Rohingya crisis: What life is like inside world’s largest refugee camp
Local
villagers helped Shamsark off the boat, all but carrying her and her three
small children as they stumbled up the slippery bank to safety. She took one
look back across the river, through the grey mist to the orange fires of
burning Rohingya villages, to where their whole lives
had been, where she’d left her husband’s body lying on the ground after he’d
been shot.
Then she turned away and
led her children through the scrubland to the roadside, joining tens of
thousands of other weary refugees clustering
around the bright printed logos of international relief organisations.
In Kutupalong camp, near Cox’s Bazar
in the far southeast of Bangladesh, Shamsark and
her children received emergency food supplies, water and medical attention. She
was registered as the female head of household, and given plastic
sheeting, matting, bamboo poles and a 10sq-m plot on a bare hillside.
Here, she had to try to construct a new life for her surviving family.
Here,
in a “town” of nearly 1 million refugees, where only temporary shelters
were allowed. Here, where the rain washed the topsoil off deforested
hillsides into mudslides. Here, where much of the water was unclean and
people often had to slosh knee-deep through mud and human waste.
The risk of infections was high. The
children were vaccinated against measles, rubella and polio almost
immediately but there were other diseases to worry about, most notably cholera. Many of the aid workers in the camp
remembered Haiti after the devastating earthquake in 2010. Ten months later,
that country experienced its first cholera outbreak in a century, and it is
still going – nearly 10,000 people have died of cholera in Haiti since 2010,
and there have been more than 800,000 cases.
The aid agencies in
Kutupalong were determined not to let it become another Haiti. An
epidemic here of cholera – a highly infectious waterborne disease that thrives in overcrowded,
unsanitary living conditions – would be disastrous, and would risk spreading to
the local community in Cox’s Bazar, already struggling to adjust after taking
in a large number of refugees.
So organisations working in the
camp came up with an unprecedented public health intervention: to give
every single person a new oral cholera vaccine. It was an enormous undertaking,
but it seemed to work. There were no cholera outbreaks.
Eva Bee
What happened instead took them all
by surprise.
* * *
Since the 1960s, the majority
Buddhist nation of Myanmar has
restricted the movements and rights of its minority ethnic groups. Despite
having lived in Myanmar for centuries, the mainly Muslim Rohingya people have
been particularly targeted.
Things worsened in 1982, when the
Citizenship Law denied the Rohingya citizenship, effectively rendering them
stateless. Their rights to marriage, education, health care and employment were
severely restricted; many were forced into labour and had their land seized
arbitrarily; they lived in extreme poverty, paid excessive taxes and were not
allowed to travel freely. Further restrictions in 2012 confined thousands to
ghettos and displacement camps, a policy that Amnesty International likened to
apartheid. Almost 200,000 Rohingya are estimated to have fled to Bangladesh
during these decades of discrimination, but not all were granted refugee
status.
200,000
Rohingya
estimated to have fled to Banglades
Then, on 25 August 2017, the Myanmar
military began a coordinated massacre of the Rohingya who remained, delegating
much of the violence to unofficial groups of anti-Rohingya militants. In what
the United Nations has described as genocide, people were tortured, raped and
murdered, their houses burnt and their animals killed.
Shamsark was at home in her village,
sleeping. At midnight, gunshots and screams shattered the silence of paddy
fields.
With a pounding heart, Shamsark and
her husband, Khalad, grabbed their children and ran outside. The village was on
fire. As they ran, a staccato of bullets flew at their backs. The air was thick
with smoke and Shamsark screamed at her children to hold hands as people fell
around them. Four bullets pierced Khalad and he dropped to the ground, bleeding
and unconscious.
As the gunmen approached, Shamsark’s
neighbours urged her to run with the children. If you can make it to the
forest, you will be safe, they told her. We will bring your husband to you.
She just about made it to the forest
with the children. Her leg had been injured but it was too dark to see how
badly. There were hundreds of people around her, struggling through the
undergrowth, all fleeing from their villages towards the banks of the river
Naf, the border with Bangladesh. She clutched her children close, urging them
on through their tiredness.
When they had made it a safe distance,
she stopped. We will wait here for your father, she told the children. As the
light came up, it began to rain with the heavy commitment of monsoon. This was
rice-planting season – the paddy fields would usually be full of activity,
growing the food for the coming months. Shamsark thought of the barren land and
the empty bellies of her children.
