Mental health is just as important as physical health

08 Oct 2024

Dr Trudy Rosenwald, who has worked as a mental health activity manager with Médecins Sans Frontières (MSF) in Bangladesh, explains the connection between physical and mental health.  

As a ‘flying’ mental health activity manager, Trudy worked across three locations on two projects in Cox’s Bazar mega refugee camp. Almost one million Rohingya refugees are living there after fleeing their homes in Myanmar seven years ago. In this article she talks about the experience of the Rohingya and the importance of mental health support for this population. 

MSF psychologist Dr Trudy Rosenwald and MSF medical doctor Dr Jackson at the new mental health clinic in Balukhali project.

MSF psychologist Dr Trudy Rosenwald and MSF medical doctor Dr Jackson at the new mental health clinic in Balukhali project. © Dr Trudy Rosenwald/MSF

In July 2023, I began working in the Kutapalong Field Hospital (KTP) project, the Balukhali Specialised Outpatient Department (SOPD) project, and the Unchiprang Primary Healthcare (UMS) clinic as flying mental health activity manager. MSF is the largest mental health provider in this refugee mega camp. The number of potential patients can be quite overwhelming, when you realise you're responsible for tens of thousands of traumatised Rohingya refugees living across 33 separate camps.

Since their exodus from Myanmar to Bangladesh in 2017, opportunities for a better life have dwindled further for the Rohingya. The camps’ shelters that they live in were made to be temporary, but after seven years of a lack of maintenance and natural disasters, their living conditions have slipped from hopefulness to a profound sense of hopelessness.

Living in limbo

The mega camps have been impacted by terrible weather events, including cyclone Mocha in 2023 which caused a lot of damage. There are regular destructive fires, accidental and arson. A big fire in 2021 left 45,000 people homeless and burned important infrastructure, including the physical and mental health clinics at the MSF Balukhali project. The mental health and sexual and reproductive health clinics continued operating after the fire, only moving to new facilities in early 2024.  

A big challenge for the refugees was the reduction in the World Food Program nutrition allowance from $12 to $8 a month per person. People were at starvation level.  After a huge outcry the allowance was increased to $10, but food prices had increased significantly. The allowance was recently raised to $11.50. For many of the refugees all of these stressful events have compounded their past traumatic experiences into complex post-traumatic stress, a serious condition for which the road to recovery requires a safe and peaceful environment. Unfortunately, this is still not available.

Many of the Rohingya refugees fear for the future, causing anticipatory trauma with recurring thoughts of ‘What is going to happen to us? We have been stuck here for seven years without any signs of improvement in Myanmar or Bangladesh. We want to return to our country, to our lands and homes as recognised citizens and full members of the Myanmar society.’ 

Bangla camp afhttps://msf.org.au/sites/default/files/2024-10/msf_bangla_burned_camp_24_img-20240109-wa0012_1.jpgter a hire

One of the camps in Cox's Bazar after the fire in 2022. © Dr Trudy Rosenwald/MSF

In all 33 of the camps in Cox’s Bazar, violence in the community is increasing almost daily, and understandably so. When so many people are confined to a small space with increasingly deteriorating conditions, they begin to turn on themselves and on each other, leading to issues such as suicide, domestic and sexual violence, and criminal activities like kidnapping for ransom.  

Implementing trauma coping strategies

MSF provides individual consultations and counselling for those who seek help at the mental health clinics. The mental health counsellors and social workers work closely with the mental health doctors in the psychiatric clinics and the outreach health promotion teams to run individual and group sessions in the community. They raise more awareness of the importance of mental health and the psychological and psychiatric support available. We can't change the living circumstances, but I hope we can empower this community to cope in more positive ways. By teaching and modeling prevention and early interventions strategies the refugees can learn how to help themselves and each other.

In 2023, a football competition for World Mental Health Day in the camps surrounding the Balukhali clinics was a great success and reinforced a key coping strategy for managing stress, ‘be physically active and play sport’. There was a great response with many people enthusiastic to play. With one small muddy field to play on, and approval from the camp commander, people from different camps were placed together to promote friendly competitive teamwork. This kind of community-focused strategy will help improve and sustain positive mental health. 

One of the biggest messages I want to promote is that in physical health the problem is visible to the eye on X-rays, and in blood tests. Mental health is largely invisible, but it's just as important as physical health. In fact, you cannot separate the two, as evidenced by the explained and unexplained physical symptoms that represent the connection between physical and mental health. 

Dr Trudy Rosenwald
Flying mental health activity manager
Flying mental health activity manager Dr Trudy Rosenwald at Rubber Garden mental health service with counsellor Suria Sadia Emo

MSF flying mental health activity manager Dr Trudy Rosenwald at Rubber Garden mental health service with counsellor Suria Sadia Emo. © Trudy Rosenwald/MSF

Overcoming the stigma of mental health

There is still a lot of stigma around mental health in general. Some consider it as being possessed by the devil that can only be healed by traditional healers. This results in a delay in effective treatment and increases the risk of mental distress developing into a chronic severe psychiatric condition. This makes it harder to treat the patients, and stabilise them. 

The number of psychiatric patients seen across the projects has been steadily increasing due to mental ill-health. It is therefore important to have good psychiatric services and a community-focused health promotion approach to identify and engage with mentally distressed people at an earlier stage. 

We go to the most difficult places in the world to raise awareness about the importance of mental health, because for too long it has been seen as the second cousin to physical health.

Dr Trudy Rosenwald
Flying mental health activity manager

Dr Trudy Rosenwald worked with mental health supervisor Shariful Islam to provide mental health services to the Rohingya in Bangladesh. Shariful has since progressed to the role of flying mental health activity manager, and is the first locally hired professional to take on this role, which the team is immensely proud of. 

Shariful Islam, MSF flying mental health activity manager

Shariful Islam, the flying mental health activity manager in Cox’s Bazaar. © Dr Trudy Rosenwald/MSF


There is a high need for mental health specialists on MSF projects. We are therefore actively recruiting psychologists and other mental health clinicians. If you are interested in joining our team, please read the essential criteria for international staff before applying.