Nor Anis Syazwani collects preliminary health data upon patients’ arrival at an MSF mobile clinic in Penang, Malaysia. Photo: Steven Ooi/MSF

Sometimes, Nilufah* and her dedicated team at the Medecins Sans Frontieres (MSF) clinic in Penang, Malaysia, encounter pregnant Rohingya girls as young as 12 or 13. Fleeing dire circumstances, these girls seek medical care and support.

“Some are very, very young. They don’t understand what is happening sometimes, that they are mothers or how to be a mother,” said Nilufah, a Rohingya refugee herself, who works as a volunteer with the international humanitarian organisation.

She said a lot of such cases in the past year have been girls who are new arrivals to Malaysia from congested refugee camps in Bangladesh, where about 1 million Rohingyas fled from Myanmar in 2017 to escape a brutal military crackdown targeting the Muslim ethnic minority.

However, deteriorating conditions in the camps are forcing many underage Rohingya girls to flee, with many seeking refuge in places like Malaysia for arranged marriages with Rohingya men.

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It is a very difficult situation in the Bangladesh camp, nobody [can have a] safe life there. That’s why they are coming here
Nilufah, MSF volunteer

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Nilufah said that when she asks the girls who come to see her why they are getting married so young, their answer is the same: “We do not have a choice”.

“It is a very difficult situation in the Bangladesh camp, nobody [can have a] safe life there. That’s why they are coming here,” Nilufah said.

Some girls are getting married to improve their families’ lives in Bangladesh, she added, highlighting cases in which Rohingya men in Malaysia provide financial support or payments to their bride’s families in Bangladesh as a condition of the marriage.

Desperate parents think sending their daughters away from camps might offer more security, she added, but many of the girls are vulnerable to physical and sexual violence – both by human traffickers during their journey to Malaysia, and at the hands of their husbands when they arrive.

Ali, a volunteer from the Rohingya community, takes the opportunity to run a health literacy session while patients wait for their turn at an MSF mobile clinic. Photo: Steven Ooi/MSF

“I have seen increased numbers of teenage pregnancy since last November and December,” she said, “it is sad to see them [lose their] innocence and childhood so young.”

Rohingyas are a stateless minority that have faced persecution in their home country of Myanmar for decades, but strict migration policies around the world mean that they are unwelcome in most places, with limited opportunities for resettlement.

Malaysia hosts more than 100,000 Rohingya refugees officially recognised by the United Nations High Commissioner for Refugees (UNHCR), but is not a signatory to the 1951 Refugee Convention or its 1967 Protocol, meaning it has no legislative or administrative framework to deal with refugees.

Meanwhile, the numbers show a growing trend of female refugees escaping the camp in Bangladesh. According to a UNHCR report from 2023, more than 60 per cent of Rohingya who have fled Bangladesh in boats through the Andaman Sea and survived the journey were women or children.

Video. Underage Rohingya girls forced into abusive marriages in Malaysia
Fears of arrest

Located in Malaysia’s Butterworth area of Penang, MSF’s medical centre also operates mobile units throughout the state that provide specialised healthcare to refugees, particularly undocumented Rohingya women and children.

Nilufah spoke to This Week in Asia at one of these mobile clinics, while she was in-between patients. Her team addresses issues of sexual and gender-based violence, teen pregnancies, child marriage, and intimate partner violence.

Many of the girls and women arriving in Malaysia over the past year are undocumented, she said. As a result, they are considered illegal immigrants, and often live in fear of arrest, which keeps them confined to their homes.

According to a study by Surendran Rajaratnam from the National University of Malaysia and Azlinda Azman from the University of Science Malaysia, published in November of last year, many Rohingya women are “dependent on their spouses for their survival”.

Patients await their turn for medical consultation in Butterworth, Penang State, Malaysia. Photo: Steven Ooi/MSF

The study, based on primary data from 33 participants including Rohingya women refugees and aid workers, found that “many young girls are either married off to men or ‘sold’ to them at a price”.

“Women and girls continue to face violence perpetrated by their husbands, even within and outside the institution of marriage.

“Their suffering is compounded by the lack of recognition of the status of refugees and asylum seekers in Malaysia, which prevents them from having mainstream/legal access to employment, education, and healthcare.”

Mental health challenges

Chew Ching Hoay is a psychologist and mental health supervisor at the MSF clinic in Penang. In addition to providing medical care, her team offers psychological first aid to new arrivals to assess if they have experienced sexual or physical violence.

“A lot of them have never had the opportunity to share with someone, due to isolation or fear,” she said. “So really this is just the opportunity to share openly because we assure them this is a safe space, this is a private space.”

But she acknowledged that it is an uphill battle, as many refugees fear accepting help. Young women, in particular, worry that their husbands will find out they have reported them, and many do not leave their side.

To address this issue, the team has implemented the use of a “butterfly symbol.”

MSF Psychologist and Mental Health Supervisor Chew Ching Hoay explains a chart she uses in consultations to illustrate the intensity of patients’ feelings. The larger the stone, the heavier the feeling they are carrying with them. Photo: Steven Ooi / MSF

These symbols are printed on cards displayed throughout the clinic, and if a refugee discreetly points to one, the team understands that it indicates a case related to sexual or gender-based violence, community volunteer Nilufah explained.

Volunteers and workers at MSF also stressed the importance of educating Rohingya refugees about the dangers and risks of early pregnancies, which they do through informal health literacy sessions at the mobile clinics.

At the Penang Refugee Network, a community-led initiative aimed at connecting Rohingya and other refugee families across the state, volunteers like Abu, 21, and Mumtaaz, 28, told This Week in Asia that they conduct regular community talks focused on preventing child marriage.

Both volunteers are refugees who fled Myanmar, and they have discovered that they can connect with refugee communities that may be too frightened to contact non-profit or aid organisations.

An MSF volunteer from the Rohingya community. Photo: Steven Ooi/MSF

“Child marriage is a big issue in our community, so we have been trying to find ways to reduce this,” said Abu. “[We are] directly going to the community and educating them about the dangers of child marriage.”

MSF’s Nilufah, who grew up in Myanmar’s Rakhine state, fled to Malaysia several years ago. Her father was a doctor in Myanmar, a career path she hoped to follow, but she knew there was “no future” for her there.

“At least I can be a help [for] my people here [in Malaysia],” she said.

Amy Soodin, Penang

Additional reporting by Associated Press

* The Rohingya refugees who work as volunteers requested that only their first names be used to protect their identities

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