People just keep coming: Rohingyas escaping ethnic cleansing are dying of disease

The Rohingya are a Muslim ethno-religious minority who are concentrated in the western province of Rakhine State in Myanmar. They have long been the target of persecution and violence by the predominantly Theravada Buddhist majority in collusion with the military leaders of Myanmar.

The International Rescue Committee has called the current situation ethnic cleansing. Although there have been attacks and displacement of the Rohingya in the recent past - most notably 2012 and 2016 - this concerted effort has been the most brutal and persistent. Villages have been burnt to the ground and refugees have been shot as they tried to escape to Bangladesh.

When they finally arrive at the reception area, they are given three bamboo poles, some twine and a tarp to use as shelter

The speed and scale of the influx into Bangladesh - about 10,000 refugees per day since 25 August - has resulted in a critical humanitarian crisis. These people have just escaped burning villages and personal violence so when they arrive in Cox's Bazar they have virtually nothing.

When they finally arrive at the reception area, they are given three bamboo poles, some twine and a tarp to use as shelter. They then begin the task that all refugees everywhere go through - waiting in line. There are queues to register; queues to get a meal; queues to get dry food; queues to get a pot and pan to cook the food;  queues to get fire wood to cook the food, and on and on.

	Rohingya patients wait to receive treatment at the Sadar Hospital which is currently is the most crowded hospital looking after patients suffering from road accidents, beatings, gunshot wounds [AFP]

In addition to the need for adequate food and shelter, there is an almost insurmountable need for toilets and drinking water. The risk of outbreak of communicable diseases including cholera is real and growing. 

Primary health care services are scarce to non-existent.

Those services which are implemented at the settlement level lack standardisation and the quality of care when it is available is questionable at best. Secondary and tertiary care are for the most part are unavailable. The refugees are not permitted to go to town for care. There are two field hospitals established to which all surgeries and complicated cases needing hospital care are referred.

During the time I was in the camps, a new field hospital was opened by the Bangladesh Red Crescent, which will make surgeons available around the clock. This facility will also offer caesarean sections to refugees. This made a second inpatient facility to complement the already existing Doctors Without Borders facility. This hospital is planning on opening a paediatric unit of 20 plus beds in the near future. 

Although these are both fine field hospitals, they are located about 2km away from each other on the crowded main road. Many refugees however, find themselves too far from these hospitals, particularly in emergency situations. 

How ironic that this child escaped ethnic cleansing only to be struck down by a vaccine preventable illness

Our outpatient clinic is currently on the main road in the heart of the influx. We saw over 200 patients per day. Several were quite sick and needed to be transported to one of the hospitals noted above.

That emergency transport was via a small three-wheeled motorised rickshaw. Please imagine holding your loved one in your lap along a rutted road in a golf cart for 5-8km.

While I was there, I examined a three-year-old child, Sufayma, who had been in the camp with her mother for about four weeks. Her father had been killed by the military in their village. Sufayma, her mother and younger sister hid for two days in the woods outside her village. They crossed the Naf River in the middle of he night to avoid detection by the Myanmar military. 

Three weeks ago, she developed what sounds like a case of Measles. Ever since that illness she hasn't eaten, walked well or communicated normally. Other than apathy and unwillingness to communicate, her physical examination was normal.

	The International Rescue Committee has called the current situation ethnic cleansing. Cox's Bazar, Bangladesh. [AFP]

Although the necessary diagnostic tests are unavailable, this is most likely a case of "post measles encephalopathy". The prognosis for recovery is poor. I haven't seen a case in my practice in 40 years. How ironic that this child escaped ethnic cleansing only to be struck down by a vaccine preventable illness. 

This is still relatively early in the natural history of this crisis. There were projected to have been around 1 million Rohingya in Rakhine state. It appears that the government of Myanmar is intent on removing them all from their home. With an estimated 700,000 already in Bangladesh, there are many more to come. 

The refugees are not permitted to go to town for care

Although the Bangladesh government with the help of the UNHCR, the WHO and international NGOs are doing their best, the humanitarian crisis deepens by the day.

There is already talk of forced repatriation back to Myanmar.

Members of the Rohingya ethnic group who have already fled to Bangladesh are refugees, and should be recognised as such. They are entitled to all the rights that come with refugee status. Until safety and security are assured, refugee return must be voluntary, based on a free, informed, individual choice.

Dr. Kahler is a paediatrician who is the president and co-founder of MedGlobal an international medical NGO. He was awarded Chicago Magazine Chicagoan of the Year 2016 with two of his colleagues for their work in Aleppo, Syria.

Follow him on Twitter: @drjohnkahler

Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.