One year ago, the world community saw a massive humanitarian crisis unfold in Myanmar’s Rakhine, at the north-eastern edge of the Bay of Bengal.
Hundreds of thousands of terrorised Rohingya people crossed the border into neighbouring Bangladesh. Sixty per cent of them are children and they all spoke of witnessing unspeakable violence.
Around 919,000 Rohingya refugees live in southern Bangladesh, most of them in the vast and teeming camps and settlements that have sprung up in Cox’s Bazar district, close to the border with Myanmar.
A smaller number live in the neighbouring host communities of Teknaf and Ukhia. The majority – 700,000 arrived following the violence of late August 2017. The rest had arrived using the border in previous influxes.
The unstinting support of local Bangladeshi communities, and a multi-national aid effort led by the Government of Bangladesh, have averted dire fears. Since the chaotic early phase of the crisis, basic services provided by UNICEF, a host of NGOs and humanitarian partners have expanded and scaled up massively. But they are still far outstripped by the needs of the refugees.
A semblance of normality has descended on the camps and the neighbouring communities, but it is a normality that cannot last indeﬁnitely. Twelve months on, memories of violent experiences remain raw among the one million Rohingya refugees.
“This is a challenge that must be addressed, and rapidly. The Rohingya - and their children especially – demand and deserve nothing less” – Manual Fontaine, UNICEF Director of Emergency Operations
A dangerous place for children
Make the chaotic environment safer for children
The camps have started to look organised. One year ago, the refugees were clearing scrubland to set up plastic-bamboo shelters. Paths have now layered with brick and steep slopes with sandbags and bamboo stairways. There are now more solar-powered street lights. These made the hills less hazardous.
UNICEF built 136 child-friendly spaces or CFS across the refugee camps, carving out spaces for older children and young ones alike. The child-friendly spaces provide psychosocial support to children struggling with trauma.
“They provided a secure space where children could be children again, and allowed parents to concentrate on other issues in their lives,” says UNICEF’s Child Protection Programme Manager in Cox’s Bazar, William Kollie.
Rohingya girls traditionally do not venture out of their homes after reaching puberty. Now as refugees living in congested camps they are cloistered within small, stifling shelters, with nothing to do except cooking and cleaning. For these children, UNICEF supports adolescent clubs in refugee camps and local communities.
Around 60,000 adolescent girls and boys have joined the clubs, which offer them access to life-skills, and knowledge about child rights, alternatives to marriage, under-age hazardous labour, sexual and reproductive health, psychosocial support and other issues.
At the same time UNICEF wants to strengthen the solidarity between Rohingya and host community children. “The host community has been the ﬁrst responder to this crisis, but has paid a heavy price for doing so,” says Jean Metenier, Chief of UNICEF Cox’s Bazar Field Ofﬁce.
“This is why … we are now redoubling our efforts to ensure that as a minimum, Bangladeshi children are not negatively affected as a result of the generosity they have shown.”
Avoiding a “lost generation”
Improve the quality of the learning and include adolescents
From the very beginning of the refugee crisis, the importance of getting around 381,000 newly-arrived children into school was a huge challenge for UNICEF and its education partners.
Priority was given to providing learning for children under the age of 14. By July 2018, almost 140,000 Rohingya children had been enrolled in non-formal education of some kind.
A mix of Bangladeshi and Myanmarese learning instructors, over 3,000 of them, have been trained. So enthusiastic were the children to learn that classrooms were often over-crowded.
“I see the schools here where the younger children go, but there is nothing for boys like me,” says Mohamed, a Rohingya adolescent boy. “I feel very unhappy that I am unable to study here.”
13-year-old Mohamed Faisal says getting an education is more of a priority for him than a prosthesis to replace the arm he lost during his flight from Myanmar last year.
It’s a frequent complaint among Rohingya adolescents around the camps – boys and girls alike. They represent a people who have been denied education in Rakhine over a long period of time.
“We succeeded in mushrooming the learning centres at a rapid pace,” says acting UNICEF Chief of Education, Bibek Sharma Poudyal. “Now we need to improve the quality of the learning they are offered, and expand it to provide for the requirements of adolescents.”
A new strategy is being discussed that proposes the expansion of the current contact time for each child from two hours of daily teaching to four. Classes will be provided up to grade 8 level, employing English, Burmese and local dialects used by the Rohingya as the languages of instruction.
The strategy is an ambitious undertaking, acknowledges UNICEF Bangladesh Representative Edouard Beigbeder. “But if we don’t make the investment in education now, we face the very real danger of seeing a ‘lost generation’ of Rohingya children emerge,” he says.
“Children who lack the skills they need to deal with their current situation, and who will be incapable of contributing to their society whenever they are able to return to Myanmar.”
Safe water for refugees and host communities
The vast majority of refugees rely on handpumps fitted to tubewells
Over 8,000 such waterpoints have been constructed throughout the camp areas, although only 80 per cent are currently functioning. That’s because a large number of tube-wells dug in the early weeks of the crisis were badly positioned or poorly constructed and had to be closed down as they became contaminated or dried up.
“The refugees and host communities need more than 16 million litres of safe water every day for drinking, food preparation and washing,” says UNICEF WASH Specialist Raﬁd Salih. “That’s a huge challenge, on top of which we need to construct or maintain around 50,000 latrines.”
Around 8,000 toilets are currently being decommissioned and replaced with better-quality units in more suitable locations. Solutions to the challenge of safely disposing of the sludge they produce are making progress – even if the lack of space for largescale facilities in the camps is an issue.
