.

2. Events (How our acceptance, security and access were affected)

At the initial stage, the ERU operation was discussed and planned with BDRCS, then agreed by the Bangladeshi Ministry of Health. On entry into the camp, there was a series of discussions with the team, BDRCS and camp committees. Explanation of activity, venue of mobile clinic and schedule of clinic openings were also shared with communities through mazhis (community leaders). Regular meetings with mazhis were held before and during the ERU operation for better perception and easier access to beneficiaries. Emblems of BDRCS, IFRC and JRCS have been put up at the clinic sites, so that it is identifiable that “we are here to help you”.

The prolonged ERU operations have been underpinned by many BDRCS staff, BDRCS volunteers and volunteers from host communities as well as from camps. Particularly at the initial stage, however, the team encountered difficulty discussing the status of community volunteers at camps with BDRCS, although hiring them as community volunteers was inevitable for the smooth operation due to the language barrier and social consideration. It was understandable only in retrospect that BDRCS was sandwiched in between the Bangladeshi government authority who had a concern that those fled from Myanmar might have taken advantage of settling down in Bangladesh. A draft of BDRCS’s “Community Volunteer Guideline” was shared with the ERU team in November, stating that participation of community volunteers are encouraged, and those volunteers adhere to the Fundamental Principles, the Code of Conduct, and other Movement policies. Use of emblem and BDRCS logo by community volunteers, however, was not permitted as BDRCS was anxious about their misuse of emblems and logos. Items like IDs, T-shirts and caps were provided to community volunteers, but only with PMO initials indicated, not the RC logo or emblem. Here, careful discussion and confirmation with BDRCS was necessary on occasion. Gradually, the team tried to expand roles of community volunteers, so that BDRCS staff and volunteers also understood the crucial role those community volunteers were playing.

Not only the status of community volunteers, but also the amount of per diem paid to volunteers becomes a hot topic. One issue here is the allowance difference between BDRCS volunteers, community volunteers from host communities, and those from camp communities. Another is that allowance amount varies depending on PNSs decision as BDRCS salary/allowance scale amount is too low to be quoted at the current situation, which is more or less related with the high turnover of staff and volunteers. This topic is alleged quite sensitive and currently not able to be discussed openly.

The ERU team constantly provided trainings and technical support to those staff and volunteers in anticipation of their capacity building. Trainings include first aid, triage, family planning, community health, radio communication and stress management. BDRCS medical staff and volunteers are incorporated mainly into medical teams as well as PSS activity, whereas community volunteers function as translators, security guards, crowd controllers, assistant pharmacists and technical assistants. When conducting home visit, the information from community volunteers and/or community members have occasionally enabled the team to access the most vulnerable who couldn’t come out from home and receive the necessary assistance.

Those community volunteers originally from Myanmar have been stranded as stateless for a long period, and many have gone through unimaginable hardships. On the other hand, staff and volunteers from BDRCS are newly grad, highly educated, young elites from Dhaka or Cox Bazar, and don’t have much exposure to emergency humanitarian settings. In addition, many staff and volunteers were newly recruited without receiving enough training or guidance on the Movement principles and policies as BDRCS was overwhelmed, and had less capacity to provide trainings to many of them, plus the increasing turnover of staff and volunteers. Due to those different backgrounds of volunteers, the unwelcomed status of community volunteers living at camps in Bangladesh and the disparity in allowance, frictions sometimes arose among the team. In order to ease tension, staff and volunteers have been encouraged to reiterate the Fundamental Principles at morning briefings and put them into practice at everyday work. Sometimes international delegates have interfered in between to listen to both sides and to work as a team.

Even among the international delegates, there was a misperception of ERU mode of action. For example, a delegate from Italian RC got confused why only BDRCS doctors and nurses who had less experience took care of patients while the int’l delegates provided technical assistance only in necessity. She thought the experienced international staff who got used to the emergency settings was the one standing at the forefront. Then, she finally agreed after JRCS senior medical officer (SMO) has explained her how BHC ERU team has been working as a guiding and advisory position to support and train BDRCS operation on the ground. This happened as she haven’t received any briefing on BHC ERU led by JRCS/BDRCS.

3. What we did and lessons learnt

Soon after arriving in Bangladesh, all international delegates received security briefing at IFRC PMO office in Cox’s Bazar, and such information like delegates’ entry/departure schedule and contact details was shared with PMO office for security concern.

On ERU operation, the team regularly disseminated the information on ERU activity to surrounding communities and coordinated with stakeholders (BDRCS, MoH, IFRC, PNSs, mazhis, camp committees, UN, INGOs etc). The team also secured referral system with our PSS unit, ERU field hospital, and clinics run by NGOs such as MSF and brac (LNGO) for special treatment.

In this case study, some of the lessons learnt are as follows:

Acceptance of Organization:

• Careful coordination with the Bangladeshi state bodies such as MoH was arranged for the timely and smooth humanitarian assistance under BDRCS umbrella.
• BDRCS has already established its reputation in Bangladesh. In terms of working at camps in Cox’s Bazar, the ERU team worked closely with the camp communities, mazhis and community volunteers to enhance perception and acceptance of BDRCS, ultimately to secure access to the most vulnerable.
• ERU health service was also open and reachable for the host communities.
• Providing quality medical service in timely manner may gain further trust from camp communities as well as from host communities. However, the quality has to be balanced in accordance with the local health service standard.

Acceptance of Individual:

• The team contributed fostering the environment that staff and volunteers understand and adhere to the Fundamental Principles, the Code of Conduct and other Movement policies.
• For the newly recruited BDRCS staff/volunteers, it was advisable for BDRCS to give them trainings on the Movement principles, or at least for those staff/volunteers to take WORC online course before deployed to the field.
• The team introduced the brief session on the Fundamental Principles to community volunteers who were not familiar with the concept.
• For newly recruited BDRCS staff & volunteers as well community volunteers, it is recommendable that the ERU team try to introduce those principles into practice at everyday work.

Internal Communication:

• In consideration of impartiality and neutrality, the status of community volunteers needed to be treated fairly at the initial stage. Looking back the history, this is NOT the first time to see the influx of people from Myanmar into Bangladesh. Although this is a sensitive issue, but it is a good opportunity for BDRCS to rethink how the community volunteers' status to be treated.
• There would be less confusion if the allowance scale for volunteers has been standardized among BDRCS and PNSs (if possible at least among PNSs)
• In case of joint deployment, international delegates needed to be briefed on ERU characteristic in accordance with cultural context as the characteristic may differ from PNSs, and/or situation.