Sudheer Nivedita, Banerjee Debanjan
Department of Psychiatry, Christian Medical College, Vellore, India.
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Glob Ment Health (Camb). 2021 Dec 17;8:e46. doi: 10.1017/gmh.2021.43. eCollection 2021.
Rohingya refugees, a group of religious and ethnic minorities, primarily reside in the South Asian nations. With decades of displacement, forced migration, limited freedom of movement, violence and oppression, they have been termed by the United Nations (UN) as the 'most persecuted minority group' in world history. Literature shows an increased prevalence of psychiatric disorders such as depression, anxiety, post-traumatic stress, insomnia, etc., in this population. However, beyond 'medicalisation', the psychosocial challenges of the Rohingyas need to be understood through the lens of 'social suffering', which results from a complex interplay of multiple social, political, environmental and geographical factors. Lack of essential living amenities, poverty, unemployment, overcrowding, compromised social identity, and persistent traumatic stressors lead to inequality, restricted healthcare access, human rights deprivation and social injustice in this group. Even though the United Nations High Commission for Refugees (UNHCR) has taken a renewed interest in Rohingya re-establishment with well-researched standards of care, there are several pragmatic challenges in their implementation and inclusion in policies. This paper reviews these multi-dimensional psychosocial challenges of the Rohingyas by synthesising various intersecting conceptual models including minority stress, health-stigma-discrimination framework, refugee ecological model and capability approach. Furthermore, it highlights multidisciplinary interventions to mitigate these adversities, improve their living situation and eventually foster healing via means which are culturally relevant and contextually appropriate. These interventions need to involve various stakeholders from a human rights and dignity based lens, including the voices of the Rohingyas and supported by more research in this area.
罗兴亚难民是一群宗教和少数族裔群体,主要居住在南亚国家。经过数十年的流离失所、被迫迁移、行动自由受限、暴力和压迫,他们被联合国称为世界历史上“受迫害最深的少数群体”。文献表明,这一群体中抑郁症、焦虑症、创伤后应激障碍、失眠等精神疾病的患病率有所上升。然而,除了“医学化”之外,还需要从“社会苦难”的角度来理解罗兴亚人的心理社会挑战,这种苦难是多种社会、政治、环境和地理因素复杂相互作用的结果。基本生活设施匮乏、贫困、失业、过度拥挤、社会身份受损以及持续的创伤性压力源导致了这一群体的不平等、医疗保健机会受限、人权剥夺和社会不公。尽管联合国难民事务高级专员公署(UNHCR)重新关注罗兴亚人的重新安置,并制定了经过充分研究的照护标准,但在实施这些标准并将其纳入政策方面仍存在一些实际挑战。本文通过综合多种交叉概念模型,包括少数群体压力、健康-污名-歧视框架、难民生态模型和能力方法,回顾了罗兴亚人面临的这些多维度心理社会挑战。此外,本文强调了多学科干预措施,以减轻这些困境,改善他们的生活状况,并最终通过与文化相关且符合具体情况的方式促进康复。这些干预措施需要从基于人权和尊严的角度让各种利益相关者参与进来,包括罗兴亚人的声音,并得到该领域更多研究的支持。