Slowly the hours of waiting turned
to days. Her children cried in hunger and she plucked leaves for them to chew,
but sometimes the leaves made them sick, vomiting up what little nutrition
they’d had. By the fourth day, Shamsark feared the children would not survive
if she didn’t find food, so they followed the trail left by others through the
forest.
After two days of walking they
reached the riverbank but militants had begun burning parts of the forest and
shooting the escaping Rohingya. Panicking, Shamsark took her children back into
the forest.
Created
with Sketch. Rohingya crisis one year on – Myanmar camps in pictures
Show all 30
Created with Sketch. Created with
Sketch. 1/30 Rohingya women and children wait in line for a food
distribution of super cereal at Action Against Hunger Getty Images
On the eighth day, delirious
with hunger and tiredness, she made it to a river crossing. The muddy bank
teemed with thousands of people, many injured, dirty and sick. A few small
boats were being overloaded with those who could afford to pay. Suddenly, the
moans and screams were drowned out by a new sound overhead. Looking up,
Shamsark saw a military helicopter about to launch an attack.
Eva Bee
* * *
It was the end of August when the
militants reached Feruja’s village. Heavily pregnant and uncomfortable, she was
alerted by the smell of burning and restless animals. It wasn’t totally
unexpected – there had been rumours, gruesome stories of raids on Rohingya
villages. Now it was their turn.
She urgently woke her husband and
together they bustled their five children to the door. They heard shouts and
gunshots, then screams. Militants were torching their neighbours’ homes and
attacking the fleeing occupants with knives.
As her children began running, it
became clear that Feruja was in no state to escape. She begged her husband,
North, to flee with the children. Instead, he took them all to Feruja’s
parents’ house at the far edge of the village. Silently, the family of nine hid
in an outhouse, chickens pecking at their feet and screams in their ears.
After an eternity, the village fell
silent. In the blackness, North rose to his feet and whispered that it was time
to leave. They needed to make it into the forest before daybreak. But Feruja
could not stand. Her labour pains had started while they hid, and were now
intense: the baby was coming.
At 3am, less than an hour after
she’d given birth, North carried Feruja’s bleeding, semi-conscious body out of
the house. Her father refused to go with his wife, daughter, son-in-law and now
six grandchildren, saying he would rather die there than flee his home.
Reluctantly they left him and made their way through the darkness. When they
reached the riverbank, they hid there with hundreds of other families.
To Feruja’s joy, her father joined
them the next day – seeing the devastation of his ancestral village, he’d
realised there was nothing left for him in Myanmar.
After three days, the group set off
for the crossing point, where some 5,000 refugees were already waiting to cross
to Bangladesh on dangerously overloaded vessels. Boatmen were charging 10,000
Bangladeshi taka (£90) – a fortune for such impoverished people, most of whom
had fled their homes with nothing.
£90
Cost for
refugee boat to Bangladesh
Feruja’s brother, who was living
outside Myanmar, was able to send her the money for passage for the whole
family. They were a quarter of the way across when gunmen started firing at
them. A bullet hit her four-year-old daughter in the head. Feruja screamed at
the boatmen to go faster, as she desperately cradled her bleeding child and her
newborn.
* * *
Initial media coverage was followed
by mounting reports of atrocities. Footage of thousands of desperate people
fleeing burning villages was beamed across the world. Within weeks, hundreds of
thousands of survivors had crossed from Rakhine state on the west coast of
Myanmar, across the river Naf and into Bangladesh, swelling the number of
Rohingya refugees there to over half a million, and more were on their
way.
Both Feruja’s and Shamsark’s
families were among them having somehow, miraculously, made it to safety – even
Feruja’s shot daughter.
Like many others, Mainul Hasan felt
compelled to help his fellow Muslims, and, as a doctor and public health
specialist living in Dhaka, the capital of Bangladesh, he was in a position to
do so. Impulsively he headed to the airport and bought a ticket on the first
flight to Cox’s Bazar.
“At that time, I wasn’t involved
with any relief organisations, I just came to do some voluntary work, to try to
help out. I found some of my former colleagues at MSF [Médecins Sans
Frontières], who were already there, so I went to join them,” Hasan says.
Eva Bee
It was an utterly chaotic scene:
thousands of refugees arriving daily and nowhere to put them. “People were just
standing on the roadside, they had travelled long distances, they were injured,
some were carrying other people, and there was no food or anything.”
