Myanmar Refugees in Bangladesh : A Report on Gonoshasthaya Kendra7s
Refugee Relief Programme, January-March , 1992
1.
The Myanmar Refugees in Bangladesh
Refugees from Myanmar started entering Bangladesh as early as
April , 1991. ^ A f e w families were found scattered in Cox 's Ba zaar
and Bandarban districts. Gonoshasthaya Kendra workers who were
in the Cox 's Bazaar area a f t e r the cyclone in April , 1991 f i r s t
noticed refugees in the Dhechuapalong and Teknaf area in June ,
1991. By January , 1992 the onrush of refugees had turned the
problem into a grave situation. Although , the magnitude of the
by local authorities ,
problem was immediately understood
authorities at the national level continued to ignore the problem
until very late . Moreover , local organisations were prevented
from providing humanitarian assistance and working with the
refugees f o r reasons best known to the government . Gonoshasthaya
Kendra started to work with the refugees in providing emergency
food rations and medical care in December 1992 and has continued
its work among the refugees at the insistence of the local
authorities and the Divisional Commissioner in Chittagong.
Nearly 250 , 000 refugees have so f a r entered into Bangladesh , of
which approximately 180, 000 have registered with Bangladesh
Government and^ are residing in 12 camp sites. Another_2 0 , 0 0 0 are
waiting to be registered . The 12 camp sites are located in :
A.
Ramu Upazila
1.Duapalong
2 .Dhechuapalong-1
3 .Dhechuapalong-2
4 .Haldiapalong
B.
Ukhia Upazila
5 .Marichapalong
G .Kutupalong
7 .Balukhali
8 .Ghundum
C.
Teknaf Upazila
9 .Damdamia—1
10.Damdamia -2
11.Nayapara
D .12 .Na ikhonqchari
Except f o r Naikhongchari which is located in Bandarban
district, all the camps are located in Cox 's Bazaar
district.
Among the registered refugees over 95% are Muslims from the
Rohingya community while the rest are Buddhist and Hindu
Rakhaines , all from the Arakan state of Myanmar . Most of them
are poor and survived as agricultural labourers . The Rohingyas
are almost 100% illiterate and have large families, usually with
6-8 children . Approximately, 2 5-4 0 , 000 Rohingya refugees have
taken shelter with the local populations in the neighbouring
villages of Cox 's Bazaar , Ramu , Naikhongchari , Thanchi and
111111111111
302838191Z
Alikadam Upazilas . Many have acquaintances and relatives
have settled in the area after the 1978 influx .
who
Another 3-5,000 non -Muslim refugees , mostly Rakhaine , Khumi ,
Moro , Chun and Chuk , have taken shelter in Thanchi , Sangoo and
Matamuhuri Reserve Forests and in the jungle in Baishari . This
group is the worst off as they are living under difficult jungle
conditions , not registered with the government and not easily
accessible by any form of transport . These people being nonMuslims they are frightened of locals and the Rohingya extremist
RSO ).
organisations such as the Rohingya Solidarity Organisation (
this
of
representatives
approached
b
y
Gonoshasthaya Kendra was
GK
visited
team
from
reconnaissance
group for assistance . A
these groups in Baishari and Matamuhuri jungles, where they also
in exile in the
met some Burmese revolutionaries who have been
area since the early 70 's. Most of the newcomers are Khumi and
at least 30% have come during the crackdown in Myanmar in 1988 .
2. Background
Arakan covers an area of 18,500 square miles encircled in the
North by China and India , on the west by the Bay of Bengal and
on the East by the Arakan Yoma mountain range which separates
Arakan from the rest of Myanmar . The Naaf river separates Arakan
from Teknaf on the Bangladesh side . Seventy percent of the area
has a forest cover of high quality teak . The northern part is
fertile agricultural land and is popularly known as the granary
Arakan has good mineral reserves which are yet
of Myanmar .
untapped .
Arakan has a population of 4 million of which Muslims are the
largest religious group with an approximate population of 1.2
million most of whom live in the northern part .
The Arakan Muslims have a mixed origin from Arabs , Moghuls and
Bengalis . In early 18th century Arakan was ruled by Arab Muslims
for 3 or 4 decades . At that time Arakan was known as Rohang and
until the beginning of the 19th century Cox's Bazaar was a part
of Arakan . By the middle of the 18th century Rohang was overrun
by the Buddhist king of Myanmar and the population was massacred .
