Aid groups and authorities in Bangladesh are preparing to ask for more than $900 million in donor funding to help Rohingya refugees in the sprawling refugee settlements of southern Bangladesh.
But nearly 18 months after 700,000 Rohingya fled a violent military crackdown in Myanmar in August 2017, the aid sector finds itself shifting from emergency response to dealing with a protracted crisis.
The camps are now home to nearly one million Rohingya, including previous generations of refugees who fled their homes in Myanmar’s Rakhine State.
“This is like a major city,” said Rachel Wolff, response director for World Vision, one of more than 100 NGOs, UN agencies, and government bodies now working in Cox’s Bazar.
There are slim prospects of a quick return home: the UN says Rakhine State is not yet safe for the Rohingya, who have faced generations of marginalisation and disenfranchisement, and most of the refugees say they won’t go back until their rights are guaranteed.
A generation of young Rohingya have spent another year without formal schooling or ways to earn a living.
The dimensions of the response are changing as the months pass: medical operations focused on saving lives in 2017 must now also think of everyday illnesses and healthcare needs; a generation of young Rohingya have spent another year without formal schooling or ways to earn a living; women reported sexual violence at the hands of Myanmar's military, but today the violence happens within the cramped confines of the camps.
Here are some of the biggest issues coming up in delivering aid in city-sized camps, as the crisis continues to evolve and pushes toward a second full year:
Healthcare: from bullet wounds to diabetes
Healthcare workers responding in the early days of the 2017 refugee outflow treated traumatic injuries like bullet and knife wounds, and rushed to implement mass vaccination campaigns and ensure access to safe water.
But as the refugee crisis prolongs, longer-term health needs also become a pressing concern.
“You go through this emergency response and then you say, OK, we don’t know when or if the situation for these refugees will improve, so we need to start addressing things like diabetes… and high blood pressure,” said Jessica Patti, medical coordinator for Médecins Sans Frontières, which runs four field hospitals and several clinics in the camps.
Major gaps in health services have emerged in the crowded camps: treatment for chronic diseases, care for sexual violence survivors, and mental health and psychiatric services for a population stuck in limbo.
The Inter Sector Coordination Group, the UN-led body coordinating aid efforts in the camps, says treatment for non-communicable diseases, as well as malaria, tuberculosis, and HIV is “insufficient”, and that health facilities are unevenly distributed – services are bunched close together in some areas, while refugees in more distant settlements may go without.
“Congestion is the recipe for all disaster.”
“After an emergency, everybody sort of comes in, responds, sets up,” Patti said. “But I think we’re at a point now where people need to take a step back and say, OK, maybe some of these services are redundant and need to consider closing, re-evaluating, or moving where we are, to allow for more space in the camps for people to live.”
The extreme lack of space in the camps cuts through the entire response: health risks from poor hygiene and sanitation soar if latrine standards are inadequate. There’s not enough room for classrooms, nor for storm shelters or comprehensive evacuation plans for the upcoming cyclone and monsoon season.
“Congestion is the recipe for all disaster,” said Rezaul Chowdhury, who leads COAST, a local NGO based in Cox’s Bazar.
The majority of the refugees now live in massive Kutupalong camp, carved out of undulating, flood-prone land.
The amount of useable space available per person – less than 10 square metres in some areas – falls far below minimum international standards for refugee camps.
Needs of women and girls
This severe congestion also adds to the risks faced by women and girls, whose health and protection needs are already “critically underserved” in the camps, according to the Inter-agency Working Group on Reproductive Health in Crises, a coalition of aid organisations.
“The fact that it's such a crowded camp, who's the most affected? It's women and girls,” Wolff said.
“They don't have a space and, being from a culture where, not all, but some portion of males, husbands, and community leaders, are pressuring them to stay in their homes – we're talking about homes that are actually glorified hovels; stay in your plastic shelter – it’s just beyond what I think a human woman could tolerate.”
Schools and livelihoods: a lost generation
There are more than half a million school-age children and young adults in the camps and surrounding areas, but for the past 18 months few have been able to access formal education.
Worried that Rohingya children educated in Bangladesh will integrate into local society and not return home, Bangladesh’s government has placed strict limits on formal education – Rohingya students are not permitted to study using the Bangladeshi curriculum.
Instead, education services are largely limited to informal classrooms run by a range of NGOs and community groups. But aid groups have been slow to finalise an alternative curriculum, and some Rohingya parents have criticised the quality of education on offer. Aid groups say this informal schooling is available to only half of children 14 years old and younger.
At the same time, only primary-level education is allowed, meaning there are few opportunities for Rohingya who are 15 and older. Fewer than 5,000 adolescents have any access to schooling or life-skills training, out of more than 117,000 who may need it, according to aid groups.
"You are developing a young generation with a lot of frustration.”
“Without formal education, without skills-building, things to do actively, and preparing for their futures, how do they start to think about where their life is going?” said Wolff. “I think all of us really hope to move a bit faster and get into more self-reliance activities for the refugees, especially the youth.”
Critics say there has been a lack of long-term planning on education, including coordinated advocacy to convince the government to change its rules.
“The Rohingya are getting older. They are growing,” said Chowdhury. “If you don’t have education, then you are developing a young generation with a lot of frustration.”
Host communities: rising tensions
The massive influxes of refugees – and the aid groups that followed them – have raised tensions among Bangladeshis in Cox’s Bazar. Some say they’ve seen their income plummet as they compete for increasingly scarce resources or services.
A January survey by Ground Truth Solutions, which researches the views of people in crises, pointed to rising tensions among the host communities: “Their attitudes have shifted from the start of the crisis, where they felt much more supportive and welcoming of Rohingya but now are much less so, feeling that Rohingya have ‘been here too long’.”
Aid groups and the government also warn of a “potential deterioration” of relations between Rohingya and the local communities. The upcoming response plan is expected to place a greater emphasis on building social cohesion and on development projects to improve education and access to water and food in host communities. Some of these projects were started last year, but the UN coordination body said a “severe funding gap” put a limit on this assistance.
Planning for the future
The upcoming appeal – north of $900 million – represents one of the largest humanitarian appeals for a crisis this year. But the 2018 Rohingya appeal went underfunded through much of the year, which aid groups said had a direct impact on the quality of services available.
Chowdhury said the aid community continues to concentrate on short-term goals, without planning for a future when funding will wane. He said local NGOs and aid workers have effectively been left out of planning, while international aid groups have done little to build skills among the local organisations that call Bangladesh home.
“When the funds dry out, when UN agencies and all the experts fly out, there should not be a burden on the local people,” Chowdhury said. “There should be an opportunity for the local people.”
At the same time, the future of the Rohingya in Bangladesh is inextricably tied to the government itself, which is in charge of the humanitarian response but also says the refugees must one day return home.
Highly criticised plans to begin refugee returns to Myanmar last year were called off when Rohingya refused to go. The government has also floated plans to resettle some Rohingya on Bhasan Char, a disaster-prone island that rights groups say would be even more precarious than the refugees’ current camp shelters.
(TOP PHOTO: Young Rohingya refugees play at Balukhali refugee camp in Ukhia on 4 February 2019. CREDIT: Munir Uz Zaman/AFP)