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Culture, Context and Mental Health of Rohingya Refugees

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Culture, Context and Mental Health of Rohingya Refugees CULTURE, CONTEXT AND MENTAL HEALTH OF ROHINGYA REFUGEES A review for staff in mental health and psychosocial support programmes for Rohingya refugees Review 1 © UNHCR, 2018. All rights reserved Reproduction and dissemination for educational or other non-commercial purposes is authorized without any prior written permission from the copyright holders provided the source is fully acknowledged. Reproduction for resale or other commercial purposes, or translation for any purpose, is prohibited without the written permission of the copyright holders. Applications for such permission should be addressed to the Public Health Section of the Office of the United Nations High Commissioner for Refugees (UNHCR) at [email protected] This document is commissioned by UNHCR and posted on the UNHCR website. However, the views expressed in this document are those of the authors and not necessarily those of UNHCR or other institutions that the authors serve. The editors and authors have taken all reasonable precautions to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the United Nations High Commissioner for Refugees be liable for damages arising from its use. Suggested citation: Tay, A.K., Islam, R., Riley, A., Welton-Mitchell, C., Duchesne, B., Waters, V., Varner, A., Silove, D., Ventevogel, P. (2018). Culture, Context and Mental Health of Rohingya Refugees: A review for staff in mental health and psychosocial support programmes for Rohingya refugees. Geneva, Switzerland. United Nations High Commissioner for Refugees (UNHCR). Cover photo: Thousands of new Rohingya refugee arrivals cross the border near Anzuman Para village, Palong Khali, Bangladesh. As an estimated 500,000 Rohingya sought safety in Bangladesh between late-August and October 2017, UNHCR worked with the authorities to create a transit centre to prepare for a further influx, as some 11,000 people crossed the border on 9th October. © UNHCR/Roger Arnold, 9 October, 2017 Graphic design: BakOS DESIGN TABLE OF CONTENTS 1. Introduction ..................................................................................................................................................................................................... 8 1.1 Rationale for the desk review ......................................................................................................................................................... 8 1.2 Methodology ......................................................................................................................................................................................... 8 2. Context .............................................................................................................................................................................................................11 2.1 Myanmar: Geographical and demographic aspects .............................................................................................................11 2.2 The Rohingya of Myanmar: A history of persecution and human rights violations ................................................11 2.3 Rohingya refugees .............................................................................................................................................................................12 2.4 Rohingya and religion .......................................................................................................................................................................16 2.5 Gender and family aspects .............................................................................................................................................................17 2.6 Customs and language .....................................................................................................................................................................19 2.7 General health aspects ....................................................................................................................................................................21 3. Mental health and psychosocial wellbeing of Rohingya.............................................................................................................23 3.1 Epidemiological studies of mental disorders and risk/protective factors ...................................................................23 4. Rohingya cultural concepts around mental health and mental illness ................................................................................29 4.1 Rohingya beliefs and expressions (idioms) of distress and mental illness...................................................................29 4.2 Concepts of the self/ person..........................................................................................................................................................33 4.3 Religion, faith, and traditional healing and their role in mental health and psychosocial support ....................33 4.4 Help-seeking behaviour ..................................................................................................................................................................35 5. Interventions to improve mental health and psychosocial wellbeing of Rohingya ........................................................37 5.1 Role of the social sector in MHPSS .............................................................................................................................................37 5.2 Role of the formal and informal educational sector in MHPSS .......................................................................................38 5.3 Role of the health sector in MHPSS ............................................................................................................................................39 5.4 Coordination of MHPSS services for Rohingya refugees in Bangladesh.....................................................................40 5.5 Documented experiences involving mental health and psychosocial support for Rohingya ..............................40 5.6 Towards a multi-layered system of services and supports ................................................................................................42 6. Challenges in providing culturally relevant and contextually appropriate services for mental health and psychosocial support to Rohingya refugees .........................................................................................................................................44 6.1 Language ...............................................................................................................................................................................................44 6.2 Concepts of psychological problems ..........................................................................................................................................44 6.3 Help seeking behaviour ...................................................................................................................................................................45 6.4 Gender norms and SGBV ................................................................................................................................................................45 6.5 Adaptation of materials ...................................................................................................................................................................45 6.6 MHPSS Settings ..................................................................................................................................................................................45 6.7 Acknowledging diversity within Rohingya refugee populations ....................................................................................45 7. Conclusion ......................................................................................................................................................................................................46 Appendices ..........................................................................................................................................................................................................47 References ...........................................................................................................................................................................................................61 Review 3 ACKNOWLEDGEMENT OF CONTRIBUTORS Editors and main authors Reviewers and other contributors (in alphabetical order) • Alvin K. Tay (University of New South Wales, Australia) • A.N.M. Mahmudul Alam (UNHCR, Bangladesh) • Peter Ventevogel (UNHCR, Switzerland) • Myintzu Aye (UNFPA, Myanmar) • Mohammad Badrudduza (Rohingya Society Core group of expert contributors Malaysia) • Rafiqul Islam (culture/ language analyst, in non- • Emanuele Bruni (WHO, Geneva) affiliated capacity, Myanmar) • Gretchen Emick (IRC, USA) • Andrew Riley (in non-affiliated capacity, United • Fahmy Hanna (WHO, Geneva) States) • Tanya Hubbard (Myanmar Art Social projeCt, • Courtney Welton-Mitchell (University of Colorado Myanmar) -Boulder (CU), USA) • Sanjida Khan (Jagannath University, Bangladesh) • Benedicte Duchesne (MHPSS consultant, France) • Tanya
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