This caused the first known major exodus of Rohang people into
the then desolate region of Cox ^ s Bazaar . In the process they
became stateless . Later Arakan came under British rule in 1823
and Myanmar became an independent republic in 1948 . The postindependence government had agreed to resolve the Rohang problem
which continued to plague Arakan by giving the Rohang people full
citizenship rights . Failure to do so perpetuated the problem and
led to the growth of a Rohingya separatist movement . Again in
1963 the Rohang people faced brutal repression from the Myanmar
government and a huge exodus took place into the then East
Pakistan . A large number of refugees managed to move onto West
Pakistan and the Middle East , especially Saudi Arabia . In 1978 ,
over 200 ,000 Rohingyas fled to Bangladesh . Through the efforts
of UNHCR and International Red Cross the refugee problem was
tackled and bilateral negotiations between Bangladesh and Myanmar
ultimately led to Myanmar taking back the refugees with the
promise to grant full citizenship . With every exodus large
numbers of refugees have chosen -bo stay back and settle in the
Cox 's Bazaar / Teknaf region .
It appears that the Arakan Muslims do not have religious freedom
and constitute a particularly backward community with very low
levels of literacy and education . Many families send at least
one son to madrashas (Muslim theological schools ) in Cox 's
An
Bazaar .
The madrashas provide f r e e food and lodging .
the
Cox 's
extraordinary number of madrashas are operating in
Bazaar region said to be funded by the Saudis and other Arab
states. The presence of a large number of Rohingya men in these
institutions has facilitated the growth of Rohingya Solidarity
Organisation (RSO ) in the area . RSO has a small training unit
in Cox 's Bazaar where armed guerrillas are said to be trained .
I n reality this is a facade f o r channelling arms f o r use in
internal political conflicts in Bangladesh . RSO is said to be
linked with Jamaat-i-Islami in Bangladesh . Jamaat is well known
f o r its use of obscurantist religious sentiments in politics .
Jamaat has taken this opportunity to raise funds and receive
weapons and military training.
Though the democratic movement has been crushed in Rangoon and
other states, the Karen resistance continues to grow and spread
out into other regions .
It is said that a section of Karen
guerrillas have taken shelter in the Arakan Yoma mountains and
are mobilising the local people to participate in the democratic
movement . The entry of the Myanmar military into the Arakan to
crush the democratic movement has led tor the repression and
torture of the local people and rapes and massacres have been
reported by journalists and international observers .
Enforced
labour to carry army supplies has caused terror and flight. Poor
peasants cannot a f f o r d to provide f r e e labour day a f t e r day and
any refusal to do so has led to physical violence .
This in
combination with the f a c t that many of these families have a son
studying in madrashas in Bangladesh has caused the Myanmar
authorities to believe that these people have active RSO links .
The poverty in Arakan , which has been exacerbated by the rent
collection system of the government , has been an additional
factor in the exodus .
The government provides agricultural
credit which has to be repaid in crop valued at extremely low
price levels .
Consequently , most of the crop goes to the
government leaving the people hungry .
3.
Humanitarian Assistance f o r the Refugees -
3 .1 Management of Relief
Though the United Nations High Commissioner f o r Refugees (UNHCR )
has primary responsibility f o r coordination , the Bangladesh
government maintains overall management and discipline in the
camps . A senior Joint Secretary, Mr . Shahidul Islam , who has
recent experience in post -cyclone relief management in Kutubdia
island , has been appointed as the Relief Commissioner .
The
Deputy
administration of camps is usually headed by a
Secretary
assisted by Assistant Secretaries and Magistrates on deputation
from other postings .
On an average -the government has deployed a large number of
officials and staff for camp administration . For example , in
Dhechuapalong 2 with a refugee population of 23 ,581 , there are
15 officers , 39 staff , 49 security personnel and 2 messengers .
by
the Relief
regular
meeting
coordination
is hosted
Commissioner where all participating agencies are requested to
attend .
It may be mentioned here that none of the Islamic
organisations who are working with the refugees attend these
meetings .
