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Table of Contents
FIELD REPORT
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 284-289

Sports and physical activity in psychosocial interventions with adolescent groups of the Rohingya community in Bangladesh: potential, limitations and critical factors for success


1 MSc, Migration Health Division, International Organization of Migration (IOM), Cox’s Bazar, Bangladesh
2 MSc, MS. Public Health and Nutrition Section, United Nations High Commissioners for Refugees, Cox’s Bazar, Bangladesh

Date of Submission14-Jul-2019
Date of Decision21-Aug-2019
Date of Acceptance14-Oct-2019
Date of Web Publication29-Nov-2019

Correspondence Address:
Mahmuda Mahmuda
Public Health Section, United Nations High Commissioner for Refugees (UNHCR), Cox’s Bazar
Bangladesh
Md. Salek Ahmed
Migration Health Division, International Organization of Migration (IOM), Cox’s Bazar
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INTV.INTV_51_19

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  Abstract 


The mental health and psychosocial needs of adolescent Rohingya refugees in Bangladesh are seriously underserved. There are few services and resources for them, and this population is hard to reach with conventional mental health and psychosocial support activities. Adolescent Rohingya refugees have very limited opportunities to express themselves and to engage in the community. This affects their mental health and psychosocial wellbeing negatively. This field report argues that the use of sports and physical activity could be a valuable means to provide psychosocial support to adolescent Rohingya refugees. A small number of research efforts and project evaluations have begun to help us understand the link between participation in sport and physical activity and mental health and psychosocial wellbeing. The data of this study were collected through focus group discussions and key informant interviews. The findings suggest that sports and physical activity may play a significant role in the psychosocial development and in strengthening positive social communication among adolescents. However, the development of sport activities in a humanitarian setting such as the Rohingya crisis is not easy. This field report explores challenges related to gender, local cultural context and community structure. Finally, some factors are discussed on how to design psychosocial programmes that include sport and physical activity and how to promote this with several stakeholders.
*Both first authors contributed equally.

Keywords: physical activity, psychosocial intervention, Rohingya refugees, sports


How to cite this article:
Ahmed MS, Mahmuda M, Mahmudul Alam AM. Sports and physical activity in psychosocial interventions with adolescent groups of the Rohingya community in Bangladesh: potential, limitations and critical factors for success. Intervention 2019;17:284-9

How to cite this URL:
Ahmed MS, Mahmuda M, Mahmudul Alam AM. Sports and physical activity in psychosocial interventions with adolescent groups of the Rohingya community in Bangladesh: potential, limitations and critical factors for success. Intervention [serial online] 2019 [cited 2019 Dec 14];17:284-9. Available from: http://www.interventionjournal.org/text.asp?2019/17/2/284/271899

Both first authors Md. Salek Ahmed and Mahmuda Mahmuda contributed equally.





  Introduction Top


After any humanitarian crisis, the life of individuals and families becomes difficult with the usual support systems becoming overburdened, dysfunctional or shattered. This has a negative impact on mental health and psychosocial wellbeing. From non-humanitarian settings, we know that sports and physical activity can protect against the development of mental illness, can reduce symptoms, increase self-esteem and feelings of energy and contribute to the overall quality of life (Janssen, 2007; ODPHP, 2008). But in humanitarian response, the role of sports and physical activity for adolescents is very limited. This is also the case in the Rohingya refugee operation in Cox’s Bazar, Bangladesh, where almost one million Rohingya refugees have found shelter. A few but not sufficient programmes for sports and physical activity are implemented in the Rohingya response to improve the mental health and psychosocial wellbeing of individuals, especially adolescents.

It is generally accepted that physical activity confers benefits to physical and mental health and improves quality of life. Physical activity is defined by WHO (2009) as ‘any bodily movement produced by skeletal muscles that results in energy expenditure’ and sports means all kind of body movement action that help an individual to stay physically fit and to improve psychosocial wellbeing and social interaction.1

Sports and physical activities as a psychosocial intervention are mainly used to create a healthy environment which helps the participants and their surroundings to cope with their daily stresses in positive ways and can improve their mental health and psychosocial wellbeing.

