icddr,b’s response to the 2024 Bangladesh Flood

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In August 2024, the eastern and southeastern regions of Bangladesh faced severe flooding. From 20 August, districts such as Feni, Cumilla, Noakhali, Habiganj, Moulvibazar, Khagrachari, and Rangamati experienced unprecedented water levels, resulting in widespread devastation. By 22 August, heavy rainfall, exacerbated by water released from upstream sources in India, intensified the floods. Major rivers, including the Gomati, Surma-Kushiara, Manu, Khowai, and Feni, overflowed, inundating low-lying areas and impacting regions like Moulvibazar, Sylhet, and beyond. The National Disaster Response Coordination Centre (NDRCC), in its report dated 7 September, highlighted that 11 districts—Feni, Cumilla, Chattogram, Khagrachari, Noakhali, Moulvibazar, Sylhet, Habiganj, Brahmanbaria, Lakshmipur, and Cox’s Bazar—were affected by the flooding. A total of 504 unions and city corporations across 68 upazilas have been impacted, with approximately 5 million people affected. The floods have led to 71 reported deaths (45 male, 7 female, and 19 children) and displaced 207,191 individuals who are currently residing in 3,372 shelters.

icddr,b’s immediate response 

With over 60 years of expertise in managing diarrhoea and cholera, icddr,b is committed to leveraging its knowledge and resources to support those affected by the recent floods in Bangladesh. Its scientists, doctors, and nurses are at the forefront of emergency response, often working with the World Health Organization to provide rapid-response teams, case management training, and laboratory services during serious outbreaks. The management at icddr,b swiftly addressed a request from the AntiDiscrimination Student Movement (ADSM) on 23 August, providing essential medical supplies to their emergency team despite the weekend. Following this, icddr,b formed an Emergency Task Force Team, consisting of seven members who meet almost every day to identify intervention areas, collaborate, and implement various activities. Drawing on its mission of creating a world where more people survive and its extensive experience in managing post-flood situations where diarrhoeal disease outbreaks are common—icddr,b has emphasised the critical areas of safe water access, diarrhoea prevention and treatment, diarrhoea case management training, and surveillance of diarrhoeal pathogens. The Task Force has collaborated closely with the Ministry of Health and Family Welfare (MoHFW), Directorate General Health Services (DGHS), local Civil Surgeons, the Bangladesh Armed Forces Division (AFD), ADSM, Lal Sabuj Society (LSS) and other stakeholders. icddr,b’s interventions include medical support, awareness campaigns, and the investigation of stool specimens. Below are some highlights of these responses: 

Safe Water Access 

Water purifying tablets icddr,b has distributed 173,000 water purifying tablets (Halotab Plus), which have the capacity to purify approximately half a million litres of flood water, making it safe for drinking. These tablets have been provided to the Armed Forces Division (AFD), who are reaching the most vulnerable populations in remote areas, as well as to the Civil Surgeons of Noakhali and Cumilla to support their efforts. Large-scale water purification solution The flood, marked by strong currents and high tides, left large areas submerged for weeks after the initial impact. In response, researchers from icddr,b’s Environmental Health Laboratory visited flood-affected Burichang, Cumilla, on 27 August to develop a simple, affordable pointof-care (POC) water purification method. They tested the optimal amounts of fitkiri (potash alum) and bleaching powder and confirmed their effectiveness in the lab. The team found that 4 grams of fitkiri per 25 litres of water helps settle particles, followed by 1 gram of bleaching powder per 20 litres of pre-treated water ensures safe drinking water. They demonstrated this two-step process to the local community, providing instructional leaflets. In a pilot effort, 100 households in Lakshmipur received water kits that included buckets, clean cloths, mugs, fitkiri, bleaching powder, and soapy water for hygiene. 

Disinfecting Submerged Tubewells 

The Department of Public Health Engineering (DPHE) of Bangladesh estimated that 193,533 tubewells were partially damaged and 49,486 fully damaged during the 2024 floods, with 80% of government-installed tubewells submerged. Based on previous studies conducted by icddr,b and Columbia University, USA, icddr,b developed a simple three-step process to disinfect tube-wells that were submerged. icddr,b distributed 8,000 leaflets locally, detailing this method, and disseminated the information on social media for wider outreach. Advocacy is also underway with various social institutions and informal groups, including ADSM, to ensure this disinfection process is widely adopted. Plans are in place to deploy icddr,b teams to flood-affected communities to demonstrate the tube-well disinfection process, ensuring access to safe drinking water during recovery efforts. 

Essential Medical Supplies 

icddr,b responded promptly to the request from the Anti-Discrimination Student Movement (ADSM) on 23 August, supplying essential medical items such as life-saving injections, oral rehydration solution (ORS), IV saline, and first aid supplies. Similar supplies were provided to the Cumilla Civil Surgeon on 28 August and to the LSS for a medical camp in Feni on 28 August. On 4 September, icddr,b supported the Noakhali Civil Surgeon with four categories of key supplies, including intravenous saline, Halotab, ORS, and antibiotics. Additionally, on 8 September, icddr,b provided six categories of essential supplies to the Lakshmipur Civil Surgeon. Furthermore, icddr,b is working with LSS to support three additional medical camps and is exploring collaborations with other groups to extend its medical aid efforts.

