It is dawn at the Kutupalong refugee camp and men, women and children are filing into a hastily erected bamboo structure resembling a covered cattle market. On all sides are tables manned by volunteer doctors armed with polio drops and measles injections; once treated, children are handed vaccination cards and have their ears blackened with marker pens. At the exit, entrepreneurial refugees wait with ice-cream bikes rented for the occasion, selling coloured ice lollies to those with spare change.
Not all who join the queue know what they are lining up for, but they are reassured when they see the Médecins Sans Frontières workers in sunhats and stained T-shirts. The Muslim Rohingya people have fled a culture of oppression in Burma to find themselves starving and stateless in Bangladesh, and the kindness of strangers isn't something they are in a position to turn down.
The discrimination and violence against the Rohingyas began in Burma's western Rakhine State following the 1962 coup, when the military junta that still reigns first seized power. Marriages became subject to costly and time-consuming applications for licences; similar permissions were required for travel, so that many Rohingyas never left their villages until the day they fled their country. Land rights were revoked, leaving farmers helpless as government officials occupied fields and repossessed livestock. Boys and men were routinely rounded up and forced to work on government projects from construction to jungle clearing; many of the mothers, wives and daughters they left behind were raped by soldiers. Those who refused to work were sent to prison, where they were beaten or tortured.
Many thousands of Rohingyas fled to Bangladesh over the decades, but in 1991 the trickle of Burmese Muslims crossing the Naf River swelled and flooded a pencil-thin peninsula with more than 250,000 refugees. The Bangladeshi government registered newcomers at 20 camps in the hills surrounding Cox's Bazar - a Dubai-style pleasure palace teeming with five-star hotels and upmarket beach cafés - where they remained while the two nations wrestled over the fine print of a repatriation agreement. Between 1992 and 1997, 236,000 refugees were sent back to Burma, the vast majority against their will. Of the 20 camps, Kutupalong is one of only two that remain, both operated by the UNHCR. Between them, they hold 26,000 Rohingyas who are registered as residing in Bangladesh.
The unofficial number of refugees is, however, far higher thanks to a second wave of border crossings in the past two years. It is hard to put even a rough figure on the scale of the influx: Bangladesh's refusal to accede to the 1951 Refugee Convention gives it no legal obligation to guarantee the status or safety of refugees, and no Rohingya has been formally registered since 1992. Moreover, the similarities between the Rohingyas and the Chittagonian-speaking natives of Cox's Bazar make it hard to distinguish asylum-seekers from local people. But the numbers are growing. The official Kutupalong camp is now surrounded by a nebulous shanty town, whose mud and thatch homes make the original wicker and galvanised steel houses look luxurious by comparison. The 200 refugees arriving at the camp in 2007 were followed by 2,000 more in 2008; by March 2009, more than 20,000 unofficial settlers were ranged around Kutupalong, and hundreds more are turning up every week.
Conservative estimates now put the total number of Rohingyas in Bangladesh back at around 250,000. This is a grave problem for the world's eighth most densely populated country, in which roughly a quarter of the people live in extreme poverty. In May, the Bangladeshi foreign minister travelled to Burma to begin rewording a repatriation deal proposed by the military government in late 2008, but failed to secure formal assurances that those resettled would be treated any better than before.
Meanwhile, the squalor at Kutupalong deepens. The open doorways of the low-slung mud huts offer glimpses of emaciated old men collapsed corpse-like in corners, or women rocking wailing babies in makeshift hammocks. An elderly man approaches with his young son. The boy is weeping: his arm is badly swollen, his lip bloodied, and one eyebrow is opened in an angry cut peppered with grit. "He was out collecting firewood this morning when a group of men from the village attacked him," the father says. "Others just watched."
Sarah, an MSF worker from Somerset, confirms that mobs of locals are now frequently attacking refugees. "It's not hard to see why: these people are living on government land, creating cultural tensions and draining resources in an already poor community. They are rejected by Burma and ignored by Bangladesh, and every time they stand up for themselves they get pushed back down."
Every day refugees arrive with severe disabilities that have gone untreated for years. Eleven-year-old Mahabieh rarely leaves her father's hut due to a tumour that has swollen one side of her face to the size of a football. Thirty-year-old Fir Ahamad is so incapacitated by a muscle-wasting disease that his elder brother Noor carries him slung over his shoulder like a sack. "In Burma I worked as a forced labourer," he says, "and every time I fell down they beat me."
For the MSF doctors, working in collaboration with Unicef, such individual ailments must take a back seat to the wider threat of humanitarian disaster. Space is now so short at Kutupalong that newcomers are being forced to erect flimsy shacks on what is essentially floodplain. Even more worrying is the water supply; the unofficial refugees are drinking from 12 hand-drawn bucket wells in which the water was milky with stagnation and chronically high in bacteria long before the monsoon began to wash human waste down the hill. "Right now the clinic is dealing mainly with malnutrition, skin diseases and respiratory infections," says Sarah, "but if the water supplies are contaminated we're likely to see a huge surge in sickness and mortality that we're going to struggle to cope with."
The Bangladeshi government constantly monitors those working to help the Rohingya people, determined to prevent too rosy a picture of refugee life being painted, lest it encourage others to cross the border. Yet many are ready to risk death to escape living under the Burmese regime. "In Burma we were less than animals," says Juhura Begum. "We were like ghosts, living lives that had already ended. At least here we can act like human beings and go about our business with a small measure of freedom."
Kamal Hussein, 35, is forced to hobble around on a wooden crutch, one leg shattered in a beating and trailing uselessly in the dust, but he says that life here is a "paradise" thanks to his new-found freedom to pray at a handful of improvised mosques.
Hossein Hag, who watched his business collapse due to travel restrictions inside Burma, feels a similar sense of hope. "I used to dream of escaping poverty by making a success of my business," he says. "Now I know there are worse things than poverty, and more important things than financial success. In Burma we lived constantly in the shadow of death. Bangladesh feels like a place where life can begin again."