COVID-19’s Mental Health Impact: How Are Refugees Coping?

Minor edits have been made to the following transcript for clarity.

Deborah 0:00
Hello everyone, I’m Deborah, New Naratif’s Membership Engagement Manager. These days, almost anyone you meet can talk about how the COVID-19 pandemic has changed their lives for the worse. Salary cuts, or a total loss of income, separation from friends and family, and long periods of isolation. It’s no surprise that this pandemic has taken a toll on our mental health. But there are some groups who are not only more systematically vulnerable to mental illness, but have also suffered from a far more brutal experience than others. From heightened xenophobic sentiment, to being raided by the authorities during a nationwide lockdown and facing threats on social media, the refugee community in Malaysia have been forced to endure all of the same hardships as Malaysian citizens, plus an additional set of hardships stemming from their refugee status. Refugee mental health already received little attention or resources before the pandemic hit, so what kind of repercussions has COVID-19 had on this marginalised community? In this episode, I speak to Matilda Xavier, clinical psychologist, and Bo Min Naing, president of the Rohingya Society in Malaysia. We look at the stigma around mental health in the refugee community, how they have been coping with it during the pandemic, and how some communities are affected more than others. If you enjoy what we’re doing, please do support our work by becoming a member of New Naratif at newnaratif.com/join. Memberships start at just 52 USD a year. That’s just $1 a week. Or you can donate at newnaratif.com/donate. Check out our website at newnaratif.com for more stories from Southeast Asia. And now, here’s the interview.

So good morning to both of you. Thank you for agreeing to this interview. How are you both doing?

Matilda 1:51
I’m fine. Thank you.

Bo 1:53
Me too. I’m fine.

Deborah 1:55
So welcome to the show, Matilda and Bo. Thank you for joining me today. Let’s start with some introductions. Matilda, you’re a clinical psychologist and part of the work you do focuses on working with refugees and trafficking victims. Can you tell us more about your work with these marginalised communities and what influenced you to take this on?

Matilda 2:15
Thank you for having me on, Deborah. You want to know what influenced me? I actually started off as a volunteer with MSF (Doctors Without Borders). And we started working with the communities, refugee communities around the Klang Valley, right up to Semenyih and Lenggeng. We also went to detention centres, and so on in 2005. That’s a long time ago. And I learned a lot as a volunteer so I decided to go and do my masters and then that chapter of MSF left, ACTS asked me to join them. So I’ve been continuing with my work with them once a week.

Deborah 3:10
And what does ACTS stand for?

Matilda 3:17
ACTS – A call to serve. This is an NGO, which has been working with refugees for the longest time. They actually were established in 2003. And we have been working with refugees for so long. We have mobile clinics and a static clinic in Brickfields. Previously—okay, we still do [but] now we can’t—we used to visit all the detention centres for medical as well as mental health services. We used to visit the communities before our static clinic was established all over in the jungles, as well as within the urban areas to provide medical as well as mental health services.

Deborah 4:01
Right. So it sounds like you actually had outreach pre-pandemic

Matilda 4:07
Oh, a long time ago before it started.

Deborah 4:10
And so now during the pandemic, how do you get in touch with people who need your services? And who pays for them?

Matilda 4:17
Okay, our static clinic is still open. So, those who need medical care, they will still come to our clinic either with a doctor’s letter when it’s necessary, because of police and all that, and (inaudible) all that. For those who are not able to come because of security purposes, we do our sessions over the phone. We do have clients coming in for face-to-face sessions, but we also—because for their safety—we do the sessions over the phone because of the pandemic and also for security purposes.

Deborah 4:57
And are your services free or low cost?

Matilda 5:01
Free, except for medical. Medical, they just pay a little bit for the medication. But for mental health, our services are free.

Deborah 5:10
Excellent. That’s great to hear. And Bo, we’re really glad to have you join us on the show. You are the president of the Rohingya Society in Malaysia. How long have you been in that role? And what does it entail?

Bo 5:23
Yeah, I was in that role since 2016. But before that, in 2015, I was the secretary general of Rohingya Society in Malaysia. Then again, I was elected as president of Rohingya Society in Malaysia. But actually, our Rohingya Society in Malaysia, it was established in 2010. So, since then, we are working for the Rohingya refugees here. So, for those who are registered with UNHCR, and also unregistered people. But yeah, we are doing this since 2010. Actually, [in] my role as president, actually we closely work with UNHCR and also other UNHCR partner NGOs. We also have partner NGOs. So, such as ACTS, [they are] also our partner NGOs. Their clinic is also [a] partner. Since long time ago, we have been working together with [ACTS]. Actually we give the service, you know, services for [the] Rohingya refugees here. We have one shelter for the [survivors] of sexual [and] gender based violence. Like, if some [women] they face, you know, domestic violence or other sexual harassment or other things, then we give them also the shelter. So, we closely work with (inaudible), and also NGOs, and we also have a healthcare shelter. This healthcare shelter is for the men, and the other transitional home is for (inaudible), that is for women. We give, these services free of charge. We sometimes also do vocational training, and also English classes, computer classes, [and] cooperate with NGOs in Malaysia.

