As Rohingya refugees flee to Bangladesh, urgent action is needed to provide basic needs

Rohingya people who have recently fled Rakhine state, Myanmar, face overcrowding and lack of access to essential services, as well as mental stress.

A woman and child walk up to an MSF facility in Bangladesh.

Thousands of Rohingya have arrived in Bangladesh in recent months, and the camps where they are staying are overcrowded, with poor access to food and health care. | Bangladesh 2024 © Mohammad Sazzad Hossain/MSF

Thousands of Rohingya refugees have arrived in Bangladesh in recent months after fleeing escalating violence in Myanmar, while others have been pushed back or detained while trying to escape. 

They now face immense challenges, including overcrowding, lack of access to essential services, and deteriorating mental health conditions in camps. 

Doctors Without Borders/Médecins Sans Frontières (MSF) is urging the authorities to ensure unhindered and immediate access to humanitarian assistance, care, and protection for all Rohingya refugees. 

Who are the Rohingya?

The Rohingya are a predominantly Muslim ethnic minority who have lived for centuries in the majority Buddhist Myanmar, mostly in Rakhine state, but were effectively excluded from full citizenship under the 1982 Myanmar Citizenship Law, leaving them stateless. In August 2017, a concerted campaign of extreme violence and killings by the Myanmar military against the Rohingya people forced around 770,000 people to flee to Cox’s Bazar, Bangladesh. Hundreds of thousands have also fled to countries such as Malaysia, India, and Pakistan, where they remain stateless.

Those who have managed to reach Bangladesh have described to our teams their horrific journeys, which often include witnessing loved ones dying in front of them, having to sell their remaining possessions, and being forced to incur significant debts to cover the risky journey. Others told us how they desperately tried to cross the border to find safety—a feat that sometimes took them several days.

Zahir*

Before the violence, I lived a simple life with my family in a small village. We had a small farm and a modest income, but we were happy. However, in recent years, violence and instability have become a devastating part of our lives.

In July, the violence reached our village. I was sitting outside with a neighbor when gunfire suddenly erupted. A bullet struck him, killing him instantly, and I was hit in the back. With no medical help available [in Myanmar] and fearing for our lives, we made the heartbreaking decision to leave everything behind. In the chaos of fleeing, our 3-year-old son was lost in the crowd. Though we searched desperately, the worsening danger forced us to move on with our remaining children.

I reached out to a boatman I knew, hoping he could help us escape. He agreed but demanded a steep price—around $250 per person. We had no other choice. We waded through waist-deep water to reach the boat and set off in the middle of the night. By dawn, we arrived on the shore in Bangladesh. I was exhausted and in pain from my injury.

Just when we thought we were safe, the boatman detained my eldest son, insisting on full payment. Helpless, we spent the entire day in Teknaf, reaching out to family members and friends to gather the money. My injury was worsening, but I couldn’t think about that while my son was still being held. Finally, we were able to pay, and he was released to us.

We then made our way to the refugee camp [Teknaf], where my sister-in-law and I tried to find medical help for my wound. The first facility we visited was too costly, so we continued looking, moving from place to place. Eventually, I was referred to a larger facility, where I underwent surgery.

After 45 days, I was discharged, but I was told I’d need follow-up care. By then, we were trying to secure tokens as new arrivals and missing this would mean even more suffering.

My wound has only worsened, and I know I need to go back for more treatment, but I can’t bring myself to leave my family in this vulnerable state. I’m exhausted, uncertain, and struggling to keep us together in these conditions.

We are nine people packed into a small shelter meant for just four, sharing the space with my wife’s grandmother’s family. Food is scarce, and we survive on the few rations given by the Majhee [community leader] but it’s never enough. Some days, we only have one meal, and I have to look into my children’s hungry eyes, unable to offer them anything more. Water is limited, too. We each make do with a single jar a day.

