“Nearby villages were ablaze. People were screaming everywhere. I can still hear the cries in my ears. After that, I went out with the advice to run away before they came towards our village. I was five months pregnant and carrying a small bag with some gold jewelry. My brother was with me carrying another bag. That is all I came here with. Even after entering this country, we felt like the terrorists would follow us. Five years have passed and I still wake up in a panic. Still, I feel like life has no value.” These words were spoken by a woman from Ukhiya, Balukhali camp 9.
She was not even willing to talk. Only after informing her that her name will not be mentioned anywhere, did she choose to share the events that have occurred in her life one by one. At one point, she started sobbing and crying, saying that her husband left her after they arrived in this country. “Now I survive with the help of others (relief). Thinking about the child makes me sad. He doesn't know how beautiful life could have been.”
A woman from camp 8 said, “I still get hissed if someone speaks a little too loudly. I get feverish and my body shakes. I have two children here, and my husband is bedridden. The government here provides food, clothes, blankets, and housing. But no one asked what I had there? No one asks if I want to stay here. I want to return to my home where I could say -- this is my home, this land is mine.”
In the months of October, November, and December 2022, interviews were conducted through close observation with a total of 15 women, divided among three Focus Group camps located in Ukhiya, Cox's Bazar. Among them, 9 are pregnant and 6 were pregnant when they fled to Bangladesh in 2017. They were interviewed about their lives and experiences after fleeing Myanmar and taking shelter in the camp.
On the one hand, there is the frustration of not being able to return to their home country, and on the other hand, there is the struggle of surviving in another country. Among them, everyone mentioned that pregnancy and raising children are big challenges for them. But, no one has ever talked to them about how to deal with this challenge. Those who have been working on rights in the camps for a long time claim that most of the women suffer from depression. Some of them are also suffering from severe depression. However much this issue needed to be mentioned, it did not come to the fore in various realities.
The rate of childbirth in the camp
According to the United Nations Refugee Agency UNHCR, about 30,000 children join the camps every year. According to the UNHCR, 9,23,179 registered Rohingya refugees live in Cox's Bazar camp. Among them, 4,70,822 are children. That is, 51% are children in Rohingya camps. Among the three camps, there are 2,160 girls and 2,259 boys in camp 8. In camp 8W, there are 2,280 girls and 2,427 boys and in camp 9, there are 2,386 girls and 2,452 boys.
Are Rohingya women familiar with depression?
Although they are not directly familiar with the topic of mental health/depression, Rohingya use some terminology related to mental distress to describe their situation. They use those words to explain their own situation. They use oyashanti (unrest) -- restlessness or a lack of peace and a general mental unstable condition.
When asked if she heard the name of depression or understands the meaning of it, a woman from Kutupalong main camp said that once an NGO came and talked about mental health. “They described the situation that arises when you regularly have nightmares, lose interest in work, feel lonely, and don't feel competent for any job, and that is due to this mental condition (depression). They told us to come to the center (health clinic) if we experience such conditions.”
International medical humanitarian organization -- MSF is working deeply on the mental health of women in the camp. When asked about the challenges they faced when working with the mental health issues in the camp they said, “mental illness is possessed by some kind of devil spirit. There is no treatment or way out of this situation without the local treatment of religious leaders and most of them rely on this method. Because of their cultural beliefs, customs, and societal structure, it is difficult to sensitize the mental health problems in the camp. It is especially very challenging for teenage and young girls. Women feel uncomfortable talking about their mental health issues in front of their family members and there are no secret spaces to talk about the mental health issues in the camp. Additionally, there is a great fear associated with mental health that prevents women from seeking help in distress."
Multiple members were four months pregnant in the focus group made for this report. During the conversation at Balukhali camp, one of them said that even now, she still has to stay up almost all night. Therefore, she has to take several medications during her pregnancy. She said, “the military forces broke my father's shoulder. I went to flee and got hurt all over my body. I still feel that pain. I feel sad when I think about my home, my land, and my area. I stay looking towards Myanmar from the high ground of the camp. If I could ever go back ... My blood pressure is high. I still hear the sound of gunfire.”
