No Coconuts in Camp

Rohingya Crisis

Mohammed* is 35 years old.  He looks like he is 70.  Well, until he smiles, that is. Then everything changes.  He has some malignancy growing in his liver that is destroying it and his entire body.  It is causing his muscles to waste away; nearly every bone in his arms and legs is visible.  His feet are hardened from walking to our clinic, sometimes daily, when the abdominal pain is too much or the swelling becomes unbearable.  In his condition, he should not be able to walk. But he has to.  There is no choice.  The flesh that hangs from his face lights up—wrinkle pleating upon wrinkle— and packs itself backwards into his gaunt cheekbones when Anam walks into the room. She hands him a green coconut.  Abdul Hamid brings him juice, Rache and Chris bring sweet crackers. All smiles. For two weeks we’ve brought in needles for injections of antibiotics and pain medication, and also a long cannula to insert and drain the pernicious fluid that accumulates in his belly.  From Mohammed, when I do this, I get frowns and glares—I see a young man who is dying. But when the needles come out and the fluid is drained, he also smiles at me.  He rests for a bit, then he takes his walking stick and carries himself home, barefoot, exhausted.

Mohammed is on palliative care now: there is nothing more we can do besides keeping him comfortable. This would be true in the U.S. too, but still, it smacks of shame.  Mohammed has come from a country where he has likely not received medical care for most of his life.  He crossed the river between Myanmar and Bangladesh in the middle of the night, fleeing a backdrop of burning villages and gunfire, rape, incomprehensible violations of human dignity, and profound fear.  He carried with him all that he had, including his cancer. And yet he has survived. He has survived the indignities forced upon him because he is Muslim, because his skin is darker than most Burmese citizens, because he, as Rohingya, has been declared “stateless” by a government and military regime desperately trying to maintain power.

The Bangladesh/Myanmar border.

You’ve likely seen Mohammed’s face if you’ve paid any attention to the news. His face is that of the thousands of faces burdened by suffering and fear.  But you’ve likely not seen his smile. The media follows the suffering, a one-sided story of sorrow. Mohammed’s smile, though is subversive. It is a parry against the genocide—denied by Nobel Laureate and current State Counsellor of Myanmar Aung San Suu Kyi—that lays waste the Rohingya.   Mohammed’s smile is a bold resistance against a cruel state. His smile resonates like the words of Holocaust survivor and philosopher, Viktor Frankl, “In some ways suffering ceases to be suffering at the moment it finds a meaning.”

For those of us treating him, we catch a sense of that meaning – incomprehensible but real and present every time he smiles.  It is a wordless, revolutionary act.

It is this revolution of resilience that brings light to Hakimpara Refugee Camp in the southern region of Bangladesh, home to 1.2 million people—mostly Rohingya, but also Christian and Hindu minorities who have also fled Myanmar. Here, it is mostly peaceful.  Here, communities support one another with the little that they have. I worry deeply, however, about what the future will bring. Stateless in Myanmar and stateless in Bangladesh, the citizens of this camp have very few rights.  They are not allowed to own a cell phone.  They are not allowed to work.  They are not allowed to travel outside the military checkpoints.  There are, of course, exceptions.  With countless phone calls and letters, we can sometimes move a sick patient across the boundary so that they can receive essential medical treatment in Cox’s Bazar. The movement of these patients, as exceptions go, is unpredictable.  Far more people get turned away at the checkpoints than those who are able to cross, even if their lives depend on it.

History throws opaque shadows. We can look closely at what happens when people are stripped of their rights while living in a place surrounded by others with so much more.  As we move into 2018, the word radicalization is heard frequently. Governments continue to turn a blind eye to the acute suffering of millions. People with nothing also have nothing left to lose. People with no granted rights may make a stand in order to achieve group actualization. They may do so with force. We see it time and time again.

Here, today in the Rohingya camps, there are endless opportunities to treat the sick and feed the hungry, while supporting the educational, creative, religious and community needs of millions.  Here, in this place, there is a peaceful, but poor setting that is primed for success. The opportunity for optimism remains strong.  And even as the rainy season threatens the infrastructure of the camps, there is much good work being done. World Bank President, Jim Kim says, “Optimism is a moral choice. Pessimism in the face of extreme poverty can be a self-fulfilling prophesy that is deadly for the poor.” Optimism is the only option here, but it must be shrewd and calculated.  It must be planned, well-coordinated and ethically sound. There is no other choice.

Each day on our way into camp, we pass busy markets full of tom-toms NGO vans, buses overcrowded with Bangladeshi citizens and lorries stacked with bamboo to make shelters for the camp’s newest arrivals.  In the markets, we see fresh fruit and meat: legs of cows and lambs hanging from roofs; men who stand around paan vendors to buy beetle-nut and leaf-wrapped treats; piles of daikon radishes; clothing; and other food staples.  And there are coconuts, tasty green coconuts, full of isotonic fluid. Delicious and nutritious. We stop in one of these markets before we cross the military checkpoint.  On the other side, there are markets (and they seem to expand each day). The goods sold there, though, are older and less fresh.  There is a limited selection. There are no coconuts.

The last time I saw Mohammed and we drained fluid from his abdomen, it had gone from clear to cloudy, which suggests infection.  When the draining was almost complete, the yellow tinged peritoneal fluid changed to a rich, burgundy-red. Blood in the peritoneal cavity indicates a sinister progression of his disease. He thanked us when he walked out of our clinic that day and smiled his radiant smile.  He asked us to find another green coconut for when he would return.

We know that we may never see him again.

* The patient’s name has been changed in this text to honor his privacy.