Sports and physical activity can have a stabilising impact on most children through supporting and encouraging their resilience processes, with resilience being described as the process of, and capacity for, successful adaptation, despite challenging or threatening circumstances (Henley, 2005, (2010)). Sport builds self-esteem, friendships and a sense of belonging among a team of peers within a team or competing as an individual against peers (Lenny & Angela, 2008). However, only very few studies and project evaluations address the impact of psychosocial sports activities on the mental health condition of people affected by adversity and displacement. In Guatemala, movements, games and sports were used in psychosocial intervention with affected people. The evaluation of this programme indicated that these interventions had strengthened their cognitive and psychological resources to improve their wellbeing (Ley, Barrio, & Koch, 2018). Trauma-sensitive football can play a vital role with survivors of tortures in building social relationship and can help to cope with their daily stressors and reconnect with their physical body (Horn, Ewart-Biggs, Hudson, Berilgen, Ironside & Prodromou, 2019). A programme with the Afro-Brazilian martial art/dance Capoeira brought positive changes in young refugees in Australia on interpersonal skills, sense of responsibilities and discipline, behaviour towards peers and teachers (Momartin, Coello, Pittaway, Downham, & Aroche, 2019). Sports and recreational activities helped refugees in Kakuma refugee camp in northern Kenya and reduced dropout rate in professional trainings (Ley & Rato Barrio, 2007).

Sports programmes and social bonding

An evaluation of psychosocial programmes implemented by Terre des hommes in Iran after the Bam earthquake of 2003 found that children preferred being in a group and be physically active rather than ‘doing nothing at home’ (Colliard, 2005). A study with children and youth reported that sport and play activities can enhance resilience, facilitate emotional and social stabilisation and the acquisition of new skills and abilities in people affected by disasters (Ley, Barrio, & Koch, 2018). Traditional movements and dances helped Sudanese refugees in the United States of America to achieve improvements in solidarity and social cohesion (Harris, 2007a,b). In a project in South Africa with sports and physical activities to improve social integration, an evaluation showed that dance and team sports affected more positively on social networking and bonding than individual sports (Keim, 2003). A study carried out by Armstrong, (2004a,b) found that neighbourhood football teams and their trainers contributed positively to the reconciliation process in Liberia after the civil war in that country. In the post-conflict context of Bosnia and Herzegovina, different sports and physical activities, especially football games, were applied to rebuild social connection among different communities and to develop different skills including confidence, teamwork, etc. (Kvalsund, Nyheim, & Telford, 2004).The brief literature review presented above shows that sport and physical activity can contribute towards improving the mental health and psychosocial wellbeing in humanitarian settings. This prompted us to explore if this could also be the case in the Rohingya refugee situation in Bangladesh. This field report provides an overview of the role that sports and physical activities can play in Rohingya refugee response programmes and crystallises the lessons learned. It also includes recommendations aimed at maximising and mainstreaming the use of sport and physical activity.


  Methods Top


Participants

A convenient purposeful sampling methodology was used in this study. The criteria for inclusion in this study were 12–18 years aged adolescent boys and girls, parents of those adolescent boys and girls and community leaders. The demographic variables for the 56 participants in this study are outlined in [Table 1].
Table 1 Demographic information of participants

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Questionnaires

Two questionnaires were developed in order to measure the opinions regarding sports and physical activities from adolescents, parents, religious leaders and community leaders. These questionnaires were developed by the authors and reviewed by an expert MHPSS team working in the Rohingya response in Cox’s Bazar, Bangladesh. The feedback was incorporated into the final questionnaires.
  1. Questionnaire for adolescents composed of seven open-ended questions (see Appendix 1).
  2. Questionnaire for parents, religious leaders and community leaders composed of nine open-ended questions (see Appendix 2).


Procedure

The participants of this study were asked to respond through focus group discussion (FGD) and key informant interviews (KII). There were a total of five FGDs and seven KIIs conducted to collect the information. A half-day training was conducted by the first author with six Bangladeshi staff to enable them to facilitate the FGDs and KIIs. Data were collected from different camps to increase the number and variety of respondents.