Deborah 7:31
That sounds like a very multifaceted role. The COVID-19 pandemic has stretched on now for over a year and a half. The fear, isolation, and financial stresses have affected people globally and unsurprisingly, have taken a toll on people’s mental health. Matilda, what can you tell us about your general observations on the situation in Malaysia? Has there been an increase in people seeking help for their mental health?

Matilda 8:01
Are you talking in general, not just the refugees?

Deborah 8:04
Yes

Matilda 8:04
Yes. I think there are statistics that say that the number of calls to all these hotlines [and] carelines have actually increased, because people are worried. People are lonely, people have lost their jobs, people have become very anxious about the situation. This already adds on. Isolation, physical isolation, also adds on to your mental problems. So there is definitely an increase.

Deborah 8:35
And who do you see as groups or demographics who are at risk for this increased stress during this time?

Matilda 8:46
People who have lost their jobs, people who have got psychological problems or mental illnesses, where their support system is greatly reduced. Okay, people who have financial difficulties, people who are isolated from their family and friends, they are at greater risk. Of course, it’s the B40. And some from the M40 are also affected compared to the, what’s the other one?

Deborah 9:14
T20?

Matilda 9:15
Yeah, I suppose they’re not that affected, except for the isolation.

Deborah 9:23
Yes, so the B40 and M40 that Matilda is referring to are the bottom 40 and middle 40 in Malaysia, who make up the working class and middle class in Malaysia. So yes, obviously class plays a big role in how people experience the mental health effects of the pandemic. And I think that leads quite well into my next point. Marginalised and isolated communities are really experiencing an additional layer of pressure and stress on top of the usual stressors associated with COVID-19 and refugees in particular, have been experiencing heightened xenophobic sentiment. They have been experiencing raids by the authorities and facing threats on social media, all of this on top of dealing with an ongoing health and economic crisis. Bo, Rohingya refugees in particular have been the target of such attacks during this time, how have you and your community been coping with everything so far?

Bo 10:24
Since COVID-19 started and also since the lockdown last year, people are struggling and also they are suffering loss. I mean, they’re [from the] refugee community, especially the Rohingya refugees. But last year, it had more effect on the Rohingya refugee community. But however, this year again, some people they could work before this lockdown. But last year, people suffered a lot. And they have financial difficulties. And also in other sectors, they also have some difficulties. Some pregnant women, those [who] are unregistered, their family also face difficulties, but in the community, we try our best to assist them. The UNHCR office is also close, but some officers, they are working in the office, but the office is not open for the refugees because they don’t allow the refugees to come in, that’s why it is a bit hard for registration. So, then for the wife in the family, we do some referrals. We have been doing the referrals since last year (inaudible) done for the pregnant women. So we especially do the referral for those pregnant women, who are pregnant at eight months or nine months old who are admitted to hospitals, or who are in the hospital, until now. And we also do some referral for those sick people like those who need hospital admission for the treatment. But since last year, we need to refer a lot of cases for the food distribution.

Actually, we don’t have funds to distribute the food. But we also refer the cases to our close partner NGO and also UNHCR. Last year, some people survived, but some people were evicted, because they couldn’t pay the house rent for a few months. Like three to four months, they couldn’t pay the house rental. And also there were some refugees families, they were evicted from the house. But this year again, the first few months, some refugees could work. And also they try to do the best to maintain their life. But again, the MCO started then because COVID cases are increasing. So, then everyone in the country, even the Malaysians and refugees and migrant communities, they are struggling. All are struggling, [those] who are living in Malaysia. But Rohingyas are more because at this time, they are not able to work, they are not able to go to work. So, they get some depression. But since last year, some Rohingya, they have got some experience that they can ask help from NGO or UNHCR. So, some contact to UNHCR or NGO, some contact (inaudible). But we don’t have budget to assist them. However, from our side, we refer the cases to other NGOs who can assist them.

Deborah 14:14
And these referrals are for their mental health support, is that the kind of referrals you’re doing? I know earlier, you said that you were referring people for physical health, like pregnancy or physical illnesses. But are you also making a lot of referrals for mental health support?

