Addressing the health landscape of Bangladesh’s Rohingya community

This is article no. 6 in a series about global health injustices. Previous article: Health gaps in conflict-affected Kashmir. Next article: A deep, critical reflection.

Introduction

Welcome to the sixth article of the Global Health Injustices Series, a collaboration with Nasif Mahmood. This article focuses on the ongoing injustices and health issues affecting the Rohingya refugees in Bangladesh. This community leads a vulnerable life and suffering that it is becoming one of the most significant South Asian crises in the 21st century. Due to Bangladesh's inadequate resources and geopolitical situation, the overall health and well-being of the country and the migratory population are severely hampered.

A brief history of Bangladesh and the Rohingya population

Bangladesh's history is intricate and has been influenced by many cultures. After India was divided in 1947, the area, previously part of ancient Bengal, was ruled by the British and became East Pakistan. Demands for autonomy resulted from tensions between West and East Pakistan. The Bangladesh Liberation War in 1971, culminating in these tensions, led to the country's independence. Bangladesh has made great strides in education, health, and economic growth since gaining its autonomy, despite facing economic hardship, political turmoil, and natural disasters. 

Rohingya, the Muslim ethnic minority from the state of Rakhine, were denied citizenship by the Myanmar Government, leaving them homeless. They endured years of persecution, discrimination, and violence. In 2017, an inhuman, violent crackdown by the military of the Myanmar government forced over 70,000 Rohingya to flee to Bangladesh. Over 1 million refugees live in Bangladesh, primarily in the Cox Bazar area. A lot of refugees cause overcrowding situations, and limited resources lead to a high rate of nutritional problems and spread of disease, specifically infectious diseases and mental health disorders in the refugee camp.

Connecting geopolitics and health: impacts on the Rohingya population

The Rohingya crisis is more than just a humanitarian issue; it is a tangled web of geopolitical challenges. The Myanmar government’s ongoing refusal to grant citizenship and fundamental rights to the Rohingya people not only deepens their suffering but also fuels instability in the region. They have not taken the necessary steps to ensure their safety, leaving the crisis unresolved.  As refugees continue to pour into neighbouring countries, tensions have escalated, placing a heavy burden on host nations like Bangladesh. 

This crisis worsens existing socio-economic problems and stretches resources thin in areas struggling to care for their citizens. The international community has responded in various ways; some countries are pushing for tougher sanctions against Myanmar, while others are focused on delivering aid to those affected. However, the underlying issues driving this crisis will unlikely be resolved without a coordinated and sustained political effort (Table 1, Figure 1). Addressing them can lead to improved outcomes for the Rohinyga population.

On top of that, the health challenges faced by the Rohingya people go beyond just infectious diseases. The lack of access to essential health services has not only worsened physical health problems but has also led to a growing mental health crisis. Many Rohingya individuals are grappling with post-traumatic stress disorder (PTSD), anxiety, and depression stemming from their traumatic experiences of violence, loss,  trauma, isolation, and forced displacement. Yet, mental health services in the refugee camps are severely lacking. A study showed that the prevalence of emotional and behavioural disorders is high among forcefully migrated refugee children, because of traumatic exposure like the unexpected death of parents, forceful displacement, and the witnessing of family violence and abuse.

The stigma surrounding mental health in many cultures, including in the Rohingya community, creates additional hurdles for those seeking help. Enhancing access to mental health support is crucial, not just for the immediate well-being of the refugees, but also for their long-term healing and successful integration into the societies that host them. Moreover, providing humanitarian aid and hosting such a large population in Bangladesh is becoming difficult. The national and international NGOs maintain healthcare for the Rohingya population. However, the funding shortage and inadequate infrastructure hinder the provision of adequate medical services. For this reason, the refugee camps have reported significant outbreaks of diphtheria, cholera, and COVID-19. 