Focus Group Discussions

Four FGDs were conducted across the Kutupalong registered and makeshift sites in Rohingya refugees from ages 12 to 18 years. Another focus group was conducted with five community leaders called Majhi. Six Bangladeshi staff facilitated these FGDs separately as per sex in Rohingya dialect. In this FGD, 22 adolescent male and 22 adolescent females attended. Please see [Table 1] for a breakdown of the groups.

Key Informant Interviews (KII)

Seven individual interviews were taken in different camps by the six facilitators who conducted FGDs. Among them four parents (two male and two female) and three religious leaders were asked almost the same questionnaire. The results from FGDs and KIIs were analysed as a single dataset, given that similar information was collected regardless of interview type.


  Findings Top


The participants responded overwhelmingly positively regarding the importance of sports and physical activities on adolescents’ physical and emotional health including their social life.

Sports and physical activities for adolescent girls

Around 80% of the girls showed a positive attitude towards sports. Most of them like to spend time through indoor and outdoor games such as skipping rope, ladder game, blind fly,2 playing with cooking sets, rubber bands,3 etc. But in this camp context, there is very limited scope for girls to play indoor and outdoor games because of cultural barriers, lack of support from family and safety issues. In addition, there is not enough space for their sports and physical movement. They also mentioned that there is a limited chance for sport and physical activity compare to Myanmar.

In Myanmar, they played different traditional games such as skipping rope, blind fly, hanky thief, stone thief, kutkut,4 sixteen soldiers, etc. All of those games are played in groups. Almost 95% of adolescent girls showed interest in playing group games. This is because they like the company of other girls: they can share their feelings with their peers and feel comfortable to express ‘girl-related problems’ with each other. This type of sports provides the opportunity for girls to develop a sense of camaraderie and share time and values with other girls.

A majority of girls (60%) shared that they helped their mothers in household chores such as taking care of their siblings, collecting water, cooking, etc., and 80% of them reported that sports and physical activities influenced their physical and mental health positively. It makes them happy and cheerful.

Sports and physical activities for adolescent boys

Most (60%) of the boys responded that they spent their time doing many activities such as playing, walking through the camp, shopping, selling cloths and vegetables, working, passing time with friends, etc. In case of playing they usually play indoor games, such as ludo, carom, malpat,5 etc., but they mentioned that they like more outdoor games like football, chinlone,6 cricket, volleyball, etc. The adolescent boys’ groups mentioned that there is not enough space in camp for their sports and physical movement. They shared that the host community also created barriers to playing sports in their field, even they demand money for playing in their space. In Myanmar, according to around half (46%) of the adolescent boys, they played different sports such as cricket, volleyball, football, dodo,7 malpat, etc. But the other half (54%) of the boys mentioned that they did not get any opportunity in Myanmar to play outside of their house. Any kind of sports and physical activity outside of their home was strongly prohibited for them. All participants agreed that sports and physical activity are important for their physical and mental wellbeing. It makes them happy and cheerful. It also refreshes them emotionally and makes them fit. Almost all adolescent boys showed interest to play in groups and indicated that this type of group sports or physical activity helps them to increase social interaction, to create connections and to reduce antisocial behaviour such as drug abuse, crime, etc.

Interviewees responded that sports and physical activity can contribute to social development. According to religious leaders, sports are good for adolescent boys, it protects from doing bad things like crime and watching porn movies. They also mentioned that sports can tackle juvenile crimes by disaffected youth, make positive connections with adults or peers, by integrating them into constructive activities such as tree plantation within society and by providing a useful activity for their time. They added that adolescent girls should not spend time outside of their houses, rather they should help their parents in household chores. They can play indoor games or physical activities like ludu, playing with cooking set, cooking demonstration, etc. Most of the interviewees shared that they would allow their children to play in groups because it helps to improve social cohesion and to reduce tension among the community.

Despite the limited implementation of intervention of sports and physical activity programme in the Rohingya camp, results provide evidence of respondents’ positive attitude towards sports and physical activities, connection between wellbeing and sports, limitation of sports and physical activity programmes in the camp context.

