Scratching the Scalp: Addressing Head Lice in Rohingya Refugee Camps!

In the crowded and unsanitary conditions of Rohingya refugee camps, seemingly harmless pests have revealed themselves as a harbinger of a much more serious health emergency. Head lice, commonly brushed off as a minor annoyance, have emerged as a major concern because of the environment they thrive in among their human hosts.

The prevalence of head lice infestation, medically termed pediculosis capitis, is a pressing global health issue, particularly prevalent among migrant and refugee populations. Studies in Africa, South America, Europe and Asia have showcased a wide spectrum of prevalence rates, ranging from 0.48% to a staggering 61%, with females, particularly young girls, bearing the brunt of infestation. These minute parasites thrive in conditions marked by close contact and poor personal hygiene and sanitation, circumstances regrettably commonplace in refugee settings.

The narrative took a somber turn in May 2023 when health workers, conducting a scabies prevalence survey in the Rohingya camps, stumbled upon a silent crisis: a suspected infestation of head lice that seemed widespread across the camps. This accidental discovery prompted an intensified community-based surveillance effort led by the UNHCR-led Community Health Working Group (CHWG) and WHO. The investigation revealed a staggering 35% infestation rate of head lice among the camp residents. Alarmingly, the most vulnerable groups, including girl children under five years old and women, bore the highest burdens, with infestation rates peaking at 52% and 48%, respectively, compared to 21% in males. 

While head lice themselves seldom constitute an immediate health emergency, the environments they foster, characterized by relentless itching and subsequent scratching, create conditions ripe for secondary bacterial infections at the bite sites. 

These infections can escalate into more serious health complications, particularly in settings where access to medical care is limited. The Centers for Disease Control and Prevention (CDC) warns that while head lice do not directly transmit diseases, scratching-induced secondary bacterial infections can accompany any lice infestation.
 

“WHO, with local health authorities, is directing disease surveillance and response, now also targeting neglected tropical diseases like headlice and scabies in Rohingya camps through swift, community-based interventions, aiming to alleviate disease spread and optimize healthcare resources” – Dr David Otieno, Team Lead, Epidemiology, Cox’s Bazar Sub Office.
 

In response to this escalating crisis, a targeted Mass Drug Administration (MDA) campaign is being implemented. However, due to constraints in resources, specifically the availability of drugs, the campaign is focusing its efforts on approximately 209,880 individuals identified as high-risk. This group includes pregnant and lactating mothers as well as children under the age of five who are particularly vulnerable. Permethrin 1% lotion is being administered in two doses spaced at least seven days apart to maximize effectiveness. The campaign, which began on May 5th, and concluded on May 16th, 2024, marked a concerted effort to mitigate the spread of infestation.
 

Collaborating closely with the UNHCR-led Community Health Working Group (CHWG) and under the strategic guidance of WHO's Epidemiology and Surveillance teams, the Mass Drug Administration (MDA) Campaign has been seamlessly integrated into existing primary healthcare services. Community Health Workers (CHWs) deliver these services directly to households, aiming to optimize resource utilization and minimize any disruption to essential primary healthcare tasks. The incorporation of the MDA Campaign into CHWs' daily responsibilities is essential to ensure uninterrupted and efficient healthcare delivery. This collaborative effort facilitates the distribution of treatments and reinforces the ongoing provision of critical health services. Additionally, Water, Sanitation, and Hygiene (WASH) teams play a vital role in preventing the spread of head lice and other infectious diseases by enhancing the availability of water for personal hygiene.

“Addressing scabies and head lice, categorised as neglected tropical diseases, necessitates a collaborative effort involving various sectors. These conditions are frequently worsened by living in overcrowded environments and lacking adequate hygiene and sanitation measures. A comprehensive strategy that involves health services, WASH initiatives, and educational programs is essential. The objective is to lower the incidence of these diseases and prevent them from escalating into more serious health issues.” — Dr Jorge Martinez, Head of Cox’s Bazar Sub Office, WHO Bangladesh.
 

While the immediate focus is on tackling head lice infestation, the broader aim is to advocate for improved living conditions to prevent future outbreaks. The support of the global community is crucial for protecting the health of displaced populations, with the experiences gleaned from the Rohingya camps poised to furnish invaluable insights for forthcoming public health endeavours in analogous settings.
 

The campaign against pediculosis capitis in the Rohingya camps goes beyond simple medical intervention; it represents a resolute dedication to upholding the dignity and health rights of the displaced. It serves as a rallying cry for comprehensive and compassionate solutions to the complex health challenges facing refugees globally. As the fight against head lice continues, concerted efforts must be focused on addressing the root conditions that enable such infestations, paving the way for a healthier future for everyone.
 

For more information about this publication please contact Terence Ngwabe Che, External Communications Officer, Cox’s Bazar Emergency Sub Office, WHO Bangladesh at chet@who.int