Women who are forced from their homes are particularly vulnerable. They have specific health needs that are exacerbated when they are displaced; women on the move lose access to healthcare. They may fall pregnant and give birth, and are at risk of complications that can be fatal.
I witnessed this in 2017 when I first started working among the Rohingya women as part of an emergency team of Medecins Sans Frontieres (MSF) / Doctors Without Borders. We were deployed across Cox’s Bazar district in Bangladesh to respond to the unprecedented exodus of around 700,000 Rohingya refugees fleeing persecution in neighbouring Myanmar’s Rakhine state.
For my three-week emergency mission, I was tasked to assess the needs of the newly-arrived refugees. Sexual, reproductive, and maternal healthcare was desperately needed at that time.
I returned to Bangladesh in March this year as Head of Mission, three months after MSF had marked the provision of one million consultations to refugee and host community populations in Cox’s Bazar. This number is not to be celebrated, however. If anything, it revealed what more needs to be done, and what problems persist.
Steep slippery paths to safe delivery
A discovery that particularly struck me was the small number of consultations MSF provided for maternal deliveries and antenatal care. Our teams were only able to assist 2,192 births in one year. While antenatal consultations made up only 3.36 percent (35,392) of our total consultations.
This shows that most pregnant women in the refugee camp deliver their babies at home. They do so with the help of traditional birth attendants, which is not necessarily a problem in itself. However, conditions in their homes are precarious for childbirth. They live in makeshift houses made of loosely woven bamboo with dirt floors in an overcrowded camp. Water has to be brought in from sources outside the home, sometimes requiring a long walk. Toilet facilities are also communal. Such conditions can pose health risks for the mother and child, aside from other possible complications that can arise from childbirth.
Complicated deliveries can be difficult to manage because women have to make their own way to a health structure. A woman in labour will probably have to be carried over slippery and hilly trails, usually on a chair slung between two poles, to the nearest health facility, which can be at a considerable distance. It is trickier at night when the paths are not lit, and the woman may have to wait until daybreak. It can take hours before she arrives at a health structure, which puts her life and that of her baby at risk.
MSF teams work in the community to inform women and their families of the availability and importance of free quality maternity services. This is done in order to encourage women to access reproductive healthcare. We also make sure that our services facilitate their safe delivery with privacy and dignity, or their transfer to more specialised structures when they require advanced care.
No long term solution in sight
Before I knew it, my stint as Head of Mission was over. I leave knowing that the work is far from finished. The refugees will be there for the foreseeable future, and we will have to continue caring for them to restore as much of their dignity as we can.
A personal challenge for me is to directly witness the situation of the Rohingya in Bangladesh and see no resolution to their suffering. They are caught between a rock and a hard place – living in sub-optimal conditions in Bangladesh and unable to go home to Rakhine, Myanmar, because they do not feel safe there. It is a complex problem that requires a political solution. It can be disheartening to support a population in distress whose main problem you cannot fix.
What stands out to me leaving Bangladesh is the strength of the Rohingya people in the camps. I am reminded that we must continue to highlight their situation so the world does not forget that there are almost 1 million human beings stuck in limbo in the hills of Cox's Bazar.
Dr. Natasha Reyes was formerly the Director of the Operations Support Unit of Medecins Sans Frontieres (MSF) / Doctors Without Borders - Hong Kong. She has been with MSF since 2007 as a field doctor for emergency and unstable contexts. Her assignments included Kenya, India, South Sudan, Pakistan, Afghanistan, Libya, Colombia, Sierra Leone, Liberia, Nepal, and the Philippines.