Christmas Eve: Hakimpara, Rohingya Refugee Camp

Rohingya Crisis

A woman rushed into our clinic holding a piece of cardboard. The scribbled, broken English read, Not come late…Help. Her brother for two days had neither walked nor eaten.  She said that he had been beaten. She was desperately afraid for his life.

Where they live, there are only footpaths, steps carved in dirt that traverse steep hills.  The smoothness of the steps, their ledges worn bare from feet hauling bamboo poles and tarpaulins, boxes of fruit, plastic barrels of water, firewood and human bodies into the heart of a camp too vast to count is population, tell us stories.  The more worn the steps, the older the camp.  The smoother the steps, the more we understand the density of the vast migration into the deforested hills of southern Bangladesh. On these steps we track the escape from the ongoing genocide in Myanmar.  These steps speak suffering but they also reveal a burly will to survive among the Rohingya people.

Chris, our clinic field coordinator carried a folded stretcher on his shoulder.  I followed with our translator, Mohammed, in a rushed cadence up the slopes.  “When the rainy season comes, this camp will wash away,” commented Mohammed as he slipped upwards on the loose dirt.  Up three slopes, down two and then along a final cliff-like ledge, we arrived at a small home. We removed our shoes and stepped into the shelter, wrapped in stifling plastic tarps.  There lay a 19-year old, sweating, with his eyes closed. His sister had found him unconscious with a piece of cloth tied around his neck. She heard that he had been choked before being hit by a wooden board.  Though Chris and I found minimal signs of trauma when we did a rapid initial assessment, we were very worried. This teenager was paralyzed.  He did not move; he didn’t speak; he didn’t respond to pain. His eyes shifted from side to side when different voices spoke; he wept when he heard his sister’s voice, that was all.

We moved him to the stretcher. The weight of the metal-poled retractable cot is frequently greater than the weight of the patients we’ve carried out of the camp and to our clinic.  The elderly and malnourished living here are beyond frail.  But this patient was different, he was fit, muscular, and he had been well-fed. According to his sister, he had graduated with honors from his secondary school right before fleeing his village in Myanmar.  We shifted him out of the tent and along the cliff. As we carried him out of the camp, a crowd of fifty or more people formed around us. For 30 minutes we navigated the slopes with our patient, his face covered to protect his eyes from the sunlight. The crowd asked if he was alive. Back at our clinic, we then loaded him onto an ambulance to take him to the International Red Crescent (ICRC) field hospital. I sat next to him in of the ambulance and held his arms to his chest so that he would not fall off of the stretcher while the vehicle trembled along the tired roads. The young man cried the entire trip, his tears carved rivers through the caked dirt on his cheeks. He did not fit the picture of a neurologically devastated patient, nor did he have signs on his neck from strangulation.

At the field hospital, he became slightly more responsive, but he was still far from normal.  We considered catatonia. People who have experienced profound traumatic events, when reintroduced to some other trauma, have been observed to fall into a catatonic state, in which they seem to be physically paralyzed. Our ambulance team left the patient and his sister at the field hospital to return to our clinic, now saturated with patients waiting to be seen.

The road from the ICRC to our clinic is chaotic to say the least.  Traffic, goats, people and non-governmental organizations (NGOs) line its borders in an incessant shuffle of movement and aid. We drove by one of the entrances to the camp (now preparing to increase its size to support 800,000 refugees) and there I saw a child running over a hill with a kite in tow.  Behind him, more children, more kites. We had an entourage of onlookers who followed the teenagers body down from the camp, and now back up towards the heart of it, children ran and laughed.

A few days before to this event, on Winter Solstice, my team walked through the camp. We saw soccer fields and cricket pitches we rice once grew. We saw families playing kick volley ball together, small shops selling snacks. We saw many kites made from discarded plastic. Even the darkest day of the year was filled with the palpable energy of play. Children had filled a plastic water jug with air and were hitting it into the air as if it was a balloon. Adults laughed together, telling stories.  This neighborhood in the camp was lit with excitement.  It reminded me of walking through holiday markets in New York City’s Central Park.  There was the flavor of thrill in the air.  But through the crowd of onlookers watching the evening sports, we saw a man who walked towards the festivities from the road. He carried something on his shoulder. As he approached, we saw that it was a body, a woman in her late teens or early twenties. She was dead.  He had brought her home, presumably from a clinic nearby, to his new home, to his home in which there was no fear of government sponsored rape, arson or massacre. He carried her to this now home to be buried in peace.

The scenes of suffering and joy here remain in polar contrast while ever shifting.  There are moments of paralysis and moments of action.  There are treatments for catatonia.  There are methods by which to keep moving forward regardless of what has gone in the past.  The solutions are as fluid as the crisis itself, and yet one thing remains constant in this collective.  This thing looks like hope.  It looks like resilience.  It arises from family and community.  At times it seems completely impossible, absurd even to consider.  Yet, it remains pervasive.

I write this on Christmas Eve, a holiday that I was raised celebrating.  It is time when we light candles and sing songs of birth, of rebirth.  This is a time, back home, we we use the word “peace” with abandon. Here in the camp, we say it with every greeting: as-salāmu ʿalaykum  (Peace be with you). Here, we see profound suffering every day, which is but a fraction of the trauma that most Rohingyas have experienced for years. The Myanmar government denies this ethnic cleansing, calling it “fake news.” Other media sources have reported on the horrors here, with keen accuracy, but they write without a sense of resiliency.  What you read in the free press is true. But there is another truth that I would like to add to the narrative.  It is the truth of human survival that rises with the kites in the mornings, held by children, who fly them above the hardship below.

If you are interested in helping, please consider donating to one of the many organizations working tirelessly to serve Rohingya refugees.  The organization I’m working with is called MedGlobalYou can support them here.