How Do You Help Refugees Who Are Too Traumatized To Talk?

If you walked into Cynthia Scott's waiting room at a clinic in the Cox's Bazar district of Bangladesh, you would be surrounded by people lying on benches looking pained and malnourished.

They're part of the flood of 600,000 Rohingya refugees who've fled violence in Myanmar and sought refuge in neighboring Bangladesh. The U.N. has called the exodus "the world's fastest growing refugee crisis."

"The amount of people is just unfathomable," says Scott, a clinical psychologist who is a mental health activities manager for Doctors Without Borders. "My worry is that it's in the news for a moment, and then gone."

Violence in Myanmar broke out in late August after a militant group of about 150 Rohingya attacked a military post there, NPR reported. Refugees have recounted stories of their homes being set on fire and family members brutally killed.

And sometimes they can't even put into words what they've seen.

"Almost daily, now, I'm getting people who are not talking, they were just so traumatized," Scott says.

She recounts an instance where a young girl came into the clinic that Doctors Without Borders has set up in Cox's Bazar and kept falling asleep. Scott gave her a bed. "She spent two days sleeping under the bed, just hiding," Scott says.

So it's hard to know how to help.

"We can't really get good information from them," she says. "I can't put them back on the street until I have some information, somewhere to take them. Patients who are discharged, maybe they're still recovering from whatever illness or injury they had, but they're not sick enough to be in the hospital But are they well enough to walk through the ditches and mud? It's so difficult to see them leave sometimes."

Most of the refugees in the camps in Cox's Bazar live in densely packed, makeshift shelters they've built from bamboo poles and sheets of plastic. Up to 30 people live under one tent.

No one knows exactly how many there are. "The chaos of these camps and the speed with which people came in makes it difficult to get anything but the most basic head count," says Pavlo Kolovos, head of the Doctors Without Borders mission in Bangladesh.

But it is clear that the numbers are ever-growing. So is the health-care staff. According to Kolovos, the number of Doctors Without Borders staff in the camps has gone from under 200 a few months ago to more than 1,200 (the vast majority of them are from Bangladesh). Last month they opened a second hospital in Cox's Bazar and are planning to open more.

In addition to treating the physical health of the refugees, counselors are providing psychological care, says Scott — or "psychological first aid," as she calls it.

"It's like medical first aid [when] you're just stopping the bleeding so someone doesn't die," she explains. "It's giving them water, helping them shower, helping them come back to their thinking so that they can take the next step."

Since therapy isn't common in Rohingya culture, providing mental health support is difficult. Some counselors hold waiting-room information sessions in the camp's health clinics to explain the symptoms that people might be experiencing as a result of the trauma they've been through and to let them know they're available to talk.

Scott recalls one such session last month.

"As [the counselor] was talking, three women in the waiting room just started crying. All three were survivors of rape," she says.

The counseling center is referred to as "a place of peace" in the language of the Rohingya.

"If a person in the waiting room says they want to go to the 'place of peace,' they immediately get a card with a bird on it that's a sign of peace, and they can come into our waiting area," Scott says. "The counselors all wanted to have this bird because a lot of the Rohingya do not read or write because they weren't allowed to go to school. So we wanted a symbol so they'd know they were in the right place."

Courtney Columbus is a multimedia journalist who covers science, global health and consumer health. She has contributed to the Arizona Republic and Arizona PBS. Contact her @cmcolumbus11

Copyright 2017 NPR. To see more, visit http://www.npr.org/.