It seems most of them do not have any official
permission to work either . The camp-in-charge also convenes
coordination meetings on a weekly basis .
3.
2 Food and Shelter
Bangladesh Red Crescent Society (
BDRCS ) is in charge of food
distribution in all the camps under the supervision of the camp
administration . Since December , 1991 GK has distributed food
four times in the Dhechuapalong area . In February , 1992 the
government gave the total food distribution responsibility to
BDRCS . BDRCS is distributing approximately 60-70 metric tons of
relief material daily . It is providing adequate quantities of
rice , lentils , oil and salt . Occasionally , it also distributes
powder milk and protein biscuits . Most Rohingya refugees have
never seen po appears that many refugees are selling the oil ,
lentils and powder milk to local traders . Consequently , the
market price of these goods in Cox '
s Bazaar has fallen to 50% of
regular prices . This makes the local middle class consumers
happy and may act as a deterrent
to the growing antagonism
towards such a large influx of refugees .
Shelters are built under the supervision of the camp in charge
and local administration . Over 100 ,000 people were given shelter
in bamboo huts with corrugated iron sheet roofs , by the end of
March , 1992 . Another 8-10,000 shelters are covered with plastic
sheets while at least 50-60,000 refugees are living in makeshift
shelters of leaves and twigs . Until recently , the government did
not allow any non-governmental organisation to build shelters .
The Christian Commission for Development in Bangladesh (
CCDB ) is
now building 2 ,000 shelters . GK has always expressed a concern
regarding the use of C.I. Sheets for roofing , especially as this
is within the cyclone belt . At the same time it recognises that
I. Sheets facilitate rapid construction . GK hopes to build
C.
2,000 shelters during May with EEC assistance where plastic
sheets covered with thatch will be used for roofing .
The
refugees themselves will be involved in the construction of these
shelters .
3 .3 Water and Sanitation
Except for Damdamia , all camps have a number of hand pump
tubewells which have been installed by the Department of Public
Health Engineering (
DPHE ) with the assistance of UNICEF . Local
philanthropists
have also donated
of such
a good number
tubewells . However , the numbers remain grossly inadequate in the
face of such a large number of users . Many tubewells are going
out of order through such heavy use . GK has installed 32 hand
pump tubewells in different camps .
Damdamia 1 and 2 continues to suffer from tremendous shortage of
water . There is a small spring nearby but because of use by such
Though DPHE
it is no longer potable .
large population
geological data clearly indicated that there were no easily
accessible sweet water layers in the vicinity , both DPHE and GK
carried out fresh drilling with the hope of striking some water
layer . One hand pump tubewell could be commissioned in Damdamia
1. Given the rocky subsoil in the area , the local practice of
ringwells was attempted however with no satisfactory result . GK
and DPHE have tried to drill through the rock layer and install
deep hand tubewells in 4 different locations . Two sites have
been abandoned and drilling continues in two other sites .
The government has been using fire brigade lorries to transport
water from Nila , and is seriousl y considering transferring at
least half of the refugees from Damdamia to Gundum or Nayapara .
motorized
GK is drilling for installation of a shallow tubewell (
pump ) in Nila as per request of the local authorities .
GK has recently received a donation of a 100 tubewells
concerned businessman in Chittagong .
from a
DPHE has also provided over 300 water sealed latrines , but as the
wells are not deep at least 25% of these are already full and as
Many latrines have no roof cover and
result unusable .
moreover , the latrines are not segregated for women and men . As
result , women are constrained in their use of the latrines and
Number of
often they are- waiting to go after midnight .
bathrooms is much less . The bathrooms and tubewells do not have
proper drainage facilities . As a result , water is collecting in
st.
agnant pools here and there and forming ideal mosquito breeding
grounds .
GK has so far installed 40 sanitary latrines and
constructed 4 bathing enclosures .
GK has developed a modular unit of 6-10 latrines and 8 bathrooms
to be serviced by 4 tubewells placed at a safe distance from the
sewerage pit . The latrines will be placed in a row and females
and males will have separate latrines . Each latrine will be
connected to a sewerage pit with tunnel pipes placed at a 45
degree slant . As water sealed latrin 'es require almost a gallon
of water to flush , these latrines will rely on gravity flow to
the pits and will require less water , i.
e. the small pot of water
that people normally take in for cleaning themselves should be
sufficient . The pit itself will be 10-20 feet deep , depending
on soil conditions , and sealed with bamboo matting and mud . When
this pit fills up the latrine slabs and pipes will be moved to
the other side of the tubewells and connected to a second pit .
