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    On 25 August 2017, more than 700,000 Rohingya fled from the systematic persecution in Myanmar to Cox's Bazar district in southeast Bangladesh. The Rohingya refugees arrived at the refugee camp starving, injured and traumatised.

    Doctors Without Borders/Médecins Sans Frontières (MSF) was told of harrowing tales of homes and villages being razed to the ground, some with families helpless in their homes. Women and girls were raped, and children were beaten to death. Men and boys were rounded up and executed in front of family members.

    Animation about the enduring plight of the Rohingya

    British artist Richard Swarbrick (@rikkileaks) was commissioned by Doctors Without Borders to create a rotoscope animation about the enduring plight of the Rohingya.

    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.'
    61-year-old Rohingya patient

    Now, nearly one million Rohingya refugees live in Cox's Bazar. They are crowded into 26 kilometres of land, in what has become the world’s largest displacement camp, clutching to faint hope for a better future.

    The Rohingya refugees in Bangladesh live in limbo, denied of formal education, work opportunities and a way back to their home country. Vital facilities such as toilets and food distribution are all communal, with people often waiting in large groups to access these basic services, including water and sanitation. 

    The uncertainty of their lives has merely worsened with the COVID-19 pandemic, limiting their already curbed freedom and access to life-saving healthcare.

    An injured Rohingya boy sits on his bed at MSF's medical facility in Kutupalon

    An injured Rohingya boy sits on his bed at the Doctors Without Borders medical facility in Kutupalong. © Antonio Faccilongo/MSF

    @rikkileaks OCA commissioned British artist Richard Swarbrick to create a rotoscope animation about the enduring plight of the Rohingya

    British artist Richard Swarbrick (@rikkileaks) was commissioned by Doctors Without Borders to create a rotoscope animation about the enduring plight of the Rohingya.

    Rohingya refugee camp

    The "big road" runs along the megacamp in Cox's Bazar District, where nearly one million people live. © Vincenzo Livieri/MSF

    We live in an open prison. Life for a refugee is hellish, and every day is the same. Sometimes I bite myself to see if I can feel something, and I have tried to commit suicide.
    Faruk, a Rohingya refugee

    In December 2020, the Bangladesh government began placing Rohingya refugees rescued from the sea to Bhasan Char, some 30 kilometres from the mainland. As of July 2022, over 27,000 people from Cox's Bazar have been relocated to the controversial island, a a 40-square-kilometre flood-prone island that did not exist two decades ago, and is situated in a region where about 700,000 people have died in storms in the past 50 years. More Rohingya will likely face relocation soon as authorities claim the island has an estimated capacity to house 100,000 people. Independent humanitarian organisations have yet to gain access to the site, adding fuel to growing concerns about the living conditions.

    Happiness for the opening of water faucet.

    Happiness over the opening of water faucet. © Vincenzo Livieri/MSF

    A registered refugee from Nayapara camp, Cox’s Bazar

    Faruk (not his real name) is a registered refugee from Nayapara camp, Cox’s Bazar. © Farah Tanjee

    Rohingya refugees in Kutupalong megacamp

    "It's difficult to plan a future for our children." Rohingya refugee Bibi Jan sits at a tea stall with her five year old son, Fayezorahman, in Kutupalong megacamp. © Dalila Mahdawi/MSF

    For the hundreds of thousands of Rohingya refugees in Bangladesh, 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.

    Doctors Without Borders' medical and humanitarian action in Bangladesh, Myanmar, and Malaysia is driven by a commitment to provide the Rohingya community with adequate access to quality medical care and be a witness to their plight.

    How does Doctors Without Borders respond to the Rohingya refugee crisis?

    Bangladesh

    Since 1985, Doctors Without Borders has been present in both the capital Dhaka and Cox's Bazar in Bangladesh.

    In Cox’s Bazar, across eight active facilities (plus two “standby” emergency facilities), Doctors Without Borders provides a range of specialized healthcare to address some of the vast health needs of more than 925,000 Rohingya refugees living in the camps, and  a growing number of patients from the host community. Services include general healthcare, treatment of chronic diseases, such as diabetes and hypertension, emergency care for trauma patients, mental health and women’s healthcare. Doctors Without Borders also provides key support to water and sanitation activities in the camps such as latrine de-sludging, faecal sludge treatment, maintenance of hand pumps, tube wells, and water networks, as well as hygiene promotion.  

