By Andrew Riley in Asia Times

The coup in Myanmar compounds the nationwide instability and stress that fuel the mental-health crisis

“The tiger in my mind consumes me faster than the tiger in the forest,” goes the common Rohingya saying. 

The shooting has stopped, the wounds have become scars, the burned-out husks of old villages have been cleared away, and life in the refugee camps grinds on for more than 900,000 Rohingya in Bangladesh and more than half a million living under oppressive restrictions in Myanmar. 

But as the dust settles in the aftermath of atrocities, the Rohingya continue to grapple with the tiger in the mind, the unseen mental and emotional impacts of systematic human-rights violations and violence.

The recent coup in Myanmar compounds the nationwide instability and stress that fuel the mental-health crisis festering among Rohingya survivors and places real solutions further out of reach. Continuing to address the symptoms without addressing the causes is not enough.

new study published by Fortify Rights documents severe, debilitating, and widespread mental-health symptoms among Rohingya living in refugee camps in Bangladesh. Survivors recounted in detail their experiences reliving terrifying events through flashbacks and nightmares, feeling hopeless about the future, and unrelenting anxiety. 

“The violence and torture that happened in Myanmar are usually in my thoughts and mind,” a Rohingya man is quoted in the report saying. “If I sit somewhere and remember the violence, I suddenly fall down and become faint…. If I go to bed at night, the troubles that occurred in my journey to Bangladesh appear in my mind. Thus, I cannot sleep.”

The scale of distress is overwhelming. The Fortify Rights report describes serious symptoms of trauma, depression, and anxiety at astounding rates: 62% of Rohingya refugees in Bangladesh experienced levels of trauma symptoms typically consistent with a diagnosis of post-traumatic stress disorder, while 84% experienced symptoms indicative of severe emotional distress, and 89% experienced symptom levels typically diagnostic of depression. 

To put these rates into perspective, the World Health Organization estimates that one year after an emergency only 15-20% of adults will experience some type of moderate or mild mental-health disorder. 

Why are Rohingya experiencing these extreme rates of trauma, depression, and anxiety?

Fortify Rights identifies violence against the Rohingya in Myanmar as well as restrictions on basic rights in both Myanmar and Bangladesh as key contributors to mental-health distress.  

As part of the military campaign against them in Myanmar, Rohingya survived extremely high rates of violence, including torture, stabbings, beatings, shootings, and sexual assault. 

But it’s not only experiences of direct violence that drive distress; many Rohingya in Myanmar have experienced a lifetime of extreme restrictions preventing access to health care, education, movement, work, marriage, childbirth, religious practice, citizenship, meeting in groups, or even identifying as Rohingya. 

These long-term restrictions, in addition to the genocidal attacks in 2016 and 2017, continue to erode Rohingya mental health long after escape from Myanmar. 

Sadly, the root causes of mental harm are not a thing of the past. The long-standing policies of persecution in Myanmar continue to be enforced, likely inflicting further mental harm on more than 600,000 Rohingya still living in Myanmar. 

In addition, needless and ongoing daily stressors in Bangladesh refugee camps contribute even further to mental-health distress, including serious problems due to insufficient food, water, shelter and living space, and restrictions on movement. 

Likewise, the current efforts by the government of Bangladesh to relocate Rohingya refugees forcibly to the isolated Bhasan Char island could add to existing stressors and fuel additional mental harm. These environments of restriction and deprivation must be addressed. 

Refugee mental-health crises of this scale are generally approached from a perspective of provision of public health and service. The United Nations and humanitarian aid organizations are seen as responsible for providing mental-health and psychosocial services to facilitate healing and resilience among refugee populations experiencing high levels of distress. 

This approach is absolutely necessary and also absolutely insufficient to address fully the mental-health distress among Rohingya. Providing mental-health services without restoring basic human rights places a low ceiling on the healing that can be achieved and avoids confronting the complex political realities that fuel refugee distress.

The restrictions levied against the Rohingya both in Myanmar and Bangladesh are not merely innocuous difficulties to be remedied in some distant future. They are a violation of fundamental human rights and a source of long-term and ongoing mental harm for Rohingya refugees. 

The international community must do more than write checks for humanitarian relief. Governments must use their bilateral political and economic leverage to pressure Myanmar effectively to re-establish democratic governance in the country. Furthermore, Myanmar must restore the rights of the Rohingya, including by granting citizenship and the right to freedom of movement. 

Bangladesh also has a role to play. To avoid contributing to further harm through needless restrictions on refugees, Bangladesh must ensure that Rohingya have freedom of movement, the right to work, and access to formal education. 

Last, humanitarian organizations operational in Bangladesh should continue to provide coordinated and culturally appropriate mental-health and psychosocial services that meet the scale of Rohingya needs in the camp.

Ultimately, the Rohingya want what we all want: human rights, and freedom from the tiger in the mind. 

This article was originally published in Asia Times here.

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