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Sanitation in Rohingya Refugee CampsMass persecution and forced deportation of the stateless Rohingya people in Myanmar have created over 1 million homeless refugees in Southeastern Asia. Historically facing discrimination, the Rohingya are a Muslim minority group in western Myanmar (formerly Burma). They have been regarded as stateless, meaning without citizenship or any rights associated with it, since 1982, and the recent Buddhist nationalist movement has led to increased religious tension. They have mainly fled to Bangladesh, many of them have no choice but to leave Myanmar and enter Bangladesh illegally. This is partly due to their lack of freedom under the Myanmarese government’s labeling of stateless.

Sanitation and Water Issues

The largest refugee camp area in Bangladesh is Cox’s Bazar, where over 900,000 Rohingya people have taken up residence across 27 different locations. The area, not designed to hold this many people for so long, faces extreme overcrowding. The overcrowding is so dire, Bangladesh has been searching for ways to send back the refugees. It has been difficult for many to have adequate sanitation in Rohingya refugee camps. There has even been a worry that existing wells have been constructed too close to the latrines. If this is the case, mass disease outbreaks could occur without sanitation improvements. However, organizations like the United Nations High Commissioner for Refugees (UNHCR) and Oxfam have been working to improve these conditions.

Cox’s Bazar is very susceptible to long dry seasons, from November to April or even May. Long dry seasons lead to the main water reservoirs that the refugees use for their water drying up. Shallow tube wells that some organizations have constructed are also very susceptible to drying. The dry season has been much worse recently due to the climate changes associated with El Niño. To make matters worse, the rain has come only in dramatic cyclones. To ensure sanitation in Rohingya refugee camps, including clean water access and improve sanitation, organizations developed and implemented deep-well tubes.

Deep tube wells penetrate the ground past surface-level aquifers and reach the more stable water table beneath. These wells allow for more consistent water access. The water is then piped up to above-ground tanks with solar energy, where it can be monitored and the quality of water can be maintained at safe levels. Constructed in many strategically placed areas of Cox’s Bazar, there are over 20,000 shallow and deep tube wells in place. With the rapid construction of these wells, the UNHCR and Bangladeshi government have reached the goal of 20 liters per person every day.

Rohingya Women and Issues of Safety

The issue of proper latrine construction and maintenance has also been an issue that plagues the Rohingya refugees, particularly women. Many women and girls do not feel safe using the latrines, or even walking to them. They are typically in very difficult-to-reach areas of the camps. Refugees often must walk down steep, muddy slopes to reach the toilets and showers. Other than the trek, the latrines typically have no roofs or doors, and sometimes have little to no walls. In an area with hundreds of thousands of people, a third of Rohingya women did not feel safe taking a shower or using the toilet, according to a study conducted by Oxfam in 2018.

Refugee women need to feel safe and comfortable. Oxfam has been working with the women to design new latrines. These efforts also help women become more involved in the decision-making processes in the camps. The newly designed latrines have a full four walls, as well as a door, a sink and a stall. By involving more women in infrastructure projects such as these, they become more empowered and eager to participate in decision-making processes. This creates a lasting effect, especially in the younger Rohingya generations, that ensures greater stability among gender equalities in a place where women are largely left out of critical decision discussions.

The Future of Rohingya Refugees

The number of Rohingya refugees in Bangladesh is higher than ever. But these refugees have seen major improvements through the engaging and effective efforts from many humanitarian organizations, both governmental and non-governmental. While there are still challenges to overcome, continued improvements in water access means improved sanitation in Rohingya refugee camps and clean water for refugees. Oxfam works to provide upgraded latrines and toilet sanitation for better privacy and safety for women and children. In addition, the construction of thousands of deep-tube wells ensures that no disease outbreaks will take place on account of contamination from the toilets.

While the situation in Myanmar and Bangladesh remains tumultuous, those affected experience rapid developments in their living conditions. More refugees are likely to enter Cox’s Bazar, but sustained support from the international community ensures that more refugees than ever are able to have improved sanitation in Rohingya refugee camps.

