Forced displacement has been a major driver of mental disorders among refugees due to both pre-migration and post migration experiences. Women and children are the most vulnerable groups among the forcibly displaced. Since 2017, about 750000 Rohingya refugees fled to Bangladesh from Myanmar. 52% of the overall refugees are female, and 55% are children with 41% being below the age of 11 and 18% below the age of 4. The Rohingya people of Myanmar are an ethnic, linguistic, and religious minority who are usually referred to as foreigners by other ethnic groups in Myanmar. Rohingyas have been subject to repeated waves of persecution and forced displacement since Myanmar's independence.
BRAC in Bangladesh has been working in the Rohingya refugee camps located in a South-eastern district, Cox-Bazar. BRAC developed the home-based ‘Humanitarian Play Lab’ program (HPL) to support Rohingya refugee children aged 0-6 years to help support the recent influx of refugees there. HPL is based on the play-based curriculum which focuses on the importance of play and art activities in fostering psychosocial well-being and early childhood development of refugee children. Children aged 2-6 years attended a center-based HPL, whereas children aged 0-2 years were supported indirectly through a home-based HPL. The home-based HPL (0-2) program was developed to foster the psychosocial well-being of Rohingya women that are mothers of children below 2 as well as mental, nutritional, socioemotional, physical, and cognitive development of their children.
To understand the effect of the HPL (0-2) intervention, we partnered with the BRAC Institute of Educational Development (BIED) and the BRAC Institute of Governance and Development (BIGD) in Bangladesh. We conducted a clustered randomized controlled trial in 17 Rohingya refugee camps (out of 34 camps in total). We randomly selected 251 blocks from the universe of over 2,000 blocks, and assigned 137 blocks to the psychoeducation or intervention group, while the remaining 114 blocks were not given any intervention (the control group). Mothers with at least one child between the age of 46 days and 24 months were to participate in the home-based HPL program. Approximately 3,500 Rohingya mothers and children between 0-2 years were simultaneously targeted and provided weekly support through peers. Mothers received weekly psychosocial support in groups of seven for almost a year. The session curriculum includes psychoeducation on mental health, parenting counselling for mothers, and culturally appropriate play activities for children.
We find that mental health of mothers and children improved substantially after a year of psychoeducational intervention compared to the mental health of mothers and children who did not receive the intervention.
Moreover, mothers reported being happier and shared a greater sense of belongingness. Also, the intervention strengthened the communication, problem-solving, social, and gross-motor abilities of children, and reduced the prevalence of stunting, underweight, and wasting among children. The intervention caused mother and child mental health to align with each other. Mothers that had poor mental health at baseline, high exposure to violent conflict in Myanmar, and experienced relatively more abuse in refugee camps benefited the most from the intervention. These results indicate the significance of providing displaced mothers of young children with psychosocial help for the treatment and healing of psychological stress and depression, which can have a strong positive effect on the child development.
Our study provides the first experimental evidence on improving the mental health of vulnerable Rohingya refugees through psychosocial support.
We also provide the first experimental evidence on the impact of a psychosocial intervention on the intergenerational transmission of mental health and early childhood development in a post-conflict setting.
The intervention has been a low-cost program delivered by community peers who worked as volunteers, and it’s a very cost-effective intervention compared to many other similar interventions across different settings in the world. Indeed, BRAC has been scaling up the program since we finished our RCT, and the program has already reached out to more than 13 thousand mother-child dyads. With support from international donors, the program can be scaled up much faster.
The ongoing war in Ukraine is a somber reminder that these refugees also need immediate psychosocial support and might need to continue over a long period! We should not also forget that all refugees around the world need more such support, and funding to provide services is available irrespective of their backgrounds.
Reference:
Asad Islam, Abu Siddique, Tabassum Rahman, Tanvir Mojumder and Tanvir Shatil ‘Forced Displacement, Mental Health, and Child Development: Evidence from the Rohingya Refugees’, Working Paper, 2022 (Paper)
Asad Islam
17 March 2022