For most public health experts working in or on Bangladesh, the summer has been a slowburn nightmare that at times appeared hesitant, even tenuous. But then something seemingly changed last month - yes, in August - and the perfect health crisis, or nightmare, no longer seems avoidable from where we now stand, a third of the way through September.

In case you haven't guessed it yet, that nightmare health crisis given the public health system in Bangladesh, consists of measles cases and deaths remaining high while dengue hospitalisations surge, putting additional pressure on hospitals already struggling with a heavy patient load.

As of the first week of September, nearly 8,000 patients with dengue or measles were being treated in hospitals nationwide, at a time when many public hospitals were already operating to more than double their sanctioned capacity( before the twin outbreaks took hold). The average bed occupancy at district hospitals and public medical college hospitals has remained above 160 percent over the year, according to the Directorate General of Health Services, or DGHS.

Experts say measles has effectively been left to run its course despite vaccination campaigns, while a lack of coordinated measures to control dengue has allowed infections to rise sharply.

Since March 15, the Directorate General of Health Services (DGHS) has recorded 1012 deaths among people with measles or measles-like symptoms, including 99 confirmed measles deaths. A total of 157,991 patients have been logged with measles-like symptoms, while 19,312 have tested positive for the highly-contagious disease.

Dengue hospitalisations have also risen sharply. According to Thursday's bulletin, 35,846 people have been admitted with dengue since the beginning of the year and 130 have died.

August alone accounted for 20,536 dengue hospitalisations, compared with 9,206 in July, more than double the previous month's figure. There were 2,907 admissions in June, 714 in May, 640 in April and 353 in March.

Control Measures

The government launched an emergency measles vaccination campaign in high-risk areas in April, eventually covering children aged six to 59 months nationwide. More than 19.6 million children received vaccines, exceeding the target of 18 million.

However, experts said the campaign had not brought measles under control. On August 16, the government decided to vaccinate another 1.6 million children who had been missed in different areas. Experts have also repeatedly warned that dengue could rise during the rainy season, as it does every year.

Prof Mahmudur Rahman, former director of the Institute of Epidemiology, Disease Control and Research (IEDCR), said measles appeared to have been left to "nature", with the expectation that transmission would eventually decline after widespread infections and deaths.

Mushtuq Husain, now an adviser to the IEDCR, recommended expanding dengue testing at the local level so cases can be detected early and patients receive appropriate treatment at Upazila health complexes, reducing pressure on major city hospitals. He said a group of children affected by measles were either aged between six and nine months or over two years old, but no decision had yet been made on how to address their vaccination needs.

Health and Family Welfare Minister Sardar Md Sakhawat Husain said on Thursday (Sept. 10) that another nationwide special measles vaccination campaign is being planned, possibly in late September.

"From September 25, a large-scale measles vaccination campaign will be launched again across the country," he said while speaking at a seminar at the University Women's Federation College in the capital to mark World Suicide Prevention Day 2026.

Bangladesh, which once came close to eliminating measles, is facing its worst outbreak on record, with 999 suspected and confirmed measles-related deaths reported since March as hospitals struggle with overcrowding, shortages and a continuing influx of sick children. The prolonged outbreak, despite a nationwide emergency vaccination campaign launched in April, follows disruption to routine immunisation in 2024 and 2025, experts said, when the country was going through political turmoil after a deadly uprising against then prime minister Sheikh Hasina.

Although measles generally has made something of a comeback in many countries around the world, Bangladesh is currently experiencing the biggest measles outbreak in the world by far, according to a list on the United States Centers for Disease Control and Prevention website.

Health officials and experts said missed vaccinations and vaccine supply problems as a result of the political upheaval had left children vulnerable, particularly infants under nine months who are too young to get routine vaccinations, helping fuel transmission across age groups.

Since the outbreak emerged in March, Bangladesh has recorded more than 166,000 suspected measles cases, including 19,835 laboratory-confirmed infections, according to Health Ministry data. The outbreak has been linked to over 1000 deaths - a grim milestone that was crossed this week to almost stunned silence and shock.

