Special Report

REFLECTING UPON A YEAR: INTERVENTIONS FOR A DISPLACED POPULACE

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It started with 80,000 Rohingya refugees arriving in Cox’s Bazar in 2016; they were escaping a violence that was yet to reach its peak. At a time where nations across the world were focused on defining borders, deporting the oppressed and building walls, Bangladesh welcomed a population that only knew repression and persecution as a way of life. At present, there are 900,000 Rohingyas located in the Kutupalong-Balukhali Expansion Camp; it is now the largest camp of refugees in the world. The hills have become thousands of makeshift homes made of plastic sheets, tin, and bamboo.

The people speak of violence, murder, and abuse as if it were the norm. It goes beyond tyranny. They have been denied their basic rights to access health and education. The children are not vaccinated with cholera shots; a disease that is no longer a worldly concern. They paint recollections of murders of their family member, arriving with those they had barely escaped with. Some of whom they had lost in the process. We have created child-friendly spaces and health care centers for a sense of normalcy. But normal is not the goal. Ultimately, we want to change their narrative. We want them to be citizens of a nation they can call their own. Mark Pierce, the Country Director of Save the Children Bangladesh, expounds on their activities to support the Rohingya population. 

SCALING TO ADDRESS AN EXODUS
Understanding the needs of the Rohingyas start in 2012 for Save the Children. They provided education and child protection in two of the registered camps in Cox’s Bazar. Mark Pierce recalls increasing their operations in October 2016. “Years of interventions in the area made Save the Children aware of the existing conditions and needs of the area. A few months before August 2017, we were aware of the violence that was occurring in Myanmar. Our concern of an influx was apparent when the 1,000 arrived on the 25th of that month.” Although they knew the crisis would expand, they were not prepared for the sheer size. The number of refugees had increased from 100-folds to 700,000 in a matter of six to seven months. Rohingya refugees were fleeing Myanmar by walking for weeks or taking unsafe boats to arrive at the coast of Bangladesh. “We witnessed 12,000 to 15,000 Rohingya refugees crossing over every day. It came to our attention that 80% were women and children. So we used the presence we had to provide basic food supplement and shelter for unaccompanied children.” Save the Children eventually started a family tracing and reunification process but a significant percentage of them have lost one or both of their parents.

Pierce emphasizes preparation for a crisis must be conducted months in advance. “I arrived in 2016 and we came to the conclusion that we were not prepared for major emergencies or disasters. This realization came because Bangladesh was vulnerable to natural disasters as witnessed during Bhola and Sidr.” Save the Children was only prepared for small-scale emergencies at the time and Pierce wanted that to change. He initiated training for major emergencies and prepositioned supplies throughout the country: “We started to identify vendors that we would use in advance. They would supply us with everything from tarpaulin to dairy cans. This way we were ready to tap into our global resources and provide victims with immediate assistance. We dispensed essential food and non-food items. People also need cooking utensils, plastic, and tarpaulin for shelter and mats to sleep on. The organization’s largest program is the Life-Saving Program. It reaches about two-thirds of the Rohingya refugees, providing them with basic staples. “Our biggest concern is keeping these people alive in such dismal conditions. Basic provisions such as sleeping mats, tarpaulin, and cooking utensils make a significant difference. Every individual’s first concern is food, water and a place to sleep.”

MARK PIERCE, Country Director, Save the Children, Bangladesh

AIMING TO SAVE
The severe cases of malnutrition, lack of vaccination, and trauma made health and nutrition the principal concern within the Rohingya refugee camps. “We have ten health facilities that provide health care to 6,000 patients every week. The World Food Programme is our partner in providing therapeutic feeding and sustenance to malnourished children in both the camp and the host community.” Their attention for children goes beyond providing the staples. Additionally, Save the Children has just opened a 20-bed Primary Health Care Center. It has a maternity unit, a pharmacy, separate buildings for triage, inpatient and outpatients. They have also installed a water tower and generator in the facility. “The center is the only one that administers 24/7 in-patient care. We will serve 20,000 people from both the Rohingya and host community. There is also an ambulance to bring patients who have been referred from facilities without the capacity to keep them overnight.” Save the Children trains Rohingya community volunteers to promote hygiene practices and raise awareness of health services. “When you teach the people of the community, they become the first point of assistance for patients. They are aware of where refugees can seek help. Community volunteers are also trained and empowered to identify and refer vulnerable children and families who need medical care.”

