WHO’s Scabies Campaign Halves Prevalence, Bringing Relief to Nearly One Million Rohingya Refugees

For seven-year-old Rafiq, life in the world’s largest refugee settlement meant sleepless nights and painful sores.

 “He couldn’t rest at night, and the scratching made his skin bleed,” his mother recalls.

Their experience reflects thousands of Rohingya families suffering from scabies, a highly contagious skin condition that spreads rapidly in overcrowded settings.

A Growing Public Health Challenge

A WHO-led survey in May 2023 found nearly 39% of the refugee population affected, far above the threshold for urgent public health action. While scabies is not life-threatening, persistent scratching can break the skin, allowing bacteria such as Group A Streptococcus to cause secondary infections like impetigo and cellulitis. In rare cases, these infections can trigger acute kidney inflammation, creating long-term health risks.

Figure 1. Camp-wise Distribution of Scabies Cases – Prevalence Survey, June 2023.

A Landmark Public Health Response

From November 2023 to February 2024, WHO, in collaboration with the Government of Bangladesh and health partners, led the world’s largest scabies MDA campaign, reaching nearly one million Rohingya refugees across 33 camps in Cox’s Bazar and Bhasan Char Island. Health workers distributed over 5.2 million ivermectin tablets and 185,000 tubes of permethrin cream, following WHO guidelines for children, pregnant women, and people with underlying conditions.

“WHO recommends MDA as a proven strategy to stop scabies when implemented with high coverage,” said Dr David Otieno, WHO Epidemiology Team Lead in Cox’s Bazar. “Strong coordination, technical guidance, and community engagement were critical to success.”

Mobilizing Communities and Building Local Capacity

WHO trained 100 healthcare professionals, 130 supervisors, and over 1,600 volunteers to deliver Directly Observed Therapy. The campaign prioritized inclusion, reaching older people, women, persons with disabilities, and households in remote areas.

“Families were anxious at first,” said Fatima, a community health worker in Camp 18. “But when they saw their children’s skin clearing, they became relieved. It gave them back their peace of mind.”

A community health worker administers ivermectin during the MDA campaign in Camp 18.
Photo credit: WHO / Terence Ngwabe Che

WHO co-chaired the MDA Implementation Advisory Committee with government authorities and Health and WASH sectors. Micro-plans were developed, high-risk areas mapped, and 68 storage sites established to maintain a steady supply of medicines.

Overcoming Operational Challenges

Delivering two treatment rounds to nearly one million people required careful coordination. WHO mobilized partner support, secured drug donations, and bridged operational funding gaps.

“We are grateful to partners including MAP International for donating over three million tablets and the U.S. Department of State for supporting operational costs,” said Dr Jorge Martinez, former Head of the WHO Sub-Office in Cox’s Bazar.

Coverage was achieved across Ukhiya, Teknaf, and Bhasan Char, ensuring even the most vulnerable families received timely treatment.

Measurable Impact

Within weeks, health workers observed a sharp decline in scabies consultations. Preliminary post-MDA survey results show prevalence fell to 19.2%, nearly half of the previous 39.6%. Families also reported fewer complications, particularly secondary bacterial infections such as impetigo and cellulitis, which previously caused clinic overcrowding and heightened health risks for children.

Figure 2. Post-MDA Scabies Prevalence in Rohingya Camps indicating a reduction of prevalence from 39.6% to 19.2%. March 2025

The campaign strengthened community trust and encouraged earlier care-seeking. WHO-supported surveillance tools enabled faster detection and response, reducing the risk of infections arising from persistent scratching.

“After the treatment, Rafiq sleeps peacefully,” his mother said. “We can finally focus on school, play, and daily life instead of scratching.”

“This MDA demonstrates WHO’s commitment to improving the health and well-being of Rohingya refugees,” said Dr Jamsheed Mohamed, WHO Representative to Bangladesh. “It shows what is possible when science, partnership, and community action align.”

Sustaining the Gains

The campaign marked a turning point, but ongoing effort is needed to prevent resurgence. WHO continues to support follow-up surveys, community-based surveillance, hygiene promotion, and health education. Integrated WASH actions help families recognize early symptoms, adopt preventive behaviours, and seek timely care.

In 2025, WHO distributed over 257,000 ivermectin tablets, 9,400 bottles of permethrin lotion, and 26,000 tubes of cream to health partners to sustain gains.

“This campaign was more than medicine. It brought hope,” said Fatima. “People are living comfortably again. That changes everything.”

Through evidence-based action and strong partnerships, WHO and partners have significantly reduced scabies and related infections among nearly one million Rohingya refugees, restoring comfort, improving well-being, and strengthening trust in health services. This campaign demonstrates that even in the most challenging humanitarian settings, coordinated, science-driven efforts can protect health, prevent complications, and transform lives.

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