Sustainable Development Goal 3: Good Health and Well-being

Abstract

In September 2015, the United Nations (UN) proposed Agenda 2030, an ambitious initiative to end poverty, combat climate change, and fight injustice and inequality over the next 15 years. Agenda 2030 promises a better future for all by setting out 17 sustainable development goals (SDGs) that the Member States of countries all over the world have committed to achieving. These goals cover a range of different topics—from ending poverty, improving healthcare, and building more inclusive and sustainable cities, to reducing the impacts of climate change (Fig. 4.1). The goals were adopted by all Member States of the UN formally in 2015 (September 25–27, 2015; at the 70th anniversary of the UN), and were effective from 1st January 2016 for the period 2016–2030.

Case Story

1.1 Medical Mission for Refugees in South-East Asia (FDMN in Bangladesh)

• Munir Ahmed &
• Lutful Husain 

Since August 2017, over 700,000 Myanmar nationals (Rohingyas) have migrated from the northern Rakhine state of Myanmar to Teknaf and Ukhyia sub-districts of the Cox’s Bazar district of Bangladesh (Fig. 4.4). The United Nations High Commission for Refugees (UNHCR) estimates this migrated population of ‘forcibly displaced Myanmar nationals (FDMN)’ to be 1.2 million people, including all earlier arrivals. This sudden and massive influx overwhelmed existing health services in Bangladesh. In response, the Government of Bangladesh, with a number of international non-government organizations (INGOs) set up 74 health centers, including health posts in and around the resettled migrant population. This was in accordance with the WHA resolution 70.15 of 2017 (promoting the health of refugees and migrants) that urges member states to oversee safe and orderly migration, address health needs, strengthen international cooperation on the health of refugees, and provide health-related assistance through bilateral/international cooperation [60].

Fig. 4.4

FDMN on way to southern Cox’s Bazar district I Bangladesh (Source: UNHCR)

The Bangladesh government accepted the Orbis International proposal to make provisions for primary eye care, integrated with general healthcare in this region, both for the host community, and the migrant population (Fig. 4.5). The systematic planning for this included a rapid assessment of avoidable blindness (RAAB) for people 50 years and older, establishing provisions for basic eye care, and engaging the Cox’s Bazar Baitush Sharaf Hospital (CBBSH, 34 km from the migrant population) for referrals and ophthalmic surgery. A study recorded the high burden of untreated eyes of young adults [61] and the RAAB study showed prevalences of blindness (vision < 3/60) and severe visual impairment (vision < 6/60) at 2.1% and 2.4%, respectively, in the elderly people of this population.

Fig. 4.5

FDMNs at the improvised eye screening facility at Kutupalong (camp # 4), Ukhyia, Cox’s Bazar, Bangladesh (Source: Orbis, Bangladesh)

Orbis International also addressed issues of system strengthening through the following measures: improving eye health infrastructure and service delivery at primary and secondary levels; skill development of primary eye care personnel; defining the referral pathway; building efficient data management and patient information systems; and identifying and engaging leaders from both, the host and migrant communities. Orbis International spearheaded the collaborative platform for this migrant population health crisis and formed the ‘Eye Health Forum of Cox’s Bazar’ that included the government, various UN agencies (UNHCR, WHO, IOM (International Organization for Migration), and UNICEF), and INGOs (Orbis, Seva, International Agency for the Prevention of Blindness (IAPB), the Fred Hollows Foundation, and the CBM). When this article was being written (July 2020), the Eye Health Forum had trained 800 medical and other professionals in eye health, screened 160,000 people, provided spectacles to 8370 people, and facilitated 3389 eye surgeries.

Globally, an estimated 65 million people are forcibly displaced from their homes. Developing countries host 86% of such displaced populations [60]. While this is a global tragedy calling for a political solution, experience in dealing with FDMNs in Bangladesh suggests that humanitarian efforts could be maximized by good collaboration and linkage between the Government, community, and INGOs. Additionally, an effective health model that basically consists of three phases: emergency phase, settlement phase, and (long-term) engagement phase must be put in place. Activities in the Emergency phase, include provision of emergency services when the displaced population is still moving and is dispersed; it is possibly the time for eye health scoping and positioning. In the Settlement phase, the moving population is mostly contained and settled in specific locations with a supply system of basic needs; this could be the right time for health intervention. Once this is done, a strategic, integrated, comprehensive, sustainable, inclusive eye care system could be planned for the Engagement phase. The lessons learned and evidence generated from this instance could guide policy makers in eye care and healthcare during similar human disasters.