ONE YEAR ON: Lives of Rohingya refugees in Bangladesh on hold

Rohingya refugees trapped in a cycle of suffering, poor health, legal limbo & bleak future

Wednesday, August 22, 2018 — Cox’s Bazar, Bangladesh – One year since over 700,000 Rohingya refugees were forced to flee from Myanmar into Bangladesh, the denial of their legal status, coupled with unacceptable living conditions in haphazard makeshift camps, continues to trap refugees in a cycle of suffering and poor health.

On 25 August 2017, the Myanmar Army launched renewed ‘clearance operations’ against the Rohingya people causing widespread violence and destruction, and forcing more than 706,000 to flee into neighbouring Bangladesh. They joined over 200,000 others that had fled to Bangladesh after previous waves of violence, bringing the total number of Rohingya hosted in Cox’s Bazar district to over 919,000. In the 12 months since, MSF has provided over 656,200 consultations, equivalent to more than two-thirds of Rohingya refugees, in 19 health facilities or mobile clinics.

At first, more than half of MSF’s patients were treated for violence-related injuries, but other health concerns soon emerged that were linked to the overcrowded and unhygienic conditions in the camps.

“It is unacceptable that watery diarrhoea remains one of the biggest health issues we see in the camps,” says Pavlo Kolovos, MSF head of mission in Bangladesh. “The infrastructure to meet even the most basic needs of the population is still not in place, and that seriously affects people’s wellbeing.”  

While Bangladesh showed extraordinary generosity by opening its doors to the refugees, 12 months on, the Rohingya’s fate remains very uncertain. Host states in the region deny them any formal legal status, despite the fact that they are refugees and have been made stateless by Myanmar.

We are in a situation where it is difficult to even refer to Rohingya refugees as exactly that,” says Kolovos. “By refusing to acknowledge the legal rights of Rohingya as refugees, or granting them any other legal status, intervening governments and organisations keep them in a state of acute vulnerability.”

Donors and governments with influence over the Government of Myanmar have failed to show the necessary leadership by not pressuring it to end persecution against the Rohingya, which is the cause of their displacement.

In addition, the UN-led humanitarian response in Bangladesh is, to date, only 31.7 percent funded. Within that, health care funding stands at a mere 16.9 percent, leaving significant gaps in the provision of vital medical services. The Rohingya have long been excluded from healthcare in Myanmar, meaning they have very low immunisation coverage. Preventative health measures are therefore crucial. Vaccination campaigns, supported by MSF, have been instrumental in preventing outbreaks of cholera and measles, and in containing the spread of diphtheria.

Under the pretext that the Rohingya will soon be returning to Myanmar, the humanitarian response has been hampered by restrictions placed on the provision of long term or substantial aid. The conditions endured by the Rohingya in the haphazard, makeshift camps fall far short of accepted international humanitarian standards, with the refugees still living in the same temporary plastic and bamboo shelters that were built when they first arrived.

In an area where cyclones and monsoons are common, there are almost no stable structures for Rohingya refugees, which has a tangible impact on their security and dignity,” says Kolovos.

One refugee that MSF spoke to described how vulnerable his family felt in the camp: “When it rains we sit together, all our family members, [holding the house down] so the house won’t blow away. At night it is very dark here, we have no lights.”

Considering the level of violence that the Rohingya faced in Myanmar and the trauma this will have caused, services to treat mental health issues and sexual and gender-based violence injuries remain inadequate. They are also complicated by the lack of legal status, which prevents people from reasonable access to justice and the rule of law. In addition, the Rohingya remain forcibly confined to the camps, and most of the refugee population in the camps have poor access to clean water, latrines, education, job opportunities and healthcare.

“These restrictions not only limit the quality and scale of aid, but also force the Rohingya to depend entirely on humanitarian aid. It deprives them of any chance to build a dignified future for themselves and makes every day an unnecessary struggle for survival,” says Kolovos.

Many of the refugees that MSF teams speak to are very anxious about the future.

"I've lost my strength, my ability to work. I always have so many worries, worries about the future,” says Abu Ahmad, a Rohingya father of eight. “I think about food, clothes, peace and our suffering... If I stay in this place for 10 years … or even for one month, I will have to suffer this pain."

More durable solutions must be found to respond to what is likely to be a protracted period of displacement. “The reality is that hundreds of thousands of Rohingya have been displaced in Bangladesh and elsewhere for decades, and it may be decades until they can safely return to Myanmar, if ever. The scale and scope of the Rohingya’s suffering merits a much more robust response – locally, regionally and globally,” says Kolovos. “Pressure must meanwhile continue to be exerted on the Government of Myanmar to halt its campaign against the Rohingya.”


