Dengue poses an increasingly severe threat to Bangladesh—and the world’s largest refugee camp

At the beginning of November 2024, during a spell of exceptionally hot weather, 35 year old Mizanur Rahman developed a high fever. Rahman, an electrician in Cox’s Bazar, Bangladesh, couldn’t afford to miss a single day’s work, so the next morning he set off again. That evening his fever worsened. Five days later Rahman was admitted to Sadar Hospital and was diagnosed with “Dacca fever,” otherwise known as dengue.

Sadar is one of the largest government hospitals in the region, and a designated specialist dengue hospital. An entire floor is filled with patients with dengue and their families, sleeping in corridors, next to the stairs, and even in front of the toilets, wherever they can find room.

“There are a lot of dengue cases every year, especially during the November to January period,” says Kamruzzaman Juwel, a medical officer at the hospital. “There are limited beds and we aren’t able to accommodate everyone, but patients stay at the hospital, no matter the space.”

Rahman was not the first in his family to contract dengue, which is caused by a virus transmitted by the Aedes aegypti mosquito. Four of his relatives had the illness but recovered at home—which is why they delayed taking him to hospital. “People don’t want to go to the hospital,” says Rahman’s brother Mohammed Qutubuddin, “They think it’s better to die at home.”

Dengue is endemic in Bangladesh. And it seems to be getting more severe. AGM Raihan, attending doctor at Sadar’s dengue ward, tells The BMJ that Rahman was diagnosed with dengue shock syndrome (DSS), considered the most fatal manifestation of the virus and characterised by …