Dengue Fever – Falling Between the Cracks

Naria is on the banks of the Padma river, the biggest channel of the Ganges. In recent years, severe erosion has caused 13 km2 of land to fall into the river.

In 2018, extended heavy monsoon rains resulted in the disappearance of 2 km2 of land within two months, leaving up to 5,000 people homeless. With only a few shelters available, many of these people are living in dire conditions, where the risk of diseases like dengue is much higher. 

Ibrahim (centre) has lost his house twice due to land erosion caused by the Padma river. As well as countless homes, many other buildings and services have been engulfed, including several schools, mosques, the hospital, two health clinics and parts of a bazaar.

As well as the structural devastation, this heavy tropical rainfall also contributes to the breeding success of Aedes aegypti mosquitoes and the spread of dengue, particularly in areas where healthcare provision is limited. 

The streets of Uttara, a suburb of Dhaka that has expanded rapidly over the past 20 years, are sprayed with insecticide to exterminate mosquitoes during an outbreak of dengue. This process of 'fogging' is unlikely to have much success in preventing an outbreak from spreading as it targets only adult mosquitoes, leaving eggs and larvae unharmed.

Despite its limited efficacy, the fumigation process gives communities a sense of reassurance that some effort is being made to protect them. 

Sohid, 45, is admitted at the Dhaka Medical Hospital, as the doctors suspect he has dengue. He suffers from stomach pain (which can signal a haemorrhage), vomiting and motion problems.

'I don’t have any money left,' says his wife, Shenuwar. 'I gave it all for the bed and I have spent so much the last three days for the tests.' The previous week their daughter was also hospitalised with dengue. They struggle to pay for the baksheesh (bribe) required for medical care even though basic public health services are meant to be free in Bangladesh. 

Meena is tearful. Her eight-year-old son Maruf died a week ago from dengue. 'There was blood coming out of his eyes, his ears, his mouth. Blood, blood, blood,' she recalls painfully. 'No father should carry his dead son’s body, and no mother should grieve her child,' adds the father. 'Nobody should die of this disease, there should be an initiative to cure it as soon as possible.' 

In October 2018, almost 7,450 cases had been reported in Bangladesh, making it the deadliest outbreak since the first recorded epidemic in 2000. 

On the Buriganga river at Keraniganj port, boat drivers who take people across the river during the day sleep on their boats at night protected by mosquito nets. But although the Aedes aegypti and Aedes albopictus mosquitoes that carry and transmit dengue are most active around sunrise and sunset, they predominantly bite during the daytime when the boat drivers are most exposed.