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Mental health in the Rohingya crisis: "The love for your child is good"
How do you care for people's mental health when the situation around them is so unstable? British mental health officer Alison Fogg shares her experience of treating Rohingya people inside the world's largest refugee camp.
Following Kamrul, one of the Bangladeshi mental health supervisors, I pause to catch my breath.
Men and boys pass me quickly, deftly negotiating the steep, bamboo-sided hill steps barefoot – balancing eight-foot bamboo poles on their shoulders, seemingly with ease in the 40-degree heat.
"This is one of the many times my cultural assumptions are challenged, and a reminder, amidst all the supposed differences, of our shared humanity"
Lining the narrow stairway, rows and rows of small makeshift plastic and bamboo tents cram the steep, muddy hillsides, providing little protection from the intense afternoon sun and sticky May humidity, gathering ahead of the oncoming rainy season.
Reaching a ridge, we can see these precarious shelters spreading for miles in every direction, making up the Kutupalong-Balukhali megacamp here in southeast Bangladesh. This feels even more overwhelming knowing that each of the thousands of abodes represents families of probably between six and 10 humans, each with their own story.
Place of peace
As a mental health officer for almost five months in the MSF Kutupalong project, I am in awe of my Bangladeshi and international colleagues.
It’s now May 2018, but my Bangladeshi mental health team colleagues have worked tirelessly since this crisis started on 25 August 2017.
It’s a daily privilege to work with the MSF team at Shanti Khana, or “place of peace” - the name chosen for the mental health department here - planning the training needs of our local staff and how best I can support them, given the considerable on-going emotional demands of the work.
“The love for your child is good”
Under the watchful eye of their senior clinicians, Sharif, Mofizul and Kamrul, the counsellors listen to story after story of trauma, multiple losses and ongoing fear and sadness.
They support worried parents bringing their children in with an undiagnosed learning disability or autism, reassuring them: “No, this is not your fault or God’s punishment on you. Your care and love for your child is good.”
One of the happiest, though sadly regular, occurrences for the team, is the moment they remove the chains in which some patients – often young men – are brought in by their concerned parents or siblings.
Living in such flimsy and unlockable shelters, when their adult children are agitated and perhaps violent, relatives are often at a loss as to how to protect them from themselves and others.
I’ve seen how receiving a diagnosis, perhaps of psychosis or severe epilepsy, for example, and appropriate medication, calms and stabilises a person. It provides the family great relief and the patient with an opportunity for a new life.
Our shared humanity
Spending time in the project, the positive impact of the MSF mental health team’s day-to-day efforts becomes clearly evident.
Here, there is one particular Rohingya gentleman who is especially grateful for the care the team provide to his daughter during an inpatient stay.
"My lasting hope for these children is that they will experience the reality of the words they sing"
Following a suspected traumatic event, she starts to trust the counsellor who visits her bedside. She slowly begins to talk more and eat again.
Her father visits our department daily. One day, when his daughter’s progress is really becoming clear, this diminutive-in-stature man shows his gratitude by grasping me tightly round the waist in a side hug – I literally have to catch my breath at this point, and not just in shock!
Standing in the patient waiting area, I am at this point acutely conscious of staff guidelines for culturally appropriate conduct, where women, especially not Western women, under no circumstances should have physical contact with men.
However, this is one of the many times my cultural assumptions are challenged, and a reminder, amidst all the supposed differences, of our shared humanity.
I’m surrounded by big, bright brown eyes and the excited chatter of dozens of Rohingya children.
They range from one-year-olds to teens, the toddlers balanced casually on the hips of their older siblings. They are eager to play, sing, laugh, and do whatever our two mental health counsellors are organising that day at MSF’s child-friendly space, based in the “transit centre”.
Though numbers have slowed considerably since August 2017, some Rohingya continue to arrive in Cox’s Bazar each week.
Currently known as “the Rubber Garden” (prior to the Rohingya’s arrival, it was a local rubber plantation), the transit centre is where new refugee arrivals are brought to receive vital health checks and immunisations before being moved to a more permanent site in one of the camps.
The children produce the most beautiful, intricately detailed patterns in their drawings. They squeal with delight at team games or songs (the “Hokey Cokey” never fails). However, it’s their acapella singing that I find particularly poignant.
The song that sticks with me, which they sing in English, is a gospel song called “We shall overcome”.
I’d never heard this song before, and I’m intrigued as to where the Rohingya children learnt it. I later discover that the song was key in the 1960s’ Civil Rights movement in the US and has since been adopted by people of different ethnicities and religions in protest movements around the world.
From the collective testimony of thousands of Rohingya people, the world now knows about the horrific traumas they witnessed and experienced in Myanmar.
These children and their families travelled, shocked and grief-stricken through thick, unyielding jungle, often by night. They crossed dangerous waters with little food, carrying the injured, the elderly and the young.
The children therefore seem to epitomise the resilience of the Rohingya, their survival and energy visible daily throughout the camps.
I ask one of our counsellors, Mohammad, to translate the words they’re singing for the children, who generally don’t speak English:
We shall overcome, we shall overcome,
We shall overcome some day.
Oh deep in my heart
I do believe
We shall overcome some day.
My lasting hope for these children is that they will experience the reality of the words they sing.