OVERVIEW OF THE CRISIS
Violence in Rakhine State, Myanmar, which began on 25 August 2017 has driven an estimated 509,000 Rohingya across the border into Cox’s Bazar, Bangladesh. That day, insurgents attacked army and police posts in Rakhine, resulting in widespread violence, mass displacement of civilians and the suspension of most aid activities. In the following days, people began to flee across the border into Bangladesh.
By 30 September, more than 509,000 people were estimated to have crossed into Bangladesh, joining some 300,000 that had fled in earlier waves of displacement. Those fleeing are concentrated in two upazilas; Ukhia and Teknaf, putting an immense strain on infrastructure, services and the host population. Pre-existing settlements and camps have expanded with the new influx, while new spontaneous settlements have also formed and are quickly growing. Significant numbers of new arrivals are also being absorbed into the local host community. As of 30 September, there were two formal refugee camps, four makeshift settlements and five new spontaneous sites, some of which are merging together as settlement expands. Along the border regions of Bandarban and Cox’s Bazar, an estimated 18,700 people have settled in groups in or near no man’s land, presenting additional challenges with legal and security dimensions.
The Rohingya refugee population in Cox’s Bazar tripled over two weeks and continues to grow. The speed and scale of the influx has resulted in a critical humanitarian emergency: without rapid, comprehensive response, there will be massive loss of life. The people who have arrived in Bangladesh since 25 August came with very few possessions. They have used the majority of their savings on transportation and constructing a shelter, often out of no more than bamboo and thin plastic. They are now reliant on humanitarian assistance for food, and other life-saving needs. Basic services that were available prior to the influx are under severe strain due to the massive increase in population. In some of the sites that have spontaneously emerged, there is no access to water and sanitation facilities. Combined with increasing population density, there is high risk of an outbreak of disease. The Rohingya population in Cox’s Bazar is highly vulnerable, having fled conflict and experienced severe trauma, and now living in extremely difficult conditions.
Population movements within Cox’s Bazar remain highly fluid, with increasing concentration in Ukhia, where undeveloped forest land for a new camp has been announced by the Government of Bangladesh. On 14 September, Government allocated 2,000 acres for a new camp in Ukhia Upazila. The trend since mid-September has seen people moving from transit points, smaller new sites and makeshift settlements towards the area where a new camp is proposed. Following Government messaging and with transport provided by local authorities and communities, people have begun arriving at the new, proposed site before infrastructure and services can be established. The Government plans to relocate people from other settlements in Cox’s Bazar, and in Bandarban, to the new site, and further relocations and increased density are likely to exacerbate the risks.
Massive and immediate scale-up is required to save lives and manage conflict, with urgent needs in food security, WASH, shelter, site management, health and nutrition in both settlements and host communities. Humanitarian agencies are still not operating to scale or with full coverage. The pre-existing Rohingya population already had urgent needs across sectors. Conflict sensitive, comprehensive response is required that takes into account all Rohingya refugees in Cox’s Bazar, and their hosting communities, to save lives and mitigate intra- and inter-group conflict (within Rohingya communities based on status, and between Rohingya and host communities).
Adequate land and infrastructure for multiple, properly managed camps is essential to prevent massive loss of life due to disease outbreak and insecurity, and to enable all other service delivery.
High numbers of people in one place without the supporting infrastructure will certainly result in outbreak and conflict with massive loss of life. Overcrowding that was a concern before the influx, is now a critical issue in all sites. Limited infrastructure is resulting in high and unmanageable density around service points.
Large scale infrastructure installation, including access roads, drainage, terracing and retention for shelter on hilly land is critical as an enabler for safe delivery of all other services. Strong site management teams need to be in place in all locations to manage partner delivery and ensure sufficient and consistent engagement with, and understanding of communities. Without site management at scale, a comprehensive response will not be possible.
Without immediate, adequate water, sanitation and hygiene, there will be disease outbreaks. Within the new settlements that have emerged since August, there are no pre-existing WASH facilities including latrines, water points or bathing places, and some people had reported taking water from the paddy fields for drinking. In the established makeshift settlements the limited existing WASH facilities are under immense pressure with on average 100 people using one latrine in one site. New arrivals also have limited access to bathing facilities, especially for women, and urgently require WASH supplies including soap and buckets. Prior to the August influx, assessments showed that 76 per cent had no access to safe water; however, the percentage was much higher in host communities, where 92 per cent of people had no access to safe water due to the lack of interventions in host communities. Cholera and acute watery diarrhea are endemic in Bangladesh: at the current density of population, any outbreak has the potential to kill thousands.
