Are Bangladeshis considered black

Climate change and healthBangladesh between heat deaths and cyclones

"In the West we are trying to imagine what our world will look like with two or three degrees more. In Bangladesh, you can feel the climate change for a long time."

Climate change is the greatest threat to health in the 21st century, it has been said for some time. But is that really true? Perhaps societies can adapt and somehow get by.

(Sean Gallup / Getty Images)

"For some years now, the hurricanes have been increasing and threatening the lives of the residents."

One country where people have always lived with water is Bangladesh. They found solutions for floods and monsoons. Life expectancy today is 72 years, the vaccination rate is 90 percent and in terms of infant mortality, Bangladesh has moved up from the lowest places to 45th place worldwide. Now they are hit by climate change.

The river washed away the houses

For moto rickshaws the road is over, here on the outskirts of Dacope. If you want to go further, switch to the water. The Pasur flows calmly, wider than the elongated village. Downstream it will eventually flow through the mangrove forests and flow into the Indian Ocean. A narrow wooden boat takes me to the other side of the river. There, on the bank, Satyendra Nath is waiting.

Satyendra Nath has lost his house several times to floods and rising river levels (Mathias Tertilt)

"The first house was where the river now runs. The second has also been washed away and we are now where the third was."

Nath turns away from the river and purposefully climbs a meter-high dam, a few meters behind it is now his fourth house. We continue on a poorly paved street, past a large, two-story house. The school, he says, is also a shelter from the flood.

Bangladesh knows hundreds of words for flood and flood; such as Barscha, the annual monsoon rains that irrigate the fields, and Bonna, unusual, destructive floods. Actually, they had already lost their horror. Almost 200,000 people died in the floods in the 1980s. But today there are 2,500 shelters. The whole country was diked. In the last flood, just 36 people died. But now the evil seems to be returning.

Salt in the ground spoils the rice harvest

Other men join us because what Nath says affects them all. On the left are the rice fields. The last. You harvest less and less, says Nath.

"The rice harvest from our fields is not enough. We have to buy rice to survive. The government gives us meal cards so that we can buy additional rice for 10 taka per kilo."

One fifth of the market price. Rice farmers have to buy rice because the soil has become salty.

Meager yield: More and more rice farmers are losing their harvest (Mathias Tertilt)

"Our harvest has declined sharply since 2009, since cyclone Aila. The dams have broken and our entire country has been flooded with salty water."

It's 70 kilometers from the Indian Ocean to here. The cyclones, which are so typical of Bangladesh, transport the salty sea water to the village and further inland. Nath and the other men observe that something is changing. There are actually six seasons in Bangladesh, according to which the grains of rice are sown and harvested. But today there are only three seasons left, nothing can be predicted any more.

Farmers have to look for work elsewhere

The men who are talking excitedly and wanting to be heard are the ones who are still holding out. Others are long gone:

"One in four people emigrated to India. And many other men left because of work and left their families here. Most of those who still live here no longer work in the fields, but elsewhere, for example in stone factories."

This is the fate that met Nath.

"Of five brothers only I live here."

For Bangladesh with its 160 million inhabitants, climate change is an existential problem. Part of the country is less than a meter above sea level, the majority not more than five meters. In a few decades the sea level has risen by 35 centimeters. Researchers predict that it will grow to at least one meter by the end of the century. In theory, without dikes and dams, that would permanently flood 20 percent of Bangladesh.

Salinization has several causes

To blame the rise in sea level for all the salt in the fields is too easy for the hydrologist Ainun Nishat from BRAC University in Dhaka:

"There are three factors: the first is that since the dam was built in India in 1975, less and less fresh water has flowed. That is the main reason. Second, there is the rise in sea levels. Third, there are the cyclones, which bring salt water from the sea inland float."

The Farrakhe Dam in southeast India has greatly reduced the flow of water in the Ganges. What sediment it otherwise washed up to the coast, replenished the eroded areas in the river delta. But now it is already settling on the way - the river bed flattens out and there is even less water flowing. However, the water flow is like a bulwark that constantly presses against the sea water. The less water flows, the easier the sea flows inland. Climate change and sea level rise did not cause salinization, but they do exacerbate the problem. And people have to deal with it. Not all continue to trust rice with their future.

