‘We can’t keep the Rohingya crisis together in the way it’s currently being managed’: MSF Director

Bangladesh is set to emphasise the Rohingya issue - after five years of hosting the Rohingya population from the 2017 exodus - at the 77th United Nations General Assembly. Prime Minister Sheikh Hasina is scheduled to attend a high-level discussion on the topic on the sidelines of the UNGA on 22 September. 

On Wednesday (21 September), the premier also sat down with the UN High Commissioner for Refugees Filippo Grandi at the bilateral meeting room of Lotte New York Palace hotel and restated that the Rohingya crisis can only be resolved through repatriating the forcibly displaced Rohingyas to their motherland Myanmar.

A collective inaction from the international community to pressure Myanmar into undertaking repatriation coupled with the recent spate of inflated tensions at the Myanmar-Bangladesh border, the state of affairs within the Rohingya camps in Cox's Bazar face more challenges while making repatriation an even bigger challenge.  

And the international organisations working at the ground level inside the camps are well aware of the unfolding events. 

Paul McPhun penned an opinion piece published in a news outlet in the Philippines in August calling out draconian refugee policies in the region and describing "the plight of the Rohingya" as "a pressure cooker" event  "that no one seems inclined to take off the stove." 

McPhun is currently the Director for Doctors Without Borders/Médecins Sans Frontières (MSF) regional South-East & East Asia Pacific Partnership (SEEAP) while MSF is the largest medical services provider within the Cox's Bazar Rohingya camps. 

McPhun, with nearly 30 years of professional experience in MSF humanitarian assistance under his belt, sat down for a zoom interview with The Business Standard to talk about the flaws in the systems in place, the current state of Rohingya affairs in Bangladesh and what he thinks will happen soon in future.   

You were heavily involved in the operations and in July this year, you visited the camps for the first time. Can you tell us the major changes you have noticed over the last five years in Cox's Bazar Rohingya camps? 

Over time, of course, the refugee community has had no alternative and stayed there. If anything, they had grown bigger and bigger. And I think with Covid [over time], there emerged a lot of concern. And even resentment about the risk of having this large population close by. 

And that resulted in what we now see as containment policies, where the camps [are] now barricaded, surrounded by checkpoints, razor wire, etc. 

And within the camps, there's a division between one camp and another. It massively decreased the ability of people to move around, and go in and out of the camp - which is again another layer of difficulty. And that has not been lifted. So that remains now a significant change and that really impacted people's ability to find ways to make do. [Additionally] find[ing] casual labour, things of that nature became very, very restricted. 

Now five years on, and we certainly see this in our medical data, the gradual deterioration of the response (of the systems, and services) that was put in place. And we can talk specifically of water sanitation, hygiene, which is, you know the basic fundamentals; and shelter that help keep a population healthy. And helps prevent the spread of infectious diseases etc. 

We see that [is] starting to erode and deteriorate, [in terms of] the quality, quantity and distribution. And to illustrate, we recently conducted quite a comprehensive sample survey of the availability and quality of water and sanitation across 19 camps. And from that, we saw that while on the one hand, the quality of water has improved, the availability and distribution of water have massively decreased. 

Over 51% of people reported not having continuous access to water at all. We saw that 76% of the population reported using overflowing toilets, and 88% reported inadequate access to sanitation facilities. 

And as a consequence of what we have seen and what we continue to see as the largest medical service provider in the camps - currently, there are eight [MSF] medical sites, hospitals and clinics [across all the camps] - we see a really sharp increase in skin infection, particularly, scabies right now. 

This year alone, between March and June, we have treated 42,000 cases of scabies. We saw a 50% increase in diarrhoea between 2019 and 2021. And an increase in things like dengue, which again is a water-borne disease. And we are starting to see a really heavy burden of chronic diseases. So we are looking at things like diabetes, hypertension and asthma. 

Photo: Courtesy

Between January and July, we have treated 35,000 cases [across two camps alone], so that is more indicative of the failure of health facilities. And the number of people [is] actually growing. The situation is, if anything, more precarious now for them. 

In the case of chronic diseases, what we are seeing is that people are starting to come from a much wider area, so they are clearly reporting that the services that they need are not available for them - to treat things like diabetes, asthma, and hypertension. 

And we know [many of the] similar services to ours that were in place [earlier] and were providing those services, had to close for lack of funding. Some simply don't have the medication required to provide that kind of service anymore. It's a real concern for us. 

Now patients [from] a much wider area of the camp are being referred to us. And that's indicative that somehow the services are failing those patients. 

We have a limited capacity as well, which raises classic red flags for us. 

Can you talk about funding? How much did it change in the last five years? Has it been continuous, or are there disruptions? 

Absolutely, that's a really good question. The trend of the last few years is [that] funding commitment has been decreasing. No question about it. 

[It] started, I don't know the exact figures, but in the region of $620 million, or whatsoever, decreased to $600 million. This year, currently, the commitment that's been made is somewhere in the region of $200-$250 million. So there's still a huge, huge funding gap, currently, to be filled. There are pledges but whether those pledges materialise is another thing. 

When I was in Bangladesh, I met with a lot of different people who were all talking about the so-called funding crisis. They are expecting the impact of Ukraine, Afghanistan - and other emergencies around the world - really [had] drawn the funding away from Bangladesh and this emergency to other [regions]. And we see that some countries have significantly decreased their funding commitments to this population. 

So there is no doubt that the funding is getting much harder to secure the longer this goes on. We can't keep this together in the way it's currently being managed. 