Bo 14:32
For mental health support we have some serious issues. Like, the patient is too serious, then we refer the cases to, you know, we advise them to go to HEI (Health Equity Initiatives). So, HEI [is also] based in Brickfields. (Inaudible). They give some medical services for mental health, so we advise them to go [to] HEI. Sometimes from our side also, we refer few cases to HEI, if they are very serious.

Deborah 15:06
And have people been coming to you, expressing their despair or their sadness over the job losses and financial troubles that they are experiencing because of the pandemic?

Bo 15:19
Yes, some people are in trouble. They need financial assistance. As I explained to you, some people, they were evicted from the house last year, so this year also they cannot give their two [to] three months rental again. The landlords are Malaysian, they also need money. But however, some of the landlords are [understanding towards] them. Some people, they negotiate with the landlord, some other people, they ask financial assistance from NGO and UNHCR, but UNHCR also cannot be [assisting] all refugees. So they also need to select some people who are very vulnerable, and they assist. They give some financial assistance to those who are very vulnerable.

Deborah 16:13
And how is the community supporting themselves during this time? We’re experiencing another lockdown right now.

Bo 16:21
Last year, our community [leaders] across Malaysia, they got assistance (inaudible) from NGOs, and cooperating with NGOs and going to distribute the foods in many areas. Last year, we could assist, 6000 Rohingya families, like we refer to the NGOs. Like Mercy Malaysia, and (inaudible) other NGOs. Some other NGOs, they are still supporting. Last year, we did that, and also in the community, those people who are financially strong, they also gave some donation in the community, and community itself assist each other.

Deborah 17:08
That’s good to hear. I’m glad that there is a strong community cooperation. Matilda, you work closely with refugees on their mental health. What trends have you noticed since the start of the pandemic?

Matilda 17:23
Oh, okay. There’s a lot of depression and anxiety because, a lot of people, [their] basic needs are not met. They have no money. Despite so many NGOs providing food aid, sometimes it’s not enough. Because even NGOs are stretched thin. So people worry about their babies not being able to get the milk. People worry about whether there’s enough food for their children, paying the rent like what Bo said. They have no money. That is one. The other is a fear. You know what has been happening lately in Malaysia? They are rounding up all the illegal immigrants. Refugees are actually not recognised in Malaysia, they are actually considered illegal immigrants in Malaysia. So the safety comes into play. A lot of the refugees we have today do not have a UN card because it takes at least two to three years before they can actually get a UN card. And now, with the MCO—MCO has been going on for one and a half years—UNHCR, they had to close down some of their departments. They open sporadically, so it takes even longer for them. So, if you do not have a UN card, you are not registered as a refugee, or even an asylum seeker, you are at risk of being arrested and being thrown into detention centres. Remember some time ago, UNHCR was not even allowed to go into the detention centres to register the people? So that adds another layer of fear to them. And of course, it makes their mental health even worse.

Deborah 19:14
And even with a UNHCR card, I believe you’re still vulnerable to detention.

Matilda 19:21
You are. Because the thing is, like I said, they are not recognised as refugees. Malaysia doesn’t recognise refugee status. So, if they want to charge them as illegal immigrants, they can.

Deborah 19:34
Right. So what conditions are refugees commonly diagnosed with?

Matilda 19:40
The majority of people have got depression and anxiety disorders. We also have those who come from war-torn countries. We have those who suffer from PTSD. Sometimes, we do have people who are (inaudible) psychosis.

Deborah 19:56
And yes, as you mentioned, people have arrived here with trauma from their previous countries. And I can only imagine what’s the effect of experiencing existing mental health issues, and then finding yourself in a pandemic, where you’re isolated and experiencing financial stress.

Matilda 20:16
Well, it’s not just that they have to experience trauma in their home country. Their expectations when they come to Malaysia, and then they find out that they are treated like, you know. It adds on. So it’s not just the pandemic, these problems have been going on even before the pandemic started, it has actually worsened with the pandemic, because now people are making comments on social media about refugees, asylum seekers and making them feel even more unwanted than before.

Deborah 20:52
Yes, that’s a good point, that it has always been here, this problem of xenophobia towards migrant communities and refugee communities. Do you find that there are certain refugee communities who are more vulnerable than others for mental health issues?

Matilda 21:10
Yes. There are some refugees who actually are very community based. So the community takes care of them. Like in some communities, they even have first-line mental health services. So, like very basic kind of counselling they are able to provide, so that is helpful. Some communities, they are a little bit more guarded, they’re suspicious of their own fellow men because of what they have gone through in their own countries. So they tend to be more vulnerable towards this. Some, those from, let’s say, if you want to call it B40 in their own countries, they tend to be a little bit more resilient than people who had a good life in their own country. And then when they come to Malaysia, and then they become nobodies, it’s actually a whole change, you have to change your mindset. So those people can be more vulnerable. So, those who have got strong community support, they are slightly better off.

