“I want to feel safe, but it’s hard”: living in the Cox’s Bazar refugee camps

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 amongst the Rohingya refugees, especially at night as many areas in the camps are badly lit, and trouble roams more freely. Over one million Rohingya refugees live over a surface of just 26 square kilometres in Cox’s Bazar, and the people who live there are being subjected to layers of violence that are having significant consequences on their mental and physical health. They have nowhere else to go.

Violence is an inherent part of life in the camps: there is the violence to which the Rohingya were exposed in Myanmar and the enduring physical and psychological consequences of that; the violence done to the Rohingya by stripping them of their citizenship in Myanmar; the fact they have no right to move, work or benefit from education in Bangladesh; the violence that takes root when families live for long periods in enclosed spaces with little hope, and frustrations are taken out on women and children; the spillover of violence from the conflict in Myanmar; and the jostling for control in the camps themselves. As MSF we treat the consequences of all of this and see the impact on patients, our Rohingya staff and our MSF activities.

The mental health counsellor in Jamtoli clinic explains that “Many patients are afraid to leave their shelters to seek medical care due to the threat of violence against their families. 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.” This sense of insecurity has very real consequences on access to healthcare. Recently a woman died of sepsis because her husband, not realising how sick she actually was, decided it was not safe to travel to the clinic in the dark and waited until morning.

The fear is justified. There are regular reports of beatings, abductions, and extortion in the camps, which have become a fertile ground for predatory behaviour 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. The bamboo structures are flimsy and will not keep out someone who wants to force the door, or a stray bullet from drilling through the wall.

It is estimated that more than a thousand 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 can be a way to extort money from families for the safe return of the person, or to avoid forced recruitment or a forced marriage. Those who have time to negotiate before they are moved can arrange payment for their release, as happened for this 16-year-old:

“When we arrived [at the shelter], I saw other block children, some as young as 12 or 13, tied up with ropes. 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. After some time, they agreed to talk to my father. We were held in that shelter for about 10 to 15 minutes. I watched as the group brutally beat some of the other captives who argued with them, refusing to go and fight.”

The political affiliations of the armed groups also play out in the camps in other ways. In some camps there are ‘turf wars’ over who controls which areas, and inhabitants are caught in the crossfire. In September of this year, the violence between armed groups in camps 14 and 15 reached such a level that over 40 people – men, women, and children – who had been assaulted, stabbed or shot were treated at the MSF clinic in Jamtoli. The level of insecurity was so bad that MSF had to temporarily reduce its activities and concentrate only the most life-saving activities. Today, there are still a few patients a week presenting with gunshot wounds.

If you are thought to be an affiliate of one side or the other, houses may be vandalised, or family members attacked. Armed groups will go to the homes of influential members of a rival group and if they don’t find the man they are looking for, they will attack whoever is there. Fear of stigma means women and girls do not always come for medical care for their injuries or for support after sexual assault.

It is not just what is happening inside the camps though, as the consequences of the fighting over the border in Myanmar are also making themselves felt again. In August, 116 patients with violence-related injuries (landmines, mortars and gunshots) linked to the conflict in neighbouring Rakhine State, Myanmar, were treated in MSF’s Kutupalong Hospital. These people came mainly from the area of Maungdaw, and most were women, children and the elderly.

Before escaping to safety in Bangladesh, many refugees directly experienced or witnessed significant violence and many lost immediate family members. Once they arrive in the camps, they live in cramped, overcrowded makeshift shelters, without enough food or clean water. And for some they remain unregistered, with even fewer rights – new arrivals or returnees from Bhasan Char (the island where some Rohingya have been sent) who rely on the kindness of family and friends for shelter and food.

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. The outbreaks of violence in the camps also bring back memories. As the Kutupalong mental health counsellor explains, “The constant threat of violence from armed groups has exacerbated the situation. 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 substance addiction are common. MSF psychologists say they are symptoms of trauma and unresolved grief.

The Rohingya are not allowed to leave the camps without permission, even to work, go to school or seek specialised healthcare. They cannot just pack up their things and move, although there are those that try and take unofficial routes to look for a better life elsewhere. However, even those who decide to stay close but move outside the camps, it is complicated, expensive and comes with the risk of prosecution due to lack of legal protection. This in turn exposes the Rohingya people to further risk of exploitation.

The Cox’s Bazar district on Bangladesh's southeast coast has hosted Rohingya refugees fleeing targeted violence in neighbouring Myanmar's Rakhine state 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.

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