Prodjut Roy, 29, is a mental health supervisor with Doctors Without Borders/Médecins Sans Frontières (MSF). Since June, he has worked in the primary health center (PHC) in the Nayapara refugee camp in Teknaf, Bangladesh, where tens of thousands of ethnic Rohingya refugees have settled after fleeing targeted violence and persecution in Myanmar. During his time in the camp, Roy has seen first-hand the stigma associated with mental health in the Rohingya community—but also the calm that many patients find through the services of “shanti khana,” which means a place of peace.
“Sometimes they come secretly. They do not want to share that they have some problems,” said Roy. “They know their information will be kept confidential, but when we ask if they know of other people who have similar problems, they don’t want to discuss the issue. They’re keeping the problem within the family, and they’re not going to expose the problem to others.”
Mental Health: Rohingya Trauma and Resilience – Mohammad Story
Mohammad Muslim, 18
Mohammad came to Bangladesh from Rakhine in early September. “We had to come because the Myanmar government was torturing us,” he says. “They were looking for young men and boys. They tied them up and threw them in the river. They drowned. The beautiful women, they raped. Those who were not beautiful or who were old, they would kill with a knife. I saw this with my own eyes.”
Witnessing these traumatic events has had a profound effect on Mohammad: “I’m not feeling well inside my body … I used to eat well, sleep well before, but not now. My head, chest, even my nails start shivering … I keep thinking of those things. Whenever I think of my country I am not peaceful… my nerves start hurting in my neck.” He continues: “I feel sick whenever I think of my country and that makes me sad.”
When a patient registers at an MSF health center, they receive an outpatient card showing the type of medical assistance sought. In a recent case at the Unchiprang primary health center, a patient’s card showed they were visiting for mental health services. The crowd-controller managing patient flow invited her to come to the mental health counseling room. Roy noticed that this made the patient extremely upset.
“The patient explained that in their community ‘mental’ means insane, ‘mental’ means crazy, ‘mental’ means mad,” said Roy. “I shared this experience with my team and asked them to not use the word ‘mental’ in the facility or the community.”
Mental Health: Rohingya Trauma and Resilience – Johura Story
Johura Begum, 12
Johura Begum lost 14 of her 16 family members when members of the Myanmar military attacked her village in Rakhine state. The only other survivor was her 10-year-old brother.
“The military people told us that we would be fine, that we shouldn’t worry. They separated the men from the women … I saw everything with my eyes. People were gathered by the side of the river. The pretty women were taken somewhere. The older men, they were killed. Before they were killed they were given the task of digging holes in which to bury themselves.”
Johura managed to get away. “When I was running to save my life, I fell in the river and was shot. I climbed out of the river and into the graveyard. And there was my sister … I saw one of my sisters shot in the face. She had blood all over her face. I fainted. When I woke up a man was carrying me. He was running. I woke up and along the way, I saw my young brother.”
Johura spent 14 days in the hospital. She now lives with her brother and her aunt in one of the sprawling camps for Rohingya refugees in Bangladesh.
She talks about life now, one year since she fled: “A lot of kids can call for their parents, but we don’t have parents to call out to. Whenever I can’t call for my parents, I don’t feel peaceful. Whenever I feel the pain [from the wound] or think about what the military people did in Myanmar, I remember that. I don’t feel good at all here, I want to see my parents and siblings. I have to live in someone else’s house, I don’t like it … The other kids are peaceful, that’s why they are playing. I’m not peaceful in my body and that’s why I can’t play. My brother and I have all the worries of this world.”
Breaking down the stigma of mental health
Staff and volunteers now use the term “shanti khana” for the counseling room. “Shanti means peace,” said Roy. “The Rohingya … don’t like psychology, they don’t know mental health, but they like shanti khana.”
Health promotion and psychology education activities carried out by volunteers in the community have started to ease the stigma around mental health. The Nayapara primary health center has seen the number of patients seeking mental health services almost double in the last few months.
Mental Health: Rohingya Trauma and Resilience – Majeda Story
It took Majeda 14 days to reach Bangladesh after fleeing Myanmar in early September 2017. Like many Rohingya women, she endured sexual violence. She describes the attack:
“The Mogh [derogatory term for Rakhine Buddhists] tortured [raped] me, and I became pregnant. After torturing, they would kill the girls. They would take the girls to the forest and do this. If you went into the forest today you would find their bones.” Arriving in Cox’s Bazar, Bangladesh, she learned she could have a safe abortion.
Her mother helped her. “My mother learned that we could drop the baby [have an abortion]. I went to the hospital and they gave me some medicines and it went away.” The attack still haunts her. “The thinking never stops. Whenever I think about it, the blood rushes to my brain and all the nerves in my body hurt.”
Immense mental health needs
Patients present with a mix of symptoms. The violence they experienced and witnessed has left its mark. Many suffer from post-traumatic stress disorder or acute depression. This is compounded by the daily difficulties of living in a refugee camp and uncertainty about their future.
“They have flashbacks,” said Roy. “They can’t sleep. Sometimes they experience psychosis. They can’t differentiate between the present and future. When the flashbacks come, their bodies are shivering. When they see the army of Bangladesh, they can’t differentiate it from the army of [Myanmar], so they run.”
Mental Health: Rohingya Trauma and Resilience – Nur Muhammad Testimony
Nur Muhammad Azad (known as Azad) is an MSF mental health counselor who has worked with Rohingya refugees for over seven years. For many refugees, life in the camp has exacerbated the trauma of the violence they experienced in Myanmar.
“When they arrived here in Bangladesh, many Bangladeshis helped them in various ways with food, education, clothing, and economic support. But now this help is reduced and they have no way to earn money. Every day this problem is making them more depressed.”
The symptoms of their mental health conditions often manifest physically, which makes it hard to diagnose and treat. “Here most of the people think that the physical problem is the biggest problem and they need a doctor to treat it, but they don’t understand that what they have is a mental problem.”
Roy remembers the particularly difficult case of a young women who was suicidal. Unfortunately, she was in the early stages of pregnancy, so was not able to take the medication that normally might have helped her. Roy and another specialist worked with her over several months to provide support and slowly saw her improve. Eventually, once it was safe to do so, the MSF psychiatrist was able to prescribe psychiatric medication to support her recovery.
“Every day we see the same patients,” said Roy. “They’re coming for a problem. They’re coming for a follow-up. And one day they’re getting better. That day is very special for us.”
All portraits in this article were taken by photographer and activist Robin Hammond as part of a six-day workshop conducted with MSF in Kutupalong refugee camp, in Bangladesh’s Cox’s Bazar district. Rohingya refugees were encouraged to share their stories as part of the In My World campaign to document the lives of people with mental health conditions and expand access to care.
Since August 2017, MSF has provided more than 16,000 individual mental health consultations and 18,000 group mental health sessions in Bangladesh. All MSF health facilities provide mental health services and both psychological and psychiatric services are available at all inpatient and some primary health centers. The limited availability of mental health services and particularly more advanced mental health services, including psychiatric care, in this area of Bangladesh remains a serious concern for MSF.