Deborah 22:11
Bo, are there services like that in the Rohingya community, where there is perhaps peer to peer counselling?

Bo 22:20
Peer counselling, actually, some NGOs give the peer counselling. If some of the refugees need peer counselling, we can refer to the NGO, because we don’t have the experts to do the peer counselling.

Deborah 22:38
Okay. And there have been reports about a rise in suicides among the refugee and undocumented community. Amnesty International also mentioned this in a statement recently about migrants and asylum seekers. What kind of effect has this (the findings of the report) had on the community?

Bo 22:57
Yeah, since the condition is a bit bad, so [people got] depression. And nowadays, many Rohingyas in Malaysia, I mean, those who are registered with the UNHCR, they are requesting for a third country resettlement. So, they have only that way to be resettled to a third country. But it’s impossible for UNHCR also to resettle all the refugees at once to a third country. It just depends on the third country, also how they welcome the refugees and how many refugees they will welcome in a year.

Deborah 23:39
Yes, it must be very difficult to be stuck in this limbo. This is a question for both of you. What kind of support does the government provide to refugees in this area? Do they have access to the same support Malaysians have, if any?

Bo 23:55
No, it’s a bit different. So, I mean, those have UNHCR cards only will get 50% at the government hospital.

Deborah 24:04
Matilda, do you know of other besides that discount at government hospitals?

Matilda 24:11
Okay. They have a 50% discount, like what Bo said, from the expat rate. But government hospitals, they have to pay. Less than what expatriates will do. But they still have to pay.

Deborah 24:28
Right. And that can still obviously be very prohibitive. What kind of resources are available from other organisations out there for mental health support for refugees?

Matilda 24:40
Okay, mental health, there are a number of (inaudible) centres that NGOs actually provide like ACTS [and] HEI. Mercy Malaysia runs the [QFFD Clinic], the Qatar Foundation Clinic. Then there is IMARET, then is [Tzu-Chi Free Clinic]. They all have got mental health services, free.

Deborah 25:06
Okay, so there is actually outside of the government systems-

Matilda 25:10
Oh, there’s also MSF in Penang.

Deborah 25:11
And they also have mental health support for refugees?

Matilda 25:17
Yes.

Deborah 25:19
And Matilda, for those of us who live or work in the same vicinity as refugees, what does a cry for help look like? What are things that we should be paying attention to?

Matilda 25:31
If you do live in the same area, this same apartment blocks or whatever, where the refugees live, you have already heard the kind of comments that people make about their neighbours who are refugees. So, awareness that these are also human beings who are actually going through problems, acceptance, that will help a lot towards their mental health. Accepting people instead of, you know, the xenophobia, that can help. We also have refugees all around us, those who work in the restaurants and all that. Till today, people don’t seem to be aware that a lot of the staff in restaurants are actually asylum seekers and refugees. So being accepting of them and treating them as fellow human beings would be good.

Deborah 26:27
Yes, I think, unfortunately, in Malaysia, the bar is so low right now. But yeah, I think combating some of the xenophobia in Malaysia is probably a good starting point for those of us outside of the refugee community.

Matilda 26:41
And also don’t make use of them. I mean, if you’re going to pay proper wages to Malaysians, then do not cheat the refugees and pay them [a] minimal rate. Oh, I wouldn’t even say minimum. Do not pay them such a low rate that they can’t even survive. Don’t take advantage.

Deborah 27:04
Yeah, it sounds like, especially now, survival is really tied in with mental health.

Matilda 27:12
Yes.

Deborah 27:13
Right. So would you say that ensuring that refugees have their basic rights taken care of like food and shelter, would go a long way towards also improving mental health?

Matilda 27:26
Yes, the thing is, all this while, they took care of their own basic needs, they tried. They are willing to work in the 3D jobs and all in order to survive, but now it’s because it’s so difficult. So, that’s why.

Deborah 27:42
And so this is a question for both of you. Is there a stigma surrounding conversations on mental health in your community, Bo? Are people open to having these discussions about mental health?

