Threadbare facilities, high mortality, cats in the corridors: the realities of life for new Rohingya mothers in Cox’s Bazar

The Guardian
Rebecca Root in Cox's Bazar
Thu 2 Jan 2025

Midwife Sumana Akter checks on a newborn baby inside the Friendship hospital in a Rohingya refugee camp in Cox’s Bazar. In some areas of the camp, maternal mortality is 44% higher than the Bangladesh average Photographs by Thomas Cristofoletti/Ruom for the Guardian

In the world’s largest refugee site, a lack of healthcare coupled with rising gang violence makes the journey to motherhood a perilous one

It is mid-afternoon on a Wednesday and Toyoba Begum, 37, is sitting upright at the end of her hospital bed, the second in a row of eight. Dressed in a beige tunic and canary yellow trousers, a belly recovery belt clasped around her stomach, she watches her two-day-old daughter sleeping under a fleece blanket.

She says she feels a great sense of relief that her fourth baby arrived safely into the world. That was not the case three years ago when Begum laboured for six days. Her third baby was eventually delivered by caesarean section but did not survive.

 

Looking down at her hands, Begum says she blames herself. “All the time, I would tell myself that maybe it was because I slept like this, that’s why the baby died,” she says. The exact reason will probably never be known.

Toyoba Begum looks on as midwife Sumana Akter examines her baby at the Friendship hospital in Cox’s Bazar

Begum was born here in a refugee camp at Cox’s Bazar in Bangladesh to parents from neighbouring Myanmar. In the site, made up of 33 overcrowded camps, deaths of newborns and mothers are not uncommon. While recent data is sparse, Unicef reported 84 maternal deaths in 2023 – 295 for every 100,000 births.

In some areas of the camps, which house about one million Rohingya refugees, maternal mortality is 44% higher than elsewhere in Bangladesh.

While there are efficient and well run maternal health centres in the camps, not everyone opts to use them, while the expertise to manage complications can be found only in a few specialist centres.

The 30-bed Friendship hospital, a 24-hour referral centre for emergency obstetric and neonatal care where Rohingya can seek treatment

 

This time around, Begum was able to reach Friendship hospital, a 24-hour referral centre for emergency obstetric and neonatal care, the only such facility inside the camps. As she went into labour, Begum was diagnosed with hypertension and pre-eclampsia at a smaller clinic and referred immediately to Friendship. Since then, she has been resting in the general women’s ward where eight fans circulate the clammy air and multiple other women lie with their babies. With only six cots available and up to 12 women giving birth here each day, sharing the bed is the best option. 

Most women will take the dusty roads back to their one-roomed homes within 24 hours of giving birth. But none remain safe, according to Begum, who says child trafficking and stealing are among the perils of camp life in Cox’s Bazar.

“Somebody might just pick the baby up and go and sell it in another camp,” Begum says. “After delivery and after raising the child, when somebody kidnaps or takes them away, then it is very painful.”

A Rohingya woman walks past a sewage canal on the edge of one of the refugee camps in Cox’s Bazar

In the absence of opportunities to work or study, and with no possibility of returning to Myanmar, many gangs have sprung up whose criminal activities include kidnapping, as well as rape and murder, arson and forced marriages.

Many of the Rohingya arrived in the camp in 2017, after the Myanmar military government’s persecution of the ethnic minority group. With no way of integrating into Bangladesh, Begum’s family, like others, are stuck in a no man’s land. 

Kindness Ngoh, UNFPA’s international midwife mentor, at Cox’s Bazar

Kindness Ngoh is an international midwife mentor working with the UN Population Fund (UNFPA), which funds the Friendship hospital and trains about 500 Bangladeshi midwives to work across the camps.

She explains that when women go into labour at night it can be impossible for them to leave home – violence after dark means the camps are not safe. “Because of that, the women are not able to access the health facilities on time,” says Ngoh. 

Midwife Sumana Akter at the Friendship hospital

 

Midwife Sumana Akter, 24, on a quick break from attending to three women in Friendship’s labour ward, says she opted to work here instead of a private facility because “in this Rohingya or humanitarian context there is always a need for midwives”.

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