Exploited immunity gaps

Experts blamed the outbreak on weak programme oversight, insufficient monitoring and procurement policy changes under the interim government that replaced Hasina, disrupting vaccine availability and leaving many children unprotected against the highly infectious disease.

Health Minister Sardar Md. Sakhawat Husain told parliament on Monday the procurement changes triggered a vaccine shortage, while the 2024 postponement of a vaccination programme and the cancellation of a nationwide measles-rubella campaign the following year left more children vulnerable to infection.

The World Health Organization, UNICEF and other health agencies have also pointed to the disruption to immunisation schedules. Under-fives accounted for about 80% of cases during the early stages of the disease's spread.

The outbreak follows years of progress towards measles elimination. Bangladesh maintained high measles vaccination coverage for much of the past decade, with rates staying at or above the 95% level recommended by the WHO for most of the period, apart from a dip during the COVID-19 pandemic.

Endemic, yet changing

The current dengue outbreak is placing substantial pressure on Bangladesh's health system, particularly in high-burden districts and urban centres. As of September 8, more than 45,000 dengue cases and 130 deaths had been reported nationwide this year, with over 1,500 new cases recorded in a single day and admissions continuing to rise. The surge in severe and hospitalised cases is increasing demand for hospital beds, clinical staff, diagnostics, blood transfusion services, and essential treatment supplies.

Health facilities are reporting shortages of dengue NS1 rapid diagnostic kits, intravenous fluids, bedside ultrasound equipment, hematocrit testing capacity, blood bags, and apheresis kits, which may affect timely diagnosis, monitoring, and management of severe dengue cases. Reuters also reported growing strain on hospitals and bed shortages as admissions reach their highest levels of the year.

The outbreak is also having significant secondary impacts on affected populations. Households face increased health risks and financial burdens associated with hospitalisation, transportation, caregiving responsibilities, and loss of income during illness. The rapid geographic spread of cases across all eight divisions, combined with gaps in community awareness and vector-control activities, increases the risk of continued transmission and additional severe cases.

Shortages of information, education and communication (IEC) materials and reduced community engagement activities may further limit preventive actions at household level. Experts warn, and experience since dengue became endemic to Bangladesh in the year 2000, that favourable weather conditions, including heavy rainfall, high humidity, and warm temperatures, are likely to sustain mosquito breeding and transmission in the coming weeks, while WHO has previously highlighted these environmental factors as key drivers of large-scale dengue outbreaks in Bangladesh.

Consequently, vulnerable populations, including low-income households, children, older persons, and those with limited access to healthcare, remain at heightened risk of illness, economic hardship, and adverse health outcomes during the peak transmission period.

The worst is still to come

Dengue infections in Bangladesh are rising and could reach their peak in the last week of September and early October, State Minister for Health and Family Welfare MA Muhit said Wednesday (Sept. 9).

"We are concerned that dengue cases may reach the highest level in the last week of September and the beginning of October," he said at a seminar organised by Anchal Foundation and the Human Rights Development Centre at Dhaka Reporters Unity.

The government will launch a three-month public awareness campaign involving volunteer organisations and the public to combat the outbreak, the state minister said. Meanwhile urged people to keep their homes and workplaces clean and eliminate Aedes mosquito breeding grounds.

City corporations, local government bodies and the Health Ministry will jointly conduct cleanliness drives, awareness campaigns and larva-control activities, he added.

Muhit said the government's two main objectives are to reduce dengue infections and lower the death rate. As part of preparations, around 3,000 doctors have already received refresher training on dengue management, with training set to continue at district and upazila levels, he said.

"Based on the current rate of infections, we have sufficient dengue testing kits and saline in stock," the state minister said. The state minister urged private hospitals to prepare for the expected surge.

"If necessary, private hospitals will have to play a role in treating dengue patients," he said, adding that hospitals should keep designated beds for dengue patients and avoid unreasonably increasing treatment costs during the peak period.