The bathrooms will be placed along with the tubewells in the
middle of the plot . An estimated area of 40 feet by 40 feet
would be adequate .
The technical committee attached to the
relief commissioner is examining the proposal .
3.
4 Health Care
Health care in the camps is being provided by 7 Government
medical teams , 3 GK medical teams and 2 Medicines sans Frontieres
teams . A team from Save the Children (
UK ) has joined health care
operations at the end of March , 1992 , and will be providing
immunization and nutrition support for malnourished children in
Damdamia 2.
GK is presently running 3 clinics in Dhechuapalong , Marichapalong
and Damdamia . As of 1st April , 1992 GK will discontinue its work
in Marichapalong . A government medical team of 4 doctors and
other health workers were working out of the same clinic and this
,was leading to occasional duplication of medicine supply . Of
course , this problem exists to a lesser extent in other camps
where more than one health organisation is operating , even if not
from the same clinic .
The government is setting up a new camp in Ghundum where GK has
been asked by UNHCR to provide the health services .
At the camp clinics , patients are seen everyday of the week from
morning till evening . All medicines are freely provided . A
total of 6 doctors , 40 paramedics , 5 interpreters and 20 Rohingya
volunteers are working in the health programme . The volunteers
were recruited from among the refugees and provided with training
in health messages . They are responsible for improvement of
hygiene in the living guarters and for nutrition education and
literacy in the two children ^ learning centres that have been
set up in Dhechuapalong .
GK has also built a field hospital
in February , 1992 at
Dhechuapalong 2, which is the only field hospital providing round
the clock emergency facilities .
The field hospital has an
outdoor service from 8 am to 5 pm and is equipped with a delivery
room having basic delivery facilities and 6 hospital beds . On
an average 300 patients are being seen per day .
The staff
consists of 4 resident paramedics and a team of 2 doctors and
another 12 paramedics who are residing in a nearby village .
During the last one month , 69 patients (
47 9 and 22 cf) were
admitted into the field hospital . Of these 14 women had come in
for delivery .
ANALYSIS
Childbirth
14
Diarrhoea
18
Dysentery
12
Fever & Pneumonia
11
Abdominal Pain
4
Burn injuries
2
Hypertension
2
Severe malnutrition
2
Head injury
1
Respiratory distress 2
Mastitis
1
Total
69
OF HOSPITAL
ADMISSIONS
11 normal and 3 breach positions ; 13
(
live births and 1 stillbirth )
2 infant deaths )
(
2 pneumonia
(
deaths )
GK has converted the reception centre at Dhechuapalong 2 into a
diarrhoea prevention centre , where health education on nutrition
of diarrhoea and dysentery
is given to
and the prevention
persons
with
diarrhoea
patients
and their escorts .
All
requiring
admission
complaints report at this centre . Only those
far
this
c
e
ntre has
are referred to the field hospital . So
which
247
are
children
treated 547 patients (
313 9 and 234 cQ , of
under 5 years of age .
GK has built a clinic in Marichapalong which is shared by the
government medical team which joined later . Another clinic has
been built in Damdamia where the entire GK medical team also
resides . Like the refugees in the camp the medical team is also
suffering from the scarcity of water .
Between 17th January and 28th March , 1992 , 25,565 patients
11,811 9 and 13,754 cf ; 7,477 under 5 years of age) have been
(
seen at the 3 clinics . The highest number of cases (
4,713 ) are
for scabies and other skin infections . This is obviously the
facilities
and clean
result of shortage
of water , bathing
clothes , and unhygienic living conditions .
