ASSESSMENT OF MENTAL HEALTH AND PSYCHOSOCIAL

NEEDS OF DISPLACED REFUGEES ROGINGHYA IN COX’S BAZAR

MHPSS COORDINATION

IOM-COX’S BAZAR

BACKGROUND

In the period of 4th January-12th February 2018, IOM conducted a study to assess the mental Health and Psychosocial needs, problems and to identify some of the main factors affecting mental health and psychosocial wellbeing of the Rohingya refugees displaced in Cox’s bazar in the camp sites of Kutupalong, SS and Leda.

MAIN OBJECTIVES

Identify MHPSS needs of Rohingya refugees displaced in 3 main camp sites in Cox’s BazarIdentify

Explore community’s perceptions and understandings of MHPSS needs, coping strategies and resilient responses

Explore

Map the availability and accessibility of MHPSS services. Map

STUDY SITES

• Data collection took place in Kutupalong mega camp, SS and Led. These camps were chosen due to population’s size , presence of IOM health facilities and to complement a baseline NPM site assessment that was being conducted in parallel.

ASSESSMENT METHODOLOGY & TOOLS

The method used was a mixed one and included

• Review and analysis of relevant

• Focus group discussions (FGD) with a group of key leaders and other group with health professionals .

• Focus groups discussions (FGD) with refugees

QUANTITATIVE TOOL

Moderator presented several statements and participants participants to the focus groups were asked to evaluate their adherence to the statement in a scale from zero to five , where 0 (zer0) was Never and 5 (Five) was always. Participants had to rise their hands with their answer (showing 0 to 5 with their fingers) all at the same time in the Group. Two rating scales (likert) were used:

• Part A: A scale to estimate problems and needs with statements such as: how often do I feel… sad, tense, nervous, anxious, safe, grieving.

• Part B: A scale to estimate resilient functions and coping mechanisms, with statements such as: How often… I laugh and smile, I have friends, I like being with my family, I am optimistic, I prefer being here…

• Calculations were made individually, counting how many participants were adherent to each statement

QUALITATIVE TOOL

• GDs of one hour and a half each were conducted with a predetermined semi-structured interview led by a moderator.

• The interview was divided into 4 sections, with a total of 19 questions.

• The first section:

• Main problems affecting mental health and psychosocial wellbeing of refugees.

• The second section

• Main coping mechanisms and resilience responses.

• The third section

• Understand traditional idioms for distress and other emotional issues ,

• The last section

• Perceptions on availability and accessibility of MHPSS services

STUDY RESTRICTIONS

• the difficulty to conduct a quantitatively reliable study vis a vis the impossibility to identify a representative sample, and the objectives of the study.

• It has to be noted that results of this exercise are indicative only, since the results can be biased by the fact that responses had to be given in front of a group,

• these findings are not intended to be conclusive neither pretend to be a generalization of mental health and psychosocial concerns or issues of the Rohingya community.

• Findings are indicative of this sample who participate in the FGD a total of 300 people.

• Results as indicators and informing the developing of future interventions, but not as generalisations not regarding mental health and psychosocial wellbeing, as it is always important to consider singularity and complexity of human beings.

OVERALL SAMPLE DISTRIBUTION

GroupKutupalong Leda SS

TotalM F M F M F

Affected population

Elderly (60 years old above) 10 10 10 10 9 9 58

Adult (30-55 years old) 10 10 5 15 10 8 58

Youth (17-25 years old) 10 10 2 14 10 7 53

Children (7-16 years old) 15 5 10 10 10 10 60

Total 45 35 27 49 39 34 229

Community leader 10 - 18 2 10 - 40

Health worker 12 8 10 10 6 10 58

** Data collected from 327 individuals, quantitative and qualitative information

SEX AND AGE DISTRIBUTION

26%

23%51%

Demographic data by age

7-12

18-25

30-70

MAIN FINDINGS

1. MHPSS PROBLEMS AND NEEDS

• 47 % felt sad always . (38% children, elderly 74% adults and 32% youth)

• 29% of participants reported to feel tense always (64% adults, 35% children, 16% elderly)

• 21% felt always nervous . (32% children and 48% adults)

• 34% felt always safe in the camp and by living in Bangladesh . (68% adults, 28% children, 11% youth).

• 27% of participants manifested feeling grieving always for their lost family members and their previous life

* Figures represent the average responses of each FGD

• 38% of children reported sleeping problems since they were displaced, due to bad memories of the events occurred

• 48% of youth reported sleeping problems as well due to the current situation.

• 21% of participants among children and youth reported feeling anxious about the future and the uncertainty of what is going to happen with them.