Rice farmers become fish and shrimp breeders

The bus to Mongla leads past the kilometer-wide flat landscapes of Bangladesh. The rice is often yellow, unhealthy, probably infested with parasites, and the further south we come, the rarer the rice fields become, the more frequent mangrove trees and other tree species that can withstand salty water. Once in Mongla, huge areas are reflected on the left and right. No rice stalk protrudes from them. Ananda Biswas, a man in her late 60s, crouches next to the street. He still remembers what it looked like here before:

"40 years ago we had fresh water ten months a year, the salt water only came for two months."

Rice was once grown here - now people grow shrimp (Mathias Tertilt)

He used to grow rice, today he grows fish and shrimp - like everyone here. Over the years, more and more farmers or landowners have flooded their fields with salty water. Since the 1990s, the export volume of shrimp and fish in Bangladesh has more than doubled to over US $ 630 million. The shrimp farmers are not only a symptom, but also the cause of the salinization. They kept pumping the salty water inland. As of now: almost half of 2.8 million hectares of coastal areas are affected.

People have to drink salty water

Even here in Mongla, right on the river, that's a problem. In front of Purnima Nath's house there is a large tank in which the family collects rainwater during the monsoons since they can no longer drink from the river or the well in the village.

"We collect the rainwater, we have 1,000 liters, but if we just drink that, it would be empty quickly. We've already drunk half of it, it will probably be empty in a month."

The inhabitants of the coastal region collect fresh water in large tanks (Mathias Tertilt)

While she is saying that, there are still six months to go before the next rain. You will have to drink salty water. The people here ingest three times as much salt with the water alone as recommended by the World Health Organization.

Health risk especially for pregnant women

Sontosh Kumar Mojumder is a gynecologist at the nearby hospital in Dacope. Years ago, together with other doctors and scientists, he investigated whether the salty water had any health effects on pregnant women. He points to a poster on the wall.

"In preeclampsia, the legs, body and hands swell. The women have headaches, their vision is blurred. And when it becomes more acute, it becomes eclampsia. There is premature labor and premature births and miscarriages."

The hospital is always overcrowded. Most of them are here with circulatory problems, high blood pressure and secondary diseases. According to their study, Majumder and his colleagues did a lot of educational work, and word got around about the effects salt can have on pregnant women. The educational work in the region seems to have paid off. He currently has no more eclampsia cases.

But the problem will only get worse, estimates hydrologist Nishat:

"100 years ago the whole southwest was still a freshwater ecosystem, now it is salty. In maybe 30 or 40 years we will have the salinity of the sea everywhere there."

Magnesium and potassium could also play a role

Nishat's place of work is the capital Dhaka. A third of the area of ​​Cologne, but 21 million inhabitants. One of the largest and fastest growing cities in the world. Every day the city sinks into the haze of exhaust fumes and smoke, breathing is difficult, the lungs refuse. In the middle of the city center, in the Mohakhali district, is the International Center of Diarrheal Disease Research (ICDDRb), the world's only cholera hospital and a research institute next door. Here, researchers have been studying the effects of climate change on health for years, looking for connections and causes.

Manzoor Hanifi found an influence of salt on the population in two cohorts. He also found that the saltier the drinking water, the higher the probability of miscarriages. But he does not share the simple blame for climate change - sea level - salt. He sees a correlation, not a clear cause. Minerals such as magnesium or potassium could also lead to malnutrition and health problems, as other studies have shown. According to this, blood pressure is more closely related to these concentrations than to the salt in drinking water. Nevertheless, it must be investigated further, says Hanifi:

"It's only slowly that you see the effects of climate change, but at some point they are very big. If we don't do anything now, we can't prevent them. We have to work and research much more on the connection between climate change and health, but nobody is addressing the issue. "

But one thing is certain, says Hanifi:

"Water is always the problem, in the beginning people drank the same water in which they bathed, then the heavy metal arsenic was found and now the drinking water is too salty. Water remains a problem."

