More than 1 million Rohingya refugees live within just 10 square miles in Cox’s Bazar, Bangladesh, where they face violence and hardship that has had significant consequences on their mental and physical health.
Doctors Without Borders/Médecins Sans Frontières(MSF) teams working in the camps of Cox’s Bazar are treating people affected by not only traumatic memories of violence in Myanmar but fighting between armed groups within the camps and a constant sense of insecurity. The lack of freedom of movement or access to jobs and education compounds the hardships of life as a Rohingya refugee in Cox’s Bazar.
Who are the Rohingya?
The Rohingya are a predominantly Muslim ethnic minority who have lived for centuries in Myanmar, yet were effectively excluded from full citizenship under the 1982 Myanmar Citizenship Law that left them stateless. In August 2017, a concerted campaign of extreme violence and killings by the Myanmar military against the Rohingya people occurred in Rakhine state, forcing around 770,000 people to flee to Cox’s Bazar, Bangladesh. Seven years later, more than 1 million Rohingya people now live in the camps of Cox’s Bazar, in dire conditions.
The roots of violence
Since mid-2022 there has been a significant increase in violence in the refugee camps in Cox’s Bazar. But even before that, there was a strong feeling of insecurity among Rohingya refugees, especially at night as many areas in the camps are unsafe and poorly lit.
“When I hear loud noises, it’s like I’m back in Myanmar,” says Solim*. “The sounds bring back all the fear—the fear that someone will come, that I’ll be taken, or worse. My heart races every time. I can’t sleep. I want to feel safe, but it’s hard.”
Outbreaks of violence in the camps brings back memories from Myanmar. Before escaping to safety in Bangladesh, many refugees directly experienced or witnessed significant violence and lost immediate family members. Once they arrive in the camps, they live in cramped, overcrowded makeshift shelters, without enough food or clean water. Traumatic memories combined with unemployment, anxiety about the future, poor living conditions, and little or no access to basic services such as formal education leave the Rohingya people vulnerable to long-term psychological harm.
Echoes from Myanmar
In August, 116 patients with violence-related injuries (from landmines, mortars, and gunshots) linked to the conflict in neighboring Rakhine state, Myanmar, were treated at MSF’s Kutupalong Hospital. These patients came mainly from the Maungdaw area, and most were women, children, and the elderly.
“The constant threat of violence from armed groups has exacerbated the situation,” explains a mental health counselor at Kutupalong Hospital. “The fear of sudden attacks, arson, or their children being forcibly recruited for war in Myanmar has created a heightened sense of anxiety and trauma. Their levels of fear and anxiety are escalating.”
Many MSF patients complain of nightmares and flashbacks. Aggressiveness, suicidal tendencies, delusions, and addiction are common and symptoms of trauma and unresolved grief.
Insecurity makes people delay care
There are regular reports of beatings, abductions, and extortion in the camps, which have become a fertile ground for predatory behavior by criminal and armed groups. People tell of staying awake all night to guard their families, and of not feeling safe even in their own homes, flimsybamboo structures unable to keep intruders out or stop a stray bullet.
This sense of insecurity has very real consequences on access to health care. Recently a woman died of sepsis because her husband, not realizing how sick she actually was, decided it was not safe to travel to the clinic in the dark and waited until morning.
“Many patients are afraid to leave their shelters to seek medical care due to the threat of violence against their families,” says a mental health counsellor in Jamtoli clinic. “They fear that if they are seen going to a medical facility, their homes could be targeted, or their family members could be harmed. This fear is rooted in past incidents of violence, including the intentional burning of shelters …. The constant threat of violence has made many refugees hesitant to seek out the medical care they need.”
Forced recruitment to armed groups
It is estimated that more than 1,000 young men and teenagers were forcibly recruited from the Cox’s Bazar refugee camps at the beginning of this year to fight in Myanmar. Abductions and blackmail are used to extort money from families for their safe return, or to avoid forced recruitment or a forced marriage. Those who have time to negotiate can arrange payment for their release.
“When we arrived [at the shelter], I saw other block children, some as young as 12 or 13, tied up with ropes,” said a 16-year-old victim. “At that moment, I wasn’t thinking about myself. My thoughts were with my parents. They had already lost one of their eldest sons, and if they lost me too, they would have no hope left to live for…I watched as the group brutally beat some of the other captives who argued with them, refusing to go and fight.”
In some camps there are turf wars over who controls which areas, and residents are caught in the crossfire. When a person is thought to be an affiliate of one side or the other, houses may be vandalized, or family members attacked. Armed groups will go to the homes of influential members of a rival group and if they don’t find who they are looking for, they will attack whoever is there. Women and girls who have been subjected to sexual violence do not always seek medical care or support due to fear of facing stigma.
In September 2024, 40 people in camps 14 and 15—including children—who had been assaulted, stabbed, or shot sought treatment at MSF’s clinic in Jamtoli. The level of insecurity was such that MSF had to temporarily reduce activities and focus only onlife-threatening cases. Today, there are still a few patients presenting with gunshot wounds each week.
About Cox’s Bazar
The Cox’s Bazar district along Bangladesh's southeastern coast has hosted Rohingya refugees fleeing targeted violence in neighboring Rakhine state, Myanmar, since 1978. The campaign of violence in August 2017 provoked an unprecedented exodus and MSF increased its operational presence in Bangladesh to address the needs. The conflict in Myanmar resumed in November 2023 and has led to horrific violence and widespread displacement again.
*Name has been changed to protect privacy
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