    The current Doctors Without Borders intervention in Cox’s Bazar started in 2009, when Kutupalong field hospital was established to serve both refugees and the local community. Following the August 2017 influx of over 770,000 Rohingya refugees fleeing the latest and largest campaign of targeted violence against Rohingya in Myanmar, Doctors Without Borders scaled up activities in Bangladesh to respond to the massive health needs of the population. In 2019, Doctors Without Borders’ programming transitioned towards addressing longer-term health needs. Congested “temporary” shelters and dire water and sanitation services, fires, flooding and movement restrictions all pose health risks and affect the ability of Rohingya to live in dignity. 

    Note: Doctors Without Borders' project in the Kamrangirchar neighbourhood of Dhaka (capital of Bangladesh) is not part of the Rohingya response. 

    Bangladesh 2022

    Map detailing the Doctors Without Borders response in Bangladesh

    How do the Rohingya live in Bangladesh?

    The Rohingya have very limited opportunities to work, though some find and take the risk of informal work. This renders them dependent on humanitarian assistance. Assistance includes basic food rations, cooking gas, and the shelters that were provided in 2017. It is enough to keep people alive, but leaves many Rohingya unable to afford other essentials like clothing, essential groceries, and material to repair their shelters. This dependence on humanitarian aid also takes away from people’s sense of dignity by limiting their ability to be self-reliant.

    The temporary nature of shelters, often built on slopes, is a high-risk combination. Annual flooding leaves people vulnerable to death, injury and displacement with recurrent episodes of shelters being washed away.

    Shelters cramped together make tasks like cooking risky. Outbreaks of fires are common. In 2021, around 15 people lost their lives during a massive blaze, 560 people were injured and up to 10,000 families (more than 45,000 people) were displaced. The Doctors Without Borders Balukhali clinic was also destroyed by the fire.

    There are few education prospects for children, as only primary education is provided by NGOs for a few thousand of the children within the entire camp population, meaning many go without. This is a key source of distress for parents, who worry about what the future will hold for a generation of uneducated children, either in Bangladesh or in the event of a return to Myanmar in the future.

    A study of water and sanitation conditions in the camps in Cox’s Bazar

    Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

     Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

    Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

     Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

    Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

     Results from a Doctors Without Borders study of water and sanitation conditions in the camps in Cox’s Bazar

    Water, sanitation and hygiene (WASH) situation  

    Between January to March 2022, Doctors Without Borders conducted a water and sanitation assessment in Cox's Bazar. This study, covering 361 households in 19 camps across Doctors Without Borders catchment areas, compared the situation to conditions at the onset of the initial emergency response in 2018.

    The assessment of access to water showed that there has been improvement in the proportion of refugees who have access to improved quality of water, 53% in 2018 to 99% in 2022. This is due to the installation of water networks and the use of chlorination, which should be championed as one of the successes of the response. However, 56% of respondents indicated that water was not continuously available. This means that while the quality of water has improved, access to sufficient water supply remains inadequate to meet people’s needs.

    The overall sanitation situation in the camps has deteriorated over the last four years. While more lockable doors and covers for openings were installed, 76% of respondents indicated that toilets were overflowing, compared to 38% in 2018. Respondents indicated latrines are not being de-sludged or maintained in a timely manner. This deterioration in sanitation conditions not only poses health risks to refugees, but impacts their ability to live in dignity.

    24% of respondents also indicated that there is a shortage of containers for the disposal of household waste. This is concerning, because shelters, where waste disposal practice is inadequate, attract rats and act as potential breeding sites for mosquitos, which transmit various diseases, including dengue, which is rising in prevalence in the camps.

    Health situation in Bangladesh

    Doctors Without Borders teams are witnessing the impact of prolonged displacement in congested camp conditions on the physical and mental health of Rohingya. Gaps in the provision of proper water and sanitation services present an ongoing--but amendable--risk to the health of the refugees. Sufficient provision of clean water and soap play a key role in ensuring people’s ability to practice good hygiene and mitigate some of the health risks they are exposed to, along with contributing to people’s ability to live in dignity.

    Skin infections: In the aforementioned WASH study of 2022, 31% of households reported skin infections, a significant difference in comparison to 2018, where only 7% reported skin infections. In two Doctors Without Borders facilities, in camps 14 and 15, our teams treated over 42,000 patients for scabies from March to the end of June 2022. In Doctors Without Borders’ 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.

