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| FIRST-PERSON ACCOUNT/NARRATIVE/REFLECTIONS |
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| Year : 2020 | Volume
: 2
| Issue : 1 | Page : 27-30 |
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Assessing and Addressing the Psychosocial Needs of the Rohingya Refugees in Bangladesh
Omar Reda
Department of Psychiatry, Providence Health and Services, Portland, Oregon, USA
| Date of Submission | 01-Oct-2019 |
| Date of Acceptance | 07-Nov-2019 |
| Date of Web Publication | 21-Mar-2020 |
Correspondence Address:
Dr. Omar Reda
SW Barnes Road, Portland, Oregon 97225
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_23_19
Interpersonal violence is a very serious public health hazard that is often overlooked. Ignored, trauma is known to cause family and community dysfunctions than can span generations. Unfortunately, the trauma stories of many survivors are untold because they are either too painful for the people to share or too scary for loved ones and professionals to handle. I had the great privilege of working in multiple disaster-stricken and war-torn contexts. My focus through Project Untangled is on family bonding and youth empowerment with the goal of ultimately untangling the web of dysfunction and breaking the cycle. In this first-person account, I share my recent experience working with the Rohingya refugees in Bangladesh: what I felt, what I did (or tried to do), what I learnt, how it changed me, and the implications of these experiences for social psychiatry.
Keywords: Displacement, refugee, resilience, torture
How to cite this article:
Reda O. Assessing and Addressing the Psychosocial Needs of the Rohingya Refugees in Bangladesh. World Soc Psychiatry 2020;2:27-30 |
| Introduction | |  |
In communities affected by man-made trauma such as wars, armed conflicts, and interpersonal violence, it is extremely important to assess and address the psychosocial consequences of such atrocities, for people to find meaning in suffering and move toward healing.
There are about a million Rohingyas who sought refuge in Bangladesh since 2017, fleeing the genocide in Myanmar. Many are in dire and urgent need of early prevention and intervention psychosocial programs focused on empowering them and their caregivers.
As in any ugly war context, there are many stories of heavy pain and unspeakable trauma in this community. Three encounters are briefly mentioned below to put things in perspective. This is my attempt to honor the voiceless victims and bring them out of the shadows. The rest of this writing is focused on resilience, empowerment, hope, and healing.
• STORY 1: At the age of 105, she watched with a broken heart as her five daughters ran toward the forest, heading for the border between Burma and Bangladesh. She stayed behind to make sure that her three sons were going to be okay while they tried to distract the soldiers and give their sisters enough time to flee the imminent danger. Unfortunately, sexual trauma is a commonly used dirty and humiliating weapon of war. The army had no mercy on the old woman who had to witness in horror the execution of her boys. She was left to nurse her wounds, alone. For the last 2 years, she had been living in the refugee camp hoping to one day hear any news about the whereabout of her girls. What words of consoling can I or anyone possibly offer this mom?
• STORY 2: She had to wake up to the fires, set by soldiers, engulfing her home. Frantic, she had to see two of her six children perish in the blazing inferno. Delirious, she ran with the other four for more than 4 days before reaching the river and boarding a boat to Bangladesh. What is the true meaning of safety when war continues to wage in your mind and terrorize your sleep?
• STORY 3: At a safe space I conducted with parents, he shared the story of helplessly seeing nine of his family members drown while trying to cross the dangerous waters fleeing the civil war. He talked about survivor guilt. No wonder the Australian volunteer nurse asked me, “Dr. Reda, why is it that the Rohingya refugees seem to never smile?” How can someone bring back joy when the trauma story violently takes it away?
| What I Experienced | | |
In April of 2019, a partnership between Project Untangled[1] and the NGO MedGlobal[2] led to a comprehensive healing initiative being implemented in Camp 4 in Cox's Bazar, Bangladesh. The Untangled model of psychosocial care was designed for the refugee camp with the goal of breaking the vicious cycles of dysfunction that can affect not only individuals but also families and communities and to untangle the deadly web of trauma that can span generations and carry a heavy price for the affected society as a whole, for a long time to come.
I had the privilege of spending one week at the world's largest refugee camp just outside of Cox's Bazar, Bangladesh, where all five pieces of Project Untangled (education, training, resources, safe spaces, and culturally-aware clinical care) were put together in a comprehensive manner to help solve the puzzle of how to care for large numbers of traumatized populations in a resource-limited setting.
Being a survivor of many traumatic experiences myself, I am extremely passionate about helping people find meaning, healing, and closure. I have been to many countries impacted by violence but my experience in Bangladesh had deeply affected me, both personally and professionally.
| What I Did (Or Tried to Do) | | |
Believing deeply in the importance of empowering the local community to take an active role in being part of the solution, I refused to see the Rohingya refugees as the problem and refrained from coming across as the “expert” when it came to their suffering. They themselves were the subject matter experts and the ones who needed to tell their stories and reclaim their narratives. Hence, I decided instead to have the cultural humility to sit down with members and leaders of the refugee community and their assigned NGO staff to build a system of care that leaves a long-lasting impact and ensures consistency and continuity of care.
