The Mental health and well-being of the Rohingya in Bangladesh beyond COVID-19

According to the World Health Organisation (WHO) [pdf] one in every five people living in areas beset by conflict experience some form of mental health condition. However, some Non-Governmental Organisations (NGOs) and Aid agencies have estimated this figure is higher for Rohingya people living in Bangladesh; according to these bodies the most common mental health conditions amongst the Rohingya people are post-traumatic stress disorder, depression and anxiety disorder. Recent reports by The International Crisis Group state that the Rohingya people are the most ill-treated and persecuted minority ethnic group in the world. In August 2017 the world watched as the Rohingya people fled Myanmar and sought shelter and set up a spontaneous settlement in South-Eastern Bangladesh. This was not the first time the Rohingya people had escaped Myanmar as several times in the last four decades they have fled to neighbouring countries such as Thailand, India, Malaysia. The current state of affairs is such that now Bangladesh is hosting nearly 1.1 million Rohingya people who are living in 34 extremely overcrowded camps. In view of their ordeal of  escaping Myanmar and now facing the challenge of living as stateless people in Bangladesh with an uncertain future it is not surprising that their mental health needs are increasing, and on the ground, NGOs are struggling to support them. This article will portray a story of their current mental health needs and indicate a way forward.

Mental Health of Rohingyas pre-COVID–19

On a recent visit to a number of Rohingya camps I talked with fifteen Rohingya adults as part of my pilot study to understand their health and well-being needs. It became apparent during my conversations that, although some of them had been residing in Bangladesh for nearly two and a half years, they were experiencing nightmares and flashbacks of their murdered loved ones and the destruction of their property. They went on to share with me their feelings of anger and frustration over what had happened and their inability to see justice done to those that had taken away their family, friends and former livelihoods.  As they shared their feelings, it was clear that their experiences of being displaced and the uncertainty of their future had left them powerless. But despite this sense of powerlessness what had not diminished from any of the men that were engaged in conversation with me was their wish to return to their homeland to a life free of discrimination and persecution.

As I continued my conversation with these men it was clear that some of them have already developed maladaptive techniques to manage their mental health conditions. For example, a number of them had started to take drugs; others became irate quickly and were frustrated and annoyed with minor issues. There were also those who had begun to physically abuse their family members and fought with their neighbours. On hearing this I asked what action they had taken since noticing the change in their behaviours.  A number of them did not know what to do

Those I was speaking to readily acknowledged that the NGOs that were working with them offered support, which I found out consisted of mental health and psychosocial wellbeing support. However, the men felt that the NGO workers did not understand them, what they were experiencing and how to help them. Furthermore, they spoke of not being able to trust the NGO workers. Rather, they preferred to go to the Imam (a religious leader) instead to talk about their mental health.

A systematic review by Tol indicated that mental health and psychosocial well-being support (MHPWS) which includes counselling, talking therapies and problem-solving techniques could improve day-to-day mental health and well-being. It also could make a positive impact to support people who experience post-traumatic stress disorder, particularly where resources are not adequate, such as Bangladesh. However, we do not know to what extent MHPWS is effective in supporting them to manage their mental health and well-being.

Participants in my research mostly seek support from their religion i.e. Islam. For example, Arfan Mia (pseudonym) told me: ‘Allah will only give you the burden if you can tolerate it and it is a test from Him’. He goes to the mosque regularly and talks with fellow Rohingya adults where he gets the motivation to keep going with his life. Here we see that Arfan takes comfort and sustenance from leaving his pain to Allah. A similar finding was apparent amongst eleven respondents who indicated that Islam and its scripture give them support. Relying on religion is one of the techniques they use to cope with their mental health independently of any formal intervention as would be provided by an NGO. In the provision of services by the NGO it was not only religion that was missing but also an overt and explicit link to the Rohingya cultural norms. Although the UNHCR urges NGOs to provide culturally specific services, none of the participants in my pilot study felt the support that was being offered was culturally and religiously informed. This is despite the fact that there is a considerable amount of empirical research that highlights that culture and religion are intractably linked with the mental health.

COVID–19 and Mental Health Issues

Lockdown due to the new coronavirus (COVID – 19) is placing an even greater strain on the fragile mental wellbeing of Rohingya adults, who as we know have escaped from persecution and arrived at refugee camps where there is no employment and a lack of opportunity for education and meaningful activities. These experiences coupled with overcrowded and unhygienic living conditions as well as an uncertain future have led to the increasing development of mental disorders. Despite the efforts that have been taken to manage the spread of COVID 19 it is has been established that, so far, one person died and 29 diagnosed with COVID-19. Those that occupy the camps are now extremely fearful and anxious, specifically where there is an underlying health condition. Some of them are trying to observe the lockdown rules fully and are feeling isolated and lonely. These feelings are strongly associated with depression, self-harm and suicide attempts across ages [pdf]. Some of them are becoming anxious but unaware how to deal with their feelings and emotions. In contrast, other refugees rely on their faith in Allah to keep them safe and protect them and are relaxed about the lockdown in the camp due to their strong belief on their religion. An example of this is provided by Shafiq who said, ‘If Allah wants to take me, I will go because I am His asset’. It seems religion is supporting some Rohingya adults to manage their mental health conditions differently.

Currently we do not know the long-term impacts of the lockdown on Rohingya people, but mental health issues are not going away and will most likely increase.  To address the mental health conditions, it is paramount to include religion and culture; otherwise it is going to be difficult to engage and involve Rohingya people with mental health disorders.

Post COVID-19

Undoubtedly, the mental health conditions of Rohingya people is a concern to aid agencies, NGOs and Bangladesh. It is apparent that unlike physical health, the mental health and wellbeing of the Rohingya people does not attract much attention and it is still an invisible foe. Given that the mental health conditions amongst Rohingya is high a long term strategic approach is required from both the Bangladeshi Government and NGOs to develop novel interventions which will engage and involve Rohingya people and enable them to become more resilient in managing their mental health needs, initiate their recovery process and improve their mental health and well-being. Novel approaches should not just rely on the existing Western psychosocial support but also in developing support mechanisms which are informed by their culture and religion.