As the world focuses on Ukraine, conditions in Rohingya refugee camp deteriorate

Johanna Son, Reporting ASEAN

Posted at Sep 24 2022 12:10 PM

Hopelessness, a lack of agency and despair are adding to the deterioration of minimum standards of living among the Rohingya in their cramped, contained settlements in Bangladesh.

Shajeeda Akhtar with her son, who had breathing difficulties, at a Doctors Without Borders’ hospital in the refugee camp. Photo sourtesy of Doctors Without Borders
Shajeeda Akhtar with her son, who had breathing difficulties, at a Doctors Without Borders’ hospital in the refugee camp. Photo sourtesy of Doctors Without Borders

This is a glimpse of the increasingly precarious life in what is today the world’s largest refugee camp, which hosts some one million mainly Muslim Rohingya – the biggest stateless population globally.

“There's this pervading sense of hopelessness,” Paul McPhun, director for Southeast Asia and the Pacific for Doctors Without Borders, says in this conversation with Reporting ASEAN’s Johanna Son. “It's ultimately this feeling that there is no solution, that they have been entirely abandoned. And that's what ultimately has an impact – that at a certain point you can't treat – because you can't change the circumstances. “

Yet another anniversary – the fifth – has passed since the largest exodus of over 750,000 Rohingya from Myanmar on the 25th of August 2017. Entire communities fled across the border to Bangladesh from that day on, as the Myanmar military carried out scorched-earth operations following an attack by an armed Rohingya group in Rakhine state.

The option does not exist for the Rohingya’s repatriation to Myanmar, which tried to delete their identity by making them stateless four decades ago and is now run by the same military forces that drove them out. There are also no takers, Southeast Asian countries included, for their resettlement.

In other words, they are stuck - literally, figuratively and politically so. 

Reporting ASEAN: The Rohingya is one of those issues where everybody knows that there is a problem. So I wanted to start by asking something that maybe we don't read about enough, which is that – what is daily life inside the camps like? And in particular, what kind of challenges are coming up that you've been seeing more and more?

Paul McPhun: I think the first one people have to understand is that post the period of COVID, that the camps have gone from being the kind of open-camp settings where there was freedom of movement in and out, to a closed camp setting. A closed camp setting means that this camp, this massive area, 16 kilometres of camps within camps, is entirely encircled with guardposts and fencing, and razor-wire fencing. And the camps within camps are all contained and encircled as well, so it's a setting where there's very little freedom of movement.

And the reality is, of course, that the distribution of services – which is not surprising – the distribution, the quality and the quantity of services varies a lot. So I guess daily life is partly about survival. People are almost entirely dependent on aid, or selling the aid that they receive or bartering or exchanging it, and then trying to find other ways to make income. 
The camps are not safe settings. People expressed to me, a lot, about the fact that social cohesion has collapsed. People basically don't trust each other, because you don't know who your neighbour necessarily is. . . So people feel constantly unstable, insecure. 

So that's the last concept I would express is this feeling of despair, hopelessness. And we see that in our mental health clinics, we see patients come in constantly and there's only so much we can do to treat them, you know, to improve their mental health state because the circumstances in which they're living is not changing. If they had hope for a future or hope for a change, that might be different.

Reporting ASEAN: When you talk of mental health support, what kind is that? Is that mostly counselling? And what kinds of people come in, like men, women, young people?

Paul: Exactly, it's individual, one-on-one counseling sessions, psychological first aid, but also group therapeutic sessions. So we do both. And with individual sessions, we see a lot of children, we see a lot of mothers, but we also see men, adult men and young adolescent men. 

It’s particularly difficult with children because they show the signs and symptoms of mental health disorders because many, many of them have grown up in this setting. Young children under five have known nothing else. And then other children, you know, they suffered significant trauma when they fled from Myanmar, and they witnessed horrific things that no child should ever see. So on the one hand, they suffer from post-traumatic stress disorders and acute problems, anxiety, sleeping disorders, depression, things of that nature. 

And again, we see that in more and more severe forms of anxiety, depression, self-harm, things of that nature, which is, I have to say, quite common, a trend of falling care, a deterioration in your mental well-being over time when you're subjected to living in containment-like settings.

Reporting ASEAN: You were also talking about a rise in scabies, dengue fever. What are these signs of?

Paul: We recently undertook a quite comprehensive sample survey across 19 camps. And although we could say on the one hand, that the quality of water in these camps has actually improved, the availability of that water has really gone downhill. So the access and availability, when we surveyed people, was at about 50%. 

