The cash may also be used to buy medicines, to pay debts, and for other sundry expenses. The practice has potentially negative consequences for families’ food security and nutrition.33 many people have no way to meet them and simply forego treatment. Only basic conditions are treated at camp healthcare facilities, whose services and supplies are often considered subpar. For the treatment of complex and chronic conditions, there are transportation costs, doctor’s fees, and fees for medicine, food, and overnight lodging. One woman described having to pay 1,200 taka to a camp authority for a travel permission slip required to pass the checkpoints outside the camp perimeter. An additional, smaller fee of 100 to 200 taka is also sometimes charged by officers at the checkpoint. These combined costs mean that a trip to seek treatment for a chronic condition can cost 3,500 taka or much more. STRUGGLING TO MEET NEEDS NOT COVERED BY AID As discussed above, not all needs are fully addressed by aid. Refugees have to find other ways to pay for the education of their children, communication costs, and for any medical care or supplementary food beyond the most basic. During religious holidays, families also strive to buy special food items, clothing, and gifts, but they do not always manage. For example, it is customary to prepare beef during the Eid holidays, and households feel ashamed if they are unable. In addition to these everyday and anticipated costs, families may also face large expenses related to marriage, migration, and other major life events. Communication costs are incurred by families trying to keep in touch across borders or even between different areas of the large camps, as well as for any other type of phone or internet use. Many households own a simple mobile phone or smartphone that must be charged and a SIM card that must be topped up (figure 34). Many parents see education fees as an essential investment Education fees are paid to private teachers or refugee-run academic and religious schools, services that supplement the nonformal learning facilities provided by NGOs. Religious education is a high priority for many families, and more widely accessible in the camps than academic training. Elementary and higher-level religious schools (maktaubs and madrassas, respectively) are community pillars, the loci from which religious, cultural, and linguistic knowledge is transmitted to the younger generation. Many religious schools offer classes free of charge, but books and materials must sometimes be purchased, and many families try to make donations, often as little as 40 taka per month, to sustain teachers.34 Camp residents facing health issues that require visiting a hospital outside the camps must find a way to pay for treatment. Though NGOs occasionally cover these costs, Figure 34. Sample ex penses not covered by aid Families try to supplement their food rations, which meet basic caloric needs, with vegetables, fish, fruit, and other items found in camp markets. Expenditure varies Many parents strive to pay for children’s religious education or private tutoring to supplement nonformal learning activities led by humanitarian agencies. BDT 40 to 600 per month A 50-year-old man, an unemployed day laborer and a registered refugee, spoke of his family’s sacrifices to purchase texts for the madrassa studies of an orphaned nephew. “He called me yesterday to request 1,500 taka for books. I wanted to give it to him, but I have no money. My wife may sell her nose pin and then we will send the money…I always worry about my nephew’s education. I want to help him any way I can.” Families that own a mobile phone need to top up their phone credit. BDT 350 to 700 per month Patients may travel to Cox’s Bazar to seek medical attention for a condition not treatable in camp facilities. BDT 2,975 or higher A father of ten with a sixth-grade education described how he saves his earnings from work as a laborer in a Cash for Work program to fund the studies of two sons. “My son has a private teacher who is teaching him English and math. I have to pay 600 taka per month to the teacher. My elder son is a hafez—he can recite the whole Quran. For him I have to pay 400 taka per month to the madrassa.” Most families pay a dowry for the marriage of a daughter. BDT 30,000 (median amount; amounts vary widely) Families typically purchase clothing around religious holidays. BDT 85 to 5,200 per item 33