On-site Medical Teams 

On 29 August 2024, icddr,b organised a free medical camp at Fulgazi Pilot Girls High School in Feni, one of the most severely affected districts by the recent flash floods. Flood-affected residents from Fulgazi and surrounding areas sought medical assistance for a variety of health issues, including cold, cough, fever, abdominal pain, diarrhoea, cuts, allergies, and scabies. Expert doctors from icddr,b’s Matlab Health Research Center provided both medical care and free medicines. Attendees were also educated on simple methods to purify floodwater and how to respond to cases of diarrhoea. This camp was made possible through full cooperation from the Bangladesh Navy. In addition, icddr,b deployed another medical team to Noakhali based on request from the Civil Surgeon for diagnosis and treatment of Acute Watery Diarrhoea (AWD) from 4–8 September. The 6 member team offered support to the Noakhali Sadar, Begumganj, Senbag, and Sonaimuri Health Complexes using RDT for diagnosis of cholera as well as for treatment of diarrhoeal diseases. At the request of the Bangladesh Army, an icddr,b team has been deployed in Feni 250 bedded Sadar Hospital since 4 September to address ongoing needs. icddr,b continues to coordinate with the Civil Surgeons of the affected districts and the Armed Forces Division, standing by to deploy additional medical teams as necessary. Diarrhoea Case Management Training 

In response to the flood crisis and subsequent diarrhoeal disease outbreaks, icddr,b is offering comprehensive training programmes to equip healthcare providers with effective management skills. Training is available both in-person and online, including hands-on sessions at icddr,b, day-long courses at Upazila health complexes, mobile units for field medical camps, and virtual sessions. On 4 September, icddr,b conducted a two-hour online training session on the clinical presentation and management of diarrhoeal diseases, with 44 participants from Shandhani, the Bangladesh Army, Akij Foundation, and Dreamers Foundation. On 5 September, 10 doctors from Dreamers Foundation and public medical institutions participated in hands-on training at icddr,b’s Dhaka Hospital, the world’s largest diarrhoeal disease hospital. Later that day, icddr,b doctors trained 66 doctors at ADSM’s programme at TSC, Dhaka University. Additionally, an icddr,b expert provided rapid training in several Upazilas of Noakhali from 4–5 September. On 9 September, 60 participants from Bangladesh Army, Bangladesh Navy, LLS, Akij Foundation, and local health workers attended an online session. icddr,b scientists observed that the inappropriate and indiscriminate use of antibiotics and anti-diarrhoeal agents in outbreak areas remains a common issue, reinforcing the need for more hands-on training in case management. These efforts focus on diagnosing dehydration, improving patient management, reducing unnecessary antibiotic use, promoting correct ORS use, and raising awareness on diarrhoea prevention. 

In-house ORS Production 

In late August, when ORS was unavailable in the market, icddr,b received numerous requests for this vital treatment. Drawing from past flood experiences, the task force decided to produce ORS in house, adhering to WHO GMP and DGDA standards. Sample packets were submitted to DGDA, and on 8 September, they confirmed the test results met global standards. On 9 September, icddr,b began producing 100,000 ORS packets. By 15 September, 9,222 sachets had been produced, with 4,000 given to the Bangladesh Army for distribution on 12 September. This voluntary initiative has strong support from icddr,b staff, preparing for potential large-scale outbreaks. 

Communications And Advocacy 

icddr,b produced and distributed 38,000 copies of three leaflets addressing key post-flood issues, including tubewell disinfection, flood water purification, and diarrhoeal disease prevention and treatment. icddr,b is also grateful to celebrities, media outlets, and influencers, including Ms Nusrat Imroz Tisha, for amplifying these leaflet’s reach on social media. Dr Tahmeed Ahmed, icddr,b’s Executive Director, spoke at a Prothom Alo roundtable, one of Bangladesh’s highest-circulated newspapers. He highlighted post-flood health strategies for vulnerable groups such as children, pregnant women, breastfeeding mothers, the elderly, and those with NCDs. He emphasised the importance of simple water purification methods and hygiene, promoting icddr,b innovations like soapy water. Our medical teams have reported critical issues, including misuse of water purifying tablets, improper ORS preparation, use of feeding bottles which could lead to risks like hypernatraemia, and the indiscriminate use of antibiotics. To address these, icddr,b is producing educational videos on the safe use of antibiotics, proper ORS preparation, and correct handling of water purifying tablets, along with repurposing existing videos to reinforce these important messages.

Looking Ahead 

As icddr,b continues to support communities affected by the 2024 floods, we extend our gratitude to all the organisations, partners, and individuals who have contributed to these efforts. Their support has been crucial in ensuring effective response and recovery. We remain committed to addressing the ongoing challenges and enhancing our collaborative efforts to safeguard public health in these difficult times.