Dispatch #5 - The Refugee Industrial Complex
It's weird to write about a problem when you feel like you're part of the problem. For example, this refugee crisis. I didn't personally displaced anyone, certainly didn't commit any violent acts, threaten, or attack anyone. But in trying to be part of the solution, I feel like part of the problem.
For one, any refugee crisis screws up the local economy. Before the Rohingya arrived, Cox's Bazar was a small but rowdy beach resort town for Bengali tourists. A few nice hotels, a few average hotels, 75 miles of beach, parasailing, air force base, some other government offices. When the population of the Kutupalong-Ukhia camp exploded in 2017-2018, the district of Cox's Bazar did as well. In one year, the population of the district went from 400,000 to 3.2 million. As NGOs pour into town, demand for nearly all goods rises, housing/food/raw materials supply is slow to catch up, and the cost of nearly all items rise. Basic inflation. Long-term rentals in hotels that are up to international NGO standards have monthly rents above $1,200 (Bangladesh GDP per capita = $1,751). Local Bengali staff can't afford these rents and are being pushed to the outskirts of town (away from the direction of the camp). The local Tom-Tom drivers congregate on 'Hotel Row' eager to pick up foreign staff but if you live in other Cox neighborhoods you may wait hours for a Tom-Tom to drive by. And why should they when they know this NGO volunteer is willing to pay at least double what the ride used to cost or what locals pay? For the shopkeepers, restaurant owners, and street stall owners, I don't know how you break or wind down the current cycle of inflation without putting many of these shops out of business. Based on my short observation, luckily it appears that the Rohingya crisis has so far avoided being hijacked by large companies profiteering off the refugees, like has been seen in other crises. For the journeymen workers who came to the area because of the abundance of NGO and development-related jobs, I expect most will melt back into society or move to another town with more job opportunities once the crisis is done or at least cools off. But for the business owners with loans that need paying and brick-mortar shops that have real bills where you can't just pick up and leave, I don't know how the economy downshifts without many businessmen losing their shirts. If anyone has ideas or can send me an article on this topic, I'd love to learn more!
Looking into the future, there's another crisis that I feel like I am helping to perpetuate. One of the other doctors on my trip previously volunteered in a few refugee camps in Greece. His experience there ultimately led him to conclude that the Greek government was actively shirking their responsibility for providing services to the refugees because there were so many NGOs operating in the area and if the NGOs hadn't been there, the Greek government would have been forced to step up. This last assumption is key: a belief that there's no way a government could let refugees plod along in endless squalor, that they would be forced to act due to their own compunction, or forced to act by neighboring countries/allies. Bangladesh is not here yet. The crisis is still too new, the government still reaping political benefits by taking in the refugees, the economy is growing (see above), and the problems for Bangladesh so far have been difficult but manageable albeit with ample outside support. I don't get the sense that the country is profiteering on the refugee crisis. But what happens when the NGOs start to pull out? Anecdotally, the International Red Cross is moving out and leaving the rest of the mission to the local Bangladesh Red Crescent. Which major NGO will leave next? And when the major ones leave, can the smaller ones afford to stay? MedGlobal doesn't get a break on the prices it pays for local because people know it's smaller than the Red Cross; no, instead the prices they're forced to pay may increase after the Red Cross leaves to make up for the shortfall that comes when the Red Cross is no longer paying. And when the smaller ones leave, will the government step in and step up to provide the services needed? That remains to be seen.
As my last post discussed, there isn't an end in sight and the endgame is unclear. Looking around online, I found this perfectly titled piece on Quartz.com called "When refugees camps last three generations, we must accept they’re not going anywhere." No one knows how long it takes before the NGOs tire and pull out. Actually, to say they "tire" is a misnomer. They run out of money. Maybe they run out because their services are needed more elsewhere (this appears to be the situation with the International Red Cross but the local Red Crescent will still be working). Or they run out of money because after a few years, if the world forgets about the Rohingya refugee crisis (if it's still going on), the donations for this crisis stop coming in. Or they run out of money because they spent too much upfront getting established in the camp without a prolonged funding strategy. This is what I'm worried about for the clinic I worked in. The pharmacy is stocked with nearly as many meds as my emergency department pharmacy back in Atlanta, there are two! ultrasound machines, a large bamboo structure requiring frequent maintenance and reinforcing, and a big volunteer staff that works for incentive pay (no salaries allowed - more on this in the next post). Given the circumstances, I think the clinic provides top-notch primary and urgent care. But as the needs transition towards management of chronic diseases and occasional flares requiring urgent care, can MedGlobal/OBAT/Prantic keep handing out an endless supply of free diabetes meds and asthma inhalers?
Let's face it, nearly all NGOs that do fantastic work traffic in the idea that their work is necessary, emergent, and can't be done by anyone else. If I had an organization and told you, "our work is kind of optional, it's not really an emergency but something that going to take many years to fix, and there are other people who could do it so it doesn't have to be me," would you give me money? These do-gooder organizations rely on their own PR teams, the media, and individuals like myself to keep the story alive, pressing, and compelling. The story would be there even without media coverage and is a tragedy that defies comprehension; but it is an odd feeling to actively traffic on this arena. Again, this crisis is still very dire and very emergent. These camps are not intended to be permanent cities and the refugees don't know what tomorrow will hold, much less months or years from now. But at some point in the coming years, we may cross that threshold where the camp is no longer a temporary solution, where there is general acknowledgement that the refugees can't return, and that the NGOs who responded at the start of the crisis may be doing more harm than good by continuing to stay. I don't know where the point is, how long it takes to get there, and if we'll even recognize it if it's kicks us in the ass. Let's all hope that the camp is electively disbanded and the crisis resolved long before we reach that point.
