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Rohingya refugee volunteers combat stresses of camp life with mental health support


Rohingya refugee volunteers combat stresses of camp life with mental health support

Equipped with training by UNHCR, Rohingya refugees and local Bangladeshis are delivering counselling and awareness-raising on mental health.
9 October 2023
Using a rubber band stretched tight between two hands Nur Kalam explains how stress can make us snap.

Nur Kalam conducts a counselling session with a Rohingya refugee at a community health centre in Cox's Bazar.

Nur Kalam, 21, sits cross-legged on the floor of a community health centre in southern Bangladesh’s sprawling Kutupalong camp listening carefully to the soft voice of a Rohingya mother.

The young mother, a new patient at the health centre, shares her struggles to survive amid food ration cuts, growing violence between criminal groups, and the extreme weather that batters her family’s bamboo and tarpaulin shelter every monsoon season.

Nur Kalam — himself a refugee — helps her understand how such precarious circumstances give rise to negative thoughts, and what happens when those thoughts build up. Using a rubber band stretched tight between two hands, he explains how stress can make us snap. Releasing those feelings before that happens is critical to good mental health.

Nur Kalam is one of 100 community counsellors, 80 of them refugees, trained by the UN Refugee Agency, UNHCR, and partners to provide mental health and psychosocial support to nearly 1 million Rohingya refugees forced to flee Myanmar who now live in densely packed settlements in Cox’s Bazar and on the island of Bhasan Char. They are supported by 182 community psychosocial volunteers, 87 per cent of whom are Rohingya refugees while the rest are from local Bangladeshi communities. 

Community counsellors provide one-on-one counselling, while psychosocial volunteers run group awareness sessions on topics such as better parenting and anger management. With limited mental healthcare capacity in Bangladesh, these volunteers form the backbone of UNHCR’s mental health and psychosocial support (MHPSS). Not only do they help bridge a gap, but they understand their community’s problems and the daily stresses of life in a refugee camp.

Transforming attitudes to mental health

UNHCR and partner mental health (MHPSS) staff at primary healthcare centre for Rohingya refugees in Cox's Bazar, Bangladesh

UNHCR mental health and psychosocial support officers Mahmudul Alam (middle) and Hivine Ali (right) with Md Asad Al Ahsan, an MHPSS officer from partner organization Gonoshasthaya Kendra (GK).

“Mental health is a new concept for the Rohingya here,” says Hivine Ali, UNHCR’s MHPSS officer in Cox’s Bazar. “Previously, they understood physiological disease, but not the idea that problems with our physical health can be due to stress or anxiety, which can be addressed by mental health awareness and counselling.” 

UNHCR’s MHPSS programme currently reaches over 150,000 Rohingya refugees. Alongside individualized counselling – by psychologists as well as by community counsellors – volunteers and staff provide clinical consultations, specialized trainings, and support group sessions. UNHCR also operates the only two in-patient mental health facilities within the camps through partner Gonoshasthaya Kendra (GK).

The community counsellors are trained in an approach called Integrative Adapt Therapy (IAT), which addresses challenges specific to Rohingya refugees and uses scenarios and idioms likely to resonate with them, such as the rubber band analogy used by Nur Kalam.

In group sessions, the psychosocial volunteers create safe spaces for participants to understand their thoughts and feelings and to share their struggles. They take children and adults through exercises and offer techniques to bring emotions under control. They look for warning signs of poor mental health and people needing individualized counselling.

Greater awareness of mental health has been transformative for her community, says Shahanur, 24, who has been a volunteer since 2019.

“Before, when negative things happened, they couldn’t control their feelings,” she explains. “Learning coping techniques such as breathing exercises helps them feel calmer, sooner.” 

Shahanur gives the example of a relative who often argued with her neighbours. After Shahanur taught her techniques to manage her anger, her relative’s relationships improved, as well as her peace of mind. “She is very grateful,” says Shahanur.

Increasing hopelessness

By supporting their community, the Rohingya volunteers also find meaning and purpose. For many, like Nur Kalam, who dreamt of becoming a doctor when he was a child in Myanmar, the ongoing training provided by UNHCR offers opportunities to develop their potential and pursue knowledge and skills previously denied to them. 

At the same time, as the Rohingya refugee crisis goes into its seventh year with dwindling funding for assistance, and scant progress towards solutions — even the volunteers cannot escape feelings of hopelessness and fear.

Mental health in the world's largest refugee camp

“We have overcome so many traumatic incidents,” Nur Kalam says. “Violence in the camps is increasing, and even the sound of a balloon bursting makes people afraid at night. We are afraid that we will never go back to our homeland. We worry about our children’s futures.” 

In his counselling sessions, Nur Kalam says he is seeing more people with depression and incidences of self-harm — signs of increasing hopelessness.

Galiya Gubaeva, Head of the Field Office on Bhasan Char, now home to some 30,000 Rohingya refugees relocated from Cox’s Bazar by the Government of Bangladesh, says the remoteness and isolation of the island create additional stress for refugees there: “The Rohingya people value community. It’s very important for them to feel connected, to be part of family events. Losing that affects their mental health.” 

Funding shortfalls threaten progress

Although the Government facilitates family visits to the camps in Cox’s Bazar, wait times can be very long. To address the added risks to mental health, UNHCR has intensified community-based activities and specialized psychological support on the island, including through tele-counselling. 

However, as donor funding shrinks, gains can be quickly reversed. “Already, this year we have had to cut volunteers by about 40 per cent due to budget reductions. This increases pressure on the remaining team,” says Hivine Ali. 

With resources spread so thin, she adds, cases of mild to moderate illness may slip through the cracks and become serious enough to require specialized interventions. Given limited local capacity, a spike in cases of severe mental illness would strain the system. 

"We hear from so many of our volunteers what a difference mental health support makes,” Hivine says. “We must ensure continued funding so the Rohingya can live healthy, dignified and productive lives, now and in the future.”

“Mental health is a new concept for the Rohingya here”

Hivine Ali, UNHCR MHPSS officer