On World Refugee Day, lessons from working in Camp 22
Though only 22 years old, Arafa Begum was already a mother of two when she was forced to flee her home in Myanmar because she is Rohingya, a group the government has been driving out of the country through persecution and violence. In 2017, Arafa, her husband, and their three-year-old and newborn sons took refuge in the coastal district of Cox’s Bazar, Bangladesh, where today nearly one million refugees live. Camp 22, in an area called Teknaf, became their home.
This World Refugee Day, we are bringing attention to refugees like Arafa and her family, sharing our experiences with assisting them, and calling for continued support to the refugees in Cox’s Bazar.
UN agencies and international and national NGOs—including Pathfinder—have been working in both the refugee camps and local host communities to meet the need for quality essential health services. Pathfinder’s support supplements the government of Bangladesh’s family planning staff who have worked to balance the pressing health needs and address exacerbating health-workforce and commodity shortages amid a population that has almost doubled. Approximately 171,000 Rohingya have arrived in Teknaf since 2017.
Without citizenship in Bangladesh or Myanmar, camp residents have no means for sustainable livelihoods or stability, and no clear pathway to return to Myanmar or integrate into Bangladesh. While a growing number of Rohingya young people are risking their lives on dangerous boat journeys to other Southeast Asian countries in hopes of the opportunity to build a life, the vast majority, like Arafa and her family, remain in the camps, where overcrowding and harsh conditions threaten residents’ health and wellbeing.
Serving refugees and host communities simultaneously
From 2019 to 2022, with support from the David & Lucile Packard Foundation, Pathfinder partnered with the government of Bangladesh, community leaders, and local NGO Research, Training, and Management International (RTMI) in and around Camp 22 to implement the Sexual and Reproductive Health and Rights Support for Rohingya Refugees in Cox’s Bazar project. The project strengthened the provision of sexual and reproductive health (SRH) information and services for host communities and forcibly displaced Rohingya from Myanmar.
The strain of the influx of Rohingya on the already under resourced host communities of Cox’s Bazar caused tension between the two groups. The stressors of the COVID-19 pandemic, the annual monsoon season, and dwindling humanitarian assistance exacerbated the challenges. The project’s efforts to meet the health needs of the host communities while simultaneously serving the camp population benefited everyone by encouraging the efficient use of resources and strong relationships with stakeholders. This approach helped reduce conflict between the host and camp communities.
Through the project, Pathfinder and RTMI provided comprehensive training for public-sector service providers on provision of contraception (especially for adolescents and youth), SRH, maternal and child health, services for women and girls who faced GBV, menstrual regulations and post-abortion care services, general health services for Rohingya living in Camp 22 through a health post there and for the host community through the Mina Bazar community clinic. The project also worked, primarily through Rohingya community health workers, to increase awareness of and demand for SRH services among Rohingya women and girls.
Arafa and her family began receiving health services, including short-acting contraception, to ensure healthy spacing between pregnancies, from the project-supported health post within the camp. After a couple of years in Cox’s Bazar, Arafa and her husband were ready to grow their family. Three years ago, they welcomed a daughter. The health post’s midwife, Ms. Jannat Ara, has since counseled Arafa on a range of contraceptive options, helping to address Arafa’s questions, concerns, and misconceptions about contraception. While many factors in their family’s circumstances are out of their control, they now have access to the knowledge and services they need to have agency over their family planning and reproductive health decisions.
In the nearby host community of Mina Bazar, Mahmuda Akter, 22, was married at 17 and has been pregnant four times. She lost her first pregnancy at five months; not realizing she was pregnant, she did not seek antenatal care. Within months of the miscarriage, she got pregnant again and gave birth to her son, now two years old. Shortly after the birth, she got pregnant again and had a stillbirth. Weak and sick, she consulted Lija Begum, the midwife at the project-supported Mina Bazar community clinic. After contraceptive counseling, she decided to use injectables for six months. After discontinuing use, she got pregnant again. Receiving counseling on postpartum family planning and the full range of methods helped Mahmuda recognize the importance of healthy timing and spacing of pregnancies. In a conversation with project staff, she showed willingness to use contraception after her current pregnancy.
Mahmuda Akter, a client of the project-supported Mina Bazar Community Clinic. Photo: Ridwanul Mosrur
Lessons for working in humanitarian camps
The project’s collaborative, multifaceted approach yielded three key lessons:
Projects serving populations within refugee, internally displaced persons, or other humanitarian camps should also serve the surrounding host communities, tailoring information and services to the specific context, culture, and needs of each.
RTMI’s collaboration with the government of Bangladesh to make the Mina Bazar community clinic an SRH service center to scale services for the host community created a unique but replicable model for serving host communities. In Camp22, both the strategic location of the health post and complementing the essential service package with community outreach activities proved an effective, replicable model for meeting the Rohingya’s health needs.
Strong partnerships among implementers and with government and other stakeholders helps facilitate successful implementation.
Pathfinder and RTMI’s complementary sharing of knowledge and resources helped the project avoid duplication of effort and minimize implementation costs. The project was proactive in its outreach and support to the government and other stakeholders, leading initiatives that strengthened the health system’s responsiveness to existing needs. Through RTMI, Pathfinder regularly shared updates and findings with camp management, establishing and maintaining a collaborative relationship throughout project implementation.
While providing facility-based services is important, community outreach is essential.
Two community health workers in the host community and eight Rohingya community health workers in the camp were instrumental in helping the project understand community health, language needs, and cultural preferences, making services responsive and accessible to clients. These community actors were just as important to generating awareness about the importance and availability of essential health services. The community health workers’ continuous household visits, meetings with community leaders and stakeholders, and organized events for adolescents and youth helped overcome some service-delivery barriers. For example, community health workers talked about the importance of antenatal care and postnatal care. They also held awareness-raising sessions on contraception to help address the misconceptions and social norms that discouraged contraceptive use among many Rohingya women, despite their desire to space or limit births.
To learn more about Pathfinder’s work to ensure Rohingya refugees and members of surrounding host communities in Cox’s Bazar, Bangladesh, have access to quality essential health services, read our new brief.
SRHR community session for Rohingya women and girls in Teknaf upazila of Cox’s Bazar, Bangladesh. Photo: Pathfinder Bangladesh