    Diarrhea: Water-borne diseases are another ongoing concern. The Doctors Without Borders assessment also showed that 21% of households reported diarrhea among children under the age of 5. The number of patients being treated for acute watery diarrhea (AWD) in Doctors Without Borders facilities in 2022 increased by more than 50% compared to 2019. Acute watery diarrhea is among the top five morbidities affecting the refugee population.

    Dengue: Dengue fever is a viral infection transmitted to humans by infected mosquitoes generally breeding in stagnant water, which is common in the camps due to the widespread open water accumulation points and poor drainage. While dengue outbreaks occur every year in Bangladesh, we have seen an early and steady increase of dengue fever patients in our medical facilities in Cox’s Bazar in 2022. In only two months (June and July), Doctors Without Borders facilities admitted 248 patients infected with dengue, coming from the refugee and host community to our hospitals.

    Chronic diseases: Our teams are also receiving an increasing number of patients with chronic diseases including hypertension, diabetes and asthma. From January to July 2022, our teams provided a total of 35,306 consultations to chronic disease patients. This is in addition to maintaining a cohort of 3,035 patients with chronic diseases, who receive medications on a regular basis.  

    Malaysia

    Refugees, asylum-seekers and stateless people are criminalised by domestic law and hence unable to access healthcare, education or work due to their irregular status.

    Our teams provide primary healthcare and mental health support to the Rohingya and other communities, through a clinic in Butterworth, mobile clinics in Penang and Kedah, and in activities in detention centers. We refer patients to secondary and tertiary healthcare and support an increasing number of sexual violence survivors, including victims of human trafficking both women and men.

    The Doctors Without Borders team has established a community-led refugee advocacy group to support the group in acquiring advocacy skills.

    Malaysia 2022

    How do the Rohingya live in Malaysia?

    As refugees with UNHCR cards are not allowed to work legally, many end up in the informal sector doing “3D jobs” (dirty, dangerous, difficult), which expose them to the risk of exploitation.

    Rohingya and other refugees and asylum seekers are also forced to pay the foreigners’ rate at public healthcare facilities, which can be up to 100 per cent more than what a local pays.

    Meanwhile, refugees and asylum seekers without UNHCR documents, face the risk of being reported to the immigration authorities and possibly face detention when accessing public healthcare. This is according to a Ministry of Health circular which obliges medical staff at public healthcare facilities to report undocumented/irregular migrants to Immigration Department.

    Myanmar

    Doctors Without Borders began providing healthcare in Rakhine State in 1994, treating malaria in Sittwe.

    Today, Doctors Without Borders continues to provide medical assistance to the Rohingya population still living in Myanmar, including in camps in central Rakhine state and in village settings in the north. We provide reproductive and basic healthcare, mental health support, and referrals for emergency and specialised treatment. Our teams educate communities about how to lead healthy lives, how to recognise signs and symptoms of disease, and where to go when they need treatment.

    We also provide healthcare services to ethnic Rakhine people who have been displaced by fighting, and live in internal displaced persons camps.

    What is life like for the Rohingya in Myanmar?

    Rohingya have very limited freedom of movement, and therefore restricted access to work opportunities, education and healthcare. Individuals living in camps are reliant on humanitarian assistance.

    Rohingya in Rakhine state struggle to access proper primary healthcare. Due to freedom of movement restrictions, if they require emergency treatment, for many the only way they can be admitted to the hospitals that accept Rohingya is through a Doctors Without Borders referral. Discriminatory behaviour, including extortion, towards Rohingya, particularly in public hospitals and from state officials, is an additional deterrent to accessing healthcare. They are also segregated to different areas of the hospital.

    With existences underlined by fear, struggles to afford food, and feelings of hopelessness, this protracted status quo has had drastic consequences on mental health. For those living in the squalid, cramped camps, these issues may be even more pronounced.

    Limited availability of water in the displaced persons camps in central Rakhine and in villages in northern Rakhine, including clean drinking water, puts Rohingya at risk of water-borne diseases and skin infections, particularly in the dry season.

    Find out more

    Who are the Rohingya?

    The Rohingya are people from Rakhine state, Myanmar, which borders Bangladesh to the north. They are mostly Muslims, who had lived in the predominantly Buddhist country for centuries. The Myanmar authorities disputed this and declared them to be illegal immigrants from Bangladesh.

    Before the military crackdown in August 2017, roughly 1.1 million Rohingya people lived in the country.