Graham Gordon
Photo: Wikimedia Commons

Response to the Rohingya CrisisIn Myanmar, Rohingya Muslims are the target of an ethnic cleansing campaign. Raging on since August 2017, the military-led offensive has caused the displacement of almost a million people, the destruction of at least 392 Rohingya villages and the internment of some 125,000 Rohingya in detention camps. While international authorities have placed pressure on the government to stop its atrocities, a recent update from the U.N.’s special rapporteur, Yanghee Lee, makes it clear that the situation is still dire. The U.S.’ response to the Rohingya crisis has been considerable, but there is still a lot more that needs to be done to ensure the safety of this vulnerable population.

A Coordinated Response in Bangladesh

Many Rohingya (745,000) have fled to the neighboring country of Bangladesh since the violence began. The Bangladesh government has cooperated with international bodies to ensure the reception and integration of these many refugees, but several challenges remain. For one, about 84 percent of the refugee population resides in a camp in the city of Cox’s Bazar; its location on the Bay of Bengal renders the area subject to monsoons and cyclones, which, combined with congested living conditions, increase the likelihood of death and disease. Additionally, many displaced women face sexual violence in both Myanmar and the refugee sites, and 12 percent of refugees experience acute malnutrition, creating an urgent need for adequate medical services.

In response to the Rohingya crisis, the United States has provided $450 million in aid to host communities in Bangladesh. The United States recently earmarked $105 million for the U.N.’s 2019 Joint Response Plan (JRP). This aid is important, as the JRP works to:

  • Register and document all refugees, so as to provide them with the legal standing to engage in economic activity and receive further state services in Bangladesh.
  • Improve disaster preparedness among refugee holding sites, which also entails creating an improved population density distribution.
  • Create crucial health programs, such as food vouchers and mental health services. These programs have been particularly successful—the level of acute malnutrition, while still high, is seven points lower than it was in 2018 and women’s access to reproductive health services is on the rise.

Further Steps Needed

In contributing to the U.N.’s JRP, the United States mitigates the negative effects of the Rohingya crisis. However, the political conditions in Myanmar that caused so many to flee remain, largely because the government continues to carry out atrocities against the Rohingya people. The leader of the country’s military, General Min Aung Hlaing, has directly authorized the ethnic cleansing campaigns. According to Refugees International, this has essentially allowed Myanmar soldiers to impose a reign of terror on Rohingya villages. The group has documented “consistent accounts of Myanmar soldiers surrounding villages, burning homes to the ground, stabbing, shooting, and raping the inhabitants, leaving the survivors to flee for their lives.”

Myanmar continues to block humanitarian relief organizations from entering the country, which is a roadblock preventing a thorough response to the Rohingya crisis. Moreover, the government continues to deny the existence of military campaigns, which allows perpetrators to avoid punishment.

The U.S. has worked to place pressure on the Myanmar government so as to create accountability checks and dissuade other leaders from taking similar adverse actions against the Rohingya. For example, on July 16, 2019, the Trump administration placed sanctions on a number of military officials, including General Min Aung Hlaing. Countries and organizations can do more to halt the violence, though. Both the special rapporteur and Refugees International have called upon the U.S. and other members of the U.N. Security Council to refer the case to the International Criminal Court (ICC) or to set up an independent tribunal, which could try those responsible for the Rohingya crisis. While the ICC prosecutor has already taken preliminary investigative steps, a U.N. Security Council referral or tribunal establishment would put even greater political pressure on Myanmar.

Moving Forward

While the Rohingya crisis was years in the making, its impact has been especially acute in the past two years. The U.S.’ response to the Rohingya crisis has included successful collaboration with the U.N., and raised hopes of bringing the perpetrators to justice. In so doing, it will save countless lives and move the Rohingya community in Myanmar one step closer to protection.

– James Delegal
Photo: Wikimedia Commons

Palliative Care
Providing necessary medical care is essential to any humanitarian response. For the approximately 745,000 Rohingya refugees in Cox’s Bazar, Bangladesh, home to the largest refugee camp in the world, accessing high-quality medical care is often difficult. Palliative care, which is medical treatment for those with chronic or life-threatening illnesses, is often overlooked in humanitarian crises. Two organizations, PalCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies) and the Fasiuddin Khan Research Foundation, are pioneering this treatment for Rohingya refugees.

