A survey by the U.N. refugee agency reveals heightened worries by the Rohingya refugee population in Cox’s Bazar, Bangladesh over their health and safety.

It has been nearly four months since the mass exodus of Rohingya refugees began from Myanmar into Cox’s Bazar, Bangladesh. More than 645,000 Rohingya who escaped violence and persecution in Myanmar are living in squalid, overcrowded settlements.  

A survey by the U.N. refugee agency and 13 other organizations finds the refugees have developed strong support networks to help them cope with their difficulties.

UNHCR spokesman Andrej Mahecic says the refugees have many worries. They express concern about their safety, considering their weak shelter accommodations and poor lighting at night.

“Access to sanitation is still insufficient, leading sometimes to long queues for latrines,” said Mahecic. “Women and girls are anxious about the shortage of private bathing spaces, forcing some to wash outside their shelters in early morning hours.”

The survey finds some children have to walk long distances to fetch water and firewood, a situation that can put them at risk. Mahecic says both parents and children want access to education and more safe places for children to play. He says health services also are a major concern.

“Increased mental health support for those who have witnessed the killings or suffered torture or rape remains crucially needed,” said Mahecic. “Refugees cite continued feelings of depression and rejection, especially among the elderly and disabled. Many young people are worried about their uncertain future.” 

Mahecic says the UNHCR will use the survey findings to improve its protection and assistance programs for the Rohingya in the coming year. He says the agency already has begun providing alternatives to firewood to address child labor and environmental concerns.

He says efforts also are under way to improve the hygiene and sanitary conditions for women and girls and to provide more child-friendly spaces where boys and girls can play in safety. Children account for more than half of the refugee population.

Health officials say the refugees are extremely vulnerable to diseases as they have low vaccination coverage and are living in congested, unsanitary settlements that are breeding grounds for infectious diseases.