Rafiqul Islam (40) is a resident of North Bedkashi village in Koira upazila, Khulna, and works as a rickshaw driver. Being situated on the banks of the river, his houses have been damaged by cyclones like Sidor and Ayala. At one point, his settlement was swallowed by the river, leaving him without a home. Relocating multiple times has exposed Rafiq’s family members to various infectious and non-infectious diseases. To ensure healthcare, he resorted to taking loans from relatives and neighbors, eventually leading to the sale of his last piece of agricultural land to relieve the debt burden.
Majed Ali (45), a boatman from the same area, faced a similar plight. Last year, flooding and river erosion destroyed their homes, leaving him to support a family of six, including his elderly mother. As the sole earner, Majed is battling an unknown illness while trying to ensure healthcare for his family. Resorting to desperate measures, he borrowed Tk 40,000 from a non-governmental organization (NGO) at a high interest rate.
Rafiqul Islam and Majed Ali’s stories are not unique; many coastal residents have been displaced by climate change-related disasters. Despite once being self-sufficient, most now struggle with unemployment due to the loss of support systems. Consequently, 93 percent are forced to borrow for private healthcare due to the scarcity of government healthcare in remote areas. Borrowing from relatives, neighbors, and NGOs, they find themselves trapped in a cycle of poverty.
Recent research, as detailed in the article ‘Climate Change Impacts and Adaptations on the Health of Internally Displaced People (IDP): An Exploratory Study on Coastal Areas of Bangladesh,’ sheds light on the healthcare debt accumulated by the displaced over the past decade. The study, conducted on 420 displaced families in Koira and Batiaghata upazilas of Khulna’s coastal region, utilized a range of qualitative and statistical research methods during an eight-month fieldwork period.
Findings reveal that 38.1 percent of displacement cases in the last decade were due to river erosion, while 35.7 percent resulted from cyclones. Additionally, 19 percent cited a loss of standard of living, 4.8 percent reported destruction of agricultural systems, and 2.4 percent cited a lack of clean water as reasons for displacement. Despite relocating, 78 percent of families faced adverse conditions in their new environment, resulting in increased prevalence of various diseases. Skin diseases, diarrhea, cholera, jaundice, dysentery, dengue, chikungunya, and malaria have all seen an uptick in incidence rates, emphasizing the healthcare challenges faced by the displaced.
The coastal internally displaced persons (IDPs) face various barriers to medical treatment. Ninety-three percent cite a lack of money, 91 percent limited access to health information, 88 percent a scarcity of qualified doctors, 77 percent weak social systems, 33 percent cultural diversity, 26 percent gender discrimination, and 17 percent differences in religious practices as obstacles.
One of the four researchers involved in the study is Md. Arif Chowdhury, a teacher in the Department of Disaster Management at Jessore Science and Technology University. He emphasized that families displaced by natural disasters often live below the poverty line, forming a single, impoverished community. Lacking savings for emergencies, they must travel 20 to 30 kilometers to the nearest government healthcare facility, where poor communication systems and inadequate management hinder access to proper healthcare. Consequently, they often resort to seeking treatment in larger cities like Mofswal or district/divisional centers, incurring debts to cover medical expenses, doctor’s fees, patient monitoring, and medication costs. The absence of specialist doctors in coastal areas forces them to rely on rural and traditional healthcare providers.
Due to financial constraints, most IDPs rely on formal and informal loans to access healthcare. Ninety-two point nine percent borrow from relatives, 81 percent from neighbors, and 2.4 percent from non-governmental organizations (NGOs). These impoverished families have exhausted their resources and are often forced to forego healthcare, selling livestock, birds, or ornaments to cover medical expenses.
Another displaced individual, Humayun Kabir (45) from Koira Upazila, remains indebted for his wife’s medical treatment due to unemployment. Working as a day laborer, he has taken a loan of fifty thousand taka from a local NGO to alleviate the debt burden. He laments the absence of nearby community clinics and the inadequacy of basic healthcare services in villages under government management, forcing them to incur debt for even minor medical needs amidst their struggle for survival.
However, BUET Emeritus Professor and water and climate change expert Dr. Ainun Nishat said, “It is not right to blame everything on climate change. This will eliminate the main challenge of climate change. While it is true that coastal areas are most at risk, the diseases mentioned can be caused by various factors. The borrowing of IDPs for healthcare is due to government institutional weakness and corruption. Bangladesh is preparing to face climate change, and we are trying to collect correct information and data.”
The professor of Health Economics Institute at Dhaka University, Syed Abdul Hamid, mentioned that these displaced people have no chance to break out of the vicious cycle of poverty. He stated, “The wealth of these poor people is manual labor, cattle, and birds. They have to sell and borrow these to pay for healthcare. It cannot be overcome overnight. However, if the government structure is properly managed, the basic rights of coastal people can be ensured. Government healthcare has a good structure, but the practical system is very weak.”
Dr. Abul Bashar Mohammad Khurshid Alam, Director-General of the Department of Health, emphasized, “It is not possible to ensure all services solely through government healthcare institutions. Starting with social service activities, local awareness is crucial. The government is leaving no stone unturned in ensuring healthcare. I will discuss and try to implement measures in these upazilas.”