Alive but in limbo

25 August marks five years since the campaign of targeted violence in Rakhine state, Myanmar. In my twenty years of working in the humanitarian sector, no crisis stands out more in my memory than the movement of 700,000 people across the border from Myanmar to Bangladesh.  Stories of children who watched their families slaughtered, women who held children for days as they walked for safety, the elderly who weren’t strong enough to finish the journey remain vivid to me.

Alive but in limbo, stripped of land, possessions and livelihoods, a new life of sorts began in makeshift camps in Cox’s Bazar. But after five years, Bangladesh remains hosting a population of a million refugees, mostly Rohingya, and the situation is fragile with no solution in sight.

Australia has a key opportunity to contribute to building a better future for the Rohingya people. The Government should implement a targeted humanitarian visa allocation, specifically for Rohingya refugees, as has been done for Ukrainian and Afghan people. The Rohingya are the world’s largest stateless population, who have faced extreme violence and persecution, yet there’s no specific program for their resettlement in Australia.

Bangladesh insists the Rohingya must return to Myanmar, which stripped them of their citizenship 40 years ago. But Myanmar has been at war with itself since the military seized power in February 2021, and in Rakhine state tensions between the Myanmar military and Arakan army, an ethnic armed group, are increasing. Myanmar is not close to meeting the conditions for voluntary, safe, dignified and sustainable return of the Rohingya to Myanmar.

Across the region, Rohingya people are treated as illegal migrants and exploited by authorities, host communities, smugglers, and traffickers, who seek to benefit from their precarious status. They experience prolonged detention and deportation by the police and immigration services; violence; during dangerous journeys in search of safety.

Australia and other Indo-Pacific states are providing some financial support for the humanitarian response in Cox’s Bazar, which helps contain ‘the problem’ elsewhere, but there has been no meaningful political dialogue on what to do next. The situation is becoming more urgent as new crises in Ukraine, Ethiopia and Somalia and elsewhere stretch limited humanitarian budgets.

A recent assessment by Médecins Sans Frontières/Doctors Without Borders shows that water and sanitation conditions in the Cox’s Bazar camps are hazardous. We consulted with 361 households in nineteen camps between January and March 2022.

While access to better quality water has improved since the initial year of the crisis, more than half of people interviewed lacked access to continuously available water, almost 80 per cent of people reported using toilets that were over-flowing and almost 90% of people had inadequate access to sanitation facilities like handwashing points with soap. This corresponds with an increase of skin infections, including a dramatic increase in scabies cases reported by health facilities In MSF’s Kutupalong hospital, the same number of patients were treated for skin conditions in the first quarter of 2022 as during the entire year of 2021.

Water-borne diseases are another ongoing concern. The number of patients being treated for acute watery diarrhea (AWD) in MSF facilities in 2022 has increased by more than 50 per cent when compared to 2019. Acute watery diarrhoea is among the top five morbidities affecting the refugee population.

As humanitarians we can treat what ails our patients, but we cannot fix the political impasse that is devastating the Rohingya. This is particularly apparent in our mental health services. Our clinicians tell us it is emotionally draining to know they cannot change the root cause of individuals' psycho-social well-being. At the end of every session, people must return to a life in limbo, in harsh, overcrowded camps that are now also plagued by increasing violence.  We know from experience that living in these conditions, without prospects for the future, leads to wretched health outcomes. And we are powerless to change those outcomes without systemic change.

As humanitarian leaders, we are confronted with the limits of our profession. And I fear that without a new approach, this situation is becoming a pressure cooker. Governments and the United Nations need to do more to attempt to find a solution that considers the needs and wishes of the Rohingya themselves. An Indo-Pacific approach is needed, and Australia must step up.

Australia can play a constructive role in bringing new, urgently needed ideas to the table and setting a tone for humanity and solidarity with, and better outcomes for, the Rohingya. A good start would be ending our own draconian refugee policies, which continue to keep Rohingya in Australia in arbitrary detention and limbo and encourage similar containment policies around the region. Australia can diplomatically engage with countries to offer resettlement to vulnerable Rohingya from Malaysia, Bangladesh, Indonesia and Thailand. Resettlement alone will not solve the crisis, but it is an important first step for a country like Australia towards showing meaningful solidarity with the Rohingya.

After five years in camps and decades of limbo, we must work towards new solutions for Rohingya people until a just and safe return to their native Myanmar can be negotiated. Let’s take this historic opportunity to be the kinder, gentler, Australia we know we can be.

Jennifer Tierney is Executive Director of Médecins Sans Frontières /Doctors Without Borders (MSF) Australia. Médecins Sans Frontières is an international independent medical humanitarian organisation that delivers emergency medical aid to people affected by conflict, epidemics, healthcare exclusion and natural or man-made disasters. MSF is working with Rohingya communities in Myanmar, Bangladesh, and Malaysia.