As developing countries around the world scramble to secure enough COVID-19 vaccines to inoculate their own citizens, vulnerable refugee populations like the Rohingya remain at especially high risk. Over 1 million Rohingya refugees have fled Myanmar from successive waves of violence against the Muslim minority ethnic group since the 1990s. Most have landed in Bangladesh, corralled into overcrowded camps around Cox’s Bazar, as well as the previously uninhabited island of Bhasan Char. Others have set sail on leaky vessels to Malaysia, Indonesia, and Thailand, or made their way to India and Pakistan. While the governments of Bangladesh and Malaysia have pledged to vaccinate the refugees, they have yet to release detailed plans on how they plan to do so. This constitutes a significant risk not only to the refugees themselves, but also to the citizens of these countries.

Cox’s Bazar, the region in Bangladesh where most Rohingya refugee camps are located, has so far managed to fend off the worst-case scenario. The World Health Organization (WHO) has confirmed approximately 400 cases and 10 deaths out of more than 866,000 Rohingya in the 10 square miles of Cox’s Bazar. However, testing efforts have fallen short. WHO has collected only 30,000 tests in Cox’s Bazar since March 2020 – only around 3 percent of the population there. Some Rohingya in the camps fear that they might be detained or possibly killed if they show COVID-19 symptoms.

Another public health risk is that the government of Bangladesh has shipped over 7,000 Rohingya, some forcibly, to Bhasan Char, an uninhabited island in the Bay of Bengal which lacks basic services, including running water. Without health infrastructure on the island, medical emergencies will require a three-hour journey from the island to the mainland. The island is also frequently battered by cyclones and prone to severe flooding, which would further exacerbate public health challenges for the Rohingya who are forced to live there.

Dhaka has initiated a draft proposal and budget to include the refugee population in its National Deployment and Vaccination Plan for COVID-19 Vaccines. The government is working closely with COVAX, a global vaccine distribution facility led by the WHO, and has set aside 5 percent of vaccines for applications like refugee access. But until those plans are finalized and publicized, it remains unclear whether the Rohingya will be prioritized for vaccines similar to Bangladeshi citizens or whether they will be last in line. Additionally, the strict lockdown the government imposed on Cox’s Bazar in April decreased the humanitarian aid staff deployed there by 80 percent. This will make monitoring vaccine rollout to the refugees more difficult.

While humanitarian aid workers report that the Rohingya are generally receptive to receiving the COVID-19 vaccine when it becomes available, the reduction in staff will also impinge on their ability to contain the spread of misinformation related to the vaccine, especially as the Bangladeshi government has restricted internet and phone service within the camps. Another hurdle is that Bangladesh is receiving its vaccines from India, who was contracted to manufacture the AstraZeneca vaccine. New Delhi has long displayed an antipathy toward Rohingya, including by making frequent threats of deportation.

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Poor communication between Bangladeshi government officials and Rohingya community leaders remains a serious obstacle to vaccination efforts. As Daniel Sullivan of Refugees International has reported, “engagement with the Rohingya community has been limited to poorly coordinated, last-minute information campaigns rather than genuine consultations,” while the government has stalled the U.N. refugee agency’s efforts to build a community representation system. Rohingya in Cox’s Bazar have expressed frustration at the lack of information from government officials regarding COVID-19 safety measures and testing.

Malaysia has also made initial commitments to vaccinate “undocumented migrants,” a term the government applies to the Rohingya, which it refuses to refer to them as refugees. Since 2017, more than 102,000 Rohingya have landed on Malaysia’s shores. However, many are being held in migrant detention centers, effectively cutting off humanitarian aid workers’ access to the Rohingya. Additionally, the Malaysian government has said it will prioritize giving the vaccine to Malaysian citizens and has not specified a time frame for when undocumented migrants would receive the vaccine.

Chances of vaccinating the over 600,000 Rohingya still in Myanmar are slim. Myanmar has never provided basic services to Rohingya populations, and has actively persecuted the group. However, over 130,000 Rohingya remain internally displaced in crowded detention camps within Rakhine State. Vaccinating them should be a priority if Myanmar wants to avoid another widespread COVID-19 outbreak. Unfortunately, the February 1 coup will complicate efforts to contain the spread of COVID-19, much more so in the remote parts of Rakhine where most of the Rohingya live.

As the United States brings the COVID-19 pandemic under control with its own robust vaccination program, it will need to begin planning now for diplomatic re-engagement in Southeast and South Asia. The United States may have a surplus of vaccines by the end of the year with the Johnson & Johnson vaccine’s recent approval for emergency use and Novavax showing promising results in stage 3 trials. Washington should prioritize and plan for direct vaccine aid to countries in the region that house significant populations of Rohingya. That aid should be conditioned on those countries more explicitly integrating refugees into national vaccination strategies.

In a February phone call with Secretary of State Antony Blinken, Bangladeshi Foreign Minister A.K. Abdul Momen urged the U.S. to appoint a “special envoy” for the Rohingya, and to take the lead on Rohingya repatriation efforts. Such an office may be an opportune vehicle with which to assist Bangladesh in its Rohingya vaccination efforts.

Bangladesh deserves credit for taking in the majority of Rohingya refugees and saving many lives in the process. It must now recognize that any potential COVID-19 outbreak among the camps represents a risk for all of Bangladesh. To ensure smooth vaccine rollout, the government will need to better engage and inform Rohingya community leaders. It should also explicitly include Rohingya in its vaccination plans and commit to treating vaccination of Rohingya refugees just the same as they would Bangladeshi citizens, integrating them into any tiered rollout system based on age, job sector, health conditions, or otherwise. This exact strategy worked in Jordan, where the government has already begun vaccinating Syrian refugees in its own camps.

Governments around the region can also reduce hesitancy among the Rohingya refugee population by following Indonesia’s lead and publicizing that the vaccines are safe and halal. Lastly, Bangladesh should immediately pause the relocation of Rohingya to Bhasan Char, where there is no health infrastructure, constituting a risk for widespread outbreak among the refugee population, which could lead to new mutations and outbreaks in the wider Bangladeshi population.

Simon Tran Hudes is a research associate for the Southeast Asia Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C. He can be found on Twitter @simonhudes.

Kyra Jasper is a Southeast Asia scholar in Washington, D.C. She can be found on Twitter @kj_spade.

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