- A recent MSF survey in Rohingya refugee camps in Bangladesh has found almost one in five people tested for hepatitis C have an active infection.
- However a lack of capacity in the Cox’s Bazar camps means many Rohingya with hepatitis C miss out on treatment and being cured.
- MSF calls for a coordinated humanitarian effort in the camp to implement a large-scale test and treat campaign.
A study carried out by Médecins Sans Frontières (MSF) indicates that almost 20 per cent of the Rohingya refugees tested in the Cox’s Bazar camps in Bangladesh have an active hepatitis C infection.
A blood-borne virus, hepatitis C is a disease that can remain dormant for a long time in those infected. If untreated, it can attack the liver and lead to serious or even fatal complications, usually cirrhosis or liver cancer, with an increased risk of developing several conditions including diabetes, depression, and heavy fatigue.
In the camps, people have very limited diagnostic and treatment options. MSF is calling for a joint humanitarian effort to combat the disease among this stateless group of people who are already deprived of basic rights and are heavily dependent on aid for survival.
Our teams have to turn away hepatitis C patients every day, because the need for care exceeds the capacity of our organisation alone.Sophie Baylac, MSF head of mission in Bangladesh
Faced with an influx of hepatitis C patients in the Cox’s Bazar camps over the last few years, Epicentre, MSF's epidemiology and research centre, carried out a survey of 680 households in seven camps between May and June 2023. The results show that almost a third of the adults in the camps have been exposed to hepatitis C infection at some point in their lives and that 20 per cent have an active hepatitis C infection.
“As one of the most persecuted ethnic minorities in the world, the Rohingya have been paying the price for decades for a lack of access to healthcare and to safe medical practices in their country of origin,” says Sophie Baylac, MSF head of mission in Bangladesh. “The use of healthcare equipment that has not been disinfected, such as syringes, which are widely used in alternative healthcare practices within the refugee community, could explain the potential ongoing transmission and the high prevalence of hepatitis C among the population living in the overcrowded camps.”
Extrapolating the results of this study to all the camps would suggest that about one in five adults is currently living with a hepatitis C infection – totalling an estimated 86,000 people – and requiring treatment to be cured.
“Our teams have to turn away hepatitis C patients every day, because the need for care exceeds the capacity of our organisation alone,” says Baylac. “There are barely any other available and affordable alternatives for these patients outside our clinics in the camps. This is a dead end for a stateless community deprived of the most basic rights, already facing dead ends in all areas of their daily lives.”
Access to diagnosis and treatment is inadequate in many low- and middle-income countries, making this disease a potential public health threat. Yet, direct-acting antiviral drugs can cure over 95 per cent of those infected. In the overcrowded refugee camps of Cox’s Bazar, access to diagnosis and treatment of hepatitis C is almost non-existent; MSF has been the sole provider of hepatitis C care there for four years. Yet the need for treatment is extremely high.
Refugees are not legally allowed to work or leave the camps. For those we cannot treat, paying for expensive diagnostic tests and drugs, or obtaining appropriate care outside the camps, is out of their reach.
“Most refugees simply cannot be cured and resort to alternative methods of care, which are not effective and not without risks to their health,” says Baylac. “We welcome the announcement by the World Health Organization, the International Organization for Migration and Save The Children that 900 hepatitis C patients are to be treated in two health centres in the camps. This is an important step in the right direction.”
Most refugees simply cannot be cured and resort to alternative methods of care, which are not effective and not without risks to their health.Sophie Baylac, MSF head of mission in Bangladesh
However, a large-scale prevention ‘test and treat’ campaign is needed to effectively limit the transmission of the virus and avoid severe liver complications and deaths. For this, the involvement and determination of those coordinating the humanitarian response in the Cox’s Bazar camps will be required.
“Every generation of refugees living in the camps is affected by hepatitis C,” says Baylac. “They risk severe liver complications – which are not treatable in camp settings – and may die from it despite the existence of a very effective, well tolerated and patient-friendly treatmentOne tablet per day for three months that can be inexpensive.”
World Health Organization guidelines and simplified models of care used by MSF in similar contexts have proved effective in scaling up hepatitis C treatment with very good outcomes in humanitarian and low-resource settings. Over the past two years, we have also supported the Bangladesh Ministry of Health in drafting national clinical guidelines for the treatment of hepatitis C. MSF stands ready to continue working with national authorities, and inter-governmental and non-governmental organisations to implement large-scale prevention and health promotion activities, as well as a mass ‘test and treat’ campaign in all Cox’s Bazar camps to limit the virus transmission and treat as many people as quickly as possible.
Since October 2020, MSF has been offering free hepatitis C virus screening, diagnosis and treatment to the refugee population in Cox's Bazar, Bangladesh, at two of our health facilities in the camps (Jamtoli Clinic and Hospital on the Hill). From October 2020 to May 2024, over 12,000 individuals with suspected active hepatitis C infection have been tested by MSF with the GeneXpert diagnostic machine. Over 8,000 patients with confirmed active infection have received treatment in MSF facilities. Due to the high number of HCV patients, soon after the start of the programme, our teams had to limit and establish admission criteria mainly based on patients being aged over 40, as our capacity to absorb the care needs of people with hepatitis C had quickly reached capacity. MSF's treatment programme has a maximum capacity of 150 to 200 new patients requiring treatment per month.
Through its ‘Time for $5’ Campaign, MSF has been putting pressure on the medical test maker Cepheid and its parent corporation Danaher to lower the price of the GeneXpert hepatitis C viral load test used to diagnose hepatitis C. The test is currently sold to low- and middle-income countries at US$15 each – this is more than three times what MSF-commissioned research has shown the tests could cost to produce and be sold for with a profit, which would be $5 each. Following campaign pressure, in September 2023, Danaher announced it would reduce the price of the standard tuberculosis test from $10 to $8 each. However, Danaher continues to charge at least double that price for tests for other diseases, including hepatitis C. MSF is asking Cepheid and Danaher to reduce the price of all tests to $5 so that more people can access this diagnostic test, which could lead to lifesaving treatment, and especially vulnerable people such as the refugees in Cox's Bazar camps in Bangladesh.
