Since August, about 700,000 Rohingya have fled into Bangladesh from Rakhine state in Burma, also known as Myanmar. A Muslim minority, the Rohingya have lived under increasingly repressive measures for decades, but last year the violence escalated: Refugees allege the Burmese military burned down whole villages, torturing people and raping women and girls in the process.

Many of those rapes resulted in pregnancies, and the women, now situated in the vast refugee camps of Bangladesh, are due to give birth soon.

“The peak of rape was August, so we’re expecting to see a surge of women delivering this month,” said Daniella Cassio, a midwife and lead coordinator on sexual gender-based violence with Doctors Without Borders.

Doctors Without Borders has recorded 160 cases of pregnant rape victims between August 2017 and February 2018 in the refu­gee camps. That number is expected to rise dramatically. Some 13,500 Rohingya women suffered sexual violence as they fled from their homes and made their way to Bangladesh, according to the United Nations Population Fund, or UNFPA.

“They target those between 13 and 25,” said Roksana Akter, a midwife working for Doctors Without Borders who specializes in victims of sexual violence. In November, the Burmese military released a report denying all accusations of rape and killings by their security forces.

A potential health-care crisis

Groups like Doctors Without Borders and Save the Children are scrambling to prepare for the births. They’re already struggling to meet the basic needs of the growing Rohingya population. Aid shortages and the impending monsoon season have not made caring for the Rohingyas any easier.

Kutupalong, the Rohingya camp in southern Bangladesh, is the most densely populated refu­gee camp in the world. Conditions are dire. Some families, particularly those with many children, struggle to get enough food.

In these circumstances, the exceptionally high birthrate in the camps — 50,000 babies are expected to be born in 2018, according to Save the Children — is straining overstretched health services.

The boom in babies born from rape could easily lead to a health-care crisis, Cassio said.

Unwanted pregnancies

Rohingya women facing an unwanted pregnancy have few choices in the camps. Clinics offer an emergency contraceptive up to five days after intercourse as well as abortions before 12 weeks, known as menstrual regulation. Many women either do not get to a clinic at all or are too late when they do. Desperate, the women or their families take matters into their own hands — sometimes with deadly consequences.

Akter, the midwife, recalled one patient’s case. Her family brought her to the clinic and said she had abdominal pain. They told Akter she was married.

During her exam, the midwife found a broken stick lodged in the girl’s uterus.

Two days later, she died.

Her family later admitted the girl was unmarried and had been raped; to “save her,” they paid a local woman to carry out an illegal abortion, Akter said.

Informal foster care

Because of the stigma attached to being unmarried and pregnant, organizations do not have exact figures for the number of pregnancies resulting from rape. It is not uncommon for rape victims in the camps to hide their pregnancies. About 80 percent of pregnant Rohingya women give birth at home, according to estimates by Doctors Without Borders, which means many births go undetected.

Madina Khatun, 25, gave birth to her daughter in an overcrowded camp, without help from family or a midwife.

“It’s a lot of suffering to feel, a lot of shame,” she said.

Khatun takes comfort in knowing she was not the only one. Many women were raped, she said. “It is not only my fate.”

Some families give unwanted babies away to relatives or neighbors in the community, especially childless couples, according to Doctors Without Borders, UNFPA and Save the Children. Some babies are abandoned on doorsteps.

Many abandoned children have been brought to the Doctors Without Borders maternity clinic in Kutupalong. The babies stay in the clinic for a few days, but then they are passed on to Save the Children, which has created an informal foster care system that places babies with other Rohingya families.

Without the backing of the Bangladeshi government, it will become increasingly difficult to sustain this system as the numbers rise throughout May, according to Save the Children spokeswoman Daphnee Cook.

‘Damaged goods’

Pregnant rape victims face a number of risks.

“If you’re unmarried and raped, your future is almost over in terms of your social acceptability,” said Caroline Gluck, a spokeswoman for the U.N.’s refu­gee agency. “You’re tarred, damaged goods.”

As a result, many families hastily arrange marriages for unmarried girls and women who are pregnant through rape. Save the Children and UNICEF have reported an increase in child marriage in the camps.

Aid groups in the camps have launched campaigns to avoid that outcome. They also try to identify victims of sexual violence to make it easier for them to come forward. Pregnant rape victims who have been cast out by their family and are in danger of violence or isolation are referred to safe houses, where they can stay until the end of their pregnancies.

Even then, their ordeal is far from over.

“These women are probably some of the most in need of psychological support,” said Allison Fog, a psychologist with Doctors Without Borders. “They are severely traumatized.”

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