Note to editors:

MSF first worked in Bangladesh in 1985. Since 2009, MSF has run a medical facility and a clinic close to the Kutupalong makeshift settlement in Cox’s Bazar district, offering comprehensive basic and emergency healthcare, as well as inpatient and laboratory services to Rohingya refugees and the local community. In response to the influx of refugees in Cox’s Bazar, MSF significantly increased its presence in the area, with vastly expanded operations covering water, sanitation and medical activities for the refugee population.

In December 2017, retrospective mortality surveys conducted by MSF in refugee settlements in Bangladesh found that that at least 9,000 Rohingya died in Myanmar, in Rakhine state, between 25 August and 24 September. As 71.7% of the reported deaths were caused by violence, at least 6,700 Rohingya, in the most conservative estimations, were estimated to have been killed, including at least 730 children below the age of five years. See here for the links to the surveys:

Elsewhere in Bangladesh, MSF works in Kamrangirchar slum, in the capital, Dhaka, providing mental health, reproductive health care, family planning and antenatal consultations, as well as an occupational health programme for factory workers.

MSF also provides healthcare to Rohingya and other marginalised communities in Malaysia and Myanmar. In Myanmar, MSF has provided health care to all communities in northern Rakhine since 1994. At the time its medical operations were suspended on 11 August 2017, MSF was operating four primary healthcare clinics in northern Rakhine – three of which were subsequently burnt down – and was providing over 11,000 primary and reproductive healthcare consultations per month, as well as emergency transport and assistance for patients requiring hospitalisation. MSF maintains staff presence in Maungdaw despite being unable to run medical activities, and our teams continue to hear from the Rohingya community there about the difficulties they face accessing healthcare. Muslim patients continue to face restrictions on their freedom of movement and unaffordable medical fees. MSF continues to provide primary health care and emergency referrals for patients in Sittwe district, central Rakhine. Elsewhere in Myanmar, MSF continues to run medical projects in Shan, Kachin and Yangon, as well as in the Naga Self-Administered Zone and Tanintharyi region.

