Bangladesh is facing its deadliest measles outbreak in decades, overwhelming hospitals as pediatric wards fill and doctors struggle to contain a surge that has killed more than 300 children.
The South Asian nation had made steady gains in vaccination coverage in recent years, helping suppress the virus.
But those advances were undermined by immunization gaps that emerged during and after the turmoil of a 2024 uprising that toppled the autocratic government, leaving many young children vulnerable.
"I was almost sure I was going to lose her today. Her condition was terrible in the morning,” said Rina Begum, 45, as she held her 3-year-old granddaughter, Afia.
Exhausted and tearful, Begum said Afia had missed her second measles vaccine dose at 18 months and had spent the past two weeks in a measles ward in Dhaka.
Measles is highly contagious, spreading through respiratory droplets from coughs and sneezes, and has no specific treatment once infection sets in.
It hits children the hardest. Their breathing can become strained, their strength fades and, in severe cases, the infection can reach the brain, causing swelling that may lead to permanent damage or death.
Hospitals are treating thousands of young patients while authorities race to expand vaccination coverage and prevent further deaths.
Begum offered a faint smile as Afia reached up after just turning a corner in her recovery.
"After putting her on oxygen, now she is doing much better,” she said.
Doctor’s help
Bangladesh has recorded 336 child deaths since March 15, with more than 50,000 confirmed and suspected cases, according to the latest government data.
Most cases have been among children ages 6 months to 5 years.
On May 4, the country recorded its highest single-day child death toll, 17 in 24 hours.
Bangladesh has made significant progress in immunization against infectious diseases, but a measles vaccination campaign scheduled for 2024 was delayed by the uprising that toppled the government of Sheikh Hasina.
Health officials, supported by UNICEF, the World Health Organization and security forces, are now working to vaccinate children through an emergency measles-rubella campaign launched April 5.
Nearly 17 million children have received vaccines since the drive began, according to government data.
Last year, vaccination coverage stood at 59 percent, far below the 95 percent needed to achieve herd immunity.
Without herd immunity, outbreaks can still occur even among vaccinated populations, said Abu Hussain Md Moinul Ahsan, a senior Health Ministry official.
He said it would take about a month before the impact of the campaign becomes clear.
Siam, a 14-month-old boy, spent 10 days in intensive care at Dhaka Shishu Hospital before improving enough to return to a dedicated measles ward.
He was vaccinated at 10 months, but with herd immunity weakened, it was not enough to prevent infection.
"I did not expect to get my son back,” said his mother, Brishti Akhtar, 20, watching him sleep with an oxygen tube in his nose. He is one of 97 children being treated for measles at the hospital.
"With the doctor’s help, now he is out of danger.”
Army field hospital
Ahsan said hospitals were still managing the surge.
"The hospitals are not yet overburdened,” he said.
However, as a precaution, the army has set up a 20-bed field hospital in tents on the grounds of Dhaka Medical College Hospital to handle additional cases.
"With the current measles outbreak, the Health Ministry told us to set up a field hospital,” said hospital director Brig. Gen. Md Asaduzzaman.
Other health challenges are also emerging.
Bangladesh has seen heavy rainfall in recent weeks, contributing to a rise in mosquitoes that spread dengue fever.
"We hope the measles infection rate will decrease soon,” Asaduzzaman said.
"With the dengue season in mind, the field hospital is expected to help in that crisis as well.”