Rohingya refugees: Helping today to prepare for a better tomorrow
The Rohingya people living in the refugee camps near Cox’s Bazar in Bangladesh did not come by choice: they fled from violence and persecution, to save their lives.
I have just spent a day visiting one of the Rohingya refugee camps managed by CARE – camp 13, home to 45,000 people. When you meet people who have had such a terrible experience, there’s a very natural desire to tell them how sorry you are about what they had to go through. But we were reminded by our CARE colleagues before we visited, not to ask people about the past. They are traumatised and it can be very upsetting and dangerous to trigger these terrible memories. So we only talked to people about the present and future, despite the desire to apologise for letting the world do this to them.
But what does that future hold? And how is CARE helping people in the camps today?
Is women’s empowerment the silver lining to this terrible situation?
CARE’s focus is on gender equality and women’s empowerment, in humanitarian disasters and developing countries. We know from long experience that women face different challenges in disasters and if this is not considered, a response can be skewed to what men need instead of what everyone needs. So, as always, CARE conducted a Rapid Gender Analysis of the Rohingya crisis in 2017 and shared it with the other aid charities and the UN. Our programme continues to be informed by this and subsequent analysis.
The Rohingya and the local community in Bangladesh are quite conservative and women do not exercise the same rights as men. We address this by engaging both women and adolescent girls, as well as men and adolescent boys. While I was in Cox’s Bazar, I saw one of our women’s leadership sessions taking place in one of our one-stop-shop information hubs.
I have to say, on the streets, I saw far fewer women than men. And the team explained to me that violence within the home is under-reported, as it is in most countries. We provide women and girls’ safe spaces in camps and the local community, where they can come and meet each other, share their problems and share solutions. We engage men and adolescent boys as well, to challenge the social norms that perpetuate violence against women and discrimination.
Our Head of Humanitarian Programmes, Helen Thompson, was able to go into a women and girls’ safe space and talk to some of the women there. They told her that they’ve learnt a lot about the perils of early marriage, particularly the physical impact of early birth and the fact that young girls can’t hold their own in decision-making in their husband’s family. The women say they now realise it’s better to wait until girls are 18 before marrying them off. But dowries are still demanded when girls do get married, which creates big problems for poor families.
So there is a long way to go. But there are signs that Rohingya women are more engaged in community and household decisions, than before. So perhaps there is one upside emerging from this terrible crisis. One example of this is that women are participating in the community disaster management teams, and also that many women are accessing family planning for the very first time.
Health and nutrition
One of our fastest funders to respond to the Rohingya crisis in 2017 was our longstanding partner in Bangladesh and Asia, GSK. Together, in the last few years, we have improved maternal and child mortality in Sunamganj, in north-east Bangladesh, one of the poorest parts of the country. We have achieved this by training community midwives which has increased skilled attended births from 12% in 2012 to 50%.
Now we are doing the same for the Rohingya families in south-east Bangladesh. GSK helped to fund some of the very first clinics for the Rohingya people in Bangladesh in 2017. We drew on our learning to combine the clinics with mobile outreach teams who could reach all of the pregnant and breastfeeding mothers in the camp, even if they weren’t coming to the clinic because of social restrictions or lack of awareness. We can then make sure that they understand and take up the benefit of pre and post-natal appointments at the clinic with a nurse or doctor. Skilled birth attendance has increased from less than 1 in 3 births, to over 46% of all births, in the camps, in just two years. The level of skilled delivery varies across the camps, from 100% in some camps, to less than 25% in others. But you can see from the picture below that this @GSK founded clinic is having hundreds of ante-natal contacts every month. This will save lives.
You can also see that the clinic offers a variety of family planning options for women. Very few Rohingya women previously had access to contraception. Many didn’t even know that contraception existed. Now they can choose when they have their first child, and how to space them, which is critical for the health of the mother and child. This is a very significant step forward in Rohingya women’s empowerment.
