From milking cows to saving lives

In a refugee camp close to the border between Bangladesh and Burma, a young boy arrives for medical attention.

"He was about 12, both of his parents had been killed," says Jonathan.

"He was mute, but he had to look after his four siblings. He was presenting diphtheria symptoms. We gave him a balloon, and for 10 minutes he forgot about the conflict, his parents, and he could be a child.

"He was simply happy with his balloon. He could take himself away from the conflict."

Jonathan, a dairy farmer and part-time hospital practitioner, forms part of the UK Emergency Medical Team (EMT), a register of NHS staff who volunteer their services to help in emergencies around the world.

And the situation at Cox's Bazaar, in south-east Bangladesh, is certainly an emergency. Since August alone, about 630,000 of the stateless Rohingya people have spilled over the border into Bangladesh, fleeing persecution from the authorities in Burma. Conditions in the refugee camps are grim, to say the least, and diptheria has spread around the cramped compounds like wildfire. Everyday sees 100 new reported cases of the killer disease. Keeping track of the casualties is difficult, but since the end of last year it is thought there have been nearly 4,000 suspected cases of diptheria, and at least 31 deaths, more than half of them under the age of five.

Jonathan, 37, from Calverhall, near Whitchurch, forms part of a team of volunteer medics who are carrying out a vaccination programme for the children living in the camp.

It is not his first mission abroad. In April 2015 he travelled to Nepal to help out in the wake of the devastating earthquake which rocked the country, and last year he worked as a clinical co-ordinator for the United Nations in the Iraqi city of Mosul while it was in the process of being liberated from Islamic State.

"When I first arrived I was very close to the fighting," he says.

"There were vast numbers of incredibly complex cases, with blast injuries, severe trauma and chemical injuries."

He also found himself providing healthcare to Islamic State fighters who had been detained by the allied forces.

"I know that sounds mad, but actually they were mostly relieved," he says.

"Almost all over them had been forced to fight for them, and they did not know what they were getting themselves into."

But the situation in Bangladesh is very different, and brings another set of problems on its own.

In their homeland in the Rhakine state of Burma, the Rohingya people were excluded from public healthcare, making them particularly susceptible to diptheria. Not only were they denied vaccination against the disease, it has also made them very sceptical of medical care.

"Working in a refugee camp is a challenge in itself," he says.

"Compared to a normal environment, this is vast, widespread with difficult to reach key areas and people in need.

"It makes it a really complex job of mapping the diphtheria outbreak. "Also, the Rohingya are resilient and independent – they have created their own camp, they built it, but it's harder to manage because they aren’t asking for help, they aren’t asking for things. "It’s difficult to describe, but if you compare this to refugees from Mosul, where people who grew up in cities simply couldn’t build a camp, whereas the Rohingya are so resilient."

The crisis in Bangladesh is the first major diptheria outbreak for many years, so the EMT volunteers have had to learn quickly.

"Nobody has done this before," he says. "We had had to go in blind into a situation we do not know.

"To compensate for this you have to be open minded, fluid, and understand what is happening around you.

"We have needed to understand the culture, the beliefs, the religion, and understand why the Rohingya are so resilient. Gaining trust is one of the most important and difficult parts of this response."

He admits it has been hard work persuading the refugees to take up the support that is available, and the demands vary enormously from day to day.

"The first few days are very unpredictable," he says.

"You get extremely busy days. The majority of the cases are children, and children suffer the most.

"The Rohingya have never had a health facility before, even back home, so it is so hard to get them to physically come to hospital.

"We have to get the message out just as critically as we need to treat patients. There are fatal consequences if we cannot."

Jonathan's work is funded by the Government's controversial International Aid budget, where the UK commits to spending 0.7 per cent of GDP on overseas development. Despite the criticisms that the UK can ill afford to send money overseas, not to mention numerous claims that the money has been ill spent, Jonathan believes the project in Bangladesh shows the value of the scheme.

"What we are doing here, with UK Aid money, is helping the Rohingya to look after themselves with food, education, and letting them have a life," he says.

"We are keeping children safe. Children could be grabbed and taken so easily, and they need the child protection we support.

"What is important here is that we can come in, raise standards in healthcare, and train local staff to deal with this crisis – because they are the ones who will need to deal with the next disaster. That is the absolute best thing we can do."

International Development Secretary Penny Mordaunt praises the work of volunteers like Jonathan, saying they are making a real difference for people who have endured experiences that nobody should have to suffer.

“It is difficult to comprehend the depth of human suffering among the hundreds and thousands of Rohingya who have fled persecution in Burma," she says.

"Many have sought refuge in Bangladesh, but their plight is far from over as diphtheria, an entirely preventable disease, is claiming the lives of those who thought they had finally reached safety.

“British expertise and aid is saving lives in Cox’s Bazar, preventing and treating this deadly infection. In today’s world, no child should die from a preventable disease. The UK is giving hope and a chance to Rohingya families.”

Jonathan is expected to remain at Cox's Bazaar until the middle of February. After that, he will return home to resume his duties on the farm, and also in the operating theatre at Birmingham's Queen Elizabeth Hospital, which gives him the flexibility to do aid work.

"Because of my working arrangement at the Queen Elizabeth, I can work with the EMT, I can work with the UN, I can work back in Birmingham," he says.

"I was milking the other weekend, now I'm doing this."