The purpose of humanitarian health work is to relieve suffering and save lives; however, those who are chronically and perhaps terminally ill are often given less attention than those with more easily treatable ailments.

Who Needs Palliative Care?

Palliative care improves the quality of life for children and adults who have chronic or life-threatening illnesses. Treatment focuses on physical, emotional, social and/or spiritual symptoms, and requires ongoing interaction between the patient and health provider. This care is sometimes provided alongside other therapies and treatments, including chemotherapy for cancer patients.

A 2018 study in the Journal of Pain and Symptom Management on life-threatening illness in Cox’s Bazar found that the most common life-threatening illnesses were tuberculosis, cancer and HIV/AIDS.

They also estimated that 73 percent of those with life-threatening illness experience pain. Approximately half received no pain relief and a majority receive very little pain relief. Other common symptoms include insomnia, cough, anorexia and dyspnea.

The Challenges

While medical supplies are generally available to treat these symptoms, they are often unaffordable, particularly for refugees, and more than 60 percent of patients had to stop taking medications because they were no longer able to afford them.

In addition to medication, palliative care requires a caregiver, and caregivers in Cox’s Bazar are normally family members. Approximately 94 percent of caregivers have no training, and providing hours of daily assistance bathing, feeding, giving medications, etc. is a physically and financially demanding role. Providing this treatment for Rohingya refugees, therefore, is often a significant burden on families, particularly if they have to do a lot of the work themselves.

Moreover, unique challenges arise when children need extensive treatment, as they need extra support and often spend more time in the hospital, separated from family and friends. This increases psychological stress and caregivers are in need of even more training to know how to properly care for children with chronic or life-threatening illnesses.

A Need that Should not be Overlooked

In spite of this need, palliative care for Rohingya refugees is not a priority in the aid sector’s response plan. PalCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies), an organization based in the UK, was created in response to the general lack of palliative care in disaster and conflict responses.

Co-founder Joan Marston stated that palliative care is “really about the dignity of the individual,” noting that already “there’s enough indignity within these humanitarian situations.” The goal of PalCHASE is to get more emergency response plans to incorporate palliative care, hoping that the treatment will cease being an afterthought in the humanitarian response.

The Fasiuddin Khan Research Foundation

The Fasiuddin Khan Research Foundation is Bangladesh-based and is working directly on providing palliative care for Rohingya refugees. It is the first concrete palliative care program with a humanitarian response.

Founder Farzana Khan, despite being unable to secure long-term funding, is on the ground with a team of three addressing the distinct needs in the Rohingya refugee camps. Khan spent 20 years providing palliative care in Bangladesh prior to focusing on the Rohingya refugees, noting that her “core approach” is “dignity and respect.”

Early in their response, Khan’s researchers estimated that thousands of people in the refugee camps may be in need of palliative care and were not currently getting help. To remedy this, it is essential to make this treatment more easily accessible and ensure that refugees know when to seek medical treatment and care.

Changed Lives

Sanjida, a 16-year-old refugee living with untreated meningitis, which is causing increased paralysis, has received palliative care, thanks to Khan and her team. Her sister and caregiver, Khaleda, noted that she can now do more by herself, can call for assistance more easily and just generally seems happier.

Another patient, 10-year-old Mujibur Rahman, who suffers from bone cancer, was struggling to walk and ended up confined to a wheelchair. Dedicated treatment helped manage his pain and within two months helped him walk again.

Since the Rohingya crisis began in 2017, Khan’s team has reached approximately 1,000 patients, including Sanjida and Mujibur. While funding continues to be a problem, Khan hopes that organizations’ successes will help secure more financial support so that they can continue to provide support for Rohingya refugees.

Looking Forward

Regardless, the Fasiuddin Khan Research Foundation should become a model for other humanitarian response teams looking to focus on palliative care. In addition to the Rohingya, other refugees around the world, as well as those who are impoverished, are in need of better treatment in the case of life-threatening or chronic illness. The work of PalCHASE will hopefully increase knowledge about the need for palliative care and encourage humanitarian leaders to consider it more seriously.

– Sara Olk

Photo: Flickr