ANALYSIS
Dysentery
Diarrhoea
Worms
Skin Diseases
3,724
3 ,148
3,352
4,713
Fever
3 ,702
Tuberculosis
38
Other infections 680
Asthma
259
Chicken Pox
134
Measles
144
Aches & Pains
2,563
Peptic Ulcer
1,084
Mouth Ulcer
152
Anaemia
816
Malnutrition
395
Miscellaneous
661
Total
OF OUTDOOR
Bacillary
(
PATIENTS
1,257 , Amoebic
2,467 )
Scabies 3,888 , Eczema 394 , Fungal 230,
(
Other 201 )
Pneumonia 1,084 , Viral Fever 2,294 ,
(
Malaria 140 , Respiratory Infection 124 ,
Tonsillitis 60)
Ear 316 , Eye 240 , Bladder
(
124 )
25 ,565
Although the number of malaria cases reported and treated at the
clinics is only 140, the actual prevalence is likely to be much
higher because of conditions conducive for mosquito breeding and
the fact that the region is malaria infested anyway.
The
government 's own report for Cox's Bazaar and Bandarban in 1991
shows that out of 76 ,587 blood films examined 13% were slide
positive for Cox '
s Bazaar and 35% for Bandarban . These are both
highest recorded rates in Bangladesh . The government has sent
specialised medical team with entomologists and malariologists
to this
by this
area n
i
February this year . The information
team is not as yet available .
collected
microscopes and trained paramedics in each of
GK is installing
also
to monitor
and
collect
blood
fil ms
camps
to
the
malaria
.
of
effectiveness of prevalent treatment
Immunisation
government deputed vaccinator comes at around 10 to provide
measles immunisation to children at the clinics . GK had formally
applied to the Civil Surgeon in January for provision of all
vaccines (diphtheria , pertussis , tetanus , polio , measles and BCG)
Given the
and contraceptives for delivery at the shelters .
visits
by health
shed
concentration of population and the regular
registered
,
vaccination
of
t
h
e
volunteers and health workers full
children population would be feasible within a very short time .
is not
The normal EPI practice of centre based immunisation
applicable i
n the refugee programme . Most of the refugees are
totally
illiterate
and have not had access to any health
services . Preventive health care and immunisation are new ideas
to them . Therefore , without a vigourous campaign and house to
house visits immunisation coverage is not likel y to be very high .
Unless the language differences are taken care of , double
immunisation and incorrect medication and treatment is likely to
the
centre based
occur .
t
I
may be mentioned here that
immunisation programme in Bangladesh has been seeing a decline
in coverage despite the initial
high coverage in 1989-9 0 .
Although the Civil Surgeon was interested in cooperating , as per
directive of the central health authorities onl y measles vaccines
for
were provided for dispensation at the clinics , initially
children under 1 later extended to children under 10 years of age
18th March, 1992.
and the programme could not even begin until
No contraceptives were provided . The Civil Surgeon has however
supplied GK with tetanus toxoid to be given to pregnant women
The EPI programme has from the beginning
only .
observed a
restrictive policy in not involving NGOs except for motivation
work only . A few selected NGOs have been given supplies for some
of their operational areas . t
I appears that the EPI authorities
are continuing the same attitude regarding the Myanmar refugees ,
where a potentially explosive situation exists in terms of high
concentration of population , bad sanitation and malnutrition .
I
t is not comprehensible why vaccine is such a closely guarded
item, especially as i
t is not edible nor easily sellable and thus
justifying fear of pilferage .
As a result immunisation is being primarily given only to the
sick children who are coming to the clinics , instead of to the
healthy population as a preventive measure .
Even then , many
children are missed by the vaccinator as they are usually brought
n
i
during
the first hours of the clinic .
Vaccinators are
provided with re-usable syringes and needles .
The problems related to immunisation and family planning have
been repeatedly brought to the notice of the Relief Commissioner
and the UNHCR and UNICEF representatives.
Ante -natal Care
Ante-natal care is being provided in Dhechuapalong to 410 women
in third trimester of pregnancy . Gradually , women in earlier
stages of pregnancy are being identified and will be brought
under ante-natal services .
In the 10 days after receiving
tetanus toxoid from the government , GK health workers have given
the first dose to two hundred pregnant women .
Nutrition
supplementary
450 children
are receiving
in Dhechuapalong
feeding . They are given nutrition biscuits and/or fruit and
semolina in the morning . At lunch they are usually either given
rice-lentil -vegetable mix or chapattis with vegetable
or
semolina . Twice a week fish or meat is given .
In two centres , with the help of Rohingya volunteers , basic
literacy
education
Burmese
language
is being
given .
in
Vegetables and fruits are used to both teach alphabets and give
nutrition messages .
