When