Natalia Kanem is executive director of the UNFPA. As a medical doctor she is no stranger to humanitarian crises, but she said she has never seen anything like what's happening at Cox's Bazaar.
"Just in the months of January, February, March and April, more than 20,000 Rohingya women gave birth in the camps," she said. Many of the births came 9 months after Rohingya women were subjected to what one UN official has described as "a frenzy of sexual violence."
The humanitarian medical NGO, Doctors Without Borders, say their team treated more than 18,800 victims of sexual violence last year. Kanem says when refugees arrive, the medical concerns run from pregnancy to sexually transmitted infections, and even HIV.
"It is also very important for us that the women not be stigmatized," said Kanem. "So many women, for example, do not know who the father of their baby is, and from our perspective, this is a woman who should have her full human rights. She and her child must not suffer discrimination. They must not be stigmatized."
But that is easier said than done, she adds. Kanem says the lifetime of mental anguish and stigma is also a humanitarian tragedy.
"We very often are trained to treat the problem that you can see, but one of the women said to me, "Yes they’ve been able to treat my wound on the outside, but the one inside the doctor doesn’t see, this is the one that pains me the most."
Kanem's immediate concern though, is for the safety of the mothers and their babies. She says the public health situation in the over-crowded camps is bad and getting worse. Even finding access to clean water is a tall order. She says the cultural differences are also posing a challenge.
"There is a tradition of Rohingya women delivering in their tent in their house. In fact unaided birth is not a safe birth," said Kanema. "We have deployed dedicated midwives, many of them Bangladesh midwives who know the language of the Rohingyas, and we have safe spaces along with cooperation towards even a Caesarean section we can do if necessary."
Kanem helped create one of the 19 safe spaces in the camps -- a women and girls only shelter. Over 80% of the camps are made up of women and children, and Kanem says it’s crucial to create safe spaces for counseling, privacy and medical care.
These shelters away from home are a needed refuge, but also a reminder that for many women, repatriation alone cannot be the ultimate solution.