A Rohingya mother watches over her baby at MSF's medical facility in Kutupalong. Photographer: Dalila Mahdawi
A Rohingya mother recuperates on a bed at MSF's medical facility in Kutupalong, with one of her newborn twins in the bed to the left. The other twin died. Photographer: Dalila Mahdawi
A patient sits on his bed at MSF's medical facility in Kutupalong. Photographer: Dalila Mahdawi
One year on since the biggest influx of Rohingya into Bangladesh, Rohingya refugees remain highly vulnerable. The camps are massive and overpopulated, and many children have gotten lost. Here a child wears a band around her wrist so that in case she gets lost, she can be quickly identified and returned to her parent's care. Photographer: Dalila Mahdawi
Farmers tend to their rice paddies near Teknaf, Cox's Bazar district, near the border with Myanmar. Many of the Rohingya who crossed into Bangladesh walked through these mountains before taking a boat across the water. Photographer: Dalila Mahdawi
Boys bathe in a pond near Teknaf, Cox's Bazar district. Photographer: Dalila Mahdawi
Bamboo poles are stored by the road near Kutupalong, waiting to be transported to the camps, where they are used to hold up the flimsy plastic shelters Rohingya refugees live in. Photographer: Dalila Mahdawi
A Rohingya father and his children search for fish and crabs in rice paddies near to Kutupalong camp. With over 626,000 refugees, the Kutupalong-Balukhali mega camp is now the biggest refugee camp in the world, with people living in extremely overcrowded and underresourced conditions. One year on, the UN-led response is only around 31 % funded, with healthcare a mere 17.5 percent funded. Many refugees report that they do not receive enough food rations, and try to supplement their rice and dhal diet by other means. Photographer: Dalila Mahdawi
Triage cards in the waiting room at MSF's Kutupalong medical facility- these are given to help cut down waiting times and ensure patients get the proper care they need. In the past 12 months, MSF has treated 656,300 patients - an average of 65,639 patients a month. Photographer: Dalila Mahdawi
Rohingya children recite the Quran at a madrassa in Kutupalong camp. One year since the biggest ever displacement of Rohingya refugees to Bangladesh, the Rohingya still suffer from a lack of legal status, which prevents them from accessing formal education, healthcare, livelihood opportunities, etc., trapping them in a cycle of poverty and exclusion. Photographer: Dalila Mahdawi
A Rohingya refugee carries bricks through Balukhali camp. The bricks will likely be used to fortify infrastructure, such as roads or walkways, against the heavy mosoon rains that are battering the camps and its inhabitants. Photographer: Dalila Mahdaw
A girl carries a water bucket and other relief items donated by the UN through the wet streets of Balukhali camp. The monsoons have caused havoc in the camps and for local communities, resulting in landslides, floors and fires, and have led to injuries, deaths and the destruction of infrastructure and facilities. Water supplies have become contaminated with dirty water/human waste, posing a public health risk. One year on since the biggest influx of Rohingya refugees to Bangladesh, the Rohingya face an uncertain future. Overcrowding and congestion are major issues in the camps, access to safe drinking water and sanitation services is insufficient, and the Rohingya suffer from a lack of formal legal status,. Photographer: Dalila Mahdawi
Daily workers stand on a hill they are trying to fortify against collapsing under the heavy rains. Many Rohingya shelters, made of flimsy plastic sheeting and bamboo, have already collapsed or been washed away as a result of heavy rains. One year on since the biggest ever influx of Rohingya refuguees to Bangladesh, people are still living in the precarious basic shelters as when they first arrived, which makes them vulnerable to the elements. Photographer: Dalila Mahdawi
A Rohingya girl carries a bucket of water back to her tent dwelling in Balukhali camp, just before a heavy downpour. Whenever it rains, many parts of the camps become flooded, and some tents collapse or are swept away by rains or landslides. When it rains, tap stands can become infected with dirty water, and some latrines collapse, posing a risk to people's health. One year on since the biggest influx of Rohingya refugees to Bangladesh, watery dirrhoea remains one of the main morbidities treated by MSF teams. Photographer: Dalila Mahdawi
Ismael, 14 years old, speaks about why he had to flee Myanmar alone and the challenges of being rendered stateless. Ismael is one of the younger sons of Abu Ahmad and Sara. <br/><br/>"My mum and dad came to Bangladesh first to find medical care.There were four of us left at home, I was the eldest male. We had to leave the house because Monks were threatened us. We had to hide and escape through the hills. When we arrived here, I couldn't find my parents. After 8 or 10 days, I found out they were at the MSF hospital. I had never left the area where we used to live, I didn't know anything about Bangladesh. If I had not found them, I would have died by now."<br/><br/>"Before in Burma, things were fine for us. The Monks didn't do anything to us at that time. But when we became older, they would begin torturing us. Then the war started, so we came here. We will not go back, only if they recognise the Rohingyas. If we return without Rohingya status, they will oppress us again. They will kill us." Photographer: Ikram N'gadi
Abu Ahmad: “I always have so many worries; worries about the future.”<br/><br/>Abu Ahmad is a 52-year-old father of eight (four daughters and four sons). His 11-year-old daughter Rukia became paralysed shortly before the violence erupted in August 2017. After arriving in Bangladesh, Rukia spent over seven months at MSF’s medical facility in Kutupalong. She returns to the facility every couple of days to have her bedsores treated. Here, Abu Ahmad recounts how the family fled, what life is like for his family in Bangladesh, and their hopes for the future.<br/><br/>“Before the conflict, we had cows, goats, land, all those things. Our business and livelihoods we earnt ourselves. But we faced lots of threats and torture from the government in Myanmar. If someone wanted to get higher education, that person would have to flee the country because if the government found out, they would arrest him. Our movements were very restricted; we were not allowed beyond the checkpoints. We could only move within our area. Other people, like monks and different [ethnic] communities, were free to move around everywhere. <br/><br/>Then the conflict began. <br/>Fighting, stabbings and the burning of houses. Not long before that, my daughter Rukia had somehow became paralysed. She complained of pain and then stopped being able to feel anything below the waist. One night I called all my children together to discuss what to do. We did not see much hope; we could be arrested or killed no matter what we did. My eldest son told me that when the fighting starts, we would not be able to run with Rukia. “There will be no chance to save her life, he said. “You and mother should take her to Bangladesh now, ahead of us. We can join you later.” So I told my other children to get ready, and my wife and I left for Bangladesh with Rukia. <br/><br/>Fleeing Myanmar.