“Men can spend time outdoors; the women have to spend most of their time in their shacks. There is no privacy or physical space where they can be alone,” says Pooja Iyer, MSF’s mental health manager at the Jamtoli and Hakimpara camps for Rohingya refugees in Cox’s Bazar. 

Iyer has been in Cox’s Bazar, Bangladesh since March 2019. MSF provides comprehensive mental healthcare, including psychiatric care, for Rohingya refugees and the local Bangladeshi population in the district. Mental health teams in Hakimpara and Jamtoli consist of counsellors, psychologists, a psychiatrist and community mental health educators.

 “We are seeing an increase in the number of patients with depression and anxiety,” says Iyer.  “Most of them experienced violence and the loss of an immediate relative in Myanmar. In the camps, they live in cramped shelters with poor hygiene. Sometimes a family of ten will have just enough space to sleep beside each other. It is literally cheek by jowl – imagine having no space to stretch your legs.”

Children coping with neurological, developmental or learning disorders or delays are the most vulnerable.

“We have patients with cerebral palsy, attention hyperactivity deficit or autism-spectrum disorders who cannot go to a regular school or a learning centre, as they get teased and bullied by others,” says Iyer. “They suffer in silence.”

Severe mental health gaps exist in the refugee camps for Rohingya in Cox’s Bazar. In the Jamtoli and Hakimpara camps, 450 patients are currently seeking mental health counselling. Some of the patients are receiving psychiatric treatment for severe mental disorders such as bipolar disorder, schizophrenia and other psychoses.

Is there hope? For Iyer, hope is seeing her young patients recover from trauma suffered in Myanmar.

“Most children are scared of men in uniform, as they witnessed violence perpetrated by either the Myanmar army or police,” she says. “When they improve, they are able to verbalise their experience without trembling or urinating in their clothes. Isn’t that hope?”