A shell-shocked, malnourished 10-year-old girl is in charge of eight members of her family including siblings and the elderly. Her parents are lost, mostly likely dead. Who knows what happened to them in the flight from Myanmar to this chaotic border camp in Bangladesh.
Appearing closer to seven years old due to her wasted state, and instead of playing as other 10-year-olds do, she manages to lead one of the many child-headed households in a swirling, congested and dangerous place.
"She has to organise the looking after of the kids, the going to get the aid services," CARE's Country Director for Bangladesh Zia Choudhury told HuffPost Australia by phone from the capital Dhaka. He's just returned from an inspection of the border.
It is quickly becoming the world's largest refugee camp, housing the ethnic minority Rohingya who've been forced to flee from their homes.
"We went deep inside the camp and there was no aid services," he said. "So this 10-year-old has to assign herself and her other young sibling to go stand in these aid distribution queues."
When he asked where her parents were and she "just went blank".
"She just welled up," he said. "And then I realised something terrible has happened."
"And I thought to myself what a thing for a 10-year-old girl not to even be able to recount to me where her folks were. Absolutely, it shook me to the core."
"They are living under piece of plastic which was not more than two by two metres. So they can't even lay down together. So they were coming and going in shifts.
"Some of the boys are outside the tent. Just lying outside, not even inside. Even to say tent is a bit much. It is just four sticks and a bit of plastic."
The waves of refugees fleeing violence from Myanmar are overwhelming aid workers. Tens of thousands have crossed in recent days.
On latest figures, around 800,000 Rohingya refugees have fled into Bangladesh over the past few months. Care tells HuffPost Australia that at least 448,000 refugees are in urgent need of assistance as they have either witnessed, experienced or are at risk of gender-based violence.
Zia Choudhury explains the flight from Myanmar was full of trauma and in the overflowing refugee camp, the risks are real and base. The people are vulnerable and weak.
"It is so congested and so chaotic. It is something I have not seen in 20 years of working. There are so many women-headed and child-headed households," he told HuffPost Australia.
"More than 75 percent of the women that we spoke to had either been directly victims who survived sexual assault or who had witnessed it."
"They always say men and they often say armed men."
"When we put it together with data from other organisations. It would appear to us that well over 80 percent of all women and many children have witnessed or experienced sexual abuse or assault on this journey."
Overcrowding and unregulated movement in the refugee camp has increased the threat of sexual violence.
According to Choudhury, unscrupulous people are entering camps offering work and places in orphanages but have other intentions, there's transactional sex taking place and the darkness offers little relief.
"When they go to the toilet at night time is pitch black," he explains. "You don't want to go in the day time cause you don't want to be seen, but at night they go in groups seeking safety in numbers."
Choudhury said the victims need specialised care, but there are so many people needing help.
CARE is establishing four centres in the coming weeks to provide support to 30,000 survivors of sexual violence and is setting up three mobile health clinics where women and adolescent girls can seek support for family planning, maternal health and child care.
CARE is appealing globally for $US10 million to assist more than 150,000 refugees until the end of the year. It reports less than half of the funds have been secured so far.