Our future here feels bleak. We have no home, no income, and no certainty about what lies ahead. My children’s lives feel overshadowed by hardship, and now I’ve heard that the token distribution has been postponed again. Without proper documentation, we are denied access to essential services, including health care. My ongoing medical needs are unmet, and I fear for my health and the wellbeing of my family.

Each delay only adds to our fear, knowing we may soon have no support at all. We’ve borrowed from every relative willing to help, but even their patience is wearing thin. Soon, we may truly have nowhere to turn.”

* Name changed to protect privacy

A view of Coxs Bazar camp in Bangladesh.

Risk of malnutrition in refugee camps

Access to food is a challenge in the refugee camps of Cox’s Bazar. People who were already living in the camps say that they are sharing their food rations and space with newly arrived family members, who don’t have access to services like shelter, water, and sanitation. They also lack protection from abuse, exploitation, and neglect, which particularly impacts girls, boys, and women. 

Since July, MSF has seen an increase in the number of children under 5 with moderate and severe malnutrition. Access to food and health care is almost nonexistent in Myanmar, so new arrivals are particularly vulnerable to malnutrition. The persistent under-resourcing of the humanitarian response has also severely hampered the availability of essential services, making it difficult for newly arriving Rohingya refugees to access humanitarian services. Our teams are treating newly displaced Rohingya refugees in the camps, including critically ill and war-wounded patients with mortar shell injuries and gunshot wounds. 

“People have shared with us that they are afraid to seek assistance as this might put them at risk of being exploited or even returned to Myanmar,” says Orla Murphy, MSF country representative in Bangladesh. “Our mental health teams, in particular, see how people are grappling with the violence they witnessed back home and how the lack of access to available humanitarian services has created uncertainty that is further exacerbating their trauma. We are seeing newly arrived Rohingya patients showing symptoms of stress, anxiety, and depression.”

Solim*

I was born in Myanmar and grew up with my parents and a large family—six brothers and three sisters. Now, as I speak, one brother is here in Bangladesh, another is in Yangon, and I have no idea where the others are. One of my brothers and two of my sisters are missing. Communication between villages in Myanmar became impossible and, even now, I have no way of knowing if they are safe.

Before I left Myanmar, I was repeatedly pressured to join either the Myanmar military or the Arakan Army [armed opposition group]. Both sides expected young Rohingya men to fight, as they lacked people for their ranks, but I didn’t want to be part of that violence.

One night, when our village was surrounded by the army, I escaped with my younger brother, moving through streams and across hilly areas to take shelter in a different neighborhood. There was no escaping the conflict though; there was gunfire, shelling. We went from village to village, always trying to avoid the crossfire. Eventually, my brother and I hid in the woods for two days, hoping to stay out of sight. 

We moved only at night, trying to reach the border. One night, when a boat was close by, we made a desperate attempt to cross the sea. But as soon as we reached the border, Myanmar border police found us, suspecting we were part of the Arakan Army. We tried to explain we were just students who wanted no part in the fighting. They didn’t listen and kept interrogating us. They even tried to pressure us to join the military, but we managed to escape while they were questioning others. 

After several days of escaping violence, we managed to find a boat that could take us to Bangladesh. Crossing into Bangladesh brought some relief, but my body was weak. I was injured along the way; my legs were cut and bleeding from sharp shells on the beach. I had nearly drowned when I fell into the water, I didn’t know how to swim.

I can still feel the pain from my injuries, both physical and mental. I try to tell myself that I’m safe now, but I can’t shake off the fear. The gunfire and violence in Myanmar haunt me every day. Now that I’m in Bangladesh, I spend most of my time indoors. There are so many people crowded together here—families of seven or more in small spaces, with more people coming in every day. We share what little we have, but it’s hard.

I can’t work, I have no family nearby, and there’s no way for me to contact those who are still in Myanmar. My father has a distant relative who was living in the camp. He is kind and lets us stay, and shares his food with us, even though there’s little to go around.

When I hear loud noises, it’s like I’m back in Myanmar. 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 well. I want to feel safe, but it’s hard.

A Rohingya man in Bangladesh.