Bo 27:59
Here, most of the people, they don’t know [what they’re experiencing] is concerned with mental health. They are only (inaudible) in their suffering. Only some of the people they understand what they’re feeling. So, that’s why. Sometimes, they don’t know, because they are in a very difficult condition, and they don’t know themselves [that] they are suffering something. You know, what they are only saying to ask [for is] to get financial assistance, or to get food because they need the basic needs at first. So the basic things to all their surviving. So, that’s why, because we don’t have that much in our facility to assist all the refugees. Because we are also struggling as an organisation because we don’t get the donation, and we don’t have budget, so, we cannot assist all the people. So, we can only assist those who are very vulnerable. If they need it, if they have any strong, medical recommendation or something, then we can consider to assist them as much as we can.

Deborah 29:26
And Matilda, how have the people you’ve met and treated responded? Were they comfortable with having these conversations?

Matilda 29:33
Okay. It’s very interesting when it comes to refugees. They themselves are actually, they themselves want to receive mental health services. They know counselling or psychotherapy. Because they find it very helpful. There’s someone who is listening to them unconditionally. There is someone with whom they can pour out all the problems, someone who can talk to them, who is not experiencing the same problem, because if they were to go and tell their friends, ‘I’m feeling like this, like this,’ the friend will say ‘we’re also in the same boat, [so] don’t complain’, right? So those who come to see us, they are very open to receiving help. But at the same time, they are also afraid that other people will know that they are receiving help, because there are other people in the community [who] might assume that they are crazy and stay away from them. You know, people like to gossip.

Deborah 30:32
So, there still is a lot of stigma surrounding-

Matilda 30:35
So the stigma is about letting people know, but the stigma is not so much about avoiding mental health services-

Bo 30:45
There are only some survivors (inaudible), if they want counselling, we can refer to some NGOs who are doing for these services, and they give some counselling also.

Deborah 30:59
And do you find Bo, that people in your community, they may not understand that seeking counselling, as Matilda said? That they might might think that someone who’s going for counselling is crazy. Is that that perception there?

Bo 31:18
Yeah, most of them, they don’t know. So, you know, some NGOs those [who give] counselling, they also get some awareness in the community. So, we also tell them if you need some counselling, you can. Because recently, I think, we saw some news and on social media, and also some advertisement, like, if they need counselling, they can contact to this number. So, those are free counselling. So we also give such kind of message in the community, if they need some counselling, they can contact with those numbers. And most of them, they don’t know.

Deborah 31:55
Right. And what is something the Malaysian government could do immediately to reduce the incidence of mental illness among refugees in the country?

Bo 32:06
If government also closely [work] together with the NGOs who are working for refugees. And all NGOs, they don’t have mental health services. So only few NGOs, they have, as you know, I mentioned before only few NGOs, they are doing this (inaudible). So, if they also get government cooperation with them, I think that would be a bit better.

Deborah 32:35
Do you have thoughts about that Matilda? What’s something that you think could immediately reduce the incidence of mental illness among refugees in the country?

Matilda 32:44
Well, the short term is maybe they should stop threatening to arrest all illegal immigrants. In the long term, they should maybe give some recognition to refugees. You know, some time ago, government was more lenient, they were willing to allow the refugees with UN cards to work, the odd jobs and so on. But now it has reached a stage where all refugees are so scared that they’re going to be arrested, whether they have a card or not, because of the threat of the COVID and the vaccination, and because they also live in very crowded situations. So that doesn’t help when the government is always talking about, you know, arresting illegal immigrants and so on. A lot of the refugees don’t have UN cards. So they are still considered illegal immigrants.

Deborah 33:42
Right. And I can only imagine that that kind of fear and uncertainty is wrecking havoc on people’s well-being. So, thank you both for sharing your thoughts with us. Before we cap this interview, do you have a final message you’d like to share with our listeners?

Matilda 34:00
I would say that mental health services, mental health is very important for refugees as well as other Malaysians. So, it’s time we start treating people with more compassion. Doesn’t matter who they are.

Bo 34:14
Yeah, I want all the refugees to be safe. And I also want to give the message to my Rohingya community, Rohingya refugees, and also those who are unregistered not to go outside if they don’t have anything to do. So, because this time is a bit critical if they got arrested. So they will be in detention for a long time. Since the UNHCR is not able to visit the detention centre. So, it’s a bit difficult for them to release them. That’s why.

Deborah 34:56
All right. Thank you for that. Thank you, Matilda. Thank you, Bo, for speaking to me. It has been very insightful for me. And yeah-

Matilda 35:06
It’s my pleasure. And thank you for having us on.

Bo 35:11
Thank you.

Deborah 35:13
Our thanks to Matilda and Bo for joining us on this week’s episode of Southeast Asia Dispatches. Next week, be sure to tune in to New Naratif’s Political Agenda, our podcast series on current affairs in Singapore. This is Deborah, wishing all our listeners a great week ahead. Jumpa lagi.