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

IIt’s mid-afternoon on Wednesday and Toyoba Begum, 37, is sitting up at the foot of her hospital bed, the second in a row of eight. Dressed in a beige tunic and canary yellow pants, with a belly belt clamped around her stomach, she watches her two-day-old daughter sleep under a fleece blanket.

She says she feels great relief that her fourth baby has arrived safely into the world. That wasn’t the case three years ago when Begum worked six days. Her third baby was eventually delivered by caesarean section, but did not survive.

Begum looks at her hands and says she blames herself. “The whole time I was telling myself that maybe it was because I was sleeping so much and that’s why the baby died,” she says. The exact reason will probably never be known.

Begum was born here in a refugee camp in Cox’s Bazar in Bangladesh to parents from neighboring Myanmar. On the site, which consists of 33 overcrowded camps, deaths of newborns and mothers are not uncommon. Although recent data are scarce, UNICEF reported 84 maternal deaths in 2023 – 295 per 100,000 births.

In some parts of the camps, where about a million Rohingya refugees reside, Maternal mortality is 44% higher than elsewhere in Bangladesh.

Although there are efficient and well-run maternal health centers in the camps, not everyone chooses to use them, while the expertise to manage complications can only be found in a few specialized centers.

This time, Begum was able to reach Friendship Hospital, a 24-hour referral center for emergency obstetric and neonatal care, the only such facility in the camps. When she went into labor, Begum was diagnosed with high blood pressure and preeclampsia at a smaller clinic and was immediately referred to Friendship. Since then, she has been resting in the general women’s ward, where eight fans circulate the clammy air and several other women lie with their babies. Because there are only six cots available and as many as twelve women give birth every day, bed sharing is the best option.

Most women take the dusty roads back to their one-room home within 24 hours of giving birth. But no one remains safe, according to Begum, who says child trafficking and theft are among the dangers of camp life in Cox’s Bazar.

“Maybe someone will just pick up the baby and sell it in another camp,” Begum says. “If someone kidnaps or takes away the child after giving birth and after raising it, it is very painful.”

In the absence of opportunities to work or study, and without the option of returning to Myanmar, many gangs have emerged that are guilty of kidnapping, rape and murder, arson and forced marriage, among other crimes.

Many Rohingya arrived at the camp in 2017, after Myanmar’s military government persecuted the ethnic minority group. Unable to integrate into Bangladesh, Begum’s family, like others, is stuck in a no man’s land.

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

She explains that when women give birth at night, it can be impossible for them to leave the house – violence after dark means the camps are not safe. “As a result, women cannot access health facilities on time,” says Ngoh.

Midwife Sumana Akter, 24, has taken a break from caring for three women in Friendship’s labor department, saying she chose to work here rather than in a private facility because “in this Rohingya or humanitarian context there is always a need for midwives”.

During a shift in which the four midwives on duty will likely deliver a dozen babies, Akter has already prepared a patient for a caesarean section, supported a laboring mother and treated another three for complications.

Dressed in the pink uniform and matching headscarf of the hospital’s maternity staff, Akter says it is a Rohingya tradition for a woman to give birth at home. “I’ll ask them, ‘Why didn’t you come sooner?’ Your condition is so critical.” She will say my husband did not agree.”

The journey to a clinic can also be long – often up to a 30-minute drive, depending on the camping location – and dependent on having a vehicle available. When they reach a facility, perhaps a primary health center (PHC), their case may require a referral – and even more time is wasted, says Ngoh.

Today, Kalpana Rani, midwifery coordinator for UNFPA, is on duty at the PHC in Cox’s Bazar Refugee Camp No. 4, about a 20-minute drive from Friendship. It serves a population of almost 9,000 people, with approximately 50 babies born every month. In November, three women died: two from preeclampsia and one from postpartum hemorrhage, Rani says.

A worn wooden birthing chair rests against the window, and above a narrow bed hangs a thick rope, marked by the hands that previously held it. It is traditional to use a rope for a home birth and having one here makes women feel more comfortable, she says.

Rani trains and supports other midwives in convincing communities of the benefits of maternal health care. “They advise the mother and build trust,” she says. Because of her work, she sees her husband, a long bus ride away in Dhaka, for only an hour a week.

It’s small units like this one, tucked away at the back of a larger clinic, where cats roam the concrete floors and the heat seems to float in the hallways, that refer patients with suspected complications to Friendship.

A few nights earlier, during her Sunday evening shift at Friendship, in a room with just three beds, Akter had six patients in labor, six needing C-sections and five women awaiting blood transfusions. “It wasn’t a good feeling because everyone was on active duty, so it’s not like you can prioritize this over this. It’s a shame they have to wait,” she says.

Nowadays it is quieter and she can spend more time with patients like Begum. Akter places a stethoscope in the as-yet-unnamed newborn’s heart and contacts Begum about her postpartum pain. The mother goes home later today, with a difficult future ahead, but with a healthy daughter.