Originally published on August 23, 2019
Five years after the mass exodus of Rohingya people from Myanmar, their future looks as uncertain as ever. Uprooted from their homeland by a campaign of targeted violence launched by the Myanmar military in August 2017, some 700,000 ethnic Rohingya refugees sought safety just across the border in Bangladesh. They joined thousands of others from the community who had fled earlier episodes of violence and abuse. Today there are nearly one million Rohingya living in overcrowded camps in Cox’s Bazar—now the largest refugee settlement in the world.
While the scale and speed of this population movement were unprecedented, this was not the first time the Rohingya had been driven out of Myanmar. Doctors Without Borders/Médecins Sans Frontières (MSF) has provided medical aid to the Rohingya in Myanmar and Bangladesh for decades. Their struggles over successive cycles of violence and persecution have long been an underreported crisis.
Myanmar, the country then known as Burma, launches Operation Dragon King (Naga Min) in Rakhine state. The Rohingya ethnic minority are considered "illegal" after being stripped of their citizenship, thus beginning a cycle of forced displacement.
Operation Dragon King includes mass arrests, persecution, and horrific violence, driving some 200,000 Rohingya across the border to Bangladesh. The neighboring country opens refugee camps, where MSF provides medical aid. The living conditions inside the camps are woefully inadequate. By 1979, most of the Rohingya are repatriated to Burma. Of those remaining in Bangladesh, some 10,000 people die, the majority children, after food rations are cut.
After a military crackdown that follows the suppression of a popular uprising, Burma is renamed Myanmar. The ruling State Law and Order Restoration Council increases its military presence in northern Rakhine state, and the Rohingya are reportedly subject to compulsory labor, forced relocation, rape, summary executions, and torture. Some 250,000 Rohingya flee to Bangladesh.
MSF provides medical services in nine of the 20 refugee camps established for the Rohingya in southwestern Bangladesh. Food, water, and sanitation in the camps are inadequate.
The scene at Dumdumia camp (above), in Cox's Bazar, Bangladesh, shows the lack of adequate shelter.
Rohingya refugees arrive in Bangladesh, bringing only what they can carry. The governments of Bangladesh and Myanmar sign an agreement to repatriate refugees, and the camps are closed to new arrivals in the spring. By fall, forced repatriation begins, despite protests by the international community. Over the following years, hundreds of thousands of Rohingya are sent back to Myanmar, and new refugees attempting the journey are denied entry to Bangladesh.
Of the 20 camps that were built in Bangladesh in the early '90s, two remain: Nayapara camp near Teknaf (above) and Kutupalong camp near Ukhia. Living conditions remain dire—a study finds that 58 percent of children and 53 percent of adults are chronically malnourished.
Some 79 percent of the shelters in the two remaining camps in Bangladesh are flooded during the rainy season. The substandard conditions contribute to cases of diarrhea, respiratory infections, and malnutrition. At the MSF therapeutic feeding center serving the makeshift camp near Teknaf, staff take care of an average of 40 severely malnourished children each day.
MSF runs a medical facility in Kutupalong makeshift camp in Bangladesh. Only a small percentage of Rohingya seeking refuge in Bangladesh are officially recognized as refugees. Unrecognized Rohingya refugees are vulnerable to harassment and exploitation.
MSF’s clinic in Kutupalong makeshift camp provides comprehensive medical care to Rohingya refugees and the local community in Bangladesh. The October 9 Rohingya militant attacks on border police in Myanmar’s Rakhine state trigger reprisals against the Rohingya community, bringing a new wave of refugees across the border and an influx of patients to the MSF clinic in November and December.
A Rohingya family arrives at the Bangladesh border from Myanmar. Following Rohingya militia attacks on several police and army posts in Myanmar on August 25, state security forces launch a campaign of horrific violence and terror targeting the Rohingya community. More than 700,000 Rohingya are driven out of Myanmar within weeks. The cycle of mass displacement begins again, this time on an unprecedented scale. MSF documents more than 6,700 violent deaths among the Rohingya.
