More than three years since the emergency officially began, the systematic persecution of the Rohingya people continues. Now more than 860,000 Rohingya refugees live in Cox’s Bazar in southeast Bangladesh, crowded into 26 kilometres of land, dependent on aid, and with a future that appears bleak.
“I left Myanmar because my house was burnt down,” says Abu Siddik. “They were killing and torturing everyone, and harassing our women. It was not safe.”
Abu, from Rakhine state in Myanmar, lives in a refugee camp in Cox’s Bazar with his wife and five children. When the family fled Myanmar, he and his wife carried their two youngest children the whole way because they were not old enough to walk.
Abu is in MSF’s Kutupalong hospital with his five-year-old son, Rashid, who is receiving specialist treatment after being hit by a local taxi.
“We used to live by the coast in Myanmar,” he says. “I had my own business and land. I had a house; I was a shrimp farmer. We had more space and autonomy there. Here everything is so crowded, there is not enough space. It is hard for the kids because they like to go out and play. In Myanmar there were open spaces, but here they play on the roads and it can be dangerous.
“We don't have any financial independence; all we can do is to receive aid. We can't even go to the local market. It has been worse since COVID-19, there are so many restrictions on our movement now that we have to break the rules just to survive.”
A bleak future
The so-called clearance operations launched by Myanmar’s security forces began in August 2017. During these operations, more than 700,000 Rohingya from Rakhine state were driven over the border into Bangladesh, joining 200,000 others who had fled previous waves of violence. Many experienced or witnessed horrific violence, with friends and family members killed and their homes destroyed.
Three years on, there is little hope of positive change for the Rohingya—it’s unlikely they will be returning home in a safe and dignified manner any time soon. People continue to live in overcrowded, flimsy shelters made of plastic and bamboo. Their lives remain on hold.
The mental health needs of the Rohingya have evolved over the years. Unemployment, anxiety about the future, poor living conditions, and little or no access to basic services, such as formal education, have added to the traumatic memories of the violence suffered in Myanmar. Some patients are receiving psychiatric treatment for severe mental health issues, including bipolar disorder and schizophrenia. MSF teams have seen an increasing number of people with mental health issues in our facilities across Cox’s Bazar.
Accessing essential services can be close to impossible for those living in the camps. The Rohingya are banned from accessing public health facilities, and are entirely reliant on health services provided by humanitarian actors in the refugee camps. The only legal avenue to reach Cox’s Bazar health providers is through referrals by humanitarian actors. MSF refers patients to private facilities, as a lack of capacity in public hospitals means they cannot provide adequate healthcare.
“The majority of the patients we see, both children and adults, come with respiratory infections, diarrheal diseases and skin infections,” says Tarikul Islam, MSF’s medical team leader in the Kutupalong-Balukhali megacamp, the largest refugee camp in the world.
“These illnesses are mostly related to the poor living conditions.”
Life in the camps has progressed since the early days of the emergency, with better roads and more latrines and limited clean water points. But life here is still precarious. Every year when the monsoon season arrives, the risk of floods, mudslides and losing what few possessions people have is very real. In addition to the physical barriers, there are also economic concerns to contend with. Without the finances to pay for treatment, many people take their time to seek healthcare, which makes their illnesses worse.
“Some patients arrive late, when they are already seriously ill,” says paediatrician Ferdyoli Porcel. “When a patient does not come quickly, when their condition is already complicated, and the disease is already damaging other organs in their body, it requires a lot more attention and is complicated for us to repair the situation.”
The impacts of COVID-19
COVID-19 is posing additional challenges to those providing care to the Rohingya refugees. The first Rohingya person with COVID-19 in the camps was confirmed on 15 May. This diagnosis only caused further wariness of the existing healthcare system—rumours and misinformation are rife, and fear keeps people in need of essential non-COVID-19 healthcare away from clinics.
“Some patients were not openly admitting to COVID-19 related symptoms because they think they will be treated differently,” says Tarikul Islam.
In response to COVID-19, MSF teams are carrying out health promotion activities to raise awareness and educate communities, as well as providing training frontline workers on infection prevention and control measures and setting up isolation wards in all our health facilities and dedicated treatment centres.
In Cox’s Bazar, MSF manages 10 hospitals and primary health centres, with activities including emergency and intensive care, paediatrics, obstetrics, sexual and reproductive healthcare, and treatment for survivors of sexual violence and patients with non-communicable diseases. Some healthcare providers, including MSF, had to reduce activities in the early days of the pandemic due to staffing and resource challenges. Containing the spread of COVID-19 has also meant increased restrictions on movement in the camps. This has further hampered access to healthcare and made it harder for patients with ‘invisible’ illnesses—such as psychiatric disorders or non-communicable diseases like diabetes—to prove that they are sick and to travel to medical facilities.
“Some patients were not openly admitting to COVID-19 related symptoms because they think they will be treated differently."
Jobaida gave birth a few weeks ago at the MSF Goyalmara mother and child hospital. She and her baby spent six days in the neonatal intensive care unit, during which time they were tested for COVID-19.
“I was afraid because there is a belief in our community that having COVID-19 means you will die,” she says. “The doctors and nurses were really kind; they supported me and checked on me every day. They didn't seem to be afraid to get close to me, even though I was infectious, which helped me feel less stigmatised.”
Sharing information about COVID-19 and raising awareness among communities has been crucial to MSF’s response, but doing so using social media or SMS messaging has been hampered by restrictions on mobile network availability in and around the camps. To avoid gathering people in groups, our outreach teams in the camps and the neighbouring Bangladeshi villages go house-to-house, speaking with individual family members.
“The vulnerability of the situation for Rohingya refugees has been exacerbated by the COVID-19 pandemic,” says Alan Pereira, MSF country representative in Bangladesh. “Their lack of legal status and the absence of longer-term and more sustainable solutions mean that their future is more uncertain than ever.”