Adequate shelter for all Rohingya refugees is critical: current high density and poor conditions present a major risk, in an area subject to annual cyclone and monsoon. In the makeshift settlements established prior to August, 99 per cent of shelters were constructed using bamboo and plastic sheeting, highly vulnerable to the impact of natural disasters including flooding and cyclones.. The vast majority of new arrivals in the new, spontaneous sites have no shelter and are staying in the open air, often with only an umbrella for protection. The situation is similar in makeshift settlements where between 50 and 90 per cent of people have no shelter. New arrivals who can afford it are building bamboo structures and covering them with locally bought plastic, however the quality of the plastic is extremely poor, and many people simply do not have the resources to purchase the necessary shelter materials from the local market. Many are going into debt to secure access to land or shelter, leaving them vulnerable to exploitation. New arrivals also lack basic NFI items such as cooking utensils, clothing and blankets.
All Rohingya refugees need comprehensive food security: new arrivals require immediate assistance to save lives, and safety nets must be available to all. Rakhine state has one of the highest malnutrition rates in Myanmar, with 14 per cent GAM. People arriving in Bangladesh are already highly vulnerable and in need of emergency food and nutrition support. Almost all arrivals lack the means to make an income, and the majority of people do not have sufficient household items with them or the means to buy basic items, including food, cooking fuel and cooking utensils. Up to 90 per cent of new arrivals have reported eating just one meal a day, and do not have a sufficiently diverse food intake. Alarming food insecurity and malnutrition rates were extreme even before the influx: in Balukhali, global acute malnutrition, stunting and underweight rates all exceeded WHO thresholds for nutritional emergency. 32 per cent of households reported borderline food consumption and less than half of households were eating a sufficiently diverse diet. The host community of Cox’s Bazar also experiences severe challenges accessing sufficient food with 57 per cent of the population food insecure. Alarming food insecurity and malnutrition rates were extreme even before the influx: in Balukhali, global acute malnutrition, stunting and underweight rates all exceeded WHO thresholds for nutritional emergency.
Primary and secondary healthcare needs to be ramped up to manage high levels of trauma, communicable disease and reproductive health needs, as well as disease surveillance and outbreak response. Rohingya refugees crossing to Cox’s Bazar are arriving with many health needs including: treatment for physical injuries including gunshot wounds and burns, prevention and treatment of communicable diseases, antenatal care, emergency obstetric care services, reproductive health and reproductive health, and GBV case management including clinical management of rape. While primary health clinics are available in the makeshift settlements and refugee camps, these are under severe pressure with a caseload that has tripled in a month and need to be augmented. In new spontaneous settlements, there are no pre-existing health facilities requiring urgent deployment of emergency primary health care and referral systems to be established. Suspected measles cases have already been reported and high numbers of diarrhoea, and acute respiratory tract infections have been reported, especially amongst women. The high likelihood of disease outbreak requires not only a strong early warning and surveillance system, but dedicated contingency planning and preparedness for when outbreak does occur. The new influx is also creating immense pressure on the entire district health system which impacts public health for both refugees and host communities.
The population is extremely vulnerable, requiring properly targeted interventions that address their safety and dignity, and ensure respect for individuals throughout their displacement. Among the Rohingya, 19 per cent are estimated to be female-headed households, with many having lost husbands to violence in Myanmar or migration in search of livelihoods opportunity. Elderly headed households account for 11 per cent of the population, and childheaded 5 per cent. Absence of identity documentation and legal status impedes access to justice, legal work opportunities, accredited education and other public services. Gender based violence is prevalent in displacement, with women and girls targeted for a range of abuses linked to destitution and economic dependency. High numbers are also survivors of rape in Myanmar. Growing numbers of separated and unaccompanied children are being reported, and support-services for gender-based violence has been identified as a critical need. In addition, the vast majority of newly arrived children have not been able to access education since they arrived in Cox’s Bazar.
Damaged and congested access roads into existing settlements as well as the new spontaneous sites are significantly impeding the humanitarian community’s ability to conduct humanitarian response operations. Severe weather conditions over the last few weeks have resulted in flooding in Cox Bazar with fallen trees on the roads, and limiting the availability of suitable locations to set up logistics hubs. It is expected that with the scaling up of humanitarian operations, there will be a huge logistical pressure at all entry points to the affected areas. Appropriate storage facilities to accommodate large quantities of items – in terms of tonnage and volume - will be urgently needed. There will be high demand for the establishment of storage facilities in suitable strategic locations, as well as Mobile Storage Units (MSUs) for temporary storage and offloading capacity at the Dhaka and Chittagong International Airports to manage the influx of relief items would be required. Stock management support will be a priority for humanitarian agencies.
Adequate and timely funding is required to ensure humanitarian needs are met. The combined support of donors to the Rohingya situation has been generous, with donors remaining engaged and supportive since the influx. Humanitarian needs nevertheless continue to outpace funding, and multiple large-scale humanitarian situations globally continue to compete for limited humanitarian finance. The urgency of the current situation, the risk of massive loss of life, and the likelihood of a protracted and multi-dimensional crisis, demands immediate and adequate funding. Robust resource mobilization efforts will be stepped up to ensure people in need can be assisted.