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Black plumes of smoke wind upwards in the sky over Myanmar. Lines of people stretch as far as the eye can see; some carry household items like pots or plastic bags, most have nothing.
These people are bound for a refugee camp in Cox’s Bazar, Bangladesh. A million people live there now. It’s muddy, hilly and densely populated.
I ask you now to take a moment to see this crisis from a medical perspective. To see vulnerable human beings that are cornered, in fear and in need of help.
We are Doctors Without Borders; a medical organisation, not a human rights group. This distinction may seem obvious, but I reiterate it often, to highlight the fact that our primary concern is our patients and their treatment. This is not to say that we don’t speak out about human rights abuses when we witness them. In fact, bearing witness, or temoignage is one of the key principles of our work. We report the situations we have witnessed – we do this because our single and unwavering priority is the preservation of human life.
We believe that reporting on certain situations, even if it means going against the tide of media, or being a thorn in the side of government is essential if it means more people will have access to medical care. Right now, we must report on the dire conditions of the Rohingya refugees, surviving in a refugee camp in Bangladesh. I use the word surviving, because it’s difficult to describe inhabiting a few feet of space in the mud under a plastic sheet, without clean water or sanitation as ‘living’.
Perhaps one of the worst aspects of the current situation is that there’s nothing new about it. Since the late 70s, periods of targeted violence have been followed by mass outpourings of human beings from Myanmar, though this is the largest. Aside from the violence, repatriation is hardly an attractive option: the Rohingya are denied citizenship in Myanmar and are thus denied basic rights and services.
The political situation is the cause, but it not the disease we are trying to treat. This is a population that has gone with little to no access to quality healthcare; few have received the kind of vaccinations that we would consider routine, vaccinations we may even take for granted when it comes to our own children.
To illustrate the effect a lack of vaccinations has had, we might consider a remarkable fact: the emergence of diphtheria among Rohingya refugees in Bangladesh (as of February, Doctors Without Borders teams had treated approximately 5,000 people for this in Cox’s Bazar). The fact that this disease exists at all is outrageous. Diseases like diphtheria are almost nonexistent in affluent nations. To give a little contrast, there have been just four cases of Diphtheria in the United Kingdom in the past 20 years. Before 1942 (and the introduction of vaccinations) there were an average of 55,000 cases annually, leading to approximately 3,500 deaths (mostly children). This gives an idea of the number of lives that might be saved, if proper medical care is provided for the Rohingya in a sustained manner.
The population density and sheer number of people now residing in this refugee camp is another cause for serious concern, especially given the lack of basic services. Access to clean water and sanitation has been a priority for our teams since August – it has improved, but it still requires attention. Respiratory infections, diarrhoeal diseases and skin diseases remain prevalent among the population – all issues related to poor living conditions.
Disease and infection are not the only concerns for the Rohingya – many of whom require treatment for extreme psychological trauma. A lot of these people have witnessed the violent death of a family member. A lot of people here bear the physical scars and unhealed wounds of violence they have endured – they have been shot, stabbed, raped, beaten and even attacked with swords.
All of these issues are related to the specific situation of these refugees, and they will need ongoing medical care. However, there remain the many other medical issues that everyday life entails, and which cannot be put on hold by any crisis. The pregnant women of the camp will need ongoing treatment and care, the children and the elderly of the camp will need continued access to medical professionals.
Of course a political solution will be necessary if we are to see any lasting change for the Rohingya population. But my concern is the immediate problems that can be addressed while the Rohingya remain in a refugee camp, particularly given the probability that this will be a term of years, rather than months. While I have spoken at length about the medical concerns that demand our attention, I have not spoken about something which may be of equal importance to a medical practitioner – the right to dignity.
The Rohingya were described by the United Nations in 2013 as one of the most persecuted minorities in the world, while this is a powerful statement, I think we need to do better than to offer damning observational statements. Getting caught up in the awfulness endured by an entire population has shown few tangible benefits to the population themselves.
I am not suggesting we ignore the political issues that are the underlying cause of this crisis, but I am asking that we direct our immediate focus to the human beings who have already suffered greatly, and to make a concerted effort to provide necessary, and accomplishable benefits for the people in question.
The Rohingya need urgent medical care, they have a right to dignified living conditions, they need for us to care about them as individuals with individual needs and not some monolithic burden. With the will and consistency to accomplish them, all of these things lie within our power.
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