By: Nadia Islam
Beneath the dense canopy of monsoon clouds that forever haunt the sprawling refugee settlements of Cox’s Bazar, it is the silent suffering of women—those souls battered by the twin tempests of forced exile and relentless violence, having witnessed the unspeakable horror of their husbands their children their family members murdered before their very eyes—colours the heavily pregnant air with a deep mutilated sorrow no rain can cleanse.
Much like their sisters in distant far-off lands—Afghan women in their black veils, whose dreams of simply speaking aloud are daily ground to Taliban dust beneath the patriarchal boots of conflict, and Palestinian mothers who still cradle the dead blue bodies of their children amidst the echoes of shattered ancient cities—the Rohingya women and girls of the world’s largest labyrinthine camps bear the cruellest burden, their bodies repositories of stories too harrowingly gory to utter, their minds fragile battlegrounds where trauma wages its interminable war.
Here, where the muggy corrugated tin huts shake beneath the weight of memory, these women, survivors of the Myanmar military’s odious atrocities, crowd narrow, dingy alleyways, their every step shadowed by the violence they have known and the futures now denied them.
In the course of my readings, I happened upon Dr. Gabor Maté’s 2019 work, When the Body Says No: The Hidden Cost of Stress and felt a profound fascination with the intricate ways in which mind and body intertwine, each thread of mortal experience woven into the tapestry of our very biology. In chapter fifteen, “Biology of Loss,” he wrote, “the brain’s stress-response mechanisms are programmed by experiences beginning in infancy, and so are the implicit, unconscious memories that govern our attitudes and behaviours toward ourselves, others and the world.
Cancer, multiple sclerosis, rheumatoid arthritis, and the other conditions we examined are not abrupt new developments in adult life, but culminations of lifelong processes.” These words, oxymoronically rich with the weight of black-and-white scientific insight, have deeply shaped the contours of my curiosity regarding women in war and pushed me in the direction of the psychoneuroimmunological aftermath through the research in complex connections between trauma and physiology, especially by understanding how the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis—so often seeded in early, unspoken grief and stress—finds its manifestation in illnesses such as multiple sclerosis.
In my investigations, I traversed expanses of multi-omic data—these are collections of information about the different ways our cells function, including the activity of genes, proteins, and metabolic pathways—examining gene expression patterns within the brain regions of patients, which revealed the silent molecular dialogues of suffering and resilience that are not-so-silently inscribed upon neural tissues.
Through computational choreography of heat shock proteins—a kind of protective protein that cells produce in stress response—and immune signaling cascades, the complex chains of reactions, it became clear to me that the impacts of chronic stress and psychological trauma—so often relegated to the hidden recesses of the human psyche, and which we frequently think of as “all in the mind”—lead to real, detectable changes throughout the body.
These changes are etched onto both the immune system, which defends us from disease, and the nervous system, which governs thought, emotion, and bodily function.
I understood that chronic stress, therefore, is not just an abstract or emotional burden; it produces measurable shifts in the fundamental biology of our brain and immune cells, making the ‘silent’ dialogue of suffering and resilience visible at the molecular level.
It is indeed no surprise that no one is collecting biological samples in a warzone. When you are dodging airstrikes or crammed into a refugee camp, finding basic human rights is hard enough—so good luck getting hands on an RNA sample.
Yes, the current and previous governments of Bangladesh, together with a formidable chorus of UN agencies, international NGOs, and local actors, have erected a network of nearly one hundred health posts, dozens of primary care centres, and field hospitals—each a beacon of sterile white light valiantly struggling against the darkness of constant want.
However, within these humble clinics, efforts inspired by global compassion strive only to address the physically visible wounds; in the suffocating press of so many bodies and the chokingly dense fog of chronic uncertainty, the healing of Rohingya women’s psychological trauma remains as arduous as they are Sisyphean.
In the Orwellian dystopia we live in—where war is equated with peace—no one documents how trauma, especially war trauma, evolves into metabolic and other chronic diseases. We lack records linking the aftermath of conflicts like WWII, the Vietnam War, the Tigray War in Ethiopia, the ongoing Syrian and Yemeni Civil Wars, or the recent invasion of Ukraine with depression, anxiety, shame, guilt, loss of control, and stress resulting from PTSD, and their connections to chronic diseases like multiple sclerosis, cancer, lupus, fibromyalgia, Crohn’s disease, and Parkinson’s, and with patterns of smoking or drug abuse.
After the horrific Hiroshima and Nagasaki nuclear bombings, radiation levels and associated thyroid cancer risks in the area were monitored. However, the global scientific community seemed to overlook the impact of psychological stress manifesting as physical disorders associated with such losses.
In the past, psychology was often dismissed as pseudoscience. In a 1985 editorial in The New England Journal of Medicine titled “Disease as a Reflection of the Psyche,” author Marcia Angell, M.D., questioned whether diseases like cancer are more prevalent in unhappy individuals, and if changing one’s outlook could alter the course of illnesses. She concluded that “our belief in disease as a direct reflection of mental state is largely folklore.”