In the opinion piece that you penned, you emphasised the need for draconian refugee policies to end. "We are also trying to cope with the cost of political inaction, an impotent failure of collective progress from regional states and the international community to find durable or even temporary solutions but better ones," you wrote. Against this backdrop, there's been a stop in the dialogue between Bangladesh and Myanmar since the February 2021 military coup. From your professional experience, can you tell us how you think this crisis at hand will transpire in the foreseeable future? 

I guess that's where my reference to policies comes in. Because another aspect of the pressure cooker is that countries around the region, and I include Australia in that, are being focused on keeping people out and closing their borders. 

And this is also having an impact [because] as pressure builds, people get more and more desperate in Myanmar, Bangladesh, wherever. And [Rohingya] are being persecuted or exploited. They are desperate to find a better life for their families [and] for their children and they are going to take more desperate measures.

And one is, of course, getting on boats - we see this happening periodically - or, more commonly, finding ways over land to get to a neighbouring country. And the response in those countries is to turn them back or lock them [up]. And I included Australia in it. 

Its pushback policies are not really any different. It's interesting; there are very few states that have adopted, you know, have signed up to refugee convention, for example, and demonstrated that [they will take on] protection responsibilities for asylum seekers and refugees. So it's a region where that's not happening, that's not recognising the policies [that they signed up on].

The standout is Australia, which has signed [on] these conventions but chooses instead to practice the opposite in terms of its policy. So again, that adds to this pressure cooker effect. 

So one thing that could be done [is] acknowledging [that] short-term solutions are not around the corner, certainly not with Myanmar. One thing is to look out, assuming more shared responsibility, particularly for the most vulnerable - [the ones] who are needed the protection and support—so having a more open border policy, even if it's linked to temporary protection. 

But, at the moment, it entirely falls on Bangladesh. We even see in those rare cases where there's a boat that's pushed back, it's Bangladesh that ultimately ends up taking these people back onto its shores. So yes, reaching at least some agreement to share that burden of responsibility [for] the existing displaced populations is one thing. 

And that's what Australia [for example] is not even offering [as] a pathway at the moment to the Rohingya, whereas, you know, they have promoted visa pathways for Afghans and Ukrainians today. 

A real shift in regional policy, at least offering them some protection, will be one thing. And the real solutions are diplomatic. That means working together and trying to push back against that apathy that we have tried everything and not gone anywhere. And the situation is just too volatile. Let's try more concerted efforts and come up with change. Change is possible. 

However, with the re-emerging conflicts in the Rakhine state, currently between the Arakan army and the Myanmar military, it has been harder to achieve. So in the meantime [focus should be on] what more can be done. And to improve these temporary conditions. You know we cannot allow [the discourse on this crisis] to simply disappear. We have to look at new mechanisms [and] new ways. 

Perhaps instead of tapping into classic emergency humanitarian response mechanisms, accept this population will be hosted for a longer period of time. And look for more development-type funding. If not, the situation will be ever more desperate. It will not be contained. It will be harder and harder to contain it and the consequences of that will be much harder and more expensive to deal with. 

What do you think the host country can do more to help the Rohingya population?

Ultimately, you can't provide for your family if you don't have the right to work. You are entirely dependent on humanitarian aid, for which the budget is falling rapidly. And that's not sustainable. So the only alternative — at least to look at how some people can provide for themselves and their families. Include rights [such as] their ability to work, at least [enough to] sustain a livelihood, in some way or another. 

Recognising the situation won't be resolved quickly and, then, of course, trying to improve the other services that help lift a community with more sense of purpose. So yes education. 

The people I spoke to, all they think about [is] their children. And the fact that there will be a generation that can only enjoy a primary level of education. That is risky.  

I think it will be important to think about those things; and I understand that resettlement is the only real option. Everybody including the Rohingya understand that. 

But as long as that's not possible [and] continuing with that idea for [alternative scenarios] for many more years, without people having the right and ability to actually take care of themselves is, I think, fundamentally unsustainable too. 

We certainly see that in our mental health consultations. People [are] ever more desperate, and the more and more anxiety, depression [they suffer], the [more] willing [they are] to take more and more desperate measures. Change their circumstances. Yes, there's more that can be done if there's a willingness to try anything. 

How do you cope with the constraints that you come across in your work and the limitations of your job role?

There are huge frustrations, of course. That's inherent. Humanitarian assistance is very imperfect. It's not a solution, and it's a way to manage, [for] a temporary period of [the] chaos and crisis at hand. That is not a long-term solution. [And] it shouldn't be. 

However, you know, for the patents that are there in front of us, we still have a huge impact [because of] the fact that we are there, our services are available and we are not going anywhere. 

We commit to continue to invest the $35 million euro that we invest in Bangladesh alone. We commit to maintaining the hospitable services because we know it's essential and we have to play a part. And help support this population. 

See, there is a lot of satisfaction, of course, in being able to provide the people with that lifeline and that access to essential medical care. 

With all that, of course, comes the responsibility to talk about the challenges, which is what I tried to do in the [recently published] opinion piece. It helps me deal with what I do. 

Does MSF have access to Bhasan Char?

We have applied for permission to go there and assess the situation in Bhasan char. So far, we haven't been granted permission. When we are granted, our intention is to go there and look at what's going on. 

Paul McPhun Director, Doctors Without Borders / Médecins Sans Frontières (MSF) regional South-East & East Asia Pacific Partnership (SEEAP)

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.