Save the Children has one of the largest numbers of child-friendly spaces. “We have around 90 spaces that are child-friendly and this includes girl friendly spaces. These children need a space where they feel a sense of normalcy and play. Furthermore, we are also able to address the psychosocial aspects of their conditions. We also have separate centers for adolescent girls because their safety becomes a paramount concern as they get older.” They have counselors for those children that have problems adjusting. Art therapy is one the most successful ways to help these children. “When you give a child a paper and crayon, you allow their imagination to foster. They can express their emotions and over time it helps them deal with such traumas. The child begins to feel more comfortable in their surroundings.”

Save the Children places an emphasis on learning. Their temporary learning centers teach English, Rohingya and Burmese tailored specifically for the population. “Our future plan includes scaling to another 75 learning centers to the nearly 100 we have now. It is one of our key concerns because the literacy and numeracy skills are very low within the population.” The International NGO also protects and manages 3,000 children who either have no parents or a single parent. “Children are the most marginalized within any population. That is why our efforts are conducted with them as the top priority.”

Solutions are based in such a densely populated area must be qualitative. Save the Children has placed 800 latrines and Pierce would like the next step to be a more strategic one: “We are building the latrines near our education and health centers. This way the WASH facilities are not exhausted in their traditional settings.” They also work as a support program for dozens of WASH committees. These entities work to promote good hygiene practices. “Our health promotion activities are managed through community mobilizers. They go from house to house to share WASH messaging. We also complete slope protection work around latrines to protect them from landslides during the monsoon.”

19 years-old, gets a cup of water for her baby Laila* (22 months) at Leda Camp, Cox’s Bazar, Bangladesh.
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TIMELINES AND THE COURSE OF ACTION
Large-scale emergencies such as the Rohingya Crisis have their share of peaks and valleys. Every emergency needs to be accessed differently because it has a unique context according to Pierce. “I wish we had conducted simulation testing prior to the emergency. We had planned one for November 2017 but that was too late. In such large scale situations, you will have to take your successes and assess them for later interventions; this includes learning to manage the best and worst of the situation in the best course of action possible.” Save the Children conducts real-time evaluations every three to four months of a crisis situation. Pierce understands that this is the most critical course of action; “These evaluations allow your team to understand what works and what does not. Furthermore, you can disseminate the information to other organizations and create a larger scale of awareness and knowledge.”

The most chaotic period of any catastrophe is the first 90 days. During this time, concerned organizations centered on saving the largest number of lives. Pierce’s experience of the Rohingya situation was challenging because this time frame was much longer. “We witnessed one of the longest tumultuous periods; it lasted from August to January. During this time Save the Children’s target was only on the most marginalized people and not everyone was receiving assistance.” Matters within the camp started to stabilize by the seventh month; a time during which Save the Children geared some of their aid towards those in the periphery of the camps. The monsoon season in May would usher in a number of new matters that would need to be solved. “The monsoons were soon recognized as an emergency within an emergency. We expected the potential of a cyclone, landslides, and flooding forced us to identify a new set of impacts. Furthermore, their reliefs were health risks and water-borne diseases associated with the monsoon.” While a stabilized and systematic response along with proper infrastructure provides continued relief, the dangers of this season are still a primary concern. “If you recall, Cyclone Bhola happened in November 1970. Therefore we must be alert and prepared for the worst weather conditions until December or January. It is our current plan while we anticipate what is to happen next.”

During the monsoon season, the organization is working to create shelters that would protect them from high winds, flooding, and monsoon. Pierce explains that Save the Children turns their attention to construction during these times. The first step entailed assessing what provisions were necessary for the area. “We build covers to facilitate drainage and bridges to make it easier for them to travel across the camp. We also reinforce the hillsides with sandbags to prevent water levels from rising. A larger part of our safety procedures on providing knowledge and raising awareness is on handling extreme weather.” Their provision includes strengthening shelters, healthcare centers, and temporary learning centers. However, some facilities were required to be temporarily suspended while others were decommissioned for welfare purposes. “We hope to bring these places back into their everyday functionality but the limitation of space poses a major challenge.”

