Following a concerted campaign of violence by the Myanmar authorities against Rohingya people in Myanmar’s Rakhine State, Rohingya villagers are still crossing the border into Bangladesh.
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.
Extensive surveys conducted by MSF in refugee settlements in Bangladesh estimate that at least 9,000 Rohingya died in Myanmar's Rakhine State between 25 August and 24 September 2017.
At least 6,700 Rohingya, in the most conservative estimations, are estimated to have been killed, including at least 730 children below the age of five.
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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).
However, Myanmar authorities contest this. They claim the Rohingya are Bengali immigrants who came to Myanmar in the 20th Century.
Prior to the military crackdown in August 2017, roughly 1.1 million Rohingya people lived in Myanmar.
Described by the United Nations in 2013 as one of the most persecuted minorities in the world, the Rohingya are denied citizenship under Myanmar law.
NORTHERN RAKHINE STATE, MYANMAR
Nearly all the Rohingya in Myanmar live in the western coastal state of Rakhine and are not allowed to leave without government permission.
It is one the poorest states in the country with ghetto-like camps in and around the town of Sittwe.
There is a lack of basic services and opportunities for the Rohingya in Myanmar, including freedom of movement, healthcare, state education and civil service jobs.
ONGOING VIOLENCE AND PERSECUTION
Due to ongoing violence and persecution, hundreds of thousands of Rohingya have fled to neighbouring countries either by land or boat over the course of many decades.
The most recent influx of Rohingya into Bangladesh started in August 2017, but the marginalisation and persecution of the Rohingya started over 50 years ago. Rohingya lack of citizenship rights in Myanmar and their lack of refugee status in Bangladesh is at the heart of many of these issues. More durable solutions are needed to respond to the immediate and long-term Rohingya refugee crisis.
Humanitarian organisations are still blocked from accessing and operating in northern Rakhine.
We are urging the Myanmar government to allow independent access to Rakhine State to ensure the impartial delivery of healthcare to those in need.
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.
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.
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 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.
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.