Donations of food, blankets,
medicines and other resources were pouring in from across the nation and the
international community, but there was no systematic way of distributing any of
it. “People were just throwing food to people at the roadside and people were
moving to take it,” Hasan says. Desperate, starved Rohingya arrivals were
getting injured in the rush for supplies.
We were trying to provide treatment,
but there were no clinics, so we were just putting down polythene bags in front
of us and providing treatment on these,” he says.
"We
were trying to provide treatment, but there were no clinics, so we were just
putting down polythene bags in front of us and providing treatment on these
Mainul Hasan, doctor
“There were people with bullet
injuries, head injuries, and some who were in severe shock – they couldn’t say
anything, they just keep silent, just moving around, and when you’re asking
questions then they’re crying. And they’re describing what happened in front of
them and that people were killed in front of them, and they saw their houses
burned, and they came empty-handed, with nothing.”
* * *
When Feruja and her family arrived
at the refugee camp, she had lost a lot of blood and needed urgent medical attention.
Her daughter’s head injury needed surgery, but the bullet could not be safely
extracted so it was left where it lodged. With little food and poor living
conditions, recovery was slow.
Like everyone in the camp, they
slept on mats on the bare floor, and ate sparse World Food Programme rations.
The army had helped clear a large area of hilly forest for new arrivals – it
had previously been used by local villagers for food and to graze animals – and
NGOs were sinking hand-pumps to provide water,
helping erect shelters, and distributing rations of oil, rice and pulses.
Feruja tried not to think of her
spacious family home in Myanmar, her vegetable garden, their 10 cows,
their chickens, their fields. The few families who had been able to bring with
them items of value – gold smuggled out, sewn into their clothes – could trade
it in the fast-emerging markets for vegetables or fruit, which were highly
sought-after.
But life for every refugee, whether
formerly rich or poor, had been reduced to a few square metres of shelter
abutting a stream of sewage-infested runoff water.
Aware of the enormous risk of
cholera in these circumstances, on 27 September 2017 the Bangladeshi government
made an official request for 900,000 doses of cholera vaccine. The vaccine had
been stockpiled since 2013 by an international coordinating group funded by
Gavi, the vaccine alliance.
Seth Berkley, head of Gavi, says:
“We were gravely concerned by the critical situation they faced and the
potential public health disaster that could occur if we didn’t act fast.”
"We
were gravely concerned by the critical situation they faced and the potential
public health disaster that could occur if we didn’t act fast
Seth Berkley, head of
Gavi
Approval was given within 24 hours
by the coordinating partners, including MSF, the World Health Organisation and
Unicef. By October, the enormous vaccination programme was under way to protect
hundreds of thousands of Rohingya arrivals in the camp, as well as those
outside, mostly Rohingya who had already found shelter among Bangladeshi
communities.
The new vaccine could be swallowed
rather than injected, but it had to be given twice to be fully effective, so
Hasan and his colleagues worked tirelessly day and night to administer one of
the largest cholera vaccination programmes in history. “It was a huge effort,
to make sure everyone got the first dose and then the next dose, to be
protected,” he says.
It was worth it: in spite of the
appalling slum conditions and terrible overcrowding, there have been no cholera
outbreaks to date. It was a marvellous achievement.
But before the health workers could
enjoy their success, several people in the camp developed painful swollen
throats. They became feverish, struggling to breathe. More people fell sick.
Then they started dying. Rumours about this terrifying disease swept through
the deeply traumatised camp. People became increasingly fearful. As medics ran
tests to identify the deadly plague, even the health workers were afraid
– nobody had seen this sickness before.
* * *
It turned out to be diphtheria. The
reason no one recognised it was because diphtheria, once a major killer, had
been eradicated from most of the world for decades.
A century ago, diphtheria affected
hundreds of thousands of people in the US alone, killing tens of thousands
every year. In 2016, there were just 7,097 cases reported globally because
nearly 90 per cent of the world’s children are routinely vaccinated against it,
using a widely available, cheap and highly effective vaccine.
By the end of 2017, there had been
3,000 suspected cases and 28 deaths in Kutupalong camp and Cox’s Bazar.
Why?
3,000
Suspected
cases of diphtheria in Kutupalong camp
“This outbreak was not the product
of conditions within the camps, but rather a deadly legacy of the conditions in
which they had been living before they fled Myanmar,” says Berkley.
It was yet more evidence of the
appalling living conditions the Rohingya communities endured in Myanmar – the
Buddhist majority received diphtheria protection in their routine childhood
vaccines, but most minority ethnic groups did not.
