Rohingya Refugee Crisis

More than three years since the emergency officially began, the systematic persecution of the Rohingya people continues. More than 860,000 Rohingya refugees now live in Cox’s Bazar in southeast Bangladesh, crowded into 26 kilometres of land, in what has become the world’s largest displacement camp.

Since arriving in Bangladesh, the Rohingya have known nothing but uncertainty. No formal education is allowed, they have 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 people are one of the most persecuted minority groups in the world.

MSF staff Tanbin Muftah looks over the Jamtoli refugee camp in Cox’s Bazar, south-east Bangladesh. "The majority of the patients we see, both children and adults, come with illnesses related to the poor living conditions," she says. © Hasnat Sohan/MSF

Those arriving in Bangladesh have shared stories with Médecins Sans Frontières/Doctors Without Borders (MSF) 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. It is one of the largest displacements of people in recent memory, in such a short period of time.

More than 860,000 Rohingya refugees live in just 26 square kilometres of land in Cox’s Bazar. People depend on communal distributions of water, food, and fuel, and must wait for hours in large groups to receive these services. The water they do get is barely enough to drink and cook with and is not sufficient for additional handwashing. Inadequate, unhygienic living conditions cause many of the predominant medical conditions in the refugee camps, such as acute watery diarrhoea, respiratory tract infections, skin diseases and fevers of unknown origin.

Since August 2017, MSF has treated over 7,600 patients for diphtheria and over 9,000 patients for suspected measles. Before COVID-19, around one-third of all consultations by MSF were for respiratory tract infections.

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.

A child is examined by MSF in Bangladesh.

The military came to our part of town around 6pm and said: 'Leave the village before 8am tomorrow. Every one that stays will be killed.' Read More.

61-year-old patient

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Who are the Rohingya?

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’, which Rohingya are not considered to be a part of, and as such they are regarded as foreigners.

While there is a citizenship verification exercise underway, it 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.

The Rohingya's situation in Bangladesh

Since 25 August 2017, more than 745,000 Rohingya refugees have fled from Myanmar into Bangladesh.

Their arrival comes on top of hundreds of thousands of other Rohingya who arrived in previous years and were already living in difficult conditions. Combined with the existing Rohingya refugee population, approximately 919,000 refugees are now in Bangladesh.

In the first six months of the mass exodus in August 2017, we treated more than 350,000 patients, including victims of rape, people with gunshot wounds and severe acute malnutrition.

People are continuing to cross over into Bangladesh from Myanmar. Those arriving tell MSF teams that incidents of violence, harassment and detention continue, as do household checks and coerced registration for the National Verification Card.

The current context of overcrowding and poor sanitation in these makeshift refugee camps means the risk of people getting sick is very high.

Monsoon SEASON

The Rohingya refugee camp in Bangladesh is regularly hit by extreme wind and rain from June to September, making the camp extremely vulnerable.

In 2018, and now in 2019, intense rains have caused havoc in the camps and for local communities. The rains have resulted in landslides, floods, and fires, which have led to injuries, deaths and destruction of homes and buildings.

Emergency preparedness is a key priority but continues to be hampered by the lack of useable land.

The only cyclone-proof building in the mega camp is MSF’s Hospital on the Hill.

The overnight creation of the world’s largest refugee camp

The unprecedented influx of people crossing over the border into Bangladesh in 2017 created absolute chaos.

Over half a million new arrivals set up informal shelters in the Kutupalong/Balukhali mega camp; another quarter of a million set up spontaneous settlements and other pre-existing camps; and 46,000 live within the local Bangladeshi community.

Thousands of people continue to be relocated due to unsustainable and dangerous conditions.

The absence of roads into the huge densely populated camps means that aid is still not reaching many and the living conditions in the settlements remain extremely precarious and hazardous.

Life on the Edge

With extremely densely populated camps and poor water, hygiene and sanitation conditions, the situation of the Rohingya in Bangladesh remains precarious.

Living conditions for the refugees have not improved very much since their arrival almost one year ago and need to be addressed urgently, with a particular focus on improvements to shelter, water and sanitation, and reducing population density.

What is MSF doing to help the Rohingya?

Since 1985, MSF has been present in Bangladesh in both the capital Dhaka and Cox’s Bazar, the coastal border town with Myanmar.

But with this recent and unprecedented influx of people crossing over the border into Bangladesh, we have been forced to massively increase our capacity to respond, launching additional emergency projects.

As of 30 June 2019:

Health facilities: Three field hospitals with inpatient facilities, four 24 hour primary health centres, one specialised clinic for reproductive and mental healthcare, one isolation centre for outbreak response, two health posts
Staff: More than 1,600, the majority are Bangladeshi nationals
Patients: Our teams has done more than 1,300,000 outpatient consultations and delivered over 3,200 babies
Health issues: Respiratory infections, diarrhoeal diseases, skin diseases, measles, diptheria – all related to poor living conditions
Other activities: water and sanitation, mental health

MSF teams have treated some injuries resulting from landslides and flooding but the main health issues continue to be related to poor living conditions, including respiratory tract infections, diarrheal diseases and skin diseases.

Vaccination for preventable diseases

There is also a focus on vaccinations as the majority of the Rohingya had extremely low immunisation coverage as a result of decades of restricted access to healthcare in Myanmar.

We have treated more than 7,000 people for diphtheria in the Cox’s Bazar district as of the end of March and treated over 5,000 people for measles.

Water and sanitation activities

280 million litres of chlorinated water available for over 77,000 people, five water distribution networks, and a faecal sludge management system treating over 1,400,000 million litres of faecal sludge, construction of 400 latrine blocks, desludging of 760 latrines, and conducting over 11,990 hygiene promotion sessions.

Mental Healthcare

Mental health continues to be a major concern. 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. MSF provided over 31,000 individual mental health consultations from August 2017 to June 2019.

MSF teams also continue to provide services for survivors of sexual and gender-based violence (SGBV). Rates of intimate partner and domestic violence are high.

We treated 1,087 survivors of sexual and gender-based violence between 25 August 2017 and 31 March 2019. However, the real figure of SGBV survivors is impossible to determine as we likely only treat a fraction of all cases.

What is the future for the Rohingya?

Rohingya lack of citizenship rights in Myanmar and their lack of refugee status in Bangladesh is at the heart of many issues. Long-term solutions are needed to respond to Rohingya refugee crisis.

For the Rohingya left in Rakhine in Myanmar, MSF is particularly concerned about barriers to access healthcare due to restrictions on their freedom of movement. Humanitarian actors need independent access in order to assess and respond impartially to health needs.

For the Rohingya that have fled to Bangladesh, it is critical that any return or repatriation of Rohingya refugees to Myanmar only take place if it is voluntary, their safety is guaranteed and the root causes of the violence have been addressed. That means addressing the ongoing discrimination and denial of basic human rights.