At the Unchiprang settlement, UNICEF supports a treatment plant that sources water from hilly canals and is operated by Oxfam. It is one of the two plants that produce clean drinking water, 300,000 litres every day. “And we continue to supply safe water to two Bangladeshi communities – Chakmaara and Roikum Para,” says Oxfam Programme Ofﬁcer Kazal Bardhan.
By the end of 2018, up to 200,000 Bangladeshi citizens and 150,000 refugees living alongside them are set to have access to sanitation and to safe water, much of which will be provided from four deep boreholes currently being constructed in partnership with the local Department of Public Health Engineering.
Health care across both communities
Health posts are central to avoiding major health crises
Dr Kazi Islam is the medical officer in charge of one of the bustling primary healthcare centre in Kutupalong camp. The neat, blue-painted health centre is made of brick and cement. Far more durable than the bamboo structure it replaced.
“Each day here is different,” says Dr Kazi. “But the most frequent ailments we treat are diarrhoea, and common cold.”
This particular morning, he has already referred to a nearby clinic a man with tuberculosis, the mother of a baby who may be autistic, and a small girl who had been hurt in one of the trafﬁc accidents that are a frequent occurrence on the camp’s chaotic trails.
Health posts like Dr Kazi’s – along with six larger primary health centres and ﬁve diarrhoea treatment centres – have been key to avoiding major public health crises in the months since the refugees’ arrival last August.
The beneﬁts of vaccines were almost entirely unknown to Rohingya communities back in Myanmar. Convincing newly-arrived refugees to protect their children in this way has not always been easy, due to various rumours spread about their supposed harmful side-effects.
A series of successful immunisation campaigns – nine in the space of ten months have also played a critical part in averting the worst fears of health ofﬁcials. But outbreaks of measles, and diphtheria were alarming enough. Mobilising the refugees for follow-up vaccination rounds has proved difﬁcult.
“Given the physical condition the arriving refugees were in, and the lack of vaccination coverage they had, we expected worse outbreaks than have occurred so far,” says UNICEF Health Specialist Yulia Widiati.
At Cox’s Bazar town, the inﬂux of Rohingya refugees was straining local health services like the Cox’s Bazar neonatal unit where premature babies from both communities are treated.
UNICEF has a long history of collaboration with local health authorities across Bangladesh. Besides supporting neonatal care services, the partnership extends to health worker training and health management systems.
“The neonatal unit here in Cox’s Bazar has treated around 1,700 newborns so far this year,” says UNICEF Health Ofﬁcer Helen Chakma. “The referrals come from host communities and Rohingya camps alike, so there’s beneﬁt to both.”
Killer hiding in plain sight
SAM has been identiﬁed as a major threat to children’s health
Amina Akhtar plays a life-saving role in Balukhali refugee camp. The 18-year-old is one of around 250 community volunteers, part of whose job it is to patrol the shelters of Balukhali camp in search of infants and young children up to the age of 5 who are underweight or malnourished.
One of her early successes, just days into her job, she found six-month-old refugee twins Aseea and Robina, dangerously-ill from severe acute malnutrition or SAM. Since the beginning of the refugee crisis, SAM has been identiﬁed as a major threat to children’s health.
“Now we have systems in place, building on almost one year of key emergency efforts,” says UNICEF Nutrition Team Lead Saira Khan. “Our approach now is based on mobilising the community, and helping refugees and host community families alike tackle both the immediate and long term nutritional needs of their children”
These needs arise largely from factors imposed by the camp environment, including the limited supplies of clean water, the challenging setting for good breastfeeding, and limited access to diverse, nutrient-rich foods that are essential for adolescents, mothers, and children.
The challenge posed by SAM, however, remains very real: UNICEF estimates that over 50,000 children under 5 will require treatment for the condition in 2018.
Challenging the rumour mill
Model mothers help refugees cope with the fast-changing context of life in the camps
In the narrow paths and alleyways that thread past the homes of nearly one million Rohingya refugees, there’s nothing that spreads quite as quickly as rumours.
With little or no access to television, radio, or other media, the refugees rely largely on word of mouth to keep informed not just about what is happening in the camp, but about issues critical to their health, nutrition and even survival.
Immunisation – something few Rohingya experienced back home – is one topic that has caused fevered and sometimes ill-informed discussion. One story had it that measles injections would make girls sterile. Another claimed a vaccination would convert a child into a Christian.
It is to help tackle such dangerous misconceptions, and to make the refugees more aware of the positive value of the services set up for them, that “model mothers” such as Nur Begum have been recruited.
The 50-year-old Rohingya mother and grandmother is among some 240 volunteers supported by UNICEF whose job is to go house-to-house around the camp.
Nur Begum’s prime focus are young expectant mothers. “I tell them that they must call a midwife when they are about to give birth, because she will help them if they have difﬁculties,” she says. “Likewise I tell young mothers that breastfeeding helps to keep a baby healthy.”
Personal cleanliness is also vigorously promoted. “Most people living here are unaware of basic hygiene. I tell them that a clean house is a house free of the possibility of infections and diseases.”
“One of the biggest problems I face is that of parents who want their children to marry when they’re too young – in some cases aged only 13 or 14,” she says. “I tell them they must be aged 18 or over and there can be no exceptions,” says the charismatic woman, Nur Begum
UNICEF also supports through its partner BRAC 800 community mobilisation volunteers, who are from the Rohingya community.
In addition, adolescent radio listener groups give young Rohingya refugees an opportunity to engage on issues affecting them, their families and wider communities.
“Rumours spread like wildﬁre, and can have a serious impact on our programmes, and on immunisation especially,” says UNICEF Communication for Development Specialist, Aarunima Bhatnagar. “Besides the volunteers, we engage local imams and community leaders.
We have also set up a network of 12 information and feedback centres around the camps to ensure consistent messages are disseminated, and to encourage community participation.”