Challenges

There are many challenges in accessing sports in refugee camps. Cultural barriers and gender norms are one of them. Mostly girls who haven’t started menarche are allowed to participate in outdoor activities compared to the girls whose menarche have started. And once the girls started menarche, they are more likely to involve in indoor activities. Girls and boys do not play in a group as they have different indoor and outdoor games differentiated by traditionally and culturally. There are limited spaces for arranging outdoor games. It is difficult to arrange outdoor sports and physical activities. They face difficulties in access and availability of getting sporting tools. Different stakeholders and agencies including government are not paying much attention towards promoting traditional games. There is limited knowledge on arranging sporting events inside the camp. Sometimes there are some unexpected collisions happening with refugees and host communities on the issue of organising game events like football or volleyball, for example, sometimes inside the refugee camp there is limited space on arranging big event. There are some overlapping spaces close to refugee camp; host community claim as their space and refugee people think same like hosts, which creates tension between host and refugees community. Host people don’t like to allow them manifesting any game outside of the camp and it creates collision.


  Discussion Top


The principal findings in this field report are that both adolescent boys and girls are very positive to do physical activity and sports but there are many challenges in continuing sports and physical activities in camps. There are few options for adolescent boys and girls to play inside the camp. For girls there are some women-friendly spaces (WFS) where they can go and enjoy some activities like swing, ludo, carom, playing with toys, etc. Boys go to child-friendly spaces (CFS). They also enjoy few indoor games like ludo, carom, ball throwing by hand to hand, etc. They have limited opportunities to do this. Not each camp or area has CFS or WFS. Moreover, some CFS or WFS are not well organised and staff may have limited knowledge on developing tools materials and games which are more appropriate for Rohingya boys and girls.

For outdoor games, there are many limitations especially for girls. They don’t have any access to outdoor games here, but in response to their FGD session they expressed their willingness to play different types of outdoor games. In Myanmar, they used to play many games. They have some cultural barrier towards playing game in an open field or in front of other men. In Myanmar, they had a small yard in their house and the yard was covered by fence. So, outsiders could not see them, so they played different types of games with their female friends. Here the camp construction doesn’t allow them for any kind of outdoor games. For adolescent boys, the scenario is a bit different. They have limited access here to play some games like football, chinlone, cricket, volleyball, etc. They can play somewhat but there are limited spaces for playing and have limitation on buying playing tools and materials.

Both adolescents and adults reflect that sports and physical activity have a positive impact on psychosocial development and it can really help adolescents on developing their morale and strengthening social communication but for many reasons they cannot play games in a better way.

Based on our experience we can point out some issues to make sports and physical activities more available in camps. We should do an in-depth assessment to identify the specific needs for boys’ and girls’ sports and physical activities which are culturally appropriate and to identify existing resources within community and within different organisations. Involving community volunteers and frontline staff can help to engage communities with sports and physical activity in the camps. For practical implementation, especially for girls’ sports, we need to involve community stakeholders like parents, religious leaders, community leaders, volunteers and others as well. Within the Rohingya community there is major resistance, based on religious and cultural values, to girls participating in outdoor games (Tay et al., 2019). It could be an option to arrange outdoor games where only females can participate and female audience can enjoy the game and respecting religious and cultural values. Playgrounds could be fenced so that men and boys could not enter or watch from outside − and staffed with only female staff. Dancing and aerobic exercises can be considered, as well as promoting the traditional games.

Limitations

This was a small exploratory study with only 56 participants and the results are only indicative and cannot be generalised. This study was done in a short period and the questionnaires were not very much structured. We could not include other stakeholder staff who could explore more dimension and pathway on making sports accessible for boys and girls.


  Conclusion Top


As described in this paper there is limited information about the relationship and benefit of sports and physical activity in psychosocial interventions with adolescent refugees. It is generally accepted that physical activity and sports can play a vital role in development of mental and psychosocial wellbeing. In the Rohingya context, humanitarian organisation should promote culture-friendly games and activities. People should be informed about the benefit of sports. Important is to link activities around sport and physical activity to WFS and CFS whose staff should be properly trained. Given the considerable implementation challenges (crowdedness and cultural/religious restrictions for girls) such activities can only succeed if they are developed in close consultation with the communities and are truly owned by them.

