Training health workers in Rohingya refugee camps

Bangladesh

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August 2022 marked five years since more than 700,000 Rohingya refugees fled persecution in Myanmar and arrived in refugee camps across the border in Bangladesh. Much has changed for the people who now call these camps home, but the need for sexual and reproductive health services—including abortion care—has remained constant.

Photography by Fabeha Monir for Ipas

In 2017, when this crisis was unfolding, refugees arrived in camps with acute sexual and reproductive health needs. Many had survived sexual violence. Ipas Bangladesh and partners moved quickly to train providers and support health facilities in the camps so they could offer needed contraception and abortion care (called “menstrual regulation” in Bangladesh).

Five years later, Ipas supports comprehensive family planning, abortion and postabortion care in these camps—by training providers, supporting health facilities, and coordinating with local and national organizations, camp officials and influential stakeholders (including religious leaders).

“Much has changed since we began this work, but Ipas’s commitment to ensuring reproductive health care for refugees in these camps has not wavered,” says Sayed Rubayet, director of Ipas Bangladesh. “Through flooding, landslides and a devastating pandemic, we have proven that family planning and abortion care in humanitarian settings is not only possible, but can be high-quality, survivor-centered care.”

On remote Bhasan Char island, Ipas-trained health workers are seeing change

Shamoly Khatun is a paramedic who works at 20 Beds Hospital on Bhasan Char island, where Bangladesh’s government has relocated tens of thousands of Rohingya refugees to alleviate crowding in the sprawling refugee camps on the mainland. Shamoly received training from Ipas and, since October 2021, she has been providing family planning, safe abortion care and treatment for complications of unsafe abortion (known as postabortion care).

“Mindsets have been changed among Rohingya women,” Shamoly says. “Now husbands are coming with their wives and seeking reproductive health care. This is a huge change. They also understand the importance of safe abortion and many of our patients are arriving without much delay.”

In the government-constructed refugee camp on remote and cyclone-prone Bhasan Char island, residents report despair over a lack of jobs and community. However, they have access to comprehensive reproductive health care that includes contraception and abortion provided by Ipas-trained health workers.

Ipas-trained paramedic Shamoly Khatun discusses long-term family planning options with Anwar Begum, who has five young children.

20 Beds Hospital offers a variety of short- and long-term contraceptive methods as part of its comprehensive reproductive health services that also include safe abortion care.

Anwar Begum, mother of five, decided on an injectable contraceptive that lasts three months. “I have no energy left to become pregnant again,” she says. “I also had a few miscarriages in my past. My health is becoming weaker. My husband also wants me to have this service.”

More than 20,000 Rohingya refugees now live on Bhasan Char, a formerly uninhabited sandy island in the Bay of Bengal. Bangladesh decided to relocate refugees here from the overcrowded Cox’s Bazar refugee camps where more than one million Rohingya live. Reaching Bhasan Char requires an hours-long journey by boat, and residents report feeling trapped and desperate in the isolated setting—which is also very vulnerable to cyclones and flooding.

Looking to the future: Comprehensive family planning care

Rohingya refugees in Bangladesh’s camps are settling into a more permanently displaced life—and need ongoing family planning services so they can make their own decisions about their reproductive health.

In partnership with UNFPA, Ipas is now supporting comprehensive sexual and reproductive health services at 49 health facilities serving refugees (almost all in Cox’s Bazar District) and continues to train service providers such as midwives, nurses and doctors. Training has expanded to include content on rights-based care and confronting stigma. And to prevent provider burnout in the camps, Ipas is making sure these trained providers have ongoing support from mentors. When Bangladesh’s government began relocating refugees to a new camp on the remote island of Bhasan Char, Ipas secured additional funding to ensure contraception, abortion and postabortion care are available there as well.

Conditions in the camps have become less safe over time. With limited law enforcement and few options for refugees to earn income, gangs, sex work and drug trafficking have been on the rise. Consequently, women and girls face higher risks of gender-based violence and contraceptive disruption than ever before.

That’s why Ipas is working to educate people on sexual and reproductive health and reduce the stigma around family planning and abortion. By engaging women, men, youth and camp leaders, Ipas and local partners aim to ensure everyone knows how to access contraception and abortion when needed.

The need is still overwhelming—but we are not deterred. When refugees have control over their reproductive health, it has a powerful impact on their quality of life.”

SAYED RUBAYET, Ipas Bangladesh Director

The word is spreading: Friendship Hospital has the reproductive health services women need

Ummay Roman Jannaty is an Ipas-trained paramedic who provides family planning, abortion and postabortion care at Friendship Hospital in the sprawling refugee camp in Cox’s Bazar, Bangladesh.

“Ipas gave me the knowledge to make myself useful,” Ummay says. She explains that many Rohingya women and girls arrived in the refugee camps with little knowledge of sexual and reproductive health. The community education efforts she helps with are changing that. She now sees many women who come for services at the suggestion of their friends or neighbors.

Ummay Roman Jannaty talks with 29-year-old Rojina, who has four daughters.

“I had an unwanted pregnancy. My neighbors and relatives suggested to me the Friendship Hospital,” Rojina says. “They said there is a health worker who can assist you with whatever you need.”

Rojina shared her situation with the health worker and decided to have an abortion with pills. She came back to the hospital for contraception.

“Family planning is important because it teaches us to keep a certain space of time before giving birth to another baby,” Rojina says. She had no access to family planning services in Myanmar before she came to the refugee camp.

More than one million Rohingya refugees live in squalid camps in Cox’s Bazar in southern Bangladesh, comprising the world’s largest refugee settlement.

Ipas supports comprehensive family planning, abortion and postabortion care in these camps by training health providers, supporting health facilities and coordinating with local and national organizations, camp officials and influential stakeholders.

Ummay Roman Jannaty provides family planning counseling to 25-year-old Ismeet Ara at Friendship Hospital.

Friendship Hospital offers short- and long-term contraceptive options as part of its comprehensive family planning services.

Ismeet Ara was referred to Friendship Hospital for treatment after having a miscarriage. She has one daughter and now has decided to have contraceptive injections.

Ismeet heard about the hospital and reproductive health services from others in her community. Now she happily passes on the information.

“No one knew about this treatment before, so I told people about it in my area,” she says. “If anyone falls sick and gets pregnant, I recommend this hospital. I also tell the people, ‘you will be given proper treatment and medicine free of cost.’”

Ismeet arrived in Bangladesh as a refugee five years ago when her daughter was just 18 months old.

“The Myanmar government was torturing us,” she says. “We have left our brothers, sisters and other relatives in Myanmar. We were not able to do anything to protect them.”

Ipas gratefully acknowledges the support of Canada’s Department of Foreign Affairs, Trade and Development in the collection of these stories.

Every crisis is different. Our varied solutions recognize that.

Through a variety of different programs and approaches, we’re proving that reproductive health care can be made accessible during an acute crisis and in the years that follow.