In the first part of this two-part series, the Dhaka Tribune explores how young mothers and orphans in the Rohingya refugee camps of Cox’s Bazar contend with arduous challenges while navigating the contours of hope and despair
Like many around the world, Rohingya refugees believe children are blessings from God. In spite of the difficult conditions and lack of resources in the camps, they remain steadfast in their conviction that God will help them care for their children against all odds.
With almost a million Rohingyas stranded in Cox’s Bazar, Bangladesh, official figures indicate there are 60 newborns every day.
Most Rohingya refugees seem to shun birth control and distrust vaccines and have inadequate access to nutritious food and effective health services. As a result, widespread acute respiratory diseases, infections, and malnutrition are common among children, pregnant women, and lactating mothers.
Official figures show that among children below 5, there was at least one death per day between August 25 and December 2 last year (105 deaths), which constituted two-fifths of all deaths at the camps in that period. Of these children’s deaths, almost a third (31%, 33) was due to acute respiratory infections (ARI), almost a fifth due to neonatal diseases (18%, 19), and about a tenth due to acute watery diarrhea (AWD) (10%, 11). Severe malnutrition, measles, jaundice, neonatal tetanus, and diphtheria accounted for almost a fourth of the deaths.
Three-year-old Dildar Ullah has come back to the Action Against Hunger (ACF) facility for the second time, but remains underweight and malnourished.
Health workers say once they send the children back to their homes after giving them food supplements, the children fall back into the same unhealthy diet of rice and lentils, with only the occasional addition of vegetables.
ACF Senior Project Manager Fouzia Yesmin said these children keep having to come back because the parents are unable to care for them. “The number of returning patients keep rising.”
She said parents could not provide for the children as they had no opportunity to work and thus no money to spend on food.
As of May 28, ACF treated 16,374 children with Severe Acute Malnutrition (SAM), many of whom have been repeat visitors.
Of the 403,889 people needing nutritional assistance, as assessed by the Joint Response Plan, over 157,000 children below 5 are suffering from acute or moderate malnutrition.
Birth control - still a sin
The Dhaka Tribune interviewed a twenty-six-year-old father of four – the youngest only two days old. His wife, 24, gave birth to the newest addition to their family in their hut at the refugee camp. The couple has never used any birth control methods in their eight years of marriage.
The wife said her husband forbade her to use any birth control measures.
“Children are blessings from God. We cannot go against His wishes. Preventing child birth is unforgivable. God gave us these children. He will look after them,” says Mohammad.
His wife also sees children as a blessing. “We are refugees. We do not have any assets other than our children,” she says.
With nine years of experience, Health Educator Shathi Rani Bose says Rohingyas are gradually becoming interested in birth control. “They were not interested in birth control before, but now I notice a slight change.”
UNFPA Midwife Tania Akter said they also deal with cases of forced and unwanted pregnancies where the mother is a rape victim from Myanmar or has been forced by the husband to conceive. She said the first step was to counsel these women and assure them that they are not at fault.
82% births at home increase health risk
An 18-year-old who gave birth to her first child on April 30 in her hut had a delivery kit and used the clean towel and new blades in the kit. “But my son is not well,” she said, adding that the clinic did not provide much help.
According to Unicef, only 18% of deliveries happen at health centres, meaning that four children out of every five are born at home. This leads to a high risk of infections due to overcrowded living conditions and inadequate hygiene.
There are many cases where traditional practices and the lack of hygiene increase the risk of infection. “There are many deliveries without birthing attendants and it’s difficult to prevent infection in this environment,” said Tania Akhter pointing to the other risk factors. “They often use powder or ash to heal the severed umbilical cord.”
Neonatal infection is the second highest cause of death among children under 5, according to WHO.
Tania Akhter said husbands and in-laws tend to grudgingly accept their suggestions only after much counselling. “But we have to keep at it.”
The UNFPA alone has distributed 10,630 delivery kits in the first nine months of the crisis during which time there have been 664 emergency cases involving newborns that were referred to better health facilities.
Malnourished mothers fighting for breast milk
According to another UN estimate, 4,173 pregnant and lactating mothers were found to be malnourished. 1,168 of them were included in a feeding programme.
A 19-year-old mother of three has had a child every year of her marriage. She is pregnant again and suffering from such malnutrition that she cannot breastfeed her twins, one of whom is malnourished. Both have been included in a feeding program.
Health Educator Shathi said she had seen Rohingya mothers throw away the first breast milk (colostrum). “During our sessions, we talk about the benefits of colostrum – we inform them that this yellowish, thick substance has benefits for the newborn as it helps prevent jaundice, increases immunity, and provides essential vitamins.”
She said many mothers were feeding colostrum to their newborns now.
Shathi said the Rohingya girls usually get married around 15 or 16 and become pregnant within five or six months. “They become pregnant a second time with a year of giving birth. They rarely get adequate food and cannot recover fully before giving birth again. As a result they suffer from chronic malnutrition.”
This special reporting project is funded by the International Center for Journalists