<br/>After we left the house ... we were unable to [openly] leave our village because everywhere we looked we saw government people with weapons. We trekked miles through the mountains, hiring men to carry Rukia. We finally arrived at the shoreline opposite Bangladesh late at night. By the time a boat eventually came into view, there were around 20 to 30 other people at the shore with us. The captain took all of us safely across to Bangladesh. When we arrived, the Bangladeshi border police were waiting. They helped us a lot; welcoming us and giving us food, water and biscuits. In the morning they hired a bus and brought us to <br/><br/>Kutupalong camp. <br/>I was anxious after we got off the bus. We had never been to Bangladesh before. I didn’t know where to take my sick daughter and I was asking everyone I saw. People told us about the MSF hospital in Kutupalong. The medics there took Rukia from my arms and admitted her as a patient. She spent almost seven and a half months at the hospital. She had X-rays, blood transfusions and was seen by the doctors several times a day. We were given regular meals. <br/><br/>When I left Rakhine with my wife and Rukia, things hadn’t yet become so bad. It became much worse than we thought was possible. After arriving in Kutupalong, I had no news from my other seven children that were left behind. Other people told us that our house had been set on fire and that our children had fled. We didn’t have a phone or any other way to contact our children; we were so worried. After some time, we heard from people that they had arrived in Bangladesh and were looking for us. They made it to Kutupalong and were able to find us at the MSF hospital by asking people about Rukia. When I was finally reunited with my children after two months, I began to feel calm again. I was so happy to have my children back, I felt like I had my world back. <br/><br/>Life in Bangladesh.<br/>The government gave us wood, bamboo and plastic sheeting to make a house here. We get rations of oil, rice and dhal [lentils]. We sell some of the oil and dhal they give us. After that, we buy some fish, vegetables and chillies. The reason why we sell some of our dhal and oil is so we can earn between 100-200 Taka [1-2 euros]. Even if we don't have money, we have to survive. With that 100 or 200 Taka, we have to survive for one month. Sometimes we can eat such food, sometimes we cannot. We don't have any income. If we could work, life would be easier. We aren't given the chance to do so. I have no opportunity to work and I've lost my strength. I cannot work outside and earn money to feed my children. Even if we don’t have money, we have to survive.<br/>It’s very hard with Rukia in the camp. Because she is disabled, we have to take her out of the camp to the hospital and bring her back every few days. The path from the house to the road is very difficult. The camp has so many ups and downs, and I have to carry her in my arms. I have to get the wheelchair the hospital gave us onto the road, then I have to come back and carry her to it. Then I have to push her in the wheelchair to the hospital. I couldn’t find any space in the camp that’s flat to build the house on. If I had money, then I could take her to hospital by bus and I could avoid this pain. <br/><br/>The hospital have done so many tests and treatments, but we still don’t know why Rukia became paralysed. I am always asking God to help her walk. Sometimes she asks me to take her abroad, so she can get treatment and study. When she says such things, I become more upset. I become more worried and feel so stressed. I've lost my strength, my ability to work. I always have so many worries; worries about the future. I think about food, clothes, peace and our suffering. If I have to stay in this place for 10 years, five years, four years or even for one month, I will have to suffer this pain.<br/><br/>If Rukia could move around, she would be happier. She asks me to move her around in the wheelchair, but because the camp is so hilly, I cannot do so. It is too hard for me to take the wheelchair through the hilly camp. I am in too much pain because I have to carry Rukia around. <br/><br/>We are still from Burma [Myanmar], we will return. <br/><br/>We are not stateless, we are still from Burma [Myanmar]. Our ancestors are from there; our great grandfathers were born there. The country in which we cut our umbilical cord is Burma [Myanmar]. We will return if the country becomes peaceful, but we will return with conditions. We will return if we get our freedom back; if they return our house, our land, our cattle and our goats. People from one country cannot stay in another country. God brought us here and if God wishes, he can take us back to our house and our country. We are ready to go back to our country, but how can we go back while there is still conflict there?" Photographer: Ikram N'gadi
Sara, 46 years old, is Abu Ahmad's wife. Together they have eight children - four daughters and four sons. Her daughter 11-year-old Rukia spent over seven months at MSF’s medical facility in Kutupalong. Sara spoke to MSF about fleeing to Bangladesh without seven of her children, and her hope to one day return to her home country, Myanmar.<br/><br/>" When we fled I lost contact with my children. If any of them had been caught in the fires, I could never hold them again. We even had to leave the youngest one behind. I wanted to take her with us to Bangladesh, but she had a bad fever. I am grateful she returned to my breast. <br/><br/>We don't feel good about staying here, but we have to stay here. Yes, I think about my country a lot. We cannot spend our whole life under this plastic sheet." Photographer: Ikram N'gadi
Rachida, eight years old, is Sara and Abu Ahmad’s youngest child. She fled to Bangladesh with sister Shafika, 16, and brother Roman, 12. She was happy to finally track down her parents and sister Rukia, but expresses uncertainty about their future.<br/><br/>"They came one day and they took some people away. I had no idea what would happen, I thought we could die.<br/><br/>They could not see us, because we hid in the back of a house. This is how we escaped. <br/><br/>I’m feeling happy being here,<br/>after seeing my mum and dad again. Everything is good, but we don’t have money for meat or fish. Mum and dad take my sister often to hospital,<br/>that’s why they cannot work. <br/><br/>Where will we go from here? We will stay here. We will stay for a long time." Photographer: Ikram N'gadi
Angela Makamure Press Officer at Doctors Without Borders (MSF) Southern Africa