During my short mission, I had the honor of helping serve the 6000 refugees in Camp 4, working with the MedGlobal[2] and the OBAT Helpers[3] teams. We conducted a quick assessment of needs using a questionnaire generously shared by colleagues at the Center for Victims of Torture.[4] The target goal was to obtain a sample size of 100 adults (50 men and 50 women), but after receiving 36 responses (23 men and 13 women), potential participants demanded financial incentives forcing us to discontinue recruitment and prematurely terminate the process, well aware of the limitations of our study caused by its small sample size. The following are some of our findings:
- Attitudes toward mental health: stigma is a contributing factor to refugees not speaking up or seeking help
- Conflicts and threats of violence are real daily issues facing refugees in the camp
- Most refugees lean on their family, community, and religion to find healing
- Family dynamics are negatively affected by trauma
- Many refugees exhibit their trauma somatically
- Through the support of NGOs on the ground, local healers, community leaders, and imams, Rohingyan refugees are slowly opening up to receive psychosocial education, support, and therapeutic services.
Next, in order to build the capacity of the local staff, I designed a 12hour intensive certificate course on trauma-informed care. The training was conducted over four days with 29 NGO staff divided into morning and afternoon groups for participants to benefit from the program without disrupting the flow of ongoing care of refugee provided at the clinic [Figure 1]. Topics included the definition of trauma and its impact on survivors, listening to the trauma story, harnessing resilience, and focusing on self-care. Despite the need for instant translation, the training was extremely hands-on and interactive. I was happy to gift my newly published book Untangled[5] to the camp library on the 1st day of its inauguration.
Given the importance of psycho-social education to combat stigma, I conducted a safe space and a focus group with 37 parents (25 fathers and 12 mothers) where we explored themes of one's identity, sense of dignity, stress-management, and tips for safe and healthy parenting, navigating trauma through family bonding and communal support, in addition to how to care for ourselves while caring for our loved ones [Figure 2]. I was extremely humbled by how much resilience these people exhibited despite the horrific traumas they encountered and the deep pains they endured. I was also very pleased to learn of how receptive they were to the importance of emotional well-being in the long journeys of healing they embark on and of their commitment to repair family ties and provide safety to their children and spouses. I also made myself available for an ongoing and long-term relationship with the community and support staff through supervision and consultation.
I finally conducted a play and art therapy session with 25 Rohingya children where we learned together the foundations of self-esteem, the importance of expressing one's feelings, and challenging negative thoughts and behaviors [Figure 3] and [Figure 4]. We role-played the topics of eye contact, smile, safe touch, greeting, and having heart-to-heart conversations, teamwork, non-violent conflict resolution, and how a family that bonds in the face of trauma and tackles it together is a special, safe and resilient family, where members do not see each other as the enemy but rather stay united and work as a team untangling the deadly web and breaking the dysfunctional vicious cycles.
| Implications for Social Psychiatry | | |
Trauma can lead to severe intrapsychic, interpersonal, and transgenerational dysfunction. If not addressed, that threatens the mental health and emotional well-being of individual survivors, the cohesion of the family unit, and can even lead to a wide-spread impact on the affected community.
Having lived through the asylum-seeking and forced-displacement experience, I am acutely aware of the long-term impact of trauma on the psyche of its survivors. Graduating from the Harvard Program in Refugee Trauma[6] and working as a psychiatrist in multiple disasters and war contexts, I gained a deep insight into the importance of tending to the invisible psycho-social wounds and scars of trauma if we are to help people heal and thrive.
Furthermore, having the great privilege of working with refugees and trauma survivors in the United States and globally, I created a model of care, Project Untangled,[1] that has been well-received by caregivers of traumatized children, families, and communities. Several communities in the USA, Canada, Libya, Syria, and Bangladesh, have now implemented some or all the components of Untangled and found it to be a powerful therapeutic tool and a much-welcome addition in filling important gaps in the design and delivery of culturally-sensitive trauma-informed services, especially to those who are underserved and otherwise forgotten.
It is through the genuine expression of healing love and caring for one another that we open channels of communication and build bridges of trust that can help such trauma survivors see the light at the end of a very dark and long tunnel.
This is a journey of one psychiatrist, and it had renewed my deep belief in the ability of healers to lend a helping hand even in the darkest of circumstances. It is very important to never lose hope or preach despair and to never underestimate the impact one human can have on another. Even though I did not share the language skills or some of the cultural aspects with the Rohingya refugees, they found my contribution invaluable because the approach was caring and authentic.
| How This Experience Affected Me | | |
I am very impressed and humbled by the amount of resilience and the ability of the human spirit to not only survive but also thrive when faced with tragic adversities and unimaginable suffering. I came face-to-face with how true and powerful the words of the Persian Sufi poet Rumi are when he stated that “there are beautiful things that you can only see in the dark.” I did not only experience pain but also an overwhelming amount of beauty shining out of the forgotten tents in Cox's Bazar.
I am very honored that my modest efforts in Bangladesh provided a small but much-needed glimpse of hope to a community in the midst of despair. It is my immense privilege to be of service to those in need, worldwide, and to celebrate my mother's memory and her last words of advice and wisdom, when she told me “son, stay always busy in the business of mending broken hearts. If you can't be the source of someone's joy and delight, don't be the source of their pain and distress.” It is not only my ethical duty to serve, it is a true honor!
Financial support and sponsorship
None other than travel expenses covered by MedGlobal.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | |
| 3. | |
| 4. | Center for Victims of Torture. Available from: https://www.cvt.org/. [Last accessed on 2019 Oct 01].  |
| 5. | Reda O. Untangled: A Go-To Guide for Caregivers of Traumatized Children, Families, and Communities. 1 st ed. Portland (OR): Chehalem Press; 2019. |
| 6. | |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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