Lifebuoy Friendship Hospital boat, BangladeshGAIBANDHA, Bangladesh (WOMENSENEWS)–Hardly anyone, including Bangladeshis, know of the isolated northern chars, tiny islands that barely rise above sea level. Fewer know what will become of the islets as land erosion and flash floods likely worsen in the near future.

Approximately 20 percent of this delta nation is expected to be underwater by 2050, leaving 20 million people as climate change refugees, according to the International Panel on Climate Change, based in Dhaka. Yet no organization or governmental agency has conducted environmental research on the isolated islets in northern Bangladesh, leaving their future in doubt.

One thing is certain, though–the Himalayas’ melting glaciers and the unpredictable seasons will chiefly plague women.

“The women are the ones who suffer first,” said Abdul Momen, Bangladesh’s United Nations envoy. “They are the ones working in the fields and they are the ones who have to clean up the pieces when that source of income and nourishment is destroyed.”

The rate of land erosion of the Brahmaputra-Jamuna River, which surrounds the chars, is expected to steadily increase over the next 40 years, according to the Center for the Environment and Geographic Information Services, a government-founded research organization in Bangladesh. A wider river could produce more flash floods, which routinely swallow scores of char children during the rainy months of May through September.

Wintertime presents other challenges, as the murky river recedes, uncovering long stretches of wave-imprinted mud. While the land is ripe for harvesting, it forces char-dwellers to travel greater distances to reach other chars.

A woman’s access to medical care in either the rainy or cold seasons was virtually nonexistent until 2002, when Friendship, a nongovernmental group headquartered in Dhaka, established the Lifebuoy Friendship Hospital boat.

Sole Hope for Medical Attention

Unlike the men, the char women don’t annually travel to the mainland for work, so this floating clinic has become their sole hope for medical attention.

Treating 3,000 patients monthly for free, the hospital boat offers everything from orthopedic and cataract surgery to treatment for diarrhea and burns caused by open kitchen fires.

Women can see the male residential doctor for these kinds of ailments, but the problem is that few ask him to assist with their gynecological and obstetrical medical concerns.

Another problem: they can’t always reach the boat. It moves to different major chars every few months.

In response, Friendship has trained 224 local women to serve as community medics for other women. They provide basic medical counsel, sell condoms and birth control for next-to-nothing and distribute birthing kits, complete with sanitized needles.

Char life in BangladeshGetting the women to comply with the lessons in hygiene, nutrition and family planning has been challenging, said Naisha Kader, a Friendship health program officer, but “if we keep on talking and engaging them in conversation, women start listening.”

On a hazy December afternoon, 20 or so pregnant women and nursing mothers gathered around Ferdousic, a community medic draped in a royal blue sari. She pointed to a display of locally-grown vegetables, like jute, which are high in nutrients.

“You don’t have to be rich to be healthy,” she told the women. “Beef, chicken and fish are not the only things that will keep you healthy.”

Ferdousic later opened a small plastic suitcase, revealing the makings of a sex-ed kit: birth control pills, condoms, a rubber penis and a vagina model all stacked neatly inside.

Family Size Stabilizing

Though Ferdousic and an accompanying female medic said that men willingly use condoms, Kader said the char women have greater family planning success when using birth control pills. However, not all women take their pills regularly and then they become afraid of the subsequent excessive, random bleeding.

Still, families are starting to pace their growth, with women no longer having six children within seven years, Kader said. Maternal mortality rates, though undocumented, are said to be decreasing, she added.

The medics doubt the educational sessions could continue during the rainy season, when all focus is placed on sheer survival, not infections caused by using dirty rags during menstrual cycles.

The islanders think of themselves as too poor to move to the mainland permanently, but erratic weather patterns may make that option a necessity, in time.

Following the December U. N. Climate Change Conference in Copenhagen, Bangladesh asked for at least 15 percent of any amount developed countries will put forth to help developing countries tackle climate change’s effects.

The Copenhagen Accord, which countries have yet to sign, will allocate $30 billion a year for developing countries from next year to 2012 and $100 billion a year by 2020.

It’s unclear if the char-dwellers, who do not pay taxes and are essentially unrecognized, will see any of that money.

Yet, if the government sponsored a shift to the mainland, one woman from a recently-established char explained, it wouldn’t prompt substantial change.

“This is our land and this is what we have,” said Hushinada, a young mother of two who identified herself only by her first name. “Even if we move, we will still be beggars. We will still struggle.”

Amy Lieberman is a journalist based in New York City. She writes primarily out of the United Nations Secretariat for a Brazilian newswire.