This is the last part of a two-part series on them mental health of the Roghingya refugees
As the world takes stock of the situation two years on from the forced mass expulsion of the Rohingya from Myanmar, the 'leaders' of the refugee community in Cox's Bazar placed a five point charter of demands.
Syed Ullah, refugee leader and secretary of the Arakan Rohingya Society for Peace and Human Rights (ARSPHR), placed the demands at a press briefing in Jamtoli camp of Cox's Bazar in August 2019.
It has now been two years since a brutal campaign of ethnic cleansing by the Myanmar military forced out of the country, more than two-thirds of the Rohingya population living in Myanmar.
Talking to reporters at refugee camps in Ukhiya and Teknaf, youth and elderly alike said they want to return to their homeland but before that they want reassurance from Myanmar authorities about a conducive environment in northern Rakhine state.
They said the ultimate solution to the Rohingya crisis will be a safe, voluntary, dignified, and sustainable return of those who fled their homes in Myanmar.
Meanwhile, the failure in the reparations and repatriation of Rohingya refugees has been causing mental health problems among the refugee population and people of the host communities as well.
A sense of resentment prevails among locals who now fear repatriation of the refugees might take longer than they had anticipated.
They say the Rohingya are getting basic necessities for free, and as such, they are planning a much longer stay. They accuse the Myanmar authorities of festering security threats while NGOs, they say, have been luring refugees in an effort to secure their own jobs.
Chairman of Ukhiya upazila and President of the Rohingya Repatriation Movement Committee, Hamidul Haque Chowdhury, said they were facing nagging problems from Rohingya refugees. He initially thought the Rohingya would go back to their homeland much earlier.
But it appears they have to carry forward the suffering for an extended period and that is unsettling for local communities as the ripple effects are testing their patience, he added.
Ukhiya Upazila Citizen Rights Committee President Rafiqul Islam said locals have always been in a state of anxiety and fear attacks from gangs that have sprung from the Rohingya refugee community staying in the camps. He said, these gangs would not even hesitate to kill.
Panic among locals is visibly increasing. Unless quick measures to repatriate Rohingya refugees are taken, host communities will go for a wider protest movement demanding their immediate return to Myanmar, he added.
Action Contre la Faim France (ACF) Coordinator of MHCP, Farhana Rahman Eshita, says they have noticed signs of stress and resentment among a good number of their beneficiaries in the local community.
Médecins Sans Frontières (MSF) said they have been providing mental health consultations, including psychiatric care, in the Ukhiya Upazila Health Complex since June, 2017, in collaboration with the Ministry of Health and Family Welfare (MoHFW) and the Directorate General of Health Services (DGHS). They have provided clinical care for 320 patients with mental health problems in the local community.
At the Kutupalong Field Hospital alone, some 1400 psychiatric consultations were offered to host community patients, they added.
The primary mental health scares for the local community include anxiety, depression, epilepsy, domestic violence, and suicidal tendencies, MSF's Dr Kalyan Velivela noted.
Solution seems a far cry
Meanwhile, Prime Minister Sheikh Hasina on Oct 26, at a plenary session of the 18th Summit of the Non-Aligned Movement (NAM) in Baku, capital of Azerbaijan, stressed that the voluntary return of the displaced Rohingyas to their homes in Rakhine State, with security and dignity, is the only solution to the crisis.
A specialist working in Cox's Bazar, seeking anonymity said the mental issue is badly influencing Rohingya refugees in determining their return to their home country.
“Without mental stability peaceful repatriation is remotely possible.”
Growing animosity among the host communities could bring about another crisis following mental health disturbance.
Currently, there are some visible gaps in the existing services being provided in the area.
According to the report prepared by UNHCR in June 2019, there are significant gaps in knowledge on maternal health and reproductive health, combined with traditional practices, that have resulted in poor health service utilization.
Community based psychosocial interventions are not at the scale needed to reach the high number of refugees, it added.
The International Organization for Migration’s (IOM) George McLeod says there are significant gaps in mental health services, due in part, to strained resources and a lack of case workers.
Our guidelines state that case workers should handle no more than 15 cases at a time, but many are saddled with over 30, which impedes their ability to offer quality services, he added.
Will mental health problems delay repatriation
Specialists and aid activists working in the camps could not definitively say that mental health issues are the prime reason for the delay in repatriation. But many of them defined it as one of the primary causes for them to demand security and safety as a precondition for repatriation.
They said mental health needs of the Rohingya refugees are immense. Many people have lost relatives and faced targeted violence in Myanmar.
MSF Medical Coordinator Dr Kalyan Velivela also said the mental health problems could not be described as the sole reason for the delay in repatriation.
Data presented in the WHO report suggests that far more help and medical assistance for survivors is needed.
Dr Mark Van Ommeren, Public Mental Health Adviser, WHO Department of Mental Health and Substance Abuse, who was also one of the authors of a report published on the organization's website emphasizing political commitment, said there were opportunities after conflicts to do more for people.
“Despite their tragic consequences, when there is determined political will, emergencies can turn out to be a catalyst for building quality, sustainable mental health services that continue to help people in the long term,” he said.
Underscoring the need for effective mental health programs aimed at serving local communities, IOM Chief in Bangladesh, Giorgi Gigauri, said we cannot write off the possibility of a conflict between the refugees and the host community.