Introduction 

Stateless Rohingya in Bangladesh are currently victim to unprecedented levels of violence and attempts at forced repatriation. Recent weeks have seen people arrive in their thousands at Kutupalong makeshift camp, as they flee what appears to be a violent crackdown on Rohingya presence in the country. At its clinic in Kutupalong, Cox's Bazaar, Médecins Sans Frontières (MSF) has treated victims of beatings and harassment by the authorities and members of the community; people who have been driven from their shelters throughout the district and in some cases forced back into the river which forms the border to neighbouring Myanmar. Since October, the camp has grown by 6,000 people, with 2,000 of these arriving in January alone. Without official recognition, they are prevented from supporting themselves, and are not permitted to receive official relief. As the numbers swell, nearly 29,000 people find themselves camped on a patch of ground with no infrastructure to support them, posing a serious threat to health. Action is needed now to stop this humanitarian crisis. MSF has delivered healthcare to the Rohingya and their host communities in Bangladesh since 1992.

The Rohingya in Bangladesh

For decades, thousands of Rohingya, an ethnic and religious minority from Myanmar, have sought refuge in Bangladesh. Today, despite the well-known situation in their country of origin, just 28,000 of these are recognised as prima facie refugees by the Government of Bangladesh, and live in official camps under the supervision of UNHCR. In sharp contrast, an estimated 220,000 others struggle to survive unrecognised and largely unassisted. Despite fleeing the very same circumstances as their counterparts in the official refugee camps, these people are forced to live as illegal migrants, vulnerable to ill health, exploitation, and abuse. The agreement between the Government and UNHCR restricts the latter's activities to the 28,000 registered refugees. And UNHCR, mandated to protect refugees worldwide, makes little visible protest at the injustice of this situation. The majority of Rohingya in Bangladesh reside in Cox's Bazaar, an overcrowded and resource-poor area bordering Myanmar. While thousands of self-settled Rohingya have lived in the local community for years, they are largely perceived as a burden on already scant resources and a threat to the local job market through the provision of cheap labour. Their unpopularity, fuelled by the local media, makes them an easy punch ball for unscrupulous local politicians wishing to score political points.

The Kutupalong 'makeshift' camp

In 2009, MSF was alerted to a large number of unregistered refugees gathering in desperate circumstances on the periphery of the UNHCR supported refugee camp at Kutupalong. When MSF made its first exploratory assessment in early March, it found over 20,000 people, 90% of whom were severely food insecure. Malnutrition and mortality rates were past emergency thresholds, and people had little access to safe drinking water, sanitation or medical care. In response, MSF immediately initiated an emergency humanitarian action, treating severely malnourished children, offering basic healthcare and improving water sources and waste facilities. Within one month, MSF had enrolled over 1,000 malnourished children in its therapeutic feeding programme, and treated around 4,000 under five-year-old children in its out-patients department. Since then, the project has developed into a fuller basic healthcare programme, including outpatient and inpatient care and community outreach services, in accordance with the prevalent medical needs of people in the newly established makeshift camp and surrounding area.

Violent crackdown on unregistered Rohingya

In June and July 2009, local authorities demolished shelters and forcibly removed their inhabitants in an attempt to clear a space around the perimeter of the official UNHCR camp at Kutupalong. MSF witnessed firsthand violence against the unregistered Rohingya and provided medical care for some of the consequences. At the time MSF treated 27 people who presented at the clinic with violence-related injuries, the youngest being a five-day old child who had been thrown to the ground. Then, last October, MSF again began to receive unregistered Rohingya patients suffering from violence-related injuries in the Kutupalong clinic. This time patients told stories of being driven from their homes in Bandarban district, many of which were physically destroyed by the authorities. Some of them spoke of having been forced into the river Naf and told to swim back to Myanmar. In January of this year, patients started to arrive from Cox's Bazar district with similar stories. To add to the brutality of the authorities, the Rohingya also suffer at the hands of the local population, whose anti-Rohingya sentiment is fuelled by local leaders and the media. Throughout this period, MSF has treated patients for beatings, for machete wounds, and for rape. This is continuing today. "I thought I ran away to find shelter, but before even staying one week thieves came and robbed me of the money I had, cut us with machetes and wanted us to die. Where do I run to now?" asked a patient being treated for open wounds at the MSF clinic.