Another major health concern in the camp is malnutrition. It has a combination of causes, but the main two are lack of enough food and diarrhoeal illness – which is very common when people live so close together with limited sanitation, and stops children from absorbing the nutrients from the food they do eat.
CARE has trained around 1,000 facility and outreach aid workers on community-based management of acute malnutrition. In turn, these have trained many thousands of volunteers. And these volunteers are present in every block of the camp, actively screening infants up to the age of five, for acute malnutrition. This is done using a simple paper armband called the Middle Upper Arm Circumference tape. If their upper arm is too thin, their parents are asked to bring them to a clinic where they are checked by a trained professional. Their height and weight is measured and their appetite assessed.
In severe, acute or moderate malnutrition cases where the child does not have appetite, they will be admitted to the in-patient treatment centre where they will be treated for a few days until their appetite improves. For children with severe acute malnutrition but sufficient appetite and no medical complication, their parents will be given free ready-to-use therapeutic food and given nutrition and health counselling services. They will continue to be monitored as an outpatient until they are out of danger. The main causes of malnutrition among the Rohingya are a lack of diversified food, poor care practice and poor living conditions, compounded by poor sanitation. While back in 2017, a quarter of child refugees were malnourished, this rate is now 12%, demonstrating the effectiveness of the community based management of acute malnutrition at reducing the most acute forms of malnutrition, which is now slightly lower in the camp than in the general Bangladesh population. Which is a very good demonstration of how effective aid can be.
And what about the children?
One of the other first things we noticed was how many children were wandering about. This was mid-morning on a weekday. They should definitely have been in school. But there are no official schools in the camps. Primary age children go to Learning Centres in the mornings, where they get some lessons on the alphabet, numbers and basic calculations, as well as subjects like hygiene awareness. Most children will also get religious education from the Imams in the camp.
We met a big crowd of kids on the football pitch-come-floodplain. They eagerly gathered round and when my colleague asked about their hopes for the future, hands went up – they want to be teachers, doctors, engineers. But their ambitions won’t be fulfilled growing up in camps with no proper education. Donor governments, including the UK, recognise this as a big gap that will leave this generation of Rohingya unable to fulfil their potential. The UK is in discussion with the Bangladeshi government about how to improve education provision in the camps, and working with UNICEF to deliver that.
With no schools, kids get bored. My colleague asked what they like doing apart from playing football – they said there’s nothing else to do. We saw a football tournament that CARE’s site management team had supported the community to set up, giving them something fun and competitive to do. But for girls, even football is out of reach. CARE is trying to ensure girls can get involved in recreational activities in our women and girls’ safe spaces, providing things like sewing machines so they can make clothing. But we need more support to increase the range of activities on offer. Elsewhere in Bangladesh we are making sure girls also get to play football and play outside like the boys. With the very conservative Rohingya community, we have to challenge social norms step by step.
Accountability to the people
We make sure that every person knows that humanitarian aid is free of charge to the people in need. These posters in three languages, and pictures, inform people that they do not have to provide sex, money or other favours in exchange for land, goods, food or services.
CARE believes strongly in social justice. Every person should have a meaningful say over the decisions which will affect their lives. This is true no matter how poor someone is or what gender they are. And it is particularly important for people who have just had all of their rights trampled, have had their homes burned down, relatives murdered, their citizenship denied and been forced to leave their own country by their own government.
So CARE and other agencies work hard to engage the Rohingya people in the work of the camp. This includes regularly discussing their needs and priorities with them, and developing solutions together. We have outreach teams going door to door to ensure this includes everyone – women, men, younger and older people, those who are disabled. Not just those with the confidence or resources to put themselves forward.
We also have well-developed complaints mechanisms. I met the accountability team at one of our one-stop-shop information hubs. They showed me the tablet and pad of forms that they use to record and follow up on complaints. The target is resolution within 14 days. Some of the complaints are really letting us know that something needs fixing after a storm. Others might be that someone’s food e-card is not working, and so we inform the UN in charge of these. Sometimes it is about gender-based violence, and we will respond to that appropriately depending on the nature of the case.
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