The living hell experienced by Rohingya Muslimsby Kate White
Kate White, Emergency Medical Coordinator with Médecins Sans Frontières in Bangladesh.
There are hardly any latrines so people have tried to rig up their own plastic sheeting around four bamboo poles, but there’s nowhere for their waste to go except into the stream below. That’s the same stream that just 10 meters away, others are using to collect drinking water. This has all the makings of a public health emergency.
Some people are using clothes that they’ve strung together to provide shelter from the elements. But after two days of torrential rain and tropical thunderstorms, some communities’ shelter and few belongings have completely washed away. It’s a horrific situation and you see the devastation and the absolute lack of any comfort whatsoever.
I can only imagine how incredibly terrible it must have been in their home village, if this is what they chose. If this is the better option, the other must have been a living hell.
I’ve heard the most horrific stories from women who have lost their husbands just trying to get here. They spend days walking with their young children, along crowded roads with cars coming in either direction. Some children have been struck and killed by cars. And in an instant, that secure future they were trying to build for their family vanishes. That’s a tragedy at an individual level. Multiply stories like that by 500,000 and you start to understand how harrowing this situation is.
They’re so traumatised they can’t communicate
Right now, we have a baby on our ward who is dehydrated and so severely malnourished that we’re not quite sure how old she is. She was brought to us by a woman who found her left behind at one of the border crossing points. This child has no family that we know of. And yes, she’s getting medical treatment, and thankfully improving every day, but where is she meant to go from here?
I have also heard really horrific cases from people experiencing violence along the way. Some cases of violence are so extreme that these people now have complex mental health issues. I’m talking about patients that aren’t able to verbalise; they’re so traumatised that they can’t communicate with the outside world. They’ve retreated into themselves to cope. And let me be clear, these are young people who have their whole lives ahead of them and shouldn’t have to endure this.
Our top two medical diseases right now are diarrhoeal diseases of varying kinds and with that comes severe dehydration. We know when there are this many people with both diarrhoea and dehydration that there is a significant correlation to hygiene, water and sanitation conditions.
We’re also seeing more than 100 outpatients a day needing wound care – and it’s not all violence related. People are injuring themselves living in this precarious environment, and the lack of hygiene means their wound gets infected.
Patients don’t want to leave
People have been gradually fleeing into Bangladesh for a long time. The last large group was only in October last year and the Cox’s Bazar community was still coping with that. That was a fraction of the size of what we’re seeing today. We thought we were stretched back then, but now, we routinely have around 115 patients in a 70-bed facility.
Most patients don’t want to leave once they’ve been discharged. The overcrowded hospital offers a much better living environment than what’s out there. As a medical professional, it’s so hard to send vulnerable patients out into what you know is a precarious situation. People know what they are meant to be doing but they have no means to do it; they can’t go and wash their hands because there is no clean water to do that. They can’t go and use the toilet in an appropriate place, because there are no toilets. Add to that the incredible loss of dignity they must feel to have to do everything in the public eye. Literally, everything they do is in front of massive amounts of other people.
We need to work on managing all the basics at once, in a coordinated effort with all the other agencies on the ground. Otherwise, we have no hope of stopping this from developing into a public health emergency.
There are good-hearted Bangladeshi people who want to do something to help, but unfortunately the road to hell is paved with good intention. They distribute food and clothing off the back of a truck in a crowded area and it just causes people to come running. There’s no crowd control, causing chaos and debilitating injuries for some. This is really where the coordination needs to come. We need to ensure distribution is done properly and with the safety and security of everybody in mind.
We need to act fast
To have decent coverage we need to act fast. Just to achieve relatively decent sanitation, we need 8,000 latrines built – that’s a ratio of one latrine to 50 people. The longer we delay that, the greater the risk of an outbreak of a waterborne disease. We need to supply 2 million litres of water per day just to provide 5 litres of water per person, per day in one camp. We need huge amounts of food and emergency relief supplies to avoid significant numbers of malnutrition. We need everyone to scale up in terms of experienced people on the ground who can move fast.
The numbers are massive and to top it off there are enormous logistical challenges because there are no access roads, which means everything must be brought in on foot. You carry everything you can on your back through narrow paths and hilly terrain, up and down slippery, muddy hills to get to your destination. It is supremely difficult.
The optimist in me likes to think that it’s at least humanly possible to put some very basic measures in place to try and curb the situation. The Rohingya refugees who have settled in these areas in the last month will probably never have the sense of comfort that you and I know, and may not ever have a solid roof over their heads. But it is possible is for us to make it better and more secure than what it is now.
- Over 536,000 Rohingya refugees have arrived in Bangladesh in a very short period and the scale of the crisis shows little of abating soon. Their arrival comes on top of hundreds of thousands of other Rohingyas who arrived in previous years and were already living in difficult conditions. MSF teams had already expanded activities in response to the influx of Rohingya last October, but this new influx is pushing all humanitarian actors to the limit. Camps are severely congested and refugees are in urgent need of food and clean drinking water. If the situation doesn’t improve there is a big chance of a public health emergency.
- Humanitarian aid should increase significantly. More actors are required to cope with the big amount of refugees, funding should be made available and the Government of Bangladesh needs to facilitate access for these organisations.
MSF on the ground in Cox’s Bazaar
Number of projects: 7
Number of staff: around 1,000
Number of patients since August 25: more than 30,000
Main morbidities: respiratory infections, skin diseases and diarrheal diseases
Other activities: water trucking, pumps, tube wells, emergency sanitation and mental health support
Matching the influx of people crossing over the border from Myanmar since August 25, MSF has treated more than 30,000 patients in the Cox’s Bazar area, effectively five times the number of people who sought treatment at MSF facilities during the same period last year. The main theme among these patients is respiratory tract infections and diarrheal diseases, which are directly related to the poor hygiene conditions in the informal settlements.
As a result of the massive increase in demand for our medical services, an additional 800 staff have been hired, bringing the total number of staff on the ground in Cox’s Bazar from around 200 people to 1,000. In July, MSF was treating approximately 200 patients a day, now MSF is treating over 2000 patients every day spread out over all clinics.
MSF has rapidly expanded its inpatient capacity at its Kutupalong medical facility from 50 to 70 beds, with new wards and isolation capacity for infectious diseases. The inpatient health facility, which provides basic primary and secondary healthcare services and is MSF’s largest health facility in Cox’s Bazar, has been running since 2009. A second in-patient facility is under construction in Balukhali and is expected to open in mid-October with a focus on mother and child health. Two more in-patient facilities are also planned to open in the region to meet the increased demand for secondary healthcare.
But with a population of more than 536,000 refugees on top of the existing 200,000 who arrived previously, there is still a need to substantially increase the inpatient capacity. The challenge is to find the available space to setup IPDs as the area is severely congested.
Want to help?
You can donate to MSF here.
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