Beyond Borders: The Rohingya Crisis and the Struggle for Universal Health Coverage

By S. M. Sadat

In 2017, following a violent military crackdown in Myanmar, more than 700,000 Rohingya fled across the border into Bangladesh. While Bangladesh generously opened its borders, offering shelter to those in desperate need, the burden of hosting such a large refugee population has strained the country’s already limited resources. According to the United Nations High Commissioner for Refugees (UNHCR), there are an estimated 1.2 million Rohingya refugees in Bangladesh, and the number continues to rise due to ongoing instability in Myanmar. Bangladesh’s own healthcare system, particularly at the upazila (sub-district) health complex level, struggles with overcrowding, inadequate infrastructure, and limited funding, making it impossible to provide the level of care needed by its own citizens, let alone a large refugee population.

In the refugee camps, health services are supported primarily by international organizations, the United Nations, and local NGOs. These agencies have set up health posts and makeshift clinics to address the needs of the refugee population, but these facilities, while essential, still face significant challenges. The clinics offer a wide range of services, including maternal and child health care, immunizations, and treatment for common diseases like malaria and diarrhea. However, chronic conditions, such as HIV/AIDS, diabetes, and hypertension, are harder to manage in these resource-constrained settings.

Even with these international efforts, the level of healthcare provided in the camps often surpasses what is available in government-run health centers, particularly in rural areas like upazila health complexes. According to a report by Médecins Sans Frontières (MSF), the health needs in the camps are immense, with over 15,000 consultations taking place daily. Government hospitals and health centers in Bangladesh are often underfunded, understaffed, and ill-equipped to provide comprehensive care. Basic medicines and treatments are sometimes unavailable, and health professionals are overworked and spread thin. In contrast, healthcare services in the camps, though not without their limitations, are often better resourced thanks to the support of international donors and organizations. This disparity highlights a glaring injustice: refugees, who have already suffered unimaginable hardships, are often receiving better healthcare than the citizens of the host country.

The health crisis in the refugee camps is exacerbated by the overcrowded and unsanitary conditions that prevail in the settlements. Overpopulation, poor hygiene, and inadequate sanitation facilities contribute to the spread of infectious diseases like cholera and respiratory infections. The risk is even higher for individuals living with chronic conditions, including those with HIV/AIDS, whose immune systems are compromised. Access to medications, particularly antiretroviral therapy (ART) for those living with HIV, is often inconsistent, and the healthcare facilities in the camps struggle to keep up with demand.

Additionally, climate change has made life in the refugee camps even more precarious. Flooding, landslides, and cyclones—natural disasters intensified by global climate change—destroy shelters, contaminate water sources, and disrupt health services.

According to a 2023 report by the UN Environment Programme (UNEP), climate-related disasters have increased in frequency, with Bangladesh being particularly vulnerable to such events. Every disaster exacerbates the already limited healthcare infrastructure, leaving refugees without the support they need to manage their health. The need for climate-resilient healthcare models that can withstand these challenges is urgent, as is the need for increased international collaboration to support the health of displaced populations.

The failure of Myanmar to protect the rights and health of the Rohingya population, and the subsequent burden placed on Bangladesh’s healthcare system, demonstrates a clear violation of the principles of UHC. The promise of Universal Health Coverage is that everyone, everywhere, should have access to essential health services without financial hardship. Yet, displaced populations—like the Rohingya—are often excluded from national health systems and left to rely on the goodwill of international agencies. This exclusion only deepens the health inequalities between refugees and host populations.

To achieve UHC, governments must ensure that vulnerable populations, especially refugees, are not left behind. The Rohingya crisis calls for a global response that goes beyond providing emergency relief. It requires long-term solutions to integrate refugees into national health systems, strengthen healthcare infrastructure, and address the broader determinants of health, such as sanitation, nutrition, and climate resilience. This will require both national governments and international partners to work together to build a healthcare system that is inclusive and resilient.

The Rohingya refugee crisis, compounded by climate change, is a reminder that Universal Health Coverage cannot be realized unless it addresses the needs of the most marginalized. Refugees should not be excluded from the healthcare system. The right to health is universal, and it must be protected for everyone—whether they are citizens or displaced persons. Only by extending healthcare to the most vulnerable can we move toward a truly universal and equitable health system.