A rise in temperature favors pathogens

Temperatures in Bangladesh have risen by almost one degree in the last century. In Dhaka, at 26 degrees, they are another two degrees above that of the surrounding area. At the same time, the rains are becoming more extreme. This combination offers the best conditions for many disease carriers. Brief, heavy rains create millions of mosquito breeding grounds.

In 2019, Bangladesh experienced the worst dengue outbreak on record. 20,000 people were infected, previously it was rarely more than 3,000. Sudden, short rains hit the city completely unprepared. Malaria is also penetrating further inland, and more and more people can tell about the painful infection with chikungunya.

And even a disease that has been fiercely fought in Bangladesh for decades is showing a new rise: cholera. It lurks mainly in cracks and crevices in the slums. Less than a fifth of the wastewater in the 20 million metropolis is treated. During the monsoon rain, the masses of water wash out the dangerous intestinal pathogens and distribute them. Up to 250,000 people are infected with it every year in Bangladesh, more than 4,500 people die from it - more than 100 times as many as last drowned in the worst floods.

In the ongoing battle against cholera

In the warm and dry phases, the bacteria multiply extremely quickly, and the rains then wash them through the entire city. The Cholera Hospital fights against the common diarrheal diseases every day of the year.

Dr. Azharul Islam Khan heads the facility. It's still early in the morning, but every minute cars and rickshaws drive into the forecourt, people are jostling.

Head physician Azharul Islam Khan on patient rounds (Mathias Tertilt)

"People all want to come in, but we only allow one relative per patient. Imagine we always have 500 to 600 patients, with one relative alone that's more than 1,000 people. More is simply not possible."

Most crowd around to register. A quick decision must be made here as to whether the cases are particularly severe.

"We call it an emergency because severe diarrhea dehydrates the patient. So they come on the bed and immediately get intravenous fluids. This is how you save lives."

There are only a few minutes left for each patient.

"Every hour we write here on the board how many patients are coming. This way we get a feeling for whether there is an outbreak. This way we can organize additional doctors, nurses, cleaning staff and helpers."

Cholera use in chord: The paper table with the patient numbers (Mathias Tertilt)

He looks at the numbers from yesterday evening.

"We had 872 patients. This is now an outbreak."

Pragmatic solution for diarrhea patients

More than 220,000 patients are cared for and treated here as if on an assembly line, most of them stay 24 hours. Many can also get well at home with medication.

Khan leads through the halls that are more reminiscent of field hospitals. It's bed to bed.

"It is impossible for us to meet the international standards for bed spacing."

The folding beds consist of a handful of wooden strips, the patients then lie on a thick plastic tarpaulin with a hole cut in the middle.

"The hole in the middle - imagine you have cholera and there is water flowing out of your bowels all the time like opening a faucet with a full stream. Patients are so weak, they have nowhere to go. This is the only way." you still have some comfort. The chair flows through and ends up in the bucket. "

View of the hospital ward with beds for cholera patients (Mathias Tertilt)

It can be several liters per hour. The buckets are exchanged in chord by helpers running around. This is also used to know how much fluid the patient will need again. Dr. Khan talks to a mother whose sick child lies weakly in her arms. About a third of all children are malnourished, which makes cholera particularly dangerous.

"This is a case of persistent diarrhea that has already occurred for 25 days. After 14 days, there is a special cause, an illness, an intolerance, a contamination. But she doesn't believe that the child drank dirty water."

Great strides in primary health care

Often the patients do not know what the cause of the common diarrheal diseases is. The ICDDRb scientists therefore observe and care for patients in the slums at home and provide information about hand washing and water treatment. It helps a little, say the researchers. Until the next flood comes and cholera breaks out.

In a slum area of ​​Dhaka, two health workers are sitting on the bed in a small room. The ceiling is barely visible, so many pieces of paper and documents lie around it. You are responsible for ensuring that this part of the population also receives basic medical care.

Patients and relatives in the hospital in Khulna (Mathias Tertilt)

90 percent of the population is vaccinated, polio and other poverty-related diseases have been eradicated even in the slums, and child mortality has more than halved in the last 20 years. The health system also reaches many remote villages. Bangladesh has made great strides. But now it has to completely rethink, says Dr. Quamrum Nahar, who heads the Climate Change and Health Department at ICCDRb. The non-infectious diseases of affluence are already being added and there is even more threat, she says.

