Living in overcrowded camps for years on end, without legal status in Bangladesh, was already very distressing for the Rohingya refugees in Cox’s Bazar. The COVID-19 pandemic has only brought greater restrictions, and stress, to the refugees caught in limbo.
Within the camps in Cox’s Bazar, MSF provides support through individual, family and group counselling sessions, where mental health specialists focus on coping mechanisms and building resilience. It’s a service more essential now than ever—with 61 per cent more people seeking mental health care in Cox’s Bazar over the past year.
“Life for a refugee is hellish”
“No one wants to be a refugee” says Faruk,* a Rohingya refugee living in a camp in Cox’s Bazar, Bangladesh. “The life we have here is not easy. We live in an open prison.”
For Rohingya refugees in Cox’s Bazar, living in overcrowded camps for the past three years was already affecting their mental health. The COVID-19 pandemic added even more restrictions, and with life in the camps showing no signs of improving, the mental health toll is rising.
“Life for a refugee is hellish and every day is the same,” says Faruk. “I can’t travel outside the area of the camps as we need special authorisation to leave, and it is only granted under special circumstances such as for medical care or emergencies.”
“Sometimes I bite myself to see if I can feel something and I have tried to commit suicide,” Faruk says.
The strain on Rohingya refugees is evident in the increasing number of mental health services that were provided by MSF staff in Cox’s Bazar in the last year—MSF’s figures show an estimated 61 per cent increase in the number of people seeking mental health services when compared to the year prior. Our figures also show an estimated 74 per cent increase in group mental health consultations and a 51 per cent increase in individual mental health consultations in 2020.
Mounting mental health concerns
Living in a refugee camp gives little certainty to those forced to remain inside its borders, and the potential for being relocated to other camps can have huge impacts on mental health. Rumours of the relocations to Bhasan Char, a mass of sediment which has formed an ‘island’ 30 kilometres from the mainland, date back as far as 2015.
In May 2020, around 300 Rohingya refugees who had been rescued at sea were transferred to the island for quarantine as a result of the COVID-19 pandemic, where they still remain. Little is known about the conditions they face while detained on the island. In December 2020, more than 1,600 additional refugees from Cox’s Bazar were relocated to the island.
Independent humanitarian organisations, including the UN, have yet to gain access to the site, adding fuel to the growing concerns about the conditions there. It is estimated that more than 3,000 people have now been relocated to Bhasan Char, and with authorities claiming the island has the capacity to house 100,000 people, it’s likely that many more Rohingya will face relocation soon.
But relocation is only one of many fears for those in the camps.
A recent fire at Nayapara Registered Refugee camp destroyed around 550 shelters, where news reports estimated that around 3500 refugees were staying. Although there were no casualties and only a few people with minor injuries, the disruption to daily life has been huge for those living at the site.
In reducing movement and countering the spread of COVID-19, essential services in the camps provided primarily by humanitarian organisations were reduced by up to 80 per cent. The mounting impact of many months of this reduced humanitarian support, especially on a community that is increasingly dependent on humanitarian assistance, has made meeting basic needs increasingly difficult.
These compounding factors have only heightened the extreme mental health stress faced by Rohingya refugees in Bangladesh—a stress that has recently spilled into violence.
Helplessness and violence
“I was hiding in the kitchen with my children so that no one could attack us,” Asiya says. “When the violence broke out in the camps there were no men at home. We could hear the gunshots and we stayed silent, closing all the doors. We were frightened and shocked.”
Asiya discussed October’s 12-day clash between two Rohingya groups in the camps on her arrival at MSF’s Kutupalong hospital. Our field team spoke with traumatised people who were even afraid of visiting hospitals, health posts or clinics, for basic health care. After the violence, many refugees and their relatives left their shelters and moved to other parts of the camp which were unaffected by the clashes.
MSF Mental Health Activity Manager Kathy Lostos says that, despite the recent escalations, the situation is not hopeless.
“When a group's future is uncertain and when a population is not integrated into a society, this creates a feeling of lack of safety,” says Lostos. “Feeling that your life is under threat can lead to helplessness, believing that ‘nothing that I do will matter,’ and this can have a huge impact on people’s mental wellbeing.
Having some degree of control or autonomy over one's future is a determinant of creating a sense of safety
“The best thing to improve mental health outcomes is to restore a sense of safety,” she says. “Having some degree of control or autonomy over one's future is a determinant of creating a sense of safety. This includes things like including communities in decision-making processes or creating a sense of autonomy and control over one's future. [This] serves to mitigate the long-term effects of trauma.”
Laila, a volunteer in Kutupalong hospital, faced the violence while staying in a school with her family and parents.
“We left our homes and took shelter in a school premises inside the camp, and we were out of our home for almost 20 days,” she says.
While speaking, Laila holds paper in her hands and rolls it over again and again. She makes little eye contact, and possibly trying to control her emotions by keeping herself busy.
“I am tense and truly frustrated, thinking about the future,” she says. “I started thinking, in a way, that we don’t have any future or hopes. We are just trapped here, and restrictions of movement, and the impossibility of getting jobs are making our life much tougher.”
But despite the many mounting challenges, there is still hope from within the camps—a hope that is essential.
“I have many dreams,” says Faruk. “I want to visit and explore other places. I want to go to my home, so long as we get justice and rights.”
MSF has been running mental health activities in the refugee camps in Cox’s Bazar since 2009. Our teams provide support through individual, family and group counselling sessions, where mental health specialists focus on coping mechanisms and building resilience.
*Names of patients have been changed at their request.