Bangladesh, Burma and the Rohingya crisis 53 catastrophic). In addition, a severe cyclone hits the country every three years or so. For example, in July 2015, the concurrent impacts of Cyclone Komen and monsoon season flooding caused $1.56 billion in damage to assets and impacted upon 2.6 million people. 131. Other impacts may be more insidious but are very worrying nonetheless. Erosion along Bangladesh’s long low coastline accounts for an annual loss of around 10,000 hectares as well as weakening natural coastal defences and aquatic ecosystems. There is a large problem - particularly in western Bangladesh - of scarcity of fresh water due to ‘salinisation’. Water intrusion from rising sea levels in low-lying plains has worsened the decline of agriculture and related production and employment opportunities as well as increasing the spread of water-related diseases. 132. Bangladesh has invested heavily in disaster readiness and response and has been supported in doing so by DFID and other donor partners. Investment of the order of $10 billion over 25 years has been directed at both infrastructure (such as strengthening river embankments and coastal polders, building cyclone shelters and developing early warning systems) and adaptation (government agency capacity, livelihood diversification and adapting rural farming methods). One example given was of increased crab farming or “fattening” taking advantage of the water salinisation (however the point was made that crab meat was far from a Bangladesh staple). 133. DFID’s assessment is, however, that “the impacts of global warming and climate change still have the potential to challenge the country’s development efforts, human security and the future.”167 The response has been both a specific climate change adaptation and risk reduction programme (£75 million between 2008 and 2017), a more general disaster preparedness and response improvement programme (£105 million between 2016 and 2021) and the ‘mainstreaming’ of climate change mitigation and adaptation measures across all programmes (for instance, clean energy, off-grid, for the rural poor and new schools doubling up as cyclone shelters for over 50,000 people in the vulnerable coastal zone). Health and nutrition 134. DFID also runs two further programmes in Bangladesh aimed at: improving access, particularly by the poor, to essential health, population and nutrition services (£120 million between 2011 and 2017); and strengthening care for mothers and new-borns amongst the poor (£38 million between 2013 and 2018). Undernutrition in Bangladesh is the highest in South Asia (and the percentage of babies born with ‘low birthweight’ is the highest in the world). Tackling undernutrition effectively is an end in itself (SDG2), as well as contributing to the reduction of global disease; and avoiding the economic costs (2–3% of GDP and 10% of earnings); and it breaks the inter-generational cycle. The Bangladesh government has consistently prioritised key aspects of life-saving health services (such as vaccinations, antenatal services and family planning) and DFID described access to basic health services as “almost universal” but identified: low availability of skilled assistance during childbirth, TB, diabetes, hypertension, cancers and accidents as key contributing factors to premature deaths in Bangladesh.168 We visited both a HOPE developing midwifery project in Cox’s Bazar and had a discussion with ‘Suchana’ nutrition programme deliverers (Save the Children International). 167 168 DFID country briefing, 94 Ibid, 90