Now, a surge in births among these women is imminent, according to aid officials working in the vast refugee camps in the Cox’s Bazar region. And in possibly thousands of cases, aid workers believe, the pregnancies resulted from rape — a source of silent anguish among the mothers and likely stigma for the newborns.

With the monsoon season fast approaching in Bangladesh, United Nations agencies and their partners are struggling to protect nearly 700,000 Rohingya refugees from disaster and disease. Providing proper medical care in the camps is a severe challenge at best, and one made more difficult by the wrenching legacy of sexual violence.

The displaced population includes an estimated 40,000 pregnant women, UN officials estimate, many of whom are expected to give birth in coming weeks. An unknown but significant share of these pregnancies, aid officials believe, resulted from rapes committed by members of the Myanmar army and allied militants.

"They can just see from the faces of the girls who are pregnant that something terrible happened" - Andrew Gilmour, Assistant Secretary-General

Pregnancies resulting from “what we believe could have been a frenzy of sexual violence in August and September last year could come to term very soon”, Andrew Gilmour, the UN Assistant Secretary-General for Human Rights, told UN News. “So, we are expecting a surge of births.”

In March, Mr. Gilmour travelled to Cox’s Bazar on Bangladesh’s south-east coast, where the refugees have settled in camps and makeshift clearings after escaping violence in Myanmar’s Rakhine state.

Pregnant women fear stigma

Fearing stigma, sometimes feeling depressed or shamed, pregnant refugee women are often reluctant to admit that they were raped, according to medical and aid workers in the camp. But these workers, from non-governmental groups, told Mr. Gilmour that “they can just see from the faces of the girls who are pregnant that something terrible happened”, he reported.

“And there is no joy whatsoever,” he said, “and nor is there any talk of a husband, either back home or with them in the camps.”

The Rohingya are a Muslim minority in mainly Buddhist Myanmar, where they have long been subjected to severe discrimination.

While more than 200,000 were already living in neighbouring Bangladesh, hundreds of thousands more fled across the border since last August as violence spiralled in northern Rakhine state.

Rohingya homes were looted, villages razed and civilians killed in what the UN High Commissioner for Human Rights said appeared to be: “a textbook example of ethnic cleansing”. As in many past and current conflicts, women and girls were priority targets.

Women 'profoundly traumatized'

The latest UN report on conflict-related sexual violence, issued in March, charged that members of the Myanmar Armed Forces, at times acting jointly with local militias, used rape, gang rape, forced public nudity and other sexual attacks as part of a strategy to drive the Rohingya from their homes.

Pramila Patten, Special Representative of the Secretary-General on Sexual Violence in Conflict, flew to Bangladesh in November to meet with refugees. All the Rohingya women and girls that she spoke to, she said, reported either enduring sexual violence or witnessing it.

"The two words that echoed across every account I heard were ‘slaughter’ and ‘rape’.” - Pramila Patten, UN Special Representative on Sexual Violence in Conflict.

“I met a number of profoundly traumatized women who related how their daughters were allegedly raped inside their home and left to perish when the houses were torched,” Ms. Patten told the Security Council.

“Some witnesses reported women and girls being tied to either a rock or a tree before multiple soldiers literally raped them to death,” she said. “Many reported having witnessed family members, friends and neighbours being slaughtered in front of them. The two words that echoed across every account I heard were ‘slaughter’ and ‘rape’.”

Ms. Patten had dispatched an expert team ahead of her visit, comprising representatives of a UN inter-agency network that advocates for ending conflict-related sexual violence and supporting survivors.

Her Chief of Staff, Tonderai Chikuhwa, who headed that mission, said it was among the most shocking he has experienced. With a continuing influx of desperate refugees, he recalled, the trauma was “so visceral, so raw, so immediate”.

Sexual violence in conflict, such as rape as a weapon of war, is “the most underreported human rights violation”, Mr. Chikuhwa said in an interview with UN News.

The cycle of sexual violence and stigma is a repeating one in conflicts around the world, and even has intergeneration impacts, he said.

In Bosnia, he noted, Ms. Patten met with survivors of wartime sexual violence that occurred 20 years before. The grown children of those survivors still suffered from the stigma of their origins, leaving some of them to “live on the margins of society”, he said.

In Bangladesh, Mr. Chikuhwa said, there are now fears that women and children in the camps could fall victim to traffickers. That’s one of the major concerns that Ms. Patten is looking into during a follow-up mission to Cox’s Bazar this week, he noted.

Monsoon rains inflict further hardship

Although the monsoon season in Bangladesh does not officially start until June, heavy rains and winds earlier this month had Rohingya children scuttling to the roofs of their family shelters to keep the plastic sheeting from blowing away.

And while Bangladesh has been praised for its support for the refugees, conditions in Cox’s Bazar remain challenging due to the sheer number of people crammed into what is now the world’s largest refugee camp.

Mr. Gilmour fears monsoon conditions could inflict further hardship on Rohingya women who have already suffered immensely and who now lack access to adequate medical services as they approach childbirth.

“It will be even harder for them when the rains prevent access because there will be serious flooding, we fear,” he said. “There may be landslides, there may be a cholera outbreak, there may be many things that will make it even harder for the girls to get the medical attention they so desperately need,” he said.

Women and girls who have been raped also need to see that justice is served.

Though difficult to achieve, it is not impossible, as proven by the 2016 conviction of former Congolese rebel leader Jean-Pierre Bemba for crimes committed by forces under his command in the Central African Republic.

The UN Special Court for Sierra Leone, as well as UN tribunals for the Former Yugoslavia and Rwanda, have also prosecuted sexual violence cases.

Mr. Gilmour said the Rohingya refugees, themselves, have made accountability a pre-condition for returning to Myanmar.

“Obviously, they don’t want to go back if they feel that the soldiers who may have raped them, killed their relatives, burned their houses, are going around with impunity and liable to do something similar again,” he said.

“But on top of that, in a more general sense, it is vital that there is accountability,” he said, “to send a message to other people who might be tempted to carry out such horrific crimes in the future.”