Culture, Context and Mental Health of Rohingya Refugees: A Review for staff in mental health and psychosocial support programmes for Rohingya refugeees

Summary:

In August 2017, a major humanitarian crisis in the Rakhine State of Myanmar triggered a mass exodus of around three-quarters of a million stateless Rohingya refugees into neighbouring Bangladesh, adding to the estimated 200,000–300,000 Rohingya refugees in Bangladesh who had fled Myanmar earlier and the estimated 73,000 Rohingya refugees in Malaysia.

Limited information is available on the culture and mental health of the Rohingya, which poses significant challenges to the provision of Mental Health and Psychosocial Support (MHPSS) and related services to this group. Therefore, UNHCR commissioned this document with the aim of providing a concise review of the literature concerning the culture, context, mental health and psychosocial wellbeing of Rohingya refugees.

The content of the document is based on an extensive review of the published and grey literature including various sources of information provided by United Nations agencies, non-governmental organizations, and governments. The search included published and unpublished archival data, academic articles, documents, and other relevant documentary materials from disciplines ranging across the social sciences, anthropology, ethno-cultural studies, psychology and public health. A core group of multidisciplinary personnel wrote and reviewed draft versions of the document after which an advanced draft was sent out for wide review among academics, NGO staff and UN experts.

The first part of the review provides a broad overview of the general context focusing on the historical, geographic, demographic, economic, political, religious, gender, and cultural factors relevant to the Rohingya people. The Rohingya are the largest Muslim group in Myanmar. Their history is complex, involving exposure to a long legacy of human rights violations including torture, rape, assault, extrajudicial killings, and restricted access to education and health care. Many, and probably most. Rohingya have been displaced, either within Myanmar or as refugees now residing in Bangladesh, Malaysia and other countries.

The second part of the report focuses on the mental health of the Rohingya people, including the epidemiology of mental health conditions, the range of risk factors (e.g. exposure to potentially traumatic events, poverty, shortage of food, shelter, healthcare, loss of identity, being stateless, sexual and gender-based violence), and protective factors (e.g. religion, spiritual adherence and practice, formal and informal social support). This section also describes the various terms in the Rohingya language to indicate mental health conditions. These concepts are not equivalent to the psychological concepts of depression, posttraumatic stress disorder or anxiety disorder, although they could overlap to some extent overlap with them. Thus, MHPSS service providers need to clearly explain what they mean when they use international constructs of mental ill-health in conversations with Rohingya clients. Rohingya cultural idioms of distress (common modes of expressing distress within a culture or community) and explanatory models (the ways that people explain and make sense of their symptoms or illness) are closely related to religious ideas and concepts held by the person. The Rohingya worldview of the self/ person tends to distinguish between the brain (mogos/ demag), the mind-soul (dilor/foran), and the physical body (jism). It is important that MHPSS providers working with Rohingya have a global idea of these concepts since they influence the expectations and coping strategies of their Rohingya clients.

The third part of the review describes the current humanitarian context, particularly in Bangladesh where multiple agencies are involved in MHPSS interventions within various sectors such as health, nutrition, education and protection (including child protection, community-based protection and prevention and response around sexual and genderbased violence – SGBV).

This review highlights the importance of understanding the key sociocultural aspects of mental health and wellbeing to assist humanitarian agencies, government, and non-government organizations in providing effective culturally informed services to the Rohingya. An overarching aim in providing this information is to encourage a consistent and coordinated multi-sectoral approach to address the mental health needs of the Rohingya.