MSF mental health activity manager at Kutupalong and Balukhali Clinic

Shariful Islam

As a mental health professional working with Rohingya refugees, I have witnessed firsthand the devastating impact of trauma and violence on the mental well-being of people who have recently fled Myanmar. Each month, our facilities see over 30 patients who arrive with a variety of mental health complaints, including complex trauma and post-traumatic stress disorder (PTSD). Many people with mental health disorders, who were previously stable in Myanmar, now experience worsening conditions due to a lack of treatment during their journey.

Among the most pressing mental health issues we encounter are severe depression and anxiety, compounded by the harrowing experiences these individuals have endured. When the violence escalated in Myanmar in July and August this year, we saw a significant increase in patients seeking help. Each of these patients carry not only the weight of their mental health struggles but also physical ailments resulting from prolonged exposure to violence and neglect.

People often recount their arduous journey from Myanmar to Bangladesh, a path fraught with danger and despair. Many faced obstacles at the border, including violence and pushbacks that prevented them from crossing. Their experiences are characterized by prolonged exposure to trauma, violence, loss and the deaths of loved ones. Unfortunately, these experiences are rarely reported, leaving the emotional scars of this suffering largely unacknowledged.

Despite finally reaching the safety of Bangladesh, these refugees often find their basic needs unmet. They voice concerns about registration issues, inadequate shelter, and the strain of living in overcrowded conditions with minimal resources. As they struggle to rebuild their lives, their mental health continues to deteriorate. It is challenging to maintain one’s [own mental health] in a situation where life has become so complex and uncertain. The conditions in the camps further exacerbate their mental health struggles. Patients describe the atmosphere as increasingly precarious, with daily reports of shootings and conflicts between different groups. The fear of violence is ever-present, creating a pervasive sense of anxiety and helplessness. For new arrivals, these feelings manifest as severe trauma, depressive symptoms and heightened anxiety—conditions that are now commonplace among those seeking our help.

Women and children face unique challenges in this environment. Many report feelings of hopelessness, low mood, and anxiety stemming from the ongoing trauma they have endured. The last seven years have seen little improvement in the situation in Myanmar, with extreme movement restrictions and a lack of resources. Men, feeling powerless, may project their frustrations onto vulnerable family members, further compounding the trauma experienced within households.

The horrors of forced recruitment in the camps add another layer of complexity to the distress these families face. Imagine being a parent with a 17-year-old son and facing pressure to send him away to engage in violence, knowing the chances of survival are slim. This is a reality for many families, both in Myanmar and now in Bangladesh. Each new trauma they encounter—loss of belongings, family members, and their sense of safety— only deepens their psychological wounds. The ongoing violence in the camps serves as a constant reminder of their past traumas, leading to re-traumatization and a cyclical pattern of suffering. 

In response to these pressing needs, MSF provides vital support for vulnerable groups. When patients visit our facilities, our counselors prioritize their safety, dignity and confidentiality. We create a supportive environment where they can share their experiences and express their suffering. For women, this often involves specific psychiatric consultations tailored to their unique circumstances.

Our approach includes a thorough assessment to evaluate their mental state, followed by counselling to normalize their experiences and provide mental health education. We focus on enhancing positive coping strategies and strengthening social support networks through communication with family, community members, and other organizations. For those in need of psychiatric care, our mental health doctors evaluate their conditions and prescribe psychotropic medications as necessary.

We understand that every individual’s needs are unique, and we invite patients to return for weekly follow-ups. Our social workers play a crucial role in ensuring they are supported and doing well in their homes.

Newly Arrived Rohingyas in Bangladesh

Urgent action is needed

While Bangladeshi authorities have recently committed to addressing the most urgent needs of Rohingya refugees in the camps, more must be done immediately. MSF calls for unhindered access to humanitarian assistance, care and protection for all Rohingya refugees in Bangladesh. We also urge all relevant authorities to follow international law and ensure that no one is returned to a place where they face serious harm, including persecution, torture, or other serious human rights abuses.

* Names have been changed for privacy