As soon-to-be mothers, they are often worried about the future of unborn children. They will not know their past and that feels like a failure. Fear of violence at any time removes any hope of stability and makes the future uncertain. Because of these reasons, they go through regular sleepless nights, separated from family and society in the midst of depression.
Accessing services
When asked how to handle these circumstances, all of them said, “If you are upset and cannot give your focus to the family, then what else can you do? What is the treatment for this?”
“The violence we have seen will not leave our minds.” One of them was a victim of rape during her time in Myanmar. She was advised to receive mental health services when she came to the camp to receive physical treatment. She said, “I was taken to another doctor who listened to everything I said. He gave me some medicine. But her husband did not allow to take the medicine properly. When asked why he denied her the medicine, she said, “It is not clear for us what kind of medicine it is.”
When asked how do you handle someone who is mentally unwell, the women of the Focus Group of camp 8 said, “the only thing we are good at here is looking out for each other. We have a good relationship with each other. One of us has come from Shantikhana (working to raise awareness about Rohingya entertainment, mental health and preventing sexual violence) and has taught us many things. According to her, we try to take care of ourselves. But those who feel a little more unwell and hopeless, there is no opportunity to take medicine. The family will not allow it.”
Providing services
IOM's Mental Health and Psychosocial Services (MHPSS) program has been running since August 2017 and they also conduct door-to-door symptom identification. They provide mainly individual counseling, in-patient care, patient referral, and community mobilization activities. But no one is willing to talk about exactly how many people they are able to serve.
Talking to those who provide mental health services, there are some issues with identifying people. It is often perceived that mental problems relate to deviant behavior. They don't think someone needs treatment for their mental health until they are crazy.
We talked with someone who provides mental health services at the health clinics in the camps. Upon the condition of not revealing his name and organization, he said that every day, hundreds of people come to the clinic with various problems. Those outside of us advise them, doctors determine their symptoms, and if they think that the person needs mental health attention, they refer the patient to the relevant medical professionals.
Mental Health has been a focus of MSF's medical activities in Ukhiya camps and they are providing counseling, treatment, and sessions on mental health in the Rohingya refugee camps. Their mental health activity manager, Vinila Kattamichi said, “about 60% of our mental health patients are received through internal contacts. All medical department staff and all outreach team staff are also trained in identifying mental health disorders, referral criteria, and ways to refer patients to mental health departments. Those who work in the field receive information and refer to the clinic while rotating in different rooms.”
She also said that the mental health outreach team conducts awareness sessions on the importance of treatment for the mentally challenged. Some of the patients we receive are from their relatives who have already taken our services.
The United Nations High Commissioner for Refugees (UNHCR) says that around 40 agencies are working on mental health in Cox's Bazar. After considering the overall work, they are not satisfied enough. They mentioned the challenge and said that the organizations might have received funds for one year or six months. When that ends, there is a gap, and there is no continuity. As a result, it cannot be said that a lot of work is being done.
When asked about this matter, the spokesperson for the organization, Regina De La Portilla, said that what is being done is not enough. “It would be better to have more doctors. However, at this time, we are doing our best. They think that their own country doesn't want to return and believe that they are also not accepted in this country. As a result, they feel lonely. Therefore, it feels good that someone is willing to listen to them. And so, it is very important to talk about mental health with them.”
Mekhla Sarkar, a psychoanalyst, stated that trauma cannot be handled alone and there is no specific way to deal with trauma. There is no reason to think that those who are forced to abandon their country due to war, violence, and murder, can easily escape the trauma created by this situation.
People generally create new memories of their own to overcome trauma. But they don't know about their level of depression. It requires talking to a skilled doctor to determine that. The Rohingya were not disappointed by any single issue. They are eyewitnesses of violence; they have abandoned and have had to abandon their former lives; they are limited to cherishing life in their camps with no certainty of returning. All of these issues are somewhat complicated. They need very systematic counselling.
Udisa Islam is a Special Correspondent for Bangla Tribune. This story was made possible by the Medecins Sans Frontieres (MSF) Without Borders Media Fellowship. MSF, also known as Doctors Without Borders, works with journalists to encourage independent, impartial and neutral reporting on health and humanitarian crises.