A newly arrived Rohingya family shelters in their tent (above) at Unchiparang settlement. Most of the recent arrivals have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines.
Medical facilities in Bangladesh, including those run by MSF, are quickly overwhelmed. In September, MSF calls for an immediate scale-up of humanitarian aid to the Rohingya in Bangladesh to avoid a public health disaster. MSF also urges the government of Myanmar to allow independent humanitarian organizations unfettered access to northern Rakhine state.
An outbreak of diphtheria rages in the refugee camps in Cox's Bazar. Though diphtheria is covered by the most basic vaccine packages, the deadly childhood disease spreads quickly through the camps in Bangladesh, where most children have not been immunized. MSF treats 6,442 cases from August 2017 to June 2018.
Most of the Rohingya sheltering in Bangladesh have suffered from or witnessed violence, lost family members or friends, or experienced persecution. Many say they’d like to go home, but not until their safety can be guaranteed. Since the beginning of this latest crisis, MSF has made mental health services a priority. From August 2017 to September 2018, MSF teams provided more than 16,000 individual mental health consultations and 18,000 group mental health sessions in Bangladesh.
Between August 2017 and February 2019, MSF teams provided more than one million medical consultations for Rohingya refugees in Cox's Bazar, Bangladesh. Our teams continue to treat tens of thousands of patients a month. The emergency has become a protracted crisis, with no end in sight.
In the spring of 2020, MSF begins preparing for COVID-19 in the world's largest refugee camp, scaling up activities and setting up isolation beds in our projects in Cox’s Bazar district. COVID-19 training is provided for all staff, covering everything from basic infection prevention and control measures to protocols on managing patients with suspected cases. The UN refugee agency reports the first confirmed case of COVID-19 in the camps on May 14. MSF treats several patients with COVID-19 and monitors others with suspected cases of the disease. Health workers face a higher risk of contracting COVID-19, and also come under threat for doing their jobs. Starting in December, the Bangladeshi government begins relocating some refugees to Bhasan Char, a silt island in the Bay of Bengal that had remained uninhabited until now—due in part to its remote location and unstable environment.
Bangladeshi authorities impose strict lockdown measures during the COVID-19 pandemic that further restrict freedom of movement and work opportunities for Rohingya people. Amid increasingly desperate conditions, armed groups gain strength through violence and extortion. As living conditions continue to deteriorate, fires break out in the camp, including one in the Balukhali area that injures 11 people and destroys an MSF clinic in March. The camp is then hit with heavy rains and floods starting in July.
Many people have to make impossible choices about their future. Some make the dangerous journey on trafficking boats across the Bay of Bengal to join the more than 100,000 Rohingya living in Malaysia. Often these boats are caught by Malaysian authorities, but when they turn back to Bangladesh, they are blocked by Bangladeshi authorities and stranded at sea for weeks—sometimes months.
Miserable conditions in the camp and bleak prospects for the future fuel a mental health crisis among the Rohingya living here.
Five years after the largest campaign of targeted violence ever committed against the Rohingya in Myanmar, nearly one million people are living in the same bamboo and plastic shelters in Cox's Bazar, dependent on aid, with no better solutions in sight.
The Rohingya are especially vulnerable as stateless people, long denied citizenship in Myanmar. With no official refugee status in Bangladesh, the Rohingya have little access to employment or education and remain dependent on humanitarian aid. Even the most basic needs for water and sanitation are unmet. MSF teams see the impact of these conditions on patients' health—an increase in skin infections, waterborne diseases, and chronic illnesses like diabetes and high blood pressure. As the largest provider of mental health care in the camp, MSF also sees an increase in needs for psychological and psychiatric care.
MSF will continue to provide care for the Rohingya and to advocate for greater international efforts to ensure that they have a chance for a better future.