Understanding and Adapting Spaces and Systems for Protracted Displaced Persons and Hosting Communities (the Rohingya Coomunity in Bangladesh)

As of 15 March 2019,[1] there are a total of 909,861 Rohingya refugees in and out of camp settlements in two sub-districts of the south-east corner of Bangladesh. This includes a recent influx of 706,364 refugees since 25 Aug. 2017 due to forced and violent displacement from Myanmar. It’s now past 1½ years, and indications are that they are here to stay for quite some time in the foreseeable future. Much academic literature has noted that refugees seem to be stuck in a limbo or in a liminal state, inhabiting a present but unable to plan their futures as they are excluded from their local contexts and often sequestered in camps. The assumption amongst many host communities and governments is that they are temporary populations who will soon go back. However, as displacement becomes protracted, inhabiting a continuous present instead of being able to envision and plan for futures can be deeply debilitating for displaced populations. Being sequestered in camps or being made invisible in non-camp environments where displaced persons are unable to form meaningful futures are forms of indignity.

Initial responses mainly focused on managing acute emergencies and preventing communicable diseases including provision of priority MNCH and FP services, beside providing for food, shelter and security. This points to an unmet need for services for chronic conditions, precipitated by the very nature of forced migration and camp life aggravated by social determinants of health such as poverty, exclusion and discrimination, and gender disparity. The recent 2019 Joint Response Plan for the Rohingyas[2] emphasized the provision of quality services for NCDs, mental health conditios[3] and disability; GoB has also decided to include NCD activities in its current health sector Operational Plans (OPs), but without any fixed policies so far.[4] Over and above, the host communities are variously affected due to the precarious situation arising from limited resources but unlimited need for services including services for their health and well-being.  To resolve these issues pertaining to both the refugees and their host communities, a paradigm shift from a relief-based approach to a development-based approach is warranted for equitable delivery of services including gender-equitable services, especially in the context of the SDGs.

This project aims to address the concerns around development based approaches to protracted displacement through an analysis of ‘dignified futures’. This work draws together two key strands of critical contemporary thought- dignity and futures that are key emerging issues in thinking about humanitarian and development action. The concept of dignity is critical in humanitarian action, emphasizing the idea of respect and being valued (Wein, 2018; ODI 2018). The idea of dignity within humanitarian situations is poorly understood, remains limited and focuses squarely on the experiences of displaced persons and humanitarian aid providers (ODI, 2019). Likewise, the idea of futures has gained considerable traction in recent years, particularly in the social sciences. The idea of future invokes uncertainty and anticipation, however, it also emphasizes hope and planning, important for any humanitarian work.

Thus, the proposal is being developed with the following Objectives:

i) To study current scenario of chronic conditions (NCDS such as hypertension, diabetes and cancer; mental health diseases such as anxiety and depression; disability) among the Rohingya/FDMNs living in the camps, living with the host communities, and the host communities

ii) Service readiness for these chronic conditions in the static health facilities in and around the camps, the two sub-district (UZ) health complexes (Ukhia and Teknaf Upazilas where the Rohingya Refugees are settled in and around the makeshift camps) and the Cox’s bazaar district hospital as well as facilities run by different international and national NGOs and identifying the service gaps including quality.

iii Demand side scenario: exploring perceptions and EM of chronic illnesses of both the communities including disease-specific social stigma of chronic conditions such as TB and mental health illnesses, and conditions of disability  etc. and relevant health-seeking behaviour, service needs and priorities to inform design of culture-sensitive, people centred, comprehensive package of chronic illness care.

The study will follow a Mixed methods approach (both Quantitative and Qualitative methods and tools) to address these objectives. These will comprise:

Stakeholder workshops with policy makers and programme implementers on how severe is the problem of chronic conditions, how services can be provided and how these services can be linked and integrated with existing services in the public and private sectors; perceptions/EM of mental health illnesses of the target communites explaining existing health-seeking behaviour; and FGDs with target communities to explore their needs, priorities and experiences with mental health care-seeking; structured observation of interaction with health systems for chronic illness care/chronic conditions care; IDIs/case studies of satisfied and not-so-satisfied cases.

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[1] DGHS website (accessed 2 April 2019)

[2] Joint Response Plan for Rohingya Humanitarian crisis. Jan. – Dec. 2019. Report from IOM, UNHCR, UN Res Coordinator for Bangladesh and ISCG. Available at  https://reliefweb.int/report/bangladesh/2019-joint-response-plan-rohingya-humanitarian-crisis-january-december-0 (accessed 2 Apr. 2019)

[3] Bruhn et al. The range and impact of postmigration stressors during treatment of trauma-affected refugees. J Nerv Men Dis 2018;206(1):61-68

[4] Health problems, and health services access to and utilization among Forcibly Displaced Myanmar Nationals/ Rohingya refugees in Bangladesh (draft ms/personal communication)