    Targeted violence

    The Rohingya fled by the hundreds of thousands after the Myanmar government ramped up military action against them, in retaliation to attacks claimed by the Arakan Rohingya Salvation Army in 2017.

    The Rohingya journeyed to Cox's Bazar on foot, boats and sometimes wading through a river separating the Bangladesh-Myanmar border.

    This led to the Rohingya people being marked as one of the most persecuted minorities in the world by the United Nations in 2013.

    At least 9,000 Rohingya died between 25 August and 24 September 2017 according to surveys conducted by Doctors Without Borders. In very conservative estimates, at least 6,500 were killed, including 730 children below the age of five.

    It confirms reports by international news organisations of targeted violence which the Myanmar government continues to deny.

    Why are the Rohingya stateless?

    The Rohingya are considered foreigners following the introduction of a Citizenship Law in 1982. The law does not recognise them as one of the "national race."

    While the Myanmar government was offering citizenship through a "verification" exercise, the Rohingya people are reluctant to accept National Verification Card (NVC1) as despite holding it they are still unable to move freely within the Rakhine state or the country and given access to necessary services due to checkpoints, bureaucratic barriers, and other discriminatory practices.

    “We are not stateless. We are from Myanmar. Our ancestors are from Myanmar.”  – Abu Ahmad, 52 years old, fled to Bangladesh to seek treatment for his daughters paralysis. 

    What is the Rohingya refugee crisis?

    A total of 745,000 Rohingya refugees fled to Bangladesh on August 25, 2017. Their arrival adds to thousands of their people who migrated to the refugee camps in previous years and are still living in difficult conditions.

    Today, the Cox's Bazar district is home to nearly a million refugees, making it the world's largest refugee camp.

    The Rohingya also risk their lives on boats across the Andaman sea to flee to other countries such as Malaysia, Thailand, Indonesia, Cambodia and Laos.

    The mass displacement of people in this short period is the largest in the world of its kind in recent history.

    What is the current situation of the Rohingya?

    In Bangladesh

    "Spending our lives in the camps is difficult; the area is small, and there is no space for the children to play.” – Abu Siddik, Cox's Bazar, Bangladesh

    It has been five years since the 2017 influx of more than 770,000 Rohingya to Cox’s Bazar. They joined more than 250,000 Rohingya already there from previous waves of violence. Now, almost 1 million people live in an approximately 25-kilometre zone south of Cox’s Bazar city. 

    The government of Bangladesh welcomed Rohingya refugees fleeing the violence in Myanmar and shouldered most of the burden to provide shelter and food assistance at the beginning of the influx in 2017. In collaboration with the government of Bangladesh and other actors involved in the joint response to Rohingya in camps in Cox’s Bazar, several NGOs work in the camps to respond to some of the basic needs people have, including provision of food staples (mostly rice and oil), cooking gas, water and sanitation services, basic education (up to primary school only), and primary healthcare services. However, these services barely cover the needs of the almost 1 million refugees in the camps.  

    Bangladeshi authorities and the host community are also increasingly frustrated by what they perceive as a lack of action at the international level to find a solution to this crisis. The authorities insist that repatriation should happen as soon as possible, and that the response in Bangladesh must remain temporary until then. This manifests itself in the nature of the refugee shelters inside the camps, as well as the facilities of all NGOs operating there. All establishments within the camp parameters are required to use only non-permanent structure materials (like bamboo and wooden boards). 

    To make matters worse, humanitarian attention to the Rohingya is challenged by other crises around the world. As announced by UNOCHA, funding for the Rohingya Joint Response Plan (JRP) decreased from $629 million in 2020 to $602 million in 2021. As of August 2022, the funding stands at only $266 million. 

    As most conditions in the camp worsen, people who try to escape most often pay smugglers to take them to primarily Malaysia, but also Indonesia and Thailand. 

    Since December 2020, as an apparent measure to reduce over-crowding in the camps, the authorities started to relocate Rohingya to a 40 square kilometre flood-prone island called Bhasan Char. So far, over 27,000 people have been relocated as of July 2022.

    In Malaysia

    Rohingya refugees have been going to Malaysia for more than 30 years, making the perilous journey across the Andaman Sea in search of a safe haven and hope for the future. However, in Malaysia, the life of refugees continues to be a struggle for dignity and acceptance. Malaysia is not a signatory to the 1951 UN Refugee Convention and its subsequent protocol, and the country does not recognise or protect refugees and asylum seekers in domestic law. Therefore, refugees and asylum-seekers in Malaysia are effectively criminalised, and have limited access to public services, including healthcare.

