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. 

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.

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. 

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.