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Rohingya refugee crisis

Since the late 1970s, the stateless Rohingya people have fled persecution and violence to seek refuge in Bangladesh. The Myanmar military’s campaign against the Rohingya in 2017 and the following systematic persecution has led to almost 900,000 Rohingya refugees taking shelter in Cox’s Bazar in what has become the world’s largest displacement camp. 

Since arriving in Bangladesh, the Rohingya have known nothing but uncertainty. As Bangladesh does not recognise the Rohingya as refugees, no formal education is allowed and there are few opportunities for work—and there is no safe way to return home to Myanmar. This insecurity has worsened with the outbreak of the COVID-19 pandemic, which has reduced their already limited freedoms and diminished their access to healthcare. 

For many Rohingya refugees, the situation feels hopeless, as they continue to live in overcrowded, basic conditions, dealing with outbreaks of disease, and struggling with the traumas of all they have endured. 

The Rohingya refugee crisis

MedicalRefugees and displaced persons 
More than 900,000 Rohingya have been displaced during violent and targeted campaigns led by the Myanmar military, with most fleeing across the border to Bangladesh.  

Medical

Neglected people groups 
The Rohingya have been described by the United Nations as one of the most persecuted minorities in world. Rohingya refugees lack access to basic rights and services, including freedom of movement, healthcare, state education, and civil service jobs. 

About the crisis

On 25 August 2017, a campaign of targeted violence by the Myanmar military was waged against the Rohingya in Rakhine State. 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. 

Those arriving in Bangladesh have shared stories with MSF staff about their villages being systematically raided and burnt by the Myanmar military. Mob groups targeted the Rohingya and women and children were raped and killed. Refugees arriving in Bangladesh are often in dire need of medical care, having had little to no access in Myanmar. Access to healthcare is an ongoing issue in Myanmar following the military coup in February 2021

884,000 Rohingya refugees are currently situated in Bangladesh. Most of these people have been living in one of the world’s largest refugee camps in Cox’s Bazar for the past three years. The exponential growth of the population in such a short amount of time has resulted in a severe deterioration of living conditions, and finding shelter in the overcrowded camps is a challenge. Barbed wire fences their interactions with the outside world, including options to access work or education. The situation is extremely precarious, with many people lacking access to healthcare, safe drinking water, latrines and food. 

During the COVID-19 pandemic, the humanitarian presence in Cox’s Bazar has been limited under the pretence of COVID-19 containment measures. As such, the unmet needs of those in the camps are increasing, and tensions remain high.  

Approximately 20,000 Rohingya refugees have been relocated to a man-made island off the coast of Bangladesh called Bhasan Char. MSF has concerns about the living conditions and healthcare on the island.

Who are the Rohingya?

The Rohingya are a stateless ethnic group, the majority of whom are Muslim, who have lived for centuries in the majority Buddhist Myanmar (also known as Burma). Myanmar authorities contest this, claiming that the Rohingya are Bengali immigrants who came to Myanmar in the 20th Century.

The Rohingya have been described by the United Nations as one of the most persecuted minorities in world. Prior to the military crackdown in August 2017, roughly 1.1 million Rohingya people lived in Myanmar, though they are denied citizenship under Myanmar law.

Nearly all the Rohingya in Myanmar live in the western coastal state of Rakhine, one of the poorest states in the country, and are not allowed to leave without government permission. 

The Rohingya in Myanmar lack access to basic rights and services, including freedom of movement, healthcare, state education, and civil service jobs.

Why are the Rohingya stateless?

In 1982, Myanmar introduced a Citizenship Law which arbitrarily deprived the Rohingya of their citizenship. Under this law, full citizenship is based on membership of the ‘national races.’ As the Rohingya are not considered to be part of these national races, they are regarded as foreigners. 

While a citizenship verification exercise is ongoing, this process does not meet international standards. Many Rohingya are reluctant to accept the National Verification Card (NVC1), as those holding these cards still cannot move freely within Rakhine State, or Myanmar as a whole, to access services or livelihoods due to checkpoints, bureaucratic barriers, and other discriminatory practices.

What challenges do the Rohingya face?

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 organisations such as MSF in the refugee camps. MSF refers patients to private facilities—the only legal way avenue available for those in the camps—as a lack of capacity in public hospitals means they cannot provide adequate healthcare.

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 the situation 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.”

During a moment of confusion as heavy monsoon rain came down near the Bangladesh-Myanmar border, Rohingya refugees make a run past Bangladeshi border guards preventing them from continuing their journey toward the refugee camps near Cox Bazar. October 201

MSF’s response

MSF has been working in Bangladesh since 1985 in both the capital Dhaka and Cox’s Bazar, the coastal border town with Myanmar. Our teams manage a range of activities in and around the refugee camps of Cox’s Bazar, providing essential healthcare for Rohingya and Bangladeshi communities alike. 

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 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.

“The Rohingya increasingly face a terrible dilemma. Many are becoming more and more desperate and hopeless as conditions in the camp continue to deteriorate, which makes them turn to risky choices.”

Bernard Wiseman
MSF Head of Mission in Cox’s Bazar

Areas MSF is focused on:  

  • Vaccination for preventable diseases: The majority of the Rohingya have extremely low immunisation coverage as a result of decades of restricted access to healthcare in Myanmar, and as susceptible to preventable diseases such as diphtheria and measles. 
     
  • Providing mental healthcare: The targeted violence that forced Rohingya refugees to flee their homes in Myanmar, combined with the hazardous journey and the daily stresses of life in the camps, means that many refugees experience flashbacks, generalized anxiety, panic attacks, recurring nightmares and insomnia, as well as illnesses such as post-traumatic stress disorder and major depression. This is further exacerbated by insecurity concerning their future and a lack of decision-making power and control over their own lives. Our teams provide individual mental health consultations to help those in the camps process and prioritise their mental wellbeing.   
     
  • Caring for survivors: MSF teams continue to provide services for survivors of sexual and gender-based violence. Rates of intimate partner and domestic violence are high in the refugee camps in Cox’s Bazar. 
MSF staff member Tanbin Muftah looks over Jamtoli refugee camp in Cox’s Bazar, south-east Bangladesh. August 2020. © Hasnat Sohan/MSF

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 2020. 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, MSF’s medical team leader.
In response to COVID-19, MSF teams are carrying out health promotion activities to raise awareness and educate communities, as well as providing training to frontline workers on infection prevention and control measures and setting up isolation wards in all our health facilities and dedicated treatment centres. 

Amid the COVID-19 pandemic, mothers continue to give birth, children remain at risk of vaccine-preventable diseases, and chronic patients continue to need medication. The limited availability of secondary healthcare and specialised services for the refugee community remains a serious concern. People struggle to access good-quality 24-hour surgical capacity, comprehensive obstetric and neonatal care, paediatric services, treatment for non-communicable diseases, and care following sexual and gender-based violence. Field hospitals run by MSF and other organisations are unable to perform complicated surgeries and referrals have been interrupted by the ongoing pandemic.