    The card issued by the UN High Commissioner for Refugees (UNHCR) provides registered refugees and asylum-seekers limited protection, but they still lack legal status, which means that they are at constant risk of arrest and detention, in addition to facing barriers in access to healthcare, education and legal employment.

    Many refugees, including the Rohingya, are detained in immigration detention centres nationwide. Children have also been detained. UNHCR has been denied access to these centres since August 2019. As a result, UNHCR is unable to conduct refugee status determination, and unable to seek release of the detained asylum seekers and refugees.

    Doctors Without Borders has observed an increase in xenophobic sentiment against Rohingya since the start of the COVID-19 pandemic in 2020, which coincided with the change in government. Following news of several new arrivals by boat in early 2020, the government took a hard-line stance against Rohingya refugees by preventing boats from reaching the coast, tightening the nation’s land and sea borders, and increasing raids by immigration authorities throughout the country, targeting areas where refugees and migrants reside and work.

    Three groups of new boat arrivals were reported in May 2022. Doctors Without Borders learned that these arrivals consisted of more males than females, a deviation compared to past trends, where majority of the journeys were taken by women and girls. Reportedly, the newly arrived Rohingya refugees and asylum seekers have been charged in court and are currently in prison or immigration custody. Doctors Without Borders has attempted to access these individuals to provide medical assistance and mental health support; our attempts were unsuccessful.

     

    In Myanmar

    Around 600,000 Rohingya remain in Rakhine state, with some 140,000 living in displacement sites, including camps where they have extremely limited freedom of movement. Those living in village settings also require costly and bureaucratic documentation to move around and have limited access to basic services.

    Among the Rohingya living in Rakhine state, the military coup has not led to significant shifts in their situation – it was terrible before 1 February 2021, and it remains terrible now. Despite generations of residence in Myanmar, under the 1982 Myanmar Citizenship Law, the Rohingya are not considered to be among the “135 official indigenous races” and are therefore effectively excluded from full citizenship, leaving them stateless. This led to many infringements of their human rights. They are denied freedom of movement, and subsequently access to healthcare, education and livelihoods.

    The camps remain cramped and squalid. There is no sign that people will be given permission to return to the villages they were driven from, and the reality for many is that their homes will not be there or will be occupied by other ethnicities.

    Conditions in Myanmar are nowhere close to what they need to be for the safe, voluntary repatriation of Rohingya from Bangladesh. Families have been divided not only among those who fled to Bangladesh, but also when Rohingya embark on perilous journeys to countries, particularly Malaysia, in search of better opportunities. These conditions have a serious impact on the mental health of those remaining in Myanmar.

    The impact of the military seizing power on the back of the pandemic has caused economic turmoil in the country, with the kyat nose-diving against the dollar, pushing up the price of imports. Fuel and food have both increased in price, particularly in Rakhine state where there is a reliance on transporting goods in from other areas of the country.

    Tensions in Rakhine state between the Arakan Army and the Myanmar military are growing. While Rohingya are not directly involved in this conflict, growing insecurity may cause Rohingya to be caught up in violence and have a knock-on impact on Doctors Without Borders' movements and access to communities.

    Doctors Without Borders has faced blockages at checkpoints while checks are made. Navy checkpoints on the way to our clinics in Pauktaw township are holding us for, on average, two hours, and this causes our clinic opening times to be cut in half and medical consultations fell by 30% in a week. We estimate around 200 patients a week are missing out on healthcare.

    What does the future hold for the Rohingya?

    Long-term solutions are needed to resolve this long-standing Rohingya refugee crisis. The main problem is the lack of citizenship rights in Myanmar and the recognition of refugee status in Bangladesh and Malaysia.

    For the Rohingya refugees left languishing in Rakhine, Doctors Without Borders is particularly concerned about barriers to access healthcare due to restrictions on their freedom of movement. Humanitarian actors need independent access to assess and respond impartially to health needs.

    Doctors Without Borders believes it is critical that any return or repatriation to Myanmar only occurs if it is voluntary; if the wellbeing of Rohingya refugees is guaranteed; and the root causes of the violence have been addressed. This means addressing the ongoing discrimination and denial of fundamental human rights.