Although , GK is strict in not using or encouraging the use of
powder milk in any form , other agencies such as MSF are using
powder milk in their intensive feeding programme . Some medical
teams have been found to be prescribing powder milk as part of
treatment .
This has been brought
to the notice
of the
authorities at the coordination meeting .
Physical Violations
During
the
government
January
and February , 1992
before
registration
facilities had been set up , GK had set up a
registration and reception centre in Dhechuapalong , where nearly
4,000 families were registered . Of these a census survey was
carried out among 2300 families covering basic demographic
information as well as information on the reasons , costs , route
and mode of migratio n. All families were checked for Myanmar
identification documents .
Special attention was given to find out about possible torture ,
rape and other physical assaults . Initially 90 rape cases were
reported .
However , after more in depth investigation
and
interviewing by a team of senior women staff , including a senior
gynaecologist
only 14 cases were established .
The team was
assisted by a local woman interpreter conversant in Bangia and
both Chittagonian
and Rohingya dialects . The team '
s findings
indicate that rape was committed by both j^yanmar military persons
as well as local hooligans linked with the military . In one case
awoman had been raped in the presence of her husband .
In the remaining cases where rape complaints were reported , it
appears that various degrees of physical harassment and assault
have also been commonly referred to as rape as these represent
similar violations of honour .
Eighty
four cases of torture
On
wounds
were reported .
examination 6 were found to be severe , including head injuries
and broken bones .
Family Health Cards
n
i
t
i
a
l
After the i
phase in which treatment based prescriptions
to
provided the only
client
record, GK is now preparing
distribute
specially designed health cards for each family .
These cards will be given to all families irrespective of whether
they have attended the clinics .
contain
These cards will
information on their
health and immunisation
status , family
planning practice , case history and treatment .
To prevent pilferage and sale of medicines , specially marked
packaging is being arranged . Labels will also carry pictorial
instructions for use.
Medium Term Outlook
4.
Since the visit of the UN Assistant Secretary General , the daily
influx has come down from an earlier average of 3 ,0 0 0 peaking to
5 ,000 at one point to less than 1,000 now.
However , i
t is
unlikely
that the refugee problem will have a satisfactory
solution within 1992 , especially as 3 important countries have
not expressed any stand on the problem .
Japan has timber
interests n
i
Myanmar which i
t is not prepared to jeopardize ;
China though friendly towards both Bangladesh and Myanmar is
selling weapons to Myanmar ; and , the USA besides having interests
i
n mineral deposits is concerned about elections at home .
With the onset of the nor ^ wester season i
n Baisakh (mid-April )
and the coming monsoon , the health situation
is likel y to
aggravate n
i
a number of ways .
Diarrhoeal and respiratory
problems will exacerbate resulting in a high number of deaths ,
especially
among
children
and
elderly
people .
Unless
immunisation is taken seriously , polio and tetanus outbreaks are
not unlikely .
A malnourished population with heavy smoking
habits in congested living conditions is likely to result in the
spread of tuberculosis and increase in low birth weight babies
leading to high neo-natal deaths .
Although Bangladesh is fortunate in not having an AIDS problem ,
Myanmar is known to have an AIDs problem . The use of r e-usable
needles in the vaccination programme should concern us .
The demands of emergency work involved n
i
feeding and attending
to the immediate needs of shelter and .treatment o f physical
ailments
has consumed all
our
attention
thus
far .
The
psychological needs and sufferings of the refugees have not been
addressed in a satisfactory manner . As the emergency work enters
its next phase , i
t is important to include activities that can
provide psychological relief . The establishment
of more well
equipped field hospitals , more learning centres for children ,
ante -natal groups for pregnant women , formation of cultural
teams , and to whatever extent possible production programmes for
the adult population have to be planned . Existing craft skills
can be harnessed into production programmes , adult labour can be
used for afforestation and maintenance of shelters and sanitation
facilities in exchange of food rations , and wherever literate
persons are identified they can be recruited to work in the
learning centres for children .
An organised initiative
can
»
achieve
the planting
of 20 million
new trees
in the hills
adjacent
to the camps .
This
can
become
a long
lasting
contribution by refugees to a host country , and a contribution
to the global environmental cause .