Save the Children is now devising long-term solutions and going forward with the local government.”We want to provide assistance as we have from the beginning while allowing the government to take more control. We exist to reinforce the capacity of the government. Save the Children is about extending the systems in place. For example, we expand medical facilities with funding from the USA known as health system strengthening.” Pierce commends the actions of the host community while recognizing that they also require support. He was to work with the local institution to improve the existing health and education services in the area. “You have to focus on the areas where the government is not able to reach. Development organizations should work on informal education for the Rohingya population which does not fall under the official education system of Bangladesh.”

KNOWING WHERE YOU’RE MOST EFFECTIVE
There are 20 subcamps in the Kutupalong-Balukhali Expansion Camp. Pierce explains that a coordinated effort is more important than expansive coverage. “There is a lot of coordination in the various sectors including health, protection, and education. We have to work carefully with the government to ensure that the hundreds of actors and 30 NGOs coordinated in providing maximum effort across the camp.” This poses a great challenge because numerous organizations may exhaust their attention into the same efforts. During risky weather season, Save the Children would turn their learning centers and child-friendly spaces into temporary shelters. “We have to attend to the priority at the moment. Six months ago, our efforts were geared towards health and disease outbreaks; the entire international community was concerned with the diphtheria outbreaks; it was a disease that you would barely see around the world.” Save the Children and other agencies handled around 40,000 suspected cases and a number of fatalities. The vaccination phase was executed successfully. Nonetheless, the high levels of fecal matter that increase the risk of acute diarrhea require careful monitoring.

Many of the activities require the encouragement of those in charge of camps. In such instances, a more integrated approach is devised in order to address the matters of that particular camp. “There are various institutions on a local and civil level that provide the necessary assistance to the communities. We work with influential members who are often known as the mahjis. They are elders or recognized leaders within the Rohingya community. Though it is a new methodology, it has proven to be an efficient one. We run awareness sessions with these leaders, parents, and children to help protect children from issues like trafficking, child, and child marriage.” Community-based approaches are challenging when people have to wait in lines for food, resources and health facilities. Save the Children is trying to establish local governance and democratic principles within these communities.

Pierce indicates that it is easier to create structure at a household level, “These matters include a smaller number of individuals. Our concentration is on the neediest households and their children. We distribute plastic sheeting, mats, education, and protection.” Pierce concludes that infrastructural improvements trickle down for the most substantial effect. “When you build roads and bridges, people can transport clean water easily, eliminating the chances of diseases. Additionally, there are many organizations that work on electricity generation and lighting, and signboard creation. There is also a wristband intervention for children that help children be reunited with their families if they get separated during a storm or flood.”

Children walk through a camp for Rohingya refugees in Cox’s Bazar, Bangladesh, as monsoon rains pour down.

THE INITIAL ACTORS
Pierce accredits the local community as the initial players. The host community consists of 336,000 people who have taken in a population that is nearly three times their size. “The citizens of Bangladesh have offered their limited resources to the incoming Rohingya refugee population. This is a tremendous effort by a marginalized community.” Approximately 38% of them lack food security. These actions were followed by the generosity of the Government of Bangladesh who has allocated 580 acres in the region to house the Rohingyas. “I applaud Prime Minister Sheikh Hasina and her efforts. She instantly acted and offered to house nearly a million people. I met Rohingya children and pregnant women who had walked for nearly a month. Others were on boats drifting in unknown waters.”

The Bangladesh Foreign Ministry has proposed to move approximately 100,000 of the Rohingyas to the Bhasan Char region. Pierce observes that there are a number of matters to take into consideration: “We respect any of the government’s decisions as they have been continually effective. They must consider a number of factors. The safety of the region is the first concern, particularly for children. The population that is being moved must be informed about their new location which includes providing knowledge regarding the region.” Relocation of such a large population would also include their consent; a decision that the Rohingyas will make if they are ensured safety. “The new location should have better conditions and freedom of movement. When you provide mobility, a population is able to conduct income-generating activities. Additionally, they have access to employment, education and health facilities. And these conditions would apply prior to their repatriation to Myanmar. International organizations and the Government of Bangladesh have demonstrated their collective ability to provide refuge for nearly a million people. We will ensure that they are able to live with the same dignity.” 

Photography: SAVE THE CHILDREN

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