====================================================
For today's dose of sunshine, check out this throwback tune I've been grooving to.
And this article ranking the performers makes it even better!
For one, any refugee crisis screws up the local economy. Before the Rohingya arrived, Cox's Bazar was a small but rowdy beach resort town for Bengali tourists. A few nice hotels, a few average hotels, 75 miles of beach, parasailing, air force base, some other government offices. When the population of the Kutupalong-Ukhia camp exploded in 2017-2018, the district of Cox's Bazar did as well. In one year, the population of the district went from 400,000 to 3.2 million. As NGOs pour into town, demand for nearly all goods rises, housing/food/raw materials supply is slow to catch up, and the cost of nearly all items rise. Basic inflation. Long-term rentals in hotels that are up to international NGO standards have monthly rents above $1,200 (Bangladesh GDP per capita = $1,751). Local Bengali staff can't afford these rents and are being pushed to the outskirts of town (away from the direction of the camp). The local Tom-Tom drivers congregate on 'Hotel Row' eager to pick up foreign staff but if you live in other Cox neighborhoods you may wait hours for a Tom-Tom to drive by. And why should they when they know this NGO volunteer is willing to pay at least double what the ride used to cost or what locals pay? For the shopkeepers, restaurant owners, and street stall owners, I don't know how you break or wind down the current cycle of inflation without putting many of these shops out of business. Based on my short observation, luckily it appears that the Rohingya crisis has so far avoided being hijacked by large companies profiteering off the refugees, like has been seen in other crises. For the journeymen workers who came to the area because of the abundance of NGO and development-related jobs, I expect most will melt back into society or move to another town with more job opportunities once the crisis is done or at least cools off. But for the business owners with loans that need paying and brick-mortar shops that have real bills where you can't just pick up and leave, I don't know how the economy downshifts without many businessmen losing their shirts. If anyone has ideas or can send me an article on this topic, I'd love to learn more!
Looking into the future, there's another crisis that I feel like I am helping to perpetuate. One of the other doctors on my trip previously volunteered in a few refugee camps in Greece. His experience there ultimately led him to conclude that the Greek government was actively shirking their responsibility for providing services to the refugees because there were so many NGOs operating in the area and if the NGOs hadn't been there, the Greek government would have been forced to step up. This last assumption is key: a belief that there's no way a government could let refugees plod along in endless squalor, that they would be forced to act due to their own compunction, or forced to act by neighboring countries/allies. Bangladesh is not here yet. The crisis is still too new, the government still reaping political benefits by taking in the refugees, the economy is growing (see above), and the problems for Bangladesh so far have been difficult but manageable albeit with ample outside support. I don't get the sense that the country is profiteering on the refugee crisis. But what happens when the NGOs start to pull out? Anecdotally, the International Red Cross is moving out and leaving the rest of the mission to the local Bangladesh Red Crescent. Which major NGO will leave next? And when the major ones leave, can the smaller ones afford to stay? MedGlobal doesn't get a break on the prices it pays for local because people know it's smaller than the Red Cross; no, instead the prices they're forced to pay may increase after the Red Cross leaves to make up for the shortfall that comes when the Red Cross is no longer paying. And when the smaller ones leave, will the government step in and step up to provide the services needed? That remains to be seen.
As my last post discussed, there isn't an end in sight and the endgame is unclear. Looking around online, I found this perfectly titled piece on Quartz.com called "When refugees camps last three generations, we must accept they’re not going anywhere." No one knows how long it takes before the NGOs tire and pull out. Actually, to say they "tire" is a misnomer. They run out of money. Maybe they run out because their services are needed more elsewhere (this appears to be the situation with the International Red Cross but the local Red Crescent will still be working). Or they run out of money because after a few years, if the world forgets about the Rohingya refugee crisis (if it's still going on), the donations for this crisis stop coming in. Or they run out of money because they spent too much upfront getting established in the camp without a prolonged funding strategy. This is what I'm worried about for the clinic I worked in. The pharmacy is stocked with nearly as many meds as my emergency department pharmacy back in Atlanta, there are two! ultrasound machines, a large bamboo structure requiring frequent maintenance and reinforcing, and a big volunteer staff that works for incentive pay (no salaries allowed - more on this in the next post). Given the circumstances, I think the clinic provides top-notch primary and urgent care. But as the needs transition towards management of chronic diseases and occasional flares requiring urgent care, can MedGlobal/OBAT/Prantic keep handing out an endless supply of free diabetes meds and asthma inhalers?
Let's face it, nearly all NGOs that do fantastic work traffic in the idea that their work is necessary, emergent, and can't be done by anyone else. If I had an organization and told you, "our work is kind of optional, it's not really an emergency but something that going to take many years to fix, and there are other people who could do it so it doesn't have to be me," would you give me money? These do-gooder organizations rely on their own PR teams, the media, and individuals like myself to keep the story alive, pressing, and compelling. The story would be there even without media coverage and is a tragedy that defies comprehension; but it is an odd feeling to actively traffic on this arena. Again, this crisis is still very dire and very emergent. These camps are not intended to be permanent cities and the refugees don't know what tomorrow will hold, much less months or years from now. But at some point in the coming years, we may cross that threshold where the camp is no longer a temporary solution, where there is general acknowledgement that the refugees can't return, and that the NGOs who responded at the start of the crisis may be doing more harm than good by continuing to stay. I don't know where the point is, how long it takes to get there, and if we'll even recognize it if it's kicks us in the ass. Let's all hope that the camp is electively disbanded and the crisis resolved long before we reach that point.
====================================================
For today's dose of sunshine, check out this throwback tune I've been grooving to.
And this article ranking the performers makes it even better!
Comments
Hope this helps clarify the issue and again, thank you for reading!