REPORT ON THE 1978-79
by Alan C. Lindquist
(Head of UNHCR Sub-office
Cox's Bazar, Bangladesh,
I wish to thank the
I also wish to thank Martin Haug (League Delegate from the Swiss Red Cross to the Bangladesh Red Cross Society, December, 1977 to December, 1978) and Jim Clevenger, (Deputy Field Director, Oxfam, Bangladesh from 1977 to January, 1979) assistance with sections of this report. Responsibility for the views expressed here, however, rest solely with me.
In addition, I am grateful to Tim Dyson, Demographer of the Centre for Population Studies of the London School of Hygiene and Tropical Medicine, for his assistance with the demographic statistics.
During the past
year the problems of international refugees have received much coverage in the
world press -most of it devoted to the Vietnamese "boat people" arriving
on the shores of
What apparently triggered the flight of the refugees into Bangladesh was the combined operation of the Burmese army and administration to crush the independence movement and to conduct the first census in the area since 1962. The heavy-handed methods of the police and soldiers carrying out these operations, and their exploitation of the opportunities for extortion inherent in a situation where some people lacked documentary proof of their right to reside in Burma, accompanied by an upsurge in violent clashes between the two communities, created a climate of fear. News or rumours of beatings, abductions, and killing of Muslim men, and of the rape of Muslim women, spread from village to village, and many Muslim families were spurred into flight.
There is no doubt that a number of atrocities did occur, but whether or not the fears were justified in terms of the real threat the Muslims faced from either the Burmese authorities or their Buddhist neighbors,200,000 people believed they were in sufficient peril to pack up what possessions they could carry and trek for up to 100 miles to reach the relative safety of Bangladesh.
As the refugees poured into southern Bangladesh, 12 camps were established by the Government of Bangladesh along the road connecting Teknaf at the southern tip of Bangladesh, and Cox's Bazar, the commercial and administrative centre of the area, 50 miles to the north. A 13th camp was located some distance to the northeast, in the Chittagong Hill Tracts. Officials from different government departments all over the country were deputed to administer the camps. These "magistrates", as they were called, were responsible for the registration of refugees, for the maintenance of law and order in the camps, and for the distribution of relief supplies.
The Government of Bangladesh appealed to the United Nations for assistance in May, when the number of refugees had reached 150,000. The U.N. Secretary-General designated the United Nations High Commissioner for Refugees (UNHCR) as coordinator of U.N. assistance. The High Commissioner (Poul Hartling, former Liberal Prime Minister of Denmark), who had no permanent representative in Bangladesh, appointed the United Nations Development Programme (UNDP) Resident Representative in Dacca, Bernard Zagorin, as the Special Representative of UNHCR, and then deputed an experienced UNHCR officer, Roman Kohaut, to Bangladesh as Chief of Field Operations.
The High Commissioner also issued an appeal on May 29 for $15,565,000 in cash or kind to cover assistance to the refugees through 31 December 1978. As of 30 September that year, a total of 12 governments and the EEC, 6 non-governmental organisations, as well as UNICEF and WFP, had made confirmed contributions of over $7.6 million in cash and over $6.7 in kind. In addition to this total of $14.3 million, UNHCR was informed of bi-lateral aid for the refugees valued at more than $12.7 million.
The Government of Bangladesh, with U.N. assent, established a basic daily food ration for adults consisting of 200 grams of wheat flour, 200 grams of rice, 40 grams of fish protein concentrate ("FPC"), 30 grams of vegetable oil, 10 grams of sugar, 10 grams of salt, and 2 grams of tea. The caloric value of this ration was estimated to be 1,910 cals. Children under 12 years were to get half that. This ration was to be distributed on a weekly basis by the camp administration to housing unit leaders (majhis) who would then pass it out to the individual families.
More than 2,300 communal shelters or "sheds" were constructed by the refugees with bamboo and plastic sheeting provided to them. The Bangladesh Government's Department of Public Health Engineering sank nearly 700 tube wells for drinking water in the camps and dug several times that number of trench and pit latrines.
The Bangladesh Red Cross Society (BRCS) set up medical clinics in each of the camps staffed by student doctors and nurses to supplement the government health centres. It also established "vulnerable group" feeding centres in June where children under 12 years old, expectant and breast-feeding mothers, and old people over 65 years could obtain one hot cooked meal per day of mixed rice and lentils, containing perhaps 600 calories. At least 55 per cent of the population fell into the "vulnerable" category.
Despite all this assistance, however, by July it had become
apparent that all was not well in the relief operation. Based on official
Government of Bangladesh figures, the death rate in the refugee camps during
the first part of June was running at about seven per 10,000 per week or 4
percent per year. This was already twice the average for
Yet during most of that period, more than 90 percent of the
refugees had been settled in easily accessible camps near a reasonable
all-weather road within 150 miles of
So why did so many people die?