However, the same year, the American Psychological Association challenged this view, asserting the importance of psychological factors in health. An article by Daniel Goleman in The New York Times, titled “Debate Intensifies on Attitude and Health” (October 29, 1985), highlighted evidence supporting psychotherapy’s benefits for cancer patients, advocating for integrating psychological care into medical treatment.
Since 1985, there has been an influx of evidence connecting psychology with physiology, demonstrating how mental states can influence physical health. However, despite continuous validation, sadly, the scientific community still often fails to connect psychological trauma with the physical manifestation of illnesses, citing somewhat vague concerns over “potential patient guilt” and “misguided hope”.
No, no one is suggesting that an autoimmune patient should simply stay ‘happy’ to cure their illness. That is ridiculous. We are saying—we have evidence that indicates that a persistently ‘unhappy’ state might contribute to the development of several chronic autoimmune diseases.
It is undeniable that 52% of women, afflicted by PTSD due to unfathomable, horrific crimes, along with 65% of ‘acutely vulnerable’ households in the refugee camps [1], inhabit ‘unhappy’ environments that are quintessentially classic breeding grounds for further psychological trauma. We already know that the persistent activation of the brain’s “fight or flight” response in PTSD results in a constellation of symptoms: intrusive memories, heightened emotional responses, physiological changes such as tachycardia, panic attacks, disturbed sleep, and nightmares, alongside avoidance behaviours related to trauma triggers.
We already understand that neurobiologically, chronic trauma results in increased activity and sensitivity in the amygdala, while both the hippocampus and prefrontal cortex show reduced volume and efficiency. This dysregulation propagates through the broader nervous system, potentially contributing to metabolic disorders, autoimmune diseases, and gastrointestinal disturbances.
Needless to say, the current ‘physical’ health situation among Rohingya refugees in Bangladesh is dire, with women facing ever more significant challenges. More than half of the refugees are women, as mentioned above, and around 316,000 are of reproductive age [2].
A lack of access to reproductive health services, such as antenatal care, is compounded by movement restrictions within the camps. In early 2018, over 50,000 women were pregnant, yet many could not receive essential care due to insufficient facilities and accessibility issues. Gender-based violence is also rampant, as one might assume, with reports of sexual abuse and exploitation, including rape and forced sexual favours.
Between August and December 2017, more than 14,000 incidents of such violence were reported, although the actual numbers are much likely higher due to underreporting, stigma, and fear. These traumatic experiences contribute to mental health crises, of course, as 36% of refugees suffer from PTSD, with depression widespread among 89% of the population [2].
Female children particularly face mental stress over security, lacking privacy, and shared facilities, exacerbating their vulnerability in an environment already fraught with insecurity and trauma.
So—what can we do in this situation? Yes, sending them back to their home country, Myanmar, and seeking a peaceful, long-lasting resolution is one option, but it takes time. Meanwhile, as a substantial number of Rohingya remain in Bangladesh and many begin integrating into the host community in Cox’s Bazar and beyond, we must consider the potential effects of their collective psychological trauma manifesting as physical ailments. Addressing these issues comprehensively is crucial to ensuring both the immediate and long-term well-being of the refugees and their impact on the wider Bangladeshi community.
Bangladesh is not a wealthy country; it faces its own economic and political challenges. Therefore, we need international support. We must systematically monitor the health of the camps by collecting biological samples and conducting longitudinal studies through collaboration with the international scientific community.
Specifically, studies could investigate the long-term impact of PTSD on immune function and track the prevalence of chronic diseases like type-2 diabetes and hypertension linked to stress. We must also provide these women with counselling and mental health support. Those who have faced sexual violence require focused rehabilitation efforts to aid their recovery and empowerment. Most importantly, we need to provide training and arrange livelihood opportunities for this community.
While some Bangladeshis may oppose integrating Rohingyas into their own communities for obvious reasons, having already extended a loving humanitarian hand, we cannot abandon them now into the Pacific without international intervention. Regardless of our preferences, their integration is inevitable. Therefore, offering education and even small-scale incorporation into society will be beneficial for both parties.
I am saying both parties, but there are actually no two parties.
We are all one in this journey.
Be it Rohingya, Bengali, Chakma, Rakhain, Pashtun, Tajik, Hazara, Uzbek or Arab, there is but one collective. There is no “us versus them”—we are all women of the world, “the proletariat of the proletariat”, each a sufferer of wars not of our own making, bearing wounds of trauma etched into our collective bodies and intricately woven into our shared, Muslin-like consciousness across the refugee camps of the earth, as our tears and our blood and our sufferings flow through our mitochondrial DNA, generation after generation, dissolving boundaries of land, water, and air, and uniting us as sisters on this shared odyssey.
The Rohingya woman is my sister; as long as she suffers, I cannot escape my pain.
Source:
[1] https://www.sciencedirect.com/science/article/pii/S2212420922004654
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7489778/
Nadia Islam- Writer and Researcher
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