The financial toll of the ongoing measles outbreak has been devastating for affected families, with nearly nine in 10 having to borrow money and six in 10 exhausting their savings to cover treatment-related costs, according to a new assessment.

Conducted by the Bangladesh Red Crescent Society (BDRCS) and the International Federation of Red Cross and Red Crescent Societies (IFRC), the assessment found that the economic burden of the outbreak extends far beyond hospital care, even though treatment at government hospitals is free.

Based on a survey of 2,746 measles-affected households whose members received treatment at 12 government medical college and district hospitals between May and June, the assessment found that 2,442 households, or 88.9 percent, had to borrow money to meet treatment-related expenses.

The survey was conducted to identify 2,400 of the most vulnerable families for emergency cash assistance (Tk 10,000 each family) and assess the socio-economic impact of the measles surge.

At least 1,670 households, or 60.8 percent, depleted their savings, while 112 households, or 4.1 percent, had to sell assets. Another 90 households, or 3.3 percent, relied on donations to cope with the financial strain.

Nazma Begum’s family is among those pushed into debt. Her 10-month-old daughter, Ashya, was undergoing treatment at the DNCC Dedicated Covid-19 Hospital, now exclusively treating measles patients, when The Daily Star visited the facility last month.

The findings underscore the importance of humanitarian assistance and stronger social protection systems during public health emergencies.

- Alberto Bocanegra,  head of the IFRC delegation in Bangladesh

Nazma, a homemaker from Bhedarganj upazila in Shariatpur, said her daughter first developed a high fever and was initially treated by a local doctor. “She was later taken to Bhedarganj Upazila Health Complex, where doctors diagnosed her with measles and referred her to Dhaka,” she said.

Her husband, a mason, does not get regular work. “We had to take out a loan to bring her here for treatment,” Nazma said, without specifying the amount.

As the country reels from the unprecedented outbreak, at least 1.44 lakh patients, mostly children, have been hospitalised with measles or measles-like symptoms, while the measles-related death toll was 810 as of July 31.

Over the last five months, this newspaper interviewed several dozen parents, including Nazma, at three major Dhaka hospitals treating measles patients -- the DNCC Dedicated Covid-19 Hospital, the Infectious Diseases Hospital (IDH), and Bangladesh Shishu Hospital and Institute -- and found a recurring pattern.

Many families travelled to the capital after local health facilities failed to manage complications. A significant number said they had already exhausted their savings treating other illnesses before their children contracted measles.

In May, Farzana Akther told The Daily Star that her family had already spent around Tk 35,000 on treatment after her then five-month-old daughter, Sadika Noor Safa, developed chickenpox and was referred from Shreenagar Upazila Health Complex to Dhaka.

Just 10 days after the child recovered and the family returned home, she developed measles, forcing them to travel to the capital again for treatment.

Like Farzana and Nazma, most affected families were from low-income households, where the health crisis quickly turned into a financial one. To afford treatment in Dhaka, many had to borrow money from relatives, neighbours or informal lenders to cover ambulance fares, medicines, tests, food, and other expenses.

Although treatment at government hospitals is free, treatment-related expenses -- mainly for food, medicines, tests, and transport -- typically range between Tk 20,000 and Tk 40,000. For children requiring intensive care at private hospitals, costs often run into several lakh taka.

The burden was compounded for families, who not only faced mounting medical and related expenses but also lost wages or even their sources of income while caring for their sick children in hospitals, the BDRCS and IFRC assessment said.

Most affected families depended on informal work, making the financial burden particularly severe, it said, adding that treatment and related expenses can cost an average of Tk 16,000 and can even go up to Tk 65,000,  including transport, diagnostic tests, and other daily necessities.

Medicines emerged as the top priority for 35 percent of respondents, followed by water, sanitation and hygiene support (33 percent) and food assistance (22 percent), the assessment found.

Among families that disclosed their occupations, 78 percent worked in the informal sector and earned between Tk 6,000 and Tk 20,000 a month, leaving them highly vulnerable to income loss during prolonged illnesses, it said.

Titu Nakti, a battery-run rickshaw-van driver from Madaripur, earlier told The Daily Star that he lost his income while staying in Dhaka to care for his 11-month-old son, who was undergoing treatment for measles at the DNCC Dedicated Covid-19 Hospital. He said he also had to borrow Tk 25,000 from a neighbour to cover medical expenses, leaving him with a loan carrying a monthly interest payment of Tk 2,500.

Kabir M Ashraf Alam, secretary general of BDRCS, said the organisations carried out the assessment to better understand the socio-economic impact of the outbreak on affected households and identify the most vulnerable families eligible for emergency cash assistance.

“The assessment shows that many families are facing not only a health emergency but also severe financial strain,” he said in a written statement.

Alberto Bocanegra, head of the IFRC delegation in Bangladesh, said, “The impact of the measles emergency did not end at the hospital door, as many families faced overwhelming financial hardship while caring for sick children.

“The findings underscore the importance of humanitarian assistance and stronger social protection systems during public health emergencies.”

Prof Shafiun Nahin Shimul, director of the Institute of Health Economics at Dhaka University, said the findings reflect what economists call a classic example of “catastrophic health expenditure”, warning that the measles outbreak is pushing already vulnerable families deeper into poverty.

“When healthcare expenses become disproportionately high compared to a family’s income, people are forced to exhaust their savings, sell assets or borrow money. That is exactly what this study has found,” he told this newspaper on Saturday.

He said the burden falls heaviest on low-income households, where undernutrition is more common and children are more likely to develop severe measles requiring hospitalisation.

Shimul noted that treatment at government hospitals is not entirely free. “Patients often have to buy medicines because hospitals cannot supply all the required drugs, especially costly ones.

Most patients come from rural areas, and both parents often have to travel, increasing expenses, he said.

He recommended creating an emergency fund or treatment support mechanism for poor families, warning that without such assistance, the financial impact could persist long after patients recover.