Humanitarian crisis at the makeshift camp

Today, scared and with nowhere else to go, Rohingya are arriving in their thousands at Kutupalong makeshift camp. Of those arriving at the camp, some are women travelling alone with children, whose husbands went out to work and did not return.  With no way of feeding their family they risked arrest to travel to Kutupalong seeking protection in numbers.  "I used to think I had a home but after two months of constant threats from people I have lived with for 15 years since leaving Myanmar I had to move. I felt sad and came to the makeshift camp. I lost my belongings but my life and family comes first," explained one patient who had recently arrived at the makeshift camp. Since October the camp has grown by over 25 percent (almost 6,000 people), 2,000 arriving in January alone. With a total population of over 28,400, the unregistered Rohingya at Kutupalong makeshift camp now outnumber the total registered refugee population supported by UNHCR in Bangladesh. Without official recognition these people are forced to live in overcrowded squalor, unprotected and largely unassisted. Prevented from supporting themselves, they also do not 'qualify' for UNHCR-supported food relief. As the numbers swell and resources become increasingly scarce, the cramped and unsanitary living conditions pose a significant risk to people's health.

Forced back to Myanmar

On October 24, MSF staff treated four refugees from the makeshift camp for trauma injuries. According to the patients, they had been stopped by police at night and asked to show their papers. On finding they had none, they reported being forced into a police van, beaten and finally pushed into the Naf River, which forms the border to neighbouring Myanmar, and told to go back to their country. After hiding in the water for some time, they managed to return to the MSF clinic for help. In this case, the people had been able to make their way back to Kutupalong to seek medical care for the injuries they had incurred. However, reports of people being pushed back across the border to meet an unknown fate are many. Attempts at forced repatriation by the Bangladesh border security forces (BDR) are well documented by the local media, and are repeated in the stories of unregistered Rohingya throughout the Cox's Bazaar district. Such actions clearly go against the principle of non-refoulement as laid down by international law.

History repeats itself 

This is not the first time that MSF has witnessed large numbers of unregistered Rohingya gathering in desperate circumstances, vulnerable to ill health, exploitation and abuse. In 2002, when MSF was working in one of the official camps, the police operation 'Operation Clean Heart' saw unregistered Rohingya violently forced from their homes, and led to the establishment of the original 'Tal' makeshift camp on a swamp-like patch of ground. This camp relocated, and in Spring 2006 MSF started a medical programme at the new site, where at the time around 5,700 unregistered Rohingya (a number which continued to rise) lived in atrocious unsanitary conditions on a small strip of flood-land in Teknaf, Cox's Bazar District. After two years of providing humanitarian assistance and following strong advocacy by MSF, which ultimately gained the support of UNHCR and the international community, the Government of Bangladesh allocated new land in Leda Bazar for around 10,000 people to move to in mid-2008. Less than one year later and nearly 13,000 people live in Leda Bazar Camp, their fundamental condition having changed little. Today people continue to struggle to survive without recognition and opportunities to provide for themselves, within an increasingly hostile environment. Ultimately, the plight of the unregistered Rohingya in Kutupalong and elsewhere in Bangladesh is part of a larger, chronic problem on which none of the relevant actors have chosen to act. Stemming from Myanmar, the issue has developed into a regional challenge on which the health and dignity of countless vulnerable people depends. In 2002, MSF organised a photo exhibition to mark 10 years of an unacceptable situation for these people: "Caught Between a Crocodile and a Snake". ‚Ãâ??®Incredibly, although another eight years have passed, nothing has fundamentally changed for the Rohingya. They remain trapped in a desperate situation with no future, vulnerable to neglect, abuse, and manipulation, and to the kind of intense violent crackdowns they are suffering right now.

Urgent action needed by those responsible

As the persecution of the Rohingya continues and a humanitarian crisis intensifies, it is imperative that the Government of Bangladesh act immediately to stop the violence and provide these highly vulnerable people with the protection to which they are entitled. In addition, the Government of Bangladesh must stop the practice of forcing the unregistered Rohingya back to Myanmar in contravention of international law. The United Nations High Commission for Refugees (UNHCR) needs to take greater steps to protect the unregistered Rohingya seeking asylum in Bangladesh. The UNHCR must not allow the terms of its agreement with the government to undermine its role as international protector of those who have lost the protection of their state, or who have no state to turn to. To date, the absence of a clear UN policy to tackle the crisis has left large numbers of highly vulnerable people at risk; this, in spite of continued efforts by MSF to alert UNHCR to the humanitarian needs and unacceptable abuses taking place. Regional powers have a key role in addressing the more fundamental problem. As the Thai boat crisis of 2009 made clear, regional solutions are needed to the situation of the stateless Rohingya. And the international community must support the Government of Bangladesh and UNHCR to adopt measures to guarantee the unregistered Rohingya's lasting dignity and wellbeing while they remain in Bangladesh. Bangladesh is a densely populated country, in which the Bandarban and Cox's Bazar Districts are amongst the poorest. Strong competition over work, living space and resources are inevitable at a local level. To find ways to overcome these issues and ensure the provision of adequate protection and assistance necessitates strong financial and political support from donor and regional countries.