Given the challenges, developing innovative solutions and working collaboratively on a global or regional scale is needed. By empowering local health workers and training them to offer basic healthcare and mental health support, to close the service delivery gaps. Additionally, building partnerships among NGOs, governments, and international organisations can help ensure that resources are allocated more effectively and that comprehensive health programs are created to meet the unique needs of the Rohingya population. It's crucial to engage the community; by listening to the voices and experiences of the Rohingya, we can develop interventions that truly respect their dignity and cultural context.

Additionally, raising global awareness about the struggles faced by the Rohingya can lead to stronger advocacy efforts. Involving the media, educational institutions, and civil society can foster a deeper understanding of the interconnected issues of geopolitics and health. Initiatives that share personal stories and experiences can rally public support and drive meaningful change. Ultimately, tackling the Rohingya crisis calls for a multifaceted approach that blends immediate humanitarian aid with long-term strategies aimed at ending their statelessness and ensuring their rights as human beings are upheld and protected.

Recommendations from NGOs

National NGOs:

Several national NGOs play an essential role in supporting the healthcare needs of the Rohingya population: 

1. Bangladesh Rural Advancement Committee (BRAC), one of the world's largest NGOs, provides comprehensive health care services, including maternal and child health, immunisation programmes, disease prevention initiatives, and arranges many health campaigns for refugees. 

2. Gonoshasthaya Kendra established a field hospital and free clinic in the Cox Bazar area near the refugee camp, focusing on primary health care and emergency medical support. 

International NGOs

1. MedGlobal, an international NGO, responds to this global crisis by delivering medical assistance within the refugee camp. Support hospitals and clinics for affected refugees between 2017 and 2019. This organisation's volunteers contributed over 17,000 hours of aid, assisting more than 80,000 individuals. 

2. Medair is another international NGO offering health and nutritional support to the Rohingya refugees. 

3. Migrant Offshore Aid focuses on sea rescue operations and delivering medical aid and assistance to surfers.

Together, these national and international organisations make meaningful contributions to the healthcare needs of the Rohingya population, handling both immediate medical concerns and long-term health support in a challenging environment. Their collaborative efforts help ensure that essential services reach those in critical need, facilitating better health outcomes for refugees. Although they address the healthcare needs of the Rohingya, several challenges can limit their effectiveness. 

For example, coordination issues may lead to overlapping efforts or service gaps, resulting in inequitable and unequal healthcare access. Also, limited resources and funding can slow extensive long-term support, leaving specific medical needs unaddressed. Additionally, the intricate political and social conditions restrict these organisations' capacity to operate effectively, impacting immediate care and sustainable health initiatives for the Rohingya population.

Moving forward, it is crucial for host countries to: finance extra healthcare facilities in refugee camps to enhance access and reduce diseases, launch culturally appropriate mental health initiatives with locally trained workers to decrease stigma and provide community-based support, integrate nutrition programmes to address different forms of malnutrition in vulnerable communities and encourage further international support to maintain health initiatives among the Rohingya population. 

Conclusion

The Rohingya crisis is an example of global health injustice exacerbated by geopolitical and humanitarian challenges. At the same time, Bangladesh is trying to provide temporary shelter for the refugees to minimise the crisis. However, this crisis also requires international cooperation, policy support, and increased funding. Solving this issue is essential for global public health and human rights. Notably, finding sustainable solutions will help the Rohingya people recover and thrive, and enhance stability and security in the region. 

Their future goes beyond humanitarian aid; it is about upholding inclusion, justice, and respect for human dignity, which should guide all efforts to link geopolitics with health outcomes. To truly tackle the health issues faced by the Rohingya community, we need to take a comprehensive approach that looks at the political, social, and economic factors at play. By adopting such all-encompassing systems, we can work towards a brighter and fairer future for the Rohingya community and other vulnerable groups around the globe who are facing similar challenges. The next article will be the final one reflecting on everything discussed in this series.

Written by Nasif Mahmood and Sam Jarada

Related articles: Health and well-being in- Palestine, Kashmir / South Asian famine / South Asian mental health

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