So 50% of those surveyed said that they didn't have access to a continuous available source of water. Seventy-six percent complained that the toilets they use are overflowing, and 88% had inadequate access to sanitation facilities. And what this tells us is, you know, that the very basic fundamental building blocks that you need in place, from a public health perspective to keep a population as healthy as possible under these precarious conditions, are starting to erode. 

And what we see in our clinics as a result is really quite a spike, in terms of, first of all, skin infections, so we've seen quite large outbreaks of scabies across the camps. Just between March and June, we treated 42,000 cases of scabies across two camps and two facilities. And so that really shows something's going wrong in the local environment in terms of living conditions and access to clean water. 

And we've seen quite an increase in acute watery diarrhea, so (that) particularly affects young children. And you can see the accumulated effect - between 2019 to 2021, we saw a 50% increase in cases of acute watery diarrhea. 

Reporting ASEAN: What has the funding situation been like for the camps, especially in these times? I’ve seen the figures for the humanitarian appeals for Myanmar itself, and even that has quite a shortfall.

Paul: Over the last years, we've seen a decrease in funding, particularly since the onset of COVID. That impacted where money was going and the choices that were being made. Then we have the Afghan conflict, and that was a big diversion. That's distracted international governments’ attention. And now we have Ukraine, and that has significantly changed the priorities of a number of governments that have been supporting not just Bangladesh with this huge responsibility that it's taken on itself, but other countries, as you say, like Myanmar. 

The other things now going forward into the future is we already see the funding, the funding commitments going downhill. Attention is clearly elsewhere; the priority is elsewhere. . . . 

At a certain point – and we've already passed that – maintaining the same approaches as now and expecting to receive the same kind of investment is unsustainable. And it's just going to get, I think, very much harder in the coming years, to manage this response in the way it's currently being managed.

Reporting ASEAN: You’re basically saying that the situation has reached a point where things cannot just go on like this. In your recent op-ed piece, you had used the words “increasingly unsustainable”. You were also saying that looking at resettlement is a pragmatic reality at this point ¬– how realistic is that?

Paul: Now, the solution, everybody understands, is you’re not going to resettle a million people in the region and that's very, very clear. But it would, I still think, be meaningful that we really try and shift the attitudes currently, and the political position currently, because as I see it at the moment, the policies are very much the reverse. These are fellow humans who are suffering as a result, and there are no easy solutions to see them repatriated in Myanmar. 

But in the meantime, there's nothing being done to pursue alternatives, even if those alternatives can have a minimal impact, that could have an impact on perhaps some of the most vulnerable, and that would at least be a stance, and it would shift the momentum from not taking responsibility to assuming some collective responsibility regionally. 

Reporting ASEAN: Would you agree then that this is a humanitarian emergency, but political considerations are becoming the first consideration, or driving the lack of response or taking precedence over humanitarian needs, clearly?

Paul: With most major crises, particularly conflicts, the solutions are political, and humanitarian action is just a response to those crises. The solutions are always political. It’s about political will and political willingness and timing, influence and the benefits of change. 

It really comes back to the fact that everybody I spoke to, including the Rohingya, they see that future being a return to Myanmar, and (there is not) any disagreement from anyone that that's really the only way that this current crisis will be resolved. So it really comes down to how, under what circumstances could return take place in a safe and meaningful way, where people would actually have the confidence to return. 

Reporting ASEAN: What kind of challenges and experiences do humanitarian workers have when working with people in camp situations, also in terms of their own mental health? What is it like to do this kind of work?

Paul: What we see is a real deterioration in their mental well-being, and the common thread between them is this lack of any clarity over their future. So though they've been through traumatic events, and we can help them deal with those kinds of traumas, there's this pervading sense of hopelessness. It's ultimately this feeling that there is no solution, that they have been entirely abandoned. And that's what ultimately has an impact – that at a certain point you can't treat – because you can't change the circumstances. 

Reporting ASEAN: It feels like the world has maybe accepted that Myanmar is about, you know, a lot of bad news, yes, and there is even more bad news, but this is the way it is. 

Paul: It's just important to understand this isn't a crisis that started five years ago. This latest exodus is a sort of culmination largely, I think, of years and years of exploitation, discrimination and violence and exclusion, etcetera, etcetera. And it makes it easier to understand, perhaps, why it is so much harder to come up with a real meaningful solution or change where the Rohingya would have their rights reinstated, their citizenship, their right to citizenship reinstated, to be able to enjoy the rights that anyone else, any other individual, enjoys who is a citizen of a state.

This is what makes them so much more vulnerable – that they have no one assuming a responsibility, a legal responsibility and a protection responsibility, for them. They have governments hosting them but they lack that legal status and therefore they're described as a stateless population, so (that’s) yet another vulnerability that they have to live with.

(This transcript has been edited for brevity. A full version is here.)

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