Acknowledgements

The authors wish to thank Peter Ventevogel for his support and time for this article.

Financial support and sponsorship

The authors wish to thank Mental Health and Psychosocial Support Section, Division of Migration Health, International Organization of Migration, Cox’s Bazar, Bangladesh and Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees, Geneva, Switzerland for financial support.

Conflicts of interest

The authors declare they have no potential conflicts of interest with respect to the research, authorship and/or publication of this article. The views expressed in this article are those of the authors and not necessarily those of the institutions that they serve.

APPENDIX 1:

Guidance note for FGDs with adolescent boys and girls (12–18)

Before the FGD: Make sure the venue is booked and well arranged (closed circle), with access to WC and drinking water (some refreshments may be good as well). Avoid too small or too large groups, for parents and adolescents 10–15 participants are fine.
  1. Starting the FGD:
    1. Greetings.
    2. Introduce yourself and your affiliation.
    3. Ask participants to introduce themselves and their affiliation. (if they don’t know each other, think of a quick and practical ice breaker).
    4. Explain a bit about the UNHCR model for MHPSS services and the role of the participants in this service model and get their feedback.
    5. Explain the objectives of the FGD and make sure that everyone is clear about that.
    6. Set ground roles for the group.
  2. Questions: Adolescent


Physical Activity/sporting
  1. How do you spend your time in your camp?
  2. Do you like sporting? If yes which types of − give me some examples. (Indoor and outdoor)
  3. In Myanmar is there any opportunity to play games? If yes, what types of games you used to play?
  4. As a male/female how do you see the scope, opportunity and challenges and difficulties in playing games in your camp?
  5. If you get opportunity, what types of physical activity would you like to reorganize at the camp?
  6. Do you think physical activity helps you positively in physical and mental health and how?
  7. Is it good to play alone or in a group? Do you think playing has an impact in social development?


Closure:
  1. Thank everyone for their participation.
  2. Inform them about the following steps.
  3. Document your findings and share them with your team.


APPENDIX 2: Guidance for Key Informant Interview (KII) with parents, majhees (community leaders) and Imams (religious leaders)

Questions:

Physical Activity/sports
  • How children manage their time inside camps? What do they do mostly?
  • (If your children involve physical activity/playing) what types of physical activities they like to engage at camp?
  • Did your children engage in same physical activity when they were in Myanmar? If yes/no, which types of games they enjoyed most?
  • How do you see the scope, opportunity and challenges and difficulties on playing games in your camp?
  • Do you think physical activity/sporting helps you positively in physical and mental health and how?
  • Is it good to play alone or in a group? Do you think playing has an impact in social development?
  • If you get opportunity, what types of physical activity do you like to reorganize at the camp for your children?
  • Do you think physical activity helps them positively in physical and mental health? And how?
  • Is it good to play alone or in a group? Do you think playing has an impact in social development?


Closure:
  • Thank person for their participation.
  • Inform them about the following steps.
  • Document your findings and share them with your team.


1This broad definition of sport is in keeping with many popularly used definitions including that used by the Council of Europe in 1992.

2‘Blind Fly’, known as Kanamachi, is a traditional village game known to the Rohingya community and this game has same popularity in Bangladesh and in the Indian states of West Bengal, Assam and Tripura.

3‘Rubber Bands’ is locally called Tajjong. It is an outdoor game played using some small rubber bands (garter) and stick.

4Kutkut is a traditional game. The game starts with throwing a small stone into one square, then hop into that square and push the stone out with your foot. Continue to hop around the outer squares repeating ’kit-kit-kit’. When boy/girl has jumped around all of the squares, jump onto the stone to complete a round.

5Malpat is a kind of board game.

6Chinlone, also known as Cane Ball, is the traditional, national sport of Myanmar.

7Dodo is a the traditional group game which is similar to ‘Ha-do-do/Kabaddi’. It is played by two teams, the number of members of each team is between seven and nine. In this game, the court is divided into two equal halves, one belongs to each team. A player is referred as raider to run into the opposite team’s court and earn score by touching opposite players within a single breath and shouting do-do. And opposite team players will try to save themselves as well as stop the raider to cross their line to achieve points.



[18]



 
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