• 38% of children reported sleeping problems, mainlyrelated to: food shortage and not knowing where and how their relatives are.

• 20% of participants reported some sort of somatic complaint, headaches, sore muscles and backpain. 52% of the youth respondents expressed one or more indicators of physical uneasiness, specially headaches, 28% of children reported somatic complaints

• It is important to highlight the 4% of youth respondents reported death ideas.

45% of the total participants reported experiencing some distress indicators and other negative feelings mainly among children and youth.

• Food shortage was the most recurrent answer “I’m sad because I used to have food three times a day, but since the relief was late, I eat twice a day”.

• Inadequate shelter, poor lights, poor WASH facilities and insufficient clothing were also the mainfactors associated to their mental health and psychosocial wellbeing.

Main factors associated to affect Mental Healthand Psychosocial wellbeing

MHPSS PROBLEMS AT A FAMILY LEVELLevel Negative responses

Injury Wound

Family Feelings

• Anxiety (25 %)

• Uncertainty of what would happen to them and

to the ones they left behind (64%)

• Sadness (74%)

Factors

• Safety and protection (15%)

• Unemployed/ lack of opportunity (23%)

• Loss of family and property (25%)

• Lack of freedom to move outside the camp area

(25%)

• Poor health condition (45%)

• Family separation (51%)

• Basic need fulfilment (52%)

• Previous life threatening experience (56%)

MHPSS PROBLEMS AT COMMUNITY LEVEL

Level Negative responses

Injury Wound

Community Feelings

• Generalised fear (15%)

• Camp conditions (25 %)

• Worried and anxiety (27%)

Factors

• Identity crisis

• Economical constraints to celebrate some of

their rituals

• Travel restriction

• Public facility (road and latrine )

1. MHPSS RESILIENT RESPONSES AND COPING MECHANISMS

WE PRAY… WE PLAY…WE KEEPGOING… (ABOY 12YEARS OLD)

RESILIENT RESPONSES AT INDIVIDUAL LEVEL

• Praying.

• They see themselves as individuals with an ability to adapt “we survive every day, we accept what happened and we just survive” (Man 68 years old) t.

• Religious activity is the highest resilience factor for Rohingya refugees (67%). They believe that God is the only saviour and praying could relieve them from their uneasiness. Other resilience factors are family relationship (45%) and adaptation skill to survive (40%).

COPING MECHANISMS AT FAMILY LEVEL

• ‘praying and getting support from the family

• The bond among family members is quite strong to affect each other. As like negative feeling resonated to one another, they cope with the challenge and deal with negative feelings as a unit.

RESILIENT RESPONSES AT COMMUNITY LEVEL

Positive responses

Resilience Adversity-activated development

• Social network

• Quality of

friendship

• Keeping

traditional games

and plays

• Trade in food-stuff

• Proverbs telling in groups

• Advocacy capacity to solve daily challenges

• Communication skills to disseminate key

messages to promote protection within the

community

…WE KEEP OUR HEARTS STRONG…(A GIRL 12 YEARS OLD)

KUSHI & ASHA (HAPPINESS AND

HOPE)

PERCEPTIONS OF AVAILABILITY OF MHPSS SERVICES

• According to the NPM people reported to have a difficult access to psychosocial support in the three camp sites where this assessment was conducted:

• 67% locations where people have trouble accessing psychosocial support,

• 86% in SS

• 77% in Leda It is unclear what is sad here and what the percentages refer to. Please rephrase.

• 48% respondents mentioned they didn’t have any idea about mental health and psychosocial services in the camp particularly related to stress relieving activity

MAIN RECOMMENDATIONS

• 1 Level- Mainstreaming the psychosocial

approach at basic services and security level

is critical. Advocacy in areas such as food

security and nutrition need to be

strengthened with relevant humanitarian

actors as well as shelter and site planning

and water and sanitation

• 2 Level- The Rohingya community has strong

community and group dynamics that are key

to strengthening and improving the overall

psychosocial wellbeing of the Rohingya

population

MAIN RECOMMENDATIONS

• 3 Level- Conduct support groups for those who require further focused interventions, such as children who exhibit grieving symptoms as well as support groups for women to increase stress management skills.

• The lack of refugee awareness regarding psychosocial service provided by the UN and NGOs in the field. It is important for the MHPSS Working Group to socialize and disseminate the pathways, existing services and referral systems among to beneficiaries

• 4 Level- Identify and engage with selected universities with studies in mental health and psychosocial support to establish partnerships with the aim to encourage a knowledge exchange on programming and specific trainings that address main MHPSS concerns and the needs of the Rohingya refugees in Bangladesh