In 2015, Hasan had been part of a
team sent by Unicef to assess vaccination coverage in Myanmar in light of
a polio outbreak in Rakhine state. He says that the national immunisation level
was above 80 per cent, but it had dropped far lower in Rakhine, where most
Rohingya lived, because sectarian riots since 2012, and the government
crackdown and forced displacements that followed, had disrupted the
immunisation programmes. And when not enough children are receiving routine
vaccinations, diseases long extinguished across most of the globe can reappear.
That winter, the WHO and
Unicef supported a mass polio vaccination programme across affected areas.
There were few clinics for the Rohingya, Hasan says, and health workers faced
huge issues of distrust – a hostility to officials built up through
decades of abuse by the Myanmar authorities. This same distrust made responding
to the 2017 diphtheria outbreak more challenging.
Diphtheria can kill 10 per cent of
those infected so the agencies had to act fast. Gavi provided urgent supplies
for a three-dose immunisation programme for children aged seven to 15
throughout the camp. However, unlike the cholera vaccine, this was not an oral
treatment, and the WHO and Unicef teams met resistance when they tried to
administer the injections.
Stories flew around about the
vaccines. It was said that the injections would make you infertile, or turn you
Christian, or make you sick, Hasan tells me.
Aid workers took their time,
therefore, even as diphtheria cases continued to soar. They worked with
community leaders, going shelter to shelter, building trust and ensuring that
children like Feruja’s and Shamsark’s were all protected. Gradually, the vaccination
programme succeeded: new cases peaked at a hundred a day in early December, and
then fell. The outbreak was contained by January 2018.
* * *
I visit Kutupalong camp at the end
of February 2019, 18 months after the massacre. It takes around an hour and a
half to drive south from the bustling seaside town of Cox’s Bazar to what
quickly became the world’s largest refugee camp, near the Bangladesh–Myanmar
border, a journey that hundreds of international aid workers and supply trucks
make daily.
Eva Bee
The road is poor and sections of it
are frequently closed for repairs – the Unicef vehicle I travel in has to drive
along the beach for part of the journey, passing several unlucky cars and
rickshaws that have become entrenched in the sand. We pass through small towns
and villages, each more impoverished than the last. Children search through
piles of rubbish, goats and cows chew on plastic, rice farmers wade through
their paddy fields. These are the people who opened their hearts and homes to
the thousands of Rohingya, about 80,000 of whom are not in the camp but
living with local hosts who took them in.
In fact, the Rohingya tragedy has
been devastating for the local community and its environment. Large swathes of
the forest have been cleared, the local roads have become dangerously busy,
polluted thoroughfares make journeying to school slow and difficult, food
prices have soared, wages have fallen, jobs are scarce and people feel
insecure.
In a matter of weeks, the local
population of 350,000 people accepted almost 1 million migrants. Considering
the reaction in Europe (population: 740 million) to the arrival of a similar
number of Syrian refugees over many years, it is astonishing how accommodating and
generous this community has been. Cox’s Bazar is one of Bangladesh’s poorest
districts, and they were told by the government that the Rohingya people would
be here for two or three months. One and a half years later, the strain is very
apparent.
350,000
Local
Bangladeshi population that accepted 1 million Rohingya refugees
It’s easy for a sense of disparity
to grow in a community that is struggling while refugees are being given food,
healthcare and other assistance. In fact, more than a quarter of aid
agencies’ resources here are being directed to helping the local Bangladeshi
community. Unicef funds a neonatal unit in Cox’s Bazar that benefits
babies born to either community, and during my visit I spot a group of village
schoolchildren wearing schoolbags distributed by the same organisation.
Although the Bangladeshi government
has generously accommodated the vast numbers of Rohingya, it has not granted
them refugee status. Without this status, they are not supposed to leave the
camp or work, and they have limited access to education. The Rohingya remain
stateless.
The camp has been much improved
since its foundation. The army has laid a concrete road through the
sprawling site, steps and bridges have been made so people are no longer
forced to clamber up muddy hillsides, better shelters have been constructed
with concrete bases and bamboo lattice sides (the government still forbids
permanent structures), and there are hundreds of concrete latrines.
Nevertheless, this vast sprawling
ghetto is a social and environmental calamity. I visit during the dry season,
when the untethered soil and sand streams off the hills in the breeze. A thick
layer of dust coats everything – it is no surprise that more than half of
medical admissions here are for respiratory diseases; after just two hours in
the camp, my throat is burning.