"We get a double burden. We have diabetes, high blood pressure, cancer and other problems. With climate change something like heat stress is added. This will be a big problem, especially for cities and more and more people are living in cities."

Poisoned air, sick water in the capital

The doctor believes that Bangladesh is not sufficiently prepared for what is already emerging. Data from neighboring India shows that the number of heat deaths has been rising steadily for 30 years - and has recently been three times higher.

"To be honest, I don't see that people are thinking in this direction. Our government is still busy reducing maternal and child mortality. Our health system is not prepared for the new development. And if you look at the political programs to adapt to the If you look at climate change, health is completely neglected there. The word health appears only twice in the entire document. "

More and more people are drawn to the capital Dhaka (Mathias Tertilt)

More and more people flock to Dhaka from all directions.They live in winding slums, seven of them share a bed and live from one day to the next. The air we breathe is poisoned by heavy metals, the wastewater full of pathogens - no syringe protects against this. In many hidden detours, climate change could wipe out decades of health success.

Mental stress for the population is increasing

Then there is the psychological stress, says the psychiatrist Helal Uddin Ahmed. He has found in research that most people cannot cope with the frequent flooding.

"Climate change is one of the greatest threats to mental health. But we have also seen that coastal people can cope better with it because they have always lived with the adversities of nature. Inland people are more vulnerable."

But if the coastal residents flee to the cities, they face new challenges. Cities mean stress - and a risk to the psyche, says Ahmed. He learns more and more about the extent. In 2018, Ahmed and other researchers systematically examined the mental health of the population for the first time. According to this, almost every fifth adult and every sixth child suffers from mental health problems. You have to pay special attention to them, says Ahmed:

"Children and adolescents are more susceptible to mental illnesses, the latest reviews have shown that half of all mental disorders start before the age of 25. We have to protect these people particularly."

Researchers predict that around 20 million people in Bangladesh will be displaced by climate change. There is a high probability that they will go through long, exhausting or even traumatic experiences. The government is already investing in awareness raising campaigns to get people to turn to doctors - creating another problem, says Ahmed:

"People are actually coming and we are not prepared for it at all. We are 250 psychiatrists and 100 psychologists across the country."

Plans are adapted to climate change

Atiq Rahman certainly sees the successes of his country, which climate change is now endangering:

"Child and maternal mortality has been significantly reduced, life expectancy has increased, everything shows that we are better today. But the lowest fruits are the simplest. We have now taken the simplest measures, such as expanding medical care."

Addressing climate change is more complex. Rahman therefore calls for a radical rethink in all areas:

"Climate change has to become part of education, part of social planning, part of all of our thinking. And we have no choice because climate change will not be over tomorrow."

The people of Bangladesh live with the water - dams act as roads (Mathias Tertilt)

Politicians are aware of the changes that are changing the country and life in Bangladesh now and in the future. Since 2005, Bangladesh has been the first country to adopt a national action plan against climate change. It is currently being updated for the second time. Almost everything is now being adapted to climate change. New roads are also planned as dams, and all new school buildings in the countryside are also flood bunkers.

At the same time, politics has changed completely over the past few years. Atiq Rahman used to crisscross the whole country with dykes, they were supposed to avoid disasters like flooding. Today it's about being flexible. When there is a lack of drinking water, residents should collect more rainwater. When rice isn't working, people are encouraged to make a living with other grains, fruits, or chicken. It is important to diversify and get creative.

Living with the floods

To the northeast of Bangladesh, the mighty Brahmaputra rises from the Himalayas. It is one of the richest rivers on earth. The heat of climate change has eroded the glaciers by a fifth and caused the water masses to swell.

