HOPE Shines for the Rohingya Health Crisis

Standing behind the HOPE Maternity and Fistula Field Hospital, in Cox’s Bazar, Bangladesh, I watch young Rohingya boys playing a spirited game of soccer. Barefoot and agile, they could match any team around the world.

But their refugee status confines them to playing behind a barbed wire fence -- indefinitely. Far from safe, their makeshift huts - made of dirt floors, tattered tarps for roofs, and bamboo sticks for walls - have been their shelter since 2017.

Sometimes the shacks fail to survive the monsoons, cyclones, mudslides, and fires that frequently wreak havoc here. Their homes provide no comfort from the stifling heat of the Bangladesh summers.

The refugee camps are plagued with gang violence, drug and human trafficking. Women and girls are especially vulnerable to sexual based violence, underage marriages, and domestic violence. Adding to the stress of daily life, there are communicable diseases such as hepatitis that run rampant in the overcrowded conditions. 

A 2023 study by Médecins Sans Frontières (MSF) found that 20% of Rohingya adults in Cox's Bazar refugee camps had an active hepatitis C infection. Dengue fever, typhoid, and malaria also add to stress of daily life. How did the Rohingya Muslims get here? The Myanmar government systematically forced them to flee to neighboring Bangladesh.

The camps were supposed to be temporary but due to the lack of solutions for the Rohingya and the ongoing conflict in Myanmar, the 33 camps still hold the largest Muslim refugee population in the world.

These camps became home following the two-phased Myanmar [Burma] campaign based on a policy of ethnic cleansing: the first was a military crackdown that occurred from October 2016 to January 2017, and the second has been ongoing since August 2017 - resulting in the largest human exodus in Asia since the Vietnam War.

Now, more than seven years later, what does the future hold? The refugees are dependent on aid to survive. With the initial emergency response concluded, and a dismal possibility of repatriation, the task of implementing a sustainable plan is underway.

David Bugden, Principal Coordinator of the Inter-Sector Coordination Group’s (ISCG) Rohingya Refugee Response, says organizations collaborate with the host government in sectors such as health care, food assistance, and education.

All essential services, such as sanitation, electricity, waste removal, medical services, water, and food, require constant management for a population of around one million people, For example, in camp 1W and 2W, there is a plastic recycling station, latrines, water barrels, and rows of basic shacks where sometimes more than 6 people could be living.

Because voluntary return to Myanmar is impossible for the time being, the vision now is to give the refugees a better quality of life in the camps and promote inclusive approaches that leave no one behind.

Given all that Bangladesh has done to host the Rohingya refugees, and considering the significant needs of the local population in Cox’s Bazar, partners and donors consciously include the host community through their projects.

Through a joint response, the coalition of more than 100 organizations is working on innovative solutions to give refugees not only valuable job skills, but also a sense of purpose and self-worth.

Mr. Bugden noted that so far programs have successfully trained and placed approximately 40,000 Rohingya volunteers and 10,000 nationals as part of the response. One key objective is to identify more refugees who could qualify for training programs to serve their community in varying capacities.

During my visit, I met a young Rohingya woman who was completing a 9-month medical assistant course. The training installed a sense of confidence and purpose in her. The desire to have purpose in life is universal. 

Mr. Bugden noted that the Rohingya refugees are resilient and have a strong desire to make the best of what life has dealt them - whether that is in Bangladesh or in Myanmar; if conditions ever allow for their voluntary, safe and dignified return. The entrepreneurial spirit is clearly visible inside the camp and there is a will to put their talents to use.

For example, there are people with tea stands serving samosas, and a tailor mending clothes. The United Nations High Commissioner for Refugees (UNHCR) and the International Financial Corporation (IFC) are conducting a study to understand how the economy operates inside the camp. The study results may influence future projects.

With the crowded conditions and poor nutrition, the health challenges are abundant. As a midwife, my particular interest is in maternal health and newborn are inside the camp. The founder of the Hope Foundation for the Women and Children of Bangladesh, Iftikher Mahmood, MD, FAAP, organized visits to its facilities.

The Hope Field Hospital is the only 24/7 maternity referral facility that operates within any of the camps. Imagine, for almost one million refugees, there is only one 24/7 facility to address maternal emergencies.

This is where all the other medical sites send their patients when they are unable to resolve obstetric emergencies. It has a fully functioning neonatal care unit, operating theatre, maternity wards, and cooperates with IPAS for family planning.

It was evident how empowering it was for the women to have access to family planning options in accordance with Islamic values. It allows them to focus on caring for their current children. Family planning is still a challenge and outreach programs are working within the camps to dispel cultural misconceptions.

As I held one of their children, I noticed she had a skin infection that covered her neck and back. No doubt, a casualty of the unhygienic living conditions.

Mrs. Jany, a staff midwife, noted that because of malnutrition and poor living conditions, the major obstetric challenges include pre-eclampsia, hypertension, anemia, and hemorrhage. These conditions are life threatening without the proper care that the HOPE field hospital provides. Additionally, HOPE surgeons repair fistulas -- restoring a woman’s dignity.

All the care is free to the refugees. Hope Hospital’s operational budget is completely supported by donations and as donor funding is cyclic, it has faced some financial shortfalls from time to time. The world’s attention is now diverted to other crises, and these Muslims refugees have fallen off the radar of the media and donors.

The hospital also treats infectious disease and non-communicable disease. It also has providers in pediatrics, dermatology, mental health, and dental care. The trauma of fleeing their homeland, uncertainty of the future, and then the continued stress of the living conditions has caused many to suffer psychologically. HOPE has trained their medical providers to identify and refer patients when there is evidence of psychological strain requiring additional help.

The Hope Foundation also provides care for local residents through their Cox’s Bazar based hospital. In many ways, the nationals living at the poverty line are worse off than the refugees and the hospital regularly offers free medical clinics, mobile fistula services, is adding a pediatric center, adding oncology referral services, and is opening the first maternity hospital on the main island of Moheshkhali Upazila also located in the Cox's Bazar District.

It is considered one of the country’s poorest regions. The Foundation also offers a 3-year midwifery training program to tackle the maternal and neonatal mortality rate.

Most of the refugee women wear niqab. But in the postpartum wards, they were more casual. They are strikingly beautiful with a graceful presence. They could have been anything if they weren’t confined by their refugee status.

It’s difficult to put into words the emotions I felt looking into the eyes of women that extended their hands in salaams to me, knowing they had lost everything, except faith.

Although spoken language was a barrier, we were able to communicate through the universal language of Islam. With no end in sight to the crisis in Myanmar, the refugee children risk becoming a lost and forgotten generation.

Their future is also limited, but not by their ability or dreams, but by circumstance. As the world’s focus shifts, these Muslims have become a memory to most of the world.

As I closed my eyes and heard the whistle of the soccer referee, I imagined that these young Rohingya boys will one day be playing in FIFA - proudly wearing the uniform of a place they can finally call their own. But until then, all they need from us is to remember that their plight is far from over.

Romy Sharieff is a licensed midwife and the founding contributor of the Bryan J Westfield Scholarship. To learn more about the HOPE Foundation, visit www.hopefoundationbd.org

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