Men, women and children while away
long hours of unemployed boredom sitting on the ground inside or outside their
shelters. Violence, especially against women and girls, is high, as are child
marriage and child labour. There have been at least 30 murders, I’m told, and
people smuggling is a constant danger for this vulnerable community. Agency
workers and visitors like me are under strict curfew, having to leave the camp
by 4pm and be back in Cox’s Bazar by sundown.
* * *
Feruja’s daughter is playing in the
dirt outside her shelter when I arrive. I see her healed head wound, a circle
of satin skin shining in the sun – a small souvenir of a terrifying ordeal that
has consumed much of her short life. Poking my head inside the shelter, I pick
out Feruja, sitting cross-legged on the floor, backlit by sunlight bleeding
through plastic-sheet walls. Her baby, born in exodus, is sleeping next to her
on a mat.
In these impoverished surroundings,
there is something regal about Feruja’s demeanour, her straight-backed pose,
the way her eyes rule the small space, and her unflinching account of the
massacre. Now, she tells me, they have safety, but this is not a life. Feruja
is haunted by her experiences, battling poor health and malnutrition, yet it is
their statelessness that brings out her fury. As citizens of nowhere, the
Rohingya are trapped on a bare hillside in a foreign country with no hope.
“I miss my vegetable garden,” she
says.
As the uncertainty lingers, aid
agencies are trying to alleviate some of the distress of a life lived in limbo.
Child-friendly spaces and women’s centres have been set up to provide some
informal education, family planning, advice, training and refuge from
exploitative domestic situations. In one that I visit, the children are dancing
and singing in rehearsal for a performance.
Now that the infrastructure has
improved and initial acute health problems, such as severe injuries and
epidemics, have been overcome, the aid workers here face the same day-to-day
public health challenges of any large slum. Except that here, the community is
also burdened with high rates of malnutrition, disability, mental health
problems and despair. For children and adults alike, the psychological toll of
camp life is compounded by the trauma of the events they experienced during
their escape.
* * *
I visit Shamsark’s family shelter
through a maze of paths and find her sitting with a baby. She tells me that her
children still scream out in the night, reliving terrifying incidents through
their nightmares.
In spite of everything, she longs to
go back to Myanmar, to live with her four children in their village. She is not
interested in revenge or punishing the militants, but, she says, “We have
suffered, we have been shot – many were killed – and we want our rights and our
ancestral lands.”
Crucially, Shamsark wants
citizenship. I hear the same weary demand from every person I speak to. There
is still no sign of it being met.
"We
have suffered, we have been shot – many were killed – and we want our rights
and our ancestral lands
Shamsark, refugee
While the initial public-health
response to the Rohingya’s plight, from both the Bangladeshi government and the
international community, was rapid and effective, the longer-term political
response has been lacking. The government is now considering plans to move
these vulnerable, stateless people to an isolated island, prone to cyclones and
flooding, in the Bay of Bengal. The international community must instead
support Bangladesh to manage this refugee population sustainably. They need physical
and legal security. They need a home.
There has been one bright moment for
Shamsark, however.
In November 2017, more than two
months after being forced to flee, she was approached by a UNHCR official who
asked her to come to a clinic on the other side of the camp. Nervously, she
protested that her children had had their vaccinations and were well.
Nevertheless, her community leader reassured her and told her to go with the
official.
They walked for 30 minutes in near
silence until they reached the electrical hum of the clinic’s generators. She
followed him inside. “Do you know this man?” he asked her, pointing to a thin,
sick man, lying crumpled on a bed.
Shamsark turned and looked. The man,
in his early thirties, appeared prematurely old. He had no hair and was wrapped
in bandages. Yet she knew him immediately: it was her husband, Khalad, back
from the dead. His eyes opened briefly at her shocked exclamation, before
closing once more.
After he had been shot, some of the
villagers had carried him to safety. Dressing his wounds as best they could,
they took him over the forested hills and across the border, where he was
rushed to a hospital in the Bangladeshi port city of Chittagong, 90 miles north
of Cox’s Bazar.
For weeks, Khalad had been close to
death, but eventually he had grown strong enough to be transferred to the camp
clinic, where officials had managed to trace his family.
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Shamsark was overjoyed – and
overwhelmed. Her husband was terribly weak and unable to walk, but he was
alive. Her children were no longer fatherless and she was no longer alone.
This article was first
published by Wellcome on mosaicscience.com
and is republished here under a Creative Commons licence. Sign up to the Mosaic
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