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Rohingya crisis: "Pushing the boundary of what's possible"
As part of MSF’s emergency team, Ryan Bellingham is often sent at short notice to respond to sudden emergencies.
While working in a refugee camp in Uganda, Ryan got a call saying his skills as a water and sanitation coordinator were needed in Bangladesh. Within hours he was on his way to respond to the Rohingya refugee crisis.
When I landed in Bangladesh I had just come from another major refugee crisis, but here it was remarkably different. A refugee camp usually has, dare I say, a logic to the lay out.
But in Cox’s Bazar in southeast Bangladesh, where hundreds of thousands of Rohingya refugees have fled from Myanmar, it was a sprawling mass of people in such a small, dense area.
I first arrived in October, a little over a month after the exodus began and we were still seeing 10-15,000 people arriving each day.
Columns of people streamed across the berms of the paddy fields. It’s an image that still strikes me today.
"This was my fourth assignment with MSF but the scale was just overwhelming"
One of the most worrying things when I first arrived was seeing people drinking water from open wells – hand dug ponds or puddles.
Here in this dense camp, to see people drawing water from an essentially unprotected source where open defecation was happening was really quite shocking and extremely dangerous for the people drinking the water.
But what choice did they have?
From a medical standpoint, the key risks with inadequate water and sanitation are general waterborne diseases: acute watery diarrhoea and cholera, for example.
Hepatitis-E is always a risk in this type of environment. And without the provision of hygiene materials like soap and sanitary products the risk of an outbreak in this kind of setting is high.
In an emergency, to meet the minimum requirements, we’d need to set up one well for 500 people and one latrine for 50 people.
But our aim was to get to 250 people per well and 20 per latrine.
"It was amazing to watch, if not a little terrifying..."
Constructing a well starts with identifying a suitable location. They need to be at least 30 metres from any potential source of contamination.
Essentially, we’re building on hillsides. The terrain in the camps is quite steep, so it’s always a matter of trying to bench into the hillside and protect the base as best you can.
Then, we would set up the drilling rig, which in Bangladesh is three large pieces of bamboo with a small winch and pulley system that you use to lift the drill pipe up and down.
We would raise the tripod of bamboo, have the drill pipes on the end of a rope, and it's manual labour thereafter.
The drill pipe with a drill bit is put into the ground and it’s turned manually with an iron bar called a chain-tong.
For up to seven days the guys walk around pushing and pulling the bar to turn the pipe, while at the same time pumping down a drilling fluid.
The fluid comes up the outside of the pipe carrying the small splinters of rock and sand.
We reach the bottom of the well at around 200 metres. We continue flushing and pumping more and more water to try and flush out all the cuttings.
Afterwards, a seven-person team would pull up the rope. It was amazing to watch, if not a little terrifying, with so many people working at height to pull the drill pipe out of the ground.
Then, we place a plastic pipe with small slots and screens on the inside of the well, so the water can come in but sand is held back.
The space between earth and the pipe is filled with clean gravel, which also keeps out the sand but allows fresh water to come in before sealing it properly with bentonite and cement to stop any of the surface contamination getting into the well.
After that, the small platform is constructed and the pump's put on top.
In camps like this it's very difficult for everyone to have the services they deserve and require. But we were held in quite high regard by the people living in the camps and that for me was remarkable.
The Rohingya are a hugely resilient people. For a population to be so inherently peaceful after what they've been through leaves me lost for words.
For me, what sets MSF apart in our response to the crisis is our private funding. Having unrestricted funds means we’re ready to respond to an emergency immediately.
We were able to set up five hospitals within the first couple of months. We had nine health posts by the end of the 2017.
We're able to think on our feet. We're able to go ahead and mobilise resources, people, materials and medication.
For the water and sanitation team, we can start putting wells in the ground within the first few days.
Throughout the year, we had the ability to try new things: more sustainable water sources, a centralised water supply, using solar energy to power submersible pumps to draw water from the ground.
We're able to push the boundary of what we think is possible and we can really implement innovative, new ideas.