Bangladesh has the highest natural disaster mortality rate in the world, with over half a million people lost to natural disasters since 1970. These rates are going to rise as floods and cyclones grow more prevalent due to the effects of climate change effects that we are already experiencing. Until now the government’s post-disaster response strategy has focused, increasingly and effectively, on the physical needs of survivors through the provision of shelter, food and medical care. However, the serious and widespread mental health consequences of natural and manmade disasters in Bangladesh have only recently begun to receive the attention it deserves.
A technical session on psychosocial support was held in the 2nd International conference on Disability and Disaster Risk Management (DRM) held from May 15 to May 17 this year. Although the session was titled ‘Technical Session: Models for Psychosocial Support and Management of Trauma during Humanitarian Crisis’, it only focused on the Rohingya crisis.
Most concerns regarding psychosocial interventions that were raised at the session largely focused on the long term effects and the mitigation plan. While a refugee crisis such as that of the Rohingya situation is complicated and difficult in any context, it is especially so for Bangladesh.
THE NEGLECTED STIGMA
Mental health is a very neglected and stigmatised discussion in Bangladesh, where there is no national policy for mental health care and the national budget allocation for mental health not being even 1 percent. So it is no surprise that there is a lot more to do and a dearth of knowledge and resources for developing effective psychosocial interventions. The WHO has looked for successful interventions in neighbouring countries and have found the best example from Sri Lanka’s mental health program developed in the aftermath of the Indian Ocean Tsunami in 2004.
The Indian Ocean Tsunami in 2004 was devastating to coastal regions in South Asia, particularly so to Sri Lanka where 30,000 people died and 6,000 people were never found. The government of Sri Lanka aptly recognised the mental devastation that was caused by the disaster. Part of their recovery and reconstruction program was a community-based mental health service through a year-long diploma course for medical officers to provide psychosocial support. This is particularly instructional for Bangladesh where we struggle with not having enough human resources to provided mental health services and where the prevalence of mental illness is estimated to be as high as 31 percent of our population. With a population of 160 million people, that number amounts to almost 50 million people. Displacement is also a widespread consequence during floods and cyclones as people have to move to higher land.
This is not to undermine the importance of attending to the Rohingya crisis as a man-made disaster, rather to point out that a more progressive effort is required in designing disaster management interventions in Bangladesh. While the model used to address the Indian Ocean Tsunami aftermath is a good example to follow, with particular regard to the Rohingya situation, there a similar intervention in Sri Lanka that could prove to be a more useful example.
This was an intervention developed at the end of the chronic civil war that devastated Sri Lanka, mainly the north and east of Sri Lanka. The Tamil population in particular of which a million people were estimated to have been displaced. Dr Daya Somasundaram a senior professor of psychiatry at the Faculty of Medicine, University of Jaffna, and a consultant psychiatrist working in northern Sri Lanka for over two decades does a psycho-ecological study in his book called ‘Scarred Communities’, on long term man-made and natural disasters and community based interventions in Sri Lanka.
A major consequence of the civil war was internal and external displacement of the Tamils resulting in ‘collective trauma’. The book includes recommendations for community-based psychosocial services as psychological effects were not at an individual level and were further perpetuated by collective fears. For long term sustainability and effectiveness, the capacity for psychosocial work had to be developed within the state structures and institutions functioning at the ground level, particularly in the war-affected areas. In view of the widespread traumatisation and consequences of the war, affecting large numbers of the population, the task force identified state officers working at the Divisional level as those dealing directly with the public and thus most suitable to target for the psychosocial training.
Determining long-term effects and interventions is cumbersome due to the nature and complexity of the situation of the Rohingyas. The aftermath of being persecuted and driven out of one’s land, experiencing and witnessing immense violence, results in post-traumatic stress which has been reported by the International Organization for Migration(IOM) and many development organizations that work with Rohingya refugees. The presentation by the Shuchona foundation and the WHO, at the international conference also discussed the prevalence of a feeling of displacement among the refugees. According to a study by the IOM working with refugees reported 40 percent of refugees cited “not being recognised as citizens” as psychologically destabilising. Here too the issue of an adequate supply of mental health professionals has been reported where one counsellor is available for a camp of 10,000 people.
Displacement is both a psycho-social and physical reality for the Rohingyas. The repatriation of the Rohingyas back to Myanmar being a painstaking disputed process in itself gives no immediate indication as to what the future holds for the Rohingya refugees. The only determined reality for the Rohingyas is ‘displacement’. The Rohingyas have been displaced from their home country, taking refuge in Cox’s Bazar from where it is obvious that they will be displaced again either back to their home country or, as the Bangladesh government is planning, to another island until their repatriation process is complete. Yet the current disaster risk management initiatives does not have a model for psychosocial support that strongly addresses displacement, through the help of training perhaps the army and state forces working their along with development practitioners working at the refugee camps.