In the vicinity of Kurigram the river branches into a kilometer-wide branch of tributaries, which are separated by small, flat islands, the "chars". Around ten million people live here. One of them is Hasne Ara Begum with her family of six. She sweeps the small yard in front of her corrugated iron house:

"We've been living here for seven years. Before that we lived on the other side, but our house was flooded and we had to start over. I'm used to it, in the last 17 years our house has been destroyed three times. And we had to each time." move elsewhere. "

All around are the fields from which they live. The family doesn't want to move away like many others, even if starting over is expensive. Sometimes she has to rent the land, sometimes buy it, says Hasne. The family earns their living entirely from the rice harvest, just like generations before them. But in the last few years, says Hasne, the climate has changed. Here, too, traditional knowledge is useless. She tells us that she expects the monsoon rains between March and June, but now it usually comes too late, sometimes too early. Sometimes it only lasts a very short time, sometimes a very long one. Reliable predictions are impossible.

From one "good" flood a year to three "bad" ones

Sudden and unexpected rains are often disastrous for Bangladesh. In 2017, heavy rain events in the north-east of the country led to major floods. The harvest was lost. Bangladesh had to import rice. For the farmers, their livelihoods are at stake, and so is their income. Whether Hasne can take her children to the doctor is also a question of money:

"We had to go to the doctor in Chilmari beforehand. But we only go when it was a matter of life or death. It costs 1,000 taka, so we weren't used to going to the doctor."

There used to be one flood per year, Barsha, the good fertility-giving flood. For the past few years there have been two or three a year, Bonna. Sometimes people had to spend two weeks in the flood bunkers, the harvest was lost, and at best the house was only damp. In the worst case, the floods carried away entire villages or islands. Socially and economically, people are being thrown back, says scientist Atiq Rahman:

"The natural disaster strikes and people lose their crops. The house is flooded. It's like traveling back in time. Climate change doesn't cause the cyclone, but it amplifies it, and if you're hit again and again, it rises Income doesn't, it'll end up falling. "

Hospital ships supply the islands in the river delta

Climate change leads to poverty and poverty is a health hazard. Through these complex relationships, climate change endangers a healthy life. Children with club feet can never walk properly, will never work fully in the fields, and older people can no longer see well enough to help their families. Simple interventions could change that, but there are hardly any doctors left on the Chars.

In the dry months the soil is porous and the water gnaws at it steadily. As soon as the river swells due to glacier melt or rainfall, the water pulls the earth and entire islands with it. In the past few decades, this has also meant the end of an estimated 15,000 healthcare facilities. The government basically gave up on the people.

Patients wait in front of the Friendship hospital ship (Mathias Tertilt)

They always had to go to the mainland for every diagnosis - after all: that has changed here in Kurigramm. Dr. Shafiul Azam's white coat is almost drowned in the thick fog. The ground sways very slightly. He stands on his ambulance, a hospital ship - which is supposed to guarantee medical care despite the floods. The Bangladeshi NGO "Friendship" operates several such ships in the vulnerable regions.

"We see 120 to 160 patients here every day. This is a new dock. The boat has been here for 15 days, so there aren't that many people there yet. People come by boat from the other islands."

Close relationship with water

Reproductive medicine, eye surgery, X-ray machines and a fully equipped laboratory - medical care is now much more extensive than in most villages on the mainland. From the deck, Azam looks out over several corrugated iron huts that have been erected on the bank. Patients can spend the night here if they have to be observed for several hours or days after surgery, such as cataract surgery. They are simple constructions because they have to be mobile.

Dr. Shaiful Azam on the hospital boat (Mathias Tertilt)

Depending on the weather, water level and erosion, the helpers move on. The bank, which juts steeply out of the water, is also showing the first cracks. Although the ship only docked here for a few days. It is not said that they anchor here for a long time.

"We're supposed to stay in place for at least two months. At least that's what we're trying to do. It doesn't always work."

The medical team on the ships treats more than 80,000 patients every year.

The method has proven itself. And so it is everywhere in Bangladesh: people look for solutions and often they find them. They withstand the forces of nature and still have a close relationship with the water that nourishes Bangladesh.

In the end it remains to be seen whether they are still talking about Barsha or only about Bonna, the dangerous floods.

Addendum: The research for this report took place at the end of 2019. In May, super cyclone Amphan hit Bangladesh. More than five million people were evacuated or hid in shelters. In the following weeks, the number of corona cases rose sharply. In mid-July, Bangladesh has a higher infection rate per inhabitant than all neighboring countries, according to official information.