The answer to that stark question lies squarely in the arena of
politics. The objective of the Bangladesh Government from the beginning was
that the refugees should go back to
That statement effectively ended the discussion. None of the U.N. agency heads raised any objection to using food as a political weapon. The Bangladesh Government was not going to make the refugees "comfortable." It was going to keep the pressure on them until they went back.
It is doubtful that the government had a conscious policy at this time to starve out the refugees. But anyone with a knowledge of how things actually work at the implementation level in rural Bangladesh should have realised what dangerous folly it was for officials to think they could sit in Dacca offices and "fine-tune" the food ration to the point where all refugees had enough to survive on but not so much that they were "comfortable."
Given the "slippages" (due to both inefficiency and corruption) that almost invariably occur by the time a quantity of food gets distributed to a refugee family, and the virtually inevitable inequalities in distribution between refugees, keeping the ration at an absolute minimum was bound to drive the weakest of the refugees (usually the children) over the line of existence. And so it happened. Children died literally by the thousands, including hundreds in the first month of the U.N.-declared "International Year of the Child," 1979.
History of the relief operation
The original daily food ration for adult refugees established by
the Government of Bangladesh in May, 1978 — mentioned above — was rated at the following caloric
Table 1; General Food Ration
Foodstuff Quantity Caloric Value
wheat flour 200
grams 720 Kilo calories
rice 200 grams 720 Kilo calories
fish protein con-
centrate (FPC) 40 grams 160 Kilo calories
vegetable oil 30 grams 270 Kilo calories
grams 40 Kilo calories
salt 10 grams ---
tea 2 grams ---
Total... 1,910 Kilo calories
Children under 12 years were to get half that, or 955 Kcals.
UNHCR, despite its extensive experience in refugee operations over
a period of more than 25 years, did not have a single nutritionist on its
staff, neither in Geneva Headquarters nor in any regional or field office. In
Dr. Aall wrote a number of excellent nutritional situation reports which were distributed to all U.N. agencies and government departments concerned. These clearly spelled out the food requirements of the refugees, warned of the consequences of not meeting them, and described the deteriorating nutritional situation. Unfortunately for the refugees, his advice and warnings were generally ignored - not only by the government but also by the U.N.. His contract, which ran out with FAO in September but was continued for three months by UNHCR, was ultimately not renewed - evidently because he had become too much of a thorn in the side of the government and the U.N..
Regarding the original food ration established by the government listed above, Dr. Aall wrote in a report dated 18 May 1978 that, "Although generous in protein, this ration is extremely low in calories and would hardly allow for survival, not to speak of any activity like walking, carrying water, cutting wood." In fact, however, the basic food ration was even lower than the 1,910 calories listed for adults. The vegetable oil seldom ever reached the refugees, and the government decided that the sugar (as well as the tea) was a luxury that the refugees should not receive. So the ration was actually knocked down to around 1,600 Kcals per adult (or only about 1,360 average per person) On top of this, the wheat flour and rice did not always arrive on time.
As a remedy, Dr. Aall recommended a supplementary feeding programme to provide the "vulnerable groups" (children under 12, pregnant and breast-feeding women, and old people over 65) among the refugees with one cooked meal of rice and lentils, with a caloric value of perhaps 600 Kilo-calories. This proposal was taken up by the Bangladesh Red Cross society in June. The BRCS opened up an average of about two feeding kitchens in each of the 13 refugee camps.
At least 55 percent of the refugee population were estimated to fall into the vulnerable groups. Attendance in the Red Cross feeding centres, however, never climbed above 85,000 - or 42.5 percent - in the first five months of their operation. Most of those who did not attend were women and the small children in their care. The reasons for this were partly cultural.
The Bangladesh Government resisted attempts by the FAO Food and Nutrition Advisor to get the basic food ration raised by claiming that: 1) there was no serious problem of malnutrition in the camps, 2) that the refugees were already getting as much food as a large part of the rural population of Bangladesh, and that 3) the U.N. had already agreed to the existing ration. It also pointed to the existence of the Red Cross vulnerable group feeding as sufficient supplement to the basic ration.
Despite this, when a senior planning officer, Pierre Coat, came to
Pierre Coat, before returning to Geneva, made an effective representation to the Bangladesh Government which succeeded in getting the basic staple food ration raised by about 15 percent to 465 grams of wheat flour and/or rice, adding some 234 Kcalories, and in addition instituted a special booster ration for children during the Islamic holy month of Ramadan (roughly corresponding to August, 1978) equal to a full adult ration, or double what they had been receiving. This was an attempt to bring the refugees' nutrition back up to normal. The Bangladesh Government also promised to work to immediately eliminate supply bottlenecks which had meant distribution shortfalls, and to make up any further shortfalls within a week of occurrence.
The higher ration did for a time improve the situation. By the
week of September 3-10, at the end of the month of Ramadan, the number of
deaths had dropped to around 260 per week for the entire refugee population (7
percent per year.) A month later it was down even further, to 220 for the week
(6 percent per year.) This latter figure, however, was still three times the
Resistance to Repatriation
The agreement with the Government of Burma signed in
The Government of Bangladesh grew increasingly impatient with the
refugees' resistance to repatriation. Not only was it adamantly opposed to
raising the basic food ration further, as Dr. Cato Aall was urging, but it even
began to talk of reducing it. The Secretary of the Ministry of Relief, S.A.
Khasru, said in another relief coordination meeting in
In a U.N. inter-agency coordination group meeting in early
October, UNHCR Chief Kohaut sounded out the representative of the other U.N.
agencies as to whether they would go along with what was evidently a Government
of Bangladesh proposal to reduce the food ration in order to induce the
refugees to return to
Shortly after this, however, serious shortages and delays began to
occur in the food delivery to the camps. The food supply to the camps in the
two and a half months from the beginning of August (after Pierre Coat's
successful intervention with the government) until the middle of October had
actually exceeded the ration. "From mid-October to end November,"
however, according to Dr. Aall's nutrition report of
At the same time as the food supply developed problems, the Government made other moves to put pressure on the refugees. The refugees were restricted to the confines of the camps. Refugee men, up until that time, had usually, if unofficially, been able to leave the camps and work as day labourers, using their meagre earnings to buy additional food and other necessities. Refugee women had been able to go out and collect firewood as well as edible wild plants and roots. This government move, then, cut off one of the last safety valves for the refugees.
The Bangladesh Red Cross Society, which was popular with the refugees because of the devoted service of its workers, also began to feel pressure from the Government for allegedly "spoiling" the refugees. The Government at one point threatened to close down the Red Cross feeding programme. In one camp, the magistrate even ordered Red Cross Volunteers arrested.
On October 12th the Relief Ministry, in a confidential letter from the Joint Secretary, Fariduddin Ahmed--Khasru's top deputy - to Special Representative for UNHCR Bernard Zagorin, requested the withdrawal of the head of the UNHCR Sub-office in the refugee area, who was the only UNHCR officer who knew the Bengali language and could thus speak directly with the refugees. Although the government refused to state any reason for its action beyond that it considered his presence in Cox's Bazar "objectionable from a security point of view," other officials said privately that the offense was one of "over-protecting" the refugees, The UNHCR, after a short delay, meekly complied and transferred him to Malaysia.
The direct result of this 'malign neglect' in the food deliveries
to the refugees was a rapid tripling of refugee deaths, from 11 per 10,000 per
week (6 percent per year) in the middle of October, to an incredible 33 per
10,000 per week (17 percent per year) by the end of November. This was eight
and a half times higher than the already high
In December, while the UNHCR Chief Kohaut was outside
The story finally gets out
After hearing rumours of widespread malnutrition and high death
The evidence is strong that severe malnutrition has caused excessive mortality and a measles epidemic may be a contributing cause to the most recent increases in death rates. To prevent the malnutrition problem from becoming even more severe, the amount of food reaching the refugees must increase substantially. Even then, mortality rates can be expected to remain very high for several months due to the large number of already malnourished children. The UNHCR staff, FAO advisors and some Government officials in Cox's Bazar adequately recognize the seriousness of the situation and have been expending tremendous energy to improve the flow of food. However, we did not get the impression that the obstacles were being overcome, and the refugees' nutritional status is deteriorating. Suggestions are sound from local FAO disaster relief professionals, Division of Health epidemiologists, and UNHCR to correct problems, but the corrective action by the BDG has not been adequate.
This report was also sent to the U.S. Mission in
Other articles appeared elsewhere. The response to this was almost immediate. Five days later, on January 26th, UNHCR admitted at a press briefing in Geneva that more than 10,000 of the refugees had died in the Bangladesh camps, some of them from malnutrition.
Policy "success", human and moral disaster
During the time the refugees were in the
Perhaps it is the legitimate concern of the government of a poor
and very densely populated nation to see to the early departure of unwanted
extra guests, even if they or their ancestors originally came from that
country. Perhaps also it is not so surprising that the Bangladesh Government
was prepared to use food as a lever to induce the refugees to return to
More surprising than the actions of the
What could have been done? First of all, the full influence of UNHCR Headquarters could have been brought to bear on the Bangladesh Government. If that were not enough then the greater weight of the U.N. Secretary-General, who had designated UNHCR as the coordinating agency for this refugee operation. All of this could have been done confidentially, leaving as a last resort the option of going public and denouncing the policy of starving the refugees to the world community.
The standard conservative argument again the U.N. intervening with
the Government of Bangladesh as suggested above would run something like as follows:
All knowledgeable Bangladeshi observers, both in and out of
government, that I discussed this with, however, asserted that with the
prestige, influence of the U.N., and the government of
The proof that this is so came when UNHCR was forced to announce
 This electronic version of the report was scanned from a rather poor photocopy. The original pagination has not been kept, some formatting changes have been made and the occasional typo has been corrected. Otherwise, apart from this footnote, the text follows the original.
 There are several possible explanations for this
unequal coverage, one might be that
there were few new arrivals in
 According to the UNHCR
interim report as of
 All of the health professionals who had anything to
do with the refugees agreed that most of the deaths in the camps were
malnutrition-related, whether due to malnutrition pure and simple (which used
to be called by the now unfashionable term "starvation"), or to
malnutrition-complicated measles, gastro-intestinal or respiratory diseases. As
FAO Food and Nutrition Advisor Dr. Cato Aall wrote in his nutritional status
 The author was present.
 Dr. Aall, who had previously worked in a number of
African countries, including
 According to Kushi Kabir, a Bengali woman field investigator engaged by Oxfam to look into the matter, the refugee women did not attend the vulnerable group feeding centres because:
"1) For religious reasons: the Mullahs (priests) have forbidden them to go.
2) For cultural reasons: the women are very inhibited about taking food in the presence of men, especially when not all of these men are from their own village.
3) For security reasons: it has happened that some of the women have been enticed away by ansars (militia) and police. [Some girls and women were also raped.] So the men have stopped the women from going outside the sheds.
4) For reasons of taste: the kitcherry [mixture of boiled rice and lentils] served at the centres is not well liked. In those cases. where men have been able to sneak outside the camps and earn money, other food is available and is preferred."
There were other factors as well in the women's non-attendance. Sick children often did not attend because they were too weak to travel the distance and undergo the jostling. (They were often not taken to the doctor for the same reason: after the strain of walking or being carried there and waiting for several hours in the crowd, with probably at least an even chance that they would not get to see the doctor at all or if they did then still not getting any effective treatment, they were quite likely to return to their homes sicker and weaker than when they left.) Beyond these reasons, the vulnerable group feeding programme was not very popular with the refugees because it attempted to artificially and bureaucratically split up the families and exclude the men and the women without babies.
 The Bangladesh Red Cross Society also set up a "treatment feeding programme" in late July to feed severely malnourished children special food five times a day in each camp. The Government may have thought of this as a 'safety net' to catch people before they actually starved to death. But the Red Cross was already over-extended and didn't have the fully qualified doctors necessary to staff the size and type of centres which were really needed to do this job. Thus at the beginning they took in only 20 children per camp. Later this was expanded to 50 children per camp - but this was still only a small proportion of those who needed it. Also, because the Red Cross was realistically wary of being blamed by the Government for the almost inevitably high death rate among the worst cases of malnutrition undergoing treatment feeding, they often favoured the slightly less serious cases for admission into their programme. The Government Health Department had plans to establish its own treatment feeding programme, but was almost criminally slow in getting it going and extremely inefficient in selecting the children to be fed.
 Besides the 16 percent not delivered, a government officer told me that an additional amount, though shown in the records as "delivered", was in fact diverted elsewhere and sold in this period. I was unable to personally verify this, but trust the source.
 Shortly after this trip Coat unfortunately took up a
new area of responsibility within UNHCR and could no longer concern himself
 The night before repatriation was to begin, on August
30th, the Commissioner for Repatriation - a high ranking government officer -
and a group of other officers and police were attempting to collect refugees in
the Ghundum camp to send back the next day when they were attacked by a large
group of refugees opposed to going back chanting "Allah-o-Akbar" (God
is great.) Several were injured and the police lost seven rifles when they
dropped them and ran. (The rifles were all returned by the refugees to the
police the next morning through the Bangladesh Red Cross Society workers in the
camp.) Most of the government officers spent the night hiding in rice fields or
nearby peasant's huts. On the first official day of repatriation only a handful
of refugees went back. The next day of repatriation was to be the 15th of
September. In preparation for this the government organised a number of
"motivation meetings" in the camps to try to persuade people to go
back. Militant action by thousands of refugees most opposed to returning to
 This is correct: UNHCR staff in the field, in Cox's
Bazar, worked very hard to improve the flow of food. But they could ultimately
not have much effect because the origin of the problem was in
 The number of needless deaths is actually greater
than 9,120 if we remember that at least half of the "normal" deaths
 According to the