This is the first part of a two part series on the mental health of Rohingya refugees
Tosmeda, 30, mother of two, is currently working as a homeschool teacher in Jamtoli camp. Her husband is a Médecins Sans Frontières (MSF) volunteer.
The couple earns a meagre amount of money for their work and commitment to humanitarian service. But Tosmeda says they still want to return to their homeland despite the fear, violence, and intimidation in their native Rakhine state in western Myanmar.
“There is nothing like breathing fresh air in your native land. We want to return. But whenever we think of returning, the eerie silence of the dead people and scenes of burning villages, haunt us with a violent past. The situation gets even worse when the brutality of Myanmar security forces creeps into our dreams as nightmare.”
One can come across hundreds of such stories in the 34 refugee camps in Ukhiya and Teknaf of Cox's Bazar district.
The World Health Organization (WHO) in its recent report published in the Lancet medical journal in June, says that one in every 5 persons living in areas beset by conflict is having mental health problems.
The horrific picture contradicts and overrides the previously published data of 2016 which suggested that one in 16 persons in conflict zones has mental health issues. WHO says its figures changed as new research includes more evidence-based data. 45 of 129 studies were not included in prior estimates.
The report found a range of mental health problems like depression, anxiety, post-traumatic stress disorder, and bipolar disorder or schizophrenia, to be prevalent in areas beset by conflict. It did not mention the situation in Cox's Bazar specifically but did highlight the significant humanitarian crises being brought to light by violent conflicts in Afghanistan, Iraq, Nigeria, Somalia, South Sudan, Syria and Yemen.
According to the report, 22% of people living in conflict areas have one or more of the five mental health conditions cited. Women are more likely to be affected than men and the burden rises with age. In about 9% of the population, the mental disorder is moderate to severe. In 13%, it is mild.
What is the ground reality in Cox's Bazar ?
Aid groups and humanitarian agencies working at the camps and places in Cox's Bazar said the severity of mental illness they have observed is more than what WHO research suggests.
On condition of anonymity, a senior humanitarian agency worker said they would not be surprised if the number stands at 1.5 for every 5 persons, which is more than the WHO estimate.
MSF Medical Coordinator Dr Kalyan Velivela said losing immediate relatives and facing targeted violence in Myanmar, the dangerous journey to Bangladesh following the attacks, compounded by an uncertain future and the daily stresses of living in overcrowded camps, close shelters surrounded by unhygienic conditions in the camps, are all factors increasing the prevalence of mental health illnesses.
He said refugees also suffer from flashbacks of violent, traumatic events, anxiety, agitation, acute stress, recurring nightmares, not being able to sleep, and in more severe cases, being unable to look after themselves or their families exposed to mental illness, all elements mentioned in the WHO report.
Moreover, somatic symptoms such as musculoskeletal complaints, caused by a variety of conditions can often be a physical manifestation of mental health issues, the coordinator said.
Children in both the refugee and host communities of Ukhiya and Teknaf are also suffering from mental health problems.
Experts and specialists who are providing humanitarian assistance there, say that not only refugee children but also local children are exposed to having mental health problems.
UNICEF said in 2019 alone, it offered 75,399 children structured mental health and psychosocial support services, including recreation and basic emotional support.
Among host communities, a recent secondary data review reveals that 43% of households reports the presence of children exhibiting behavioral changes that relate to symptoms of distress in the past 30 days, it added.
Experts and specialists providing mental health services, said local host community parents have noticed their children show sadness, express gloomy feelings to them regularly, have become more intolerant than before, and are becoming more aggressive.
Gender Based Violence (GBV) Operation Officer with IOM, Megan Denise Smith said many children are traumatized by what they saw or experienced back in Myanmar.
Others see something of a ‘spill down effect’ where traumas experienced by their parents are taken out on the children, she added.
UNICEF Child Protection Manager at Cox Bazar William Kpangbala Kollie, said forcibly displaced children often demonstrate disturbances in sleeping, strong fears, aggressiveness, and sadness that manifest in negative coping. Many children develop a sense of hopelessness and a feeling that life is hard. Others have difficulties in making new friends and feeling comfortable in their new found environment, he added.
Public Information Officer of International Organization for Migration (IOM) Cox's Bazar, George McLeod, says many parents often report that they find it difficult to educate their children, to transmit their values, and to practice their traditions. Family and social habits as well as traditions are completely disrupted or difficult to practice.
MSF Medical Coordinator Dr Kalyan Velivela says children coping with developmental or learning disabilities are the most vulnerable.
Patients with conditions such as autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), and cerebral palsy, among others, stop attending regular schools, or learning centers inside the camps as they get bullied or teased, he added.
The Chief of IOM- UN Migration Agency's mission in Bangladesh, Giorgi Gigauri said the investment on Rohingya children means, investment in their future when they return home. “We don't want to be held accountable for a lost generation.”