Blog from Bangladesh: Access to Healthcare for Citizens of Nowhere

Teaching doctors working in UNHCR camps with Rohingya Muslim refugees from Myanmar, April 2016

I’m sitting on the balcony on the 8th floor of the hotel venue for our training courses in Cox’s Bazar, having completed training for my two batches of nurses and health counsellors who work with the refugees in (and near) the camps located a couple of hours’ drive away.

Cox’s Bazaar owes its curious name to a British military captain who is remembered with unusual affection for a colonial officer. The (Wikipedia) story goes that when he was posted to this sleepy backwater in the 18th century he was so distressed by the plight of refugees from Burma that he set about organising shelter, support and basic livelihoods for them. I wonder if it is partly because people here are conscious of this history that they seem to be so ready to accept the influx of approximately 300,000 Rohingya Muslim refugees from Myanmar, and to do what they can to help them. Bangladesh is a country that struggles to provide services for its own people, too many of whom still live in desperate poverty. Yet the people in and around Cox’s Bazaar cope graciously with the hundreds of thousands of refugees; society has not fallen apart in the process, but simply shifted and organised itself to absorb them. And, of course, Bangladesh is a new country, the fruit of the violent, bloody conflict with Pakistan in 1971, known as the Liberation War. Millions of Bangladeshis fled to India at that time, many never to return. Several of the health care staff we have met here have personal experience in their own families of siblings, or parents, aunts and uncles, forced to become refugees in 1971; some of the older ones have parents who were directly affected by an earlier refugee experience caused by the trauma of Partition from India in 1947. When I asked one of them what motivated him to seek work in refugee health he replied: “We owe a debt to history. My sister and brother-in-law fled to India in 1971 with only the clothes they wear. India their home. Their children educated there; one is a lawyer now.”

It has taken us some time to understand the situation of the refugees here, and how their health care is provided. The context is very different from other UNHCR operations we have visited in Jordan, Kenya and Burkina Faso, where each camp holds refugees from several different countries. In this southernmost part of Bangladesh the refugees are all from one country: Rohingya Muslims from Rakhine state in Myanmar. They have been persecuted for decades, and are not recognised as Myanmar citizens. The origins of this persecution lie partly in Britain’s ignoble colonial history involving armed struggle and the re-drawing of country borders. The separation of families, military crackdown and forcible repatriation to Myanmar ensued. The result is that today the only refugees who are registered and in Bangladesh legally are the 10% of refugees who arrived in 1992 and were not repatriated – about 32,000 people in total. Despite legal status they do not have full rights in Bangladesh and are not Bangladeshi citizens. For over 25 years they have been compelled to live in two overcrowded refugee camps, which are therefore, essentially open prisons for stateless people.

These 32,000 registered refugees are grossly outnumbered by ‘Undocumented Myanmar Nationals (UMNs)’: those Rohingya who returned to Bangladesh after the forcible repatriation, and those who have fled Myanmar over the years since then. These people (thought to number about 300,000) are not allowed to live in the official camps. UMNs live in makeshift camps near the two official camps, and in small settlements on the edge of Cox’s Bazaar and other towns and villages. They are not allowed to work (neither are the legal, registered refugees in the official camps) but scrape a living together by begging or finding casual, illegal employment. The Rohingya in Bangladesh are stateless people to whom no one will offer a home. There is no UN brokered resettlement programme for them, unlike the ones offered to vulnerable Syrian or Somali refugees. They are people with no future beyond the shabby, basic existence of their official and informal camps. When we have visited refugee camps in Jordan, Kenya and Burkina Faso my efforts to greet people have been acknowledged by at least a few smiles; in Kutupalong camp no one responded at all.

Our Bangladeshi hosts have been extraordinarily kind and hospitable. Our main contact, the UNHCR Assistant Public Health Officer, took us home one evening to meet his wife and children and to eat proper, fresh fish for dinner, “not like the hotel, which is all frozen”. We were heartened by a snippet of feedback he shared with us “when learned experts come they usually cast their knowledge at us, but you people have started where we are and helped us to build up from there. You have really understood our context.” The day after finishing all the training programmes we met at the UNHCR office with the Team Leaders of both camps to discuss an operational plan for the months ahead to improve patient care.

Sadly there is no immediate prospect in view for an improvement to the situation of the Rohingya people. We hope to have at least boosted the skills, confidence and strategies of health workers interacting with the Rohingya on a daily basis such that they have improved access to quality chronic disease care, in the hope that one day they will be recognised and respected as a people.

Sarah Montgomery, May 2016

All views and opinions expressed here are solely those of the author and do not necessarily reflect those of PCI or its partners.