COVID-19 is hitting Rohingya Muslims in the world's biggest refugee camp, and humanitarian groups are fearing mass infection

• Hundreds of thousands of Rohingya Muslims from Myanmar reside in Bangladesh, with many living in the Kutupalong refugee camp in Cox's Bazar.
• They live in cramped conditions, where social distancing is almost impossible.
• The coronavirus is slowly making its way through the camp, and aid agencies are concerned they could become overwhelmed with infections if the virus gets worse.

Nearly 1 million people live in the largest refugee camp on Earth, the Kutupalong camp in southern Bangladesh.

And with a population density greater than that of Manhattan, the Rohingya refugee camps at Cox's Bazar are the ideal breeding ground for a coronavirus which thrives in crowded areas with poor sanitation.

"We are getting lots of patients. In this area it is difficult to manage cases with home isolation or quarantine due to the crowded living conditions," said Debashish Chakraborty Debu, coordinator of the HOPE Field Hospital isolation center.

The refugees are entirely reliant upon aid for their day-to-day survival. And living conditions are dire. Homes are cramped and often built from flimsy materials while toilets and washing facilities are shared.

"This house is 18 feet by 12, with 10 of us in this tiny place. We're having a really hard time," said Mohammed Osman, a Rohingya refugee, sitting alongside his wife and children.

A crackdown by the Myanmar military in August 2017 on the minority Rohingya Muslim population triggered one of the largest movements of people in recent history.

The Myanmar government claims the attacks were targeted at militants. Over 700,000 fled into neighboring Bangladesh in the months that followed, having lost everything.

"We came because the Myanmar people burned our homes and shot us," refugee Majuma Khatun, told Business Insider Today. "So to save our lives we went to the mountains. We walked through the mountains all night. Then we crossed the river by boat, that's how we came to Bangladesh."

With the refugees away from their homes and traumatized by what the UN refers to as a campaign of "ethnic cleansing," the coronavirus is only making an already dire situation worse.

"With monsoon, with soil erosion, with flooding, it's a very very difficult environment to be in," said Louise Donovan, Communications Officer for the UN High Commissioner for Refugees. "The camps are hugely overpopulated. You have more than 40,000 people living per square kilometer. And with the risk of transmission of COVID-19, it just makes life so very difficult for this population."

The World Food Programme provides food for every refugee in the camps, but lockdown restrictions mean the group has to restrict the number of times people can visit their distribution points.

"Just the idea of social distancing is almost impossible to imagine," said Alex Dattani, a Field Operations Consultant for the World Food Programme. "The refugees are scared, they're frightened, they're afraid."

With Bangladesh hit hard by the COVID-19 pandemic, it was only a matter of time before the Rohingya camps succumbed too.

The first case was detected on May 14, with the first death coming at the end of the month. As of July 12, there were 57 confirmed cases within the refugee camps and five deaths, according to World Health Organisation figures.

"First, I wash my hands with soap," Jahura Khatun, a Rohingya refugee, told Business Insider Today. "Then ensure good hygiene for the children. We give masks to the children. We are all wearing masks, not socializing with neighbors. We are staying at home."

UN and other humanitarian agencies have scrambled to construct new centers for diagnosing, isolating, and treating patients with COVID-19. And now, with the monsoon season underway, they are also working to counter the threat of landslides and other water-born illnesses.

The HOPE Foundation for Bangladesh opened a 50-bed Isolation and Treatment Center for COVID-19 patients at the end of June.

"Here in the new unit we are treating patients with symptoms of fever, runny nose, sore throat, which in medical terms is called flu like illness," said Debu, the center's coordinator. "We are keeping them separate from our main hospital to prevent spread of infection."

The region's first intensive care unit also opened at the end of June in Sadar Hospital in Cox's Bazar — with ten ICU beds with ventilators and eight high-dependency unit beds. In all, the UN High Commissioner for Refugees is aiming to create 1,900 beds for coronavirus patients.

But just when help is most needed, 80% of NGO staff are being barred from entering the camps to reduce the risk of transmission.

"This means that a number of services have been reduced and we're down to bare life-saving activities. So it's extremely tough but we're doing all that we possibly can," Dattani said.

Much of the tracking and tracing work, as well as community outreach, is now down to Rohingya volunteers. With a government-imposed internet blackout, this must be done door-to-door, with loud hailers or over the radio.

"These teams are doing contact tracing, ensuring that any close family members or close contacts are quarantined immediately and also tested," said UNHCR's Donovan.

"So we're doing what we can to try to reduce the risk of further transmission. It's possible with the population density that it can spread rapidly, and potentially it could overwhelm the response capacity that we currently have in place."

The Rohingya can see no end in sight to their suffering. Thankfully, cases of COVID-19 are so far relatively low compared to the wider region.

Moyuna Begum is a refugee and is keen to help out where she can, and has received training from the World Food Programme in how to make face masks.

"Everyone is afraid. People are thinking that it was outside, but now it has attacked us. People are dying and suffering from the illness," she said. "To help them avoid that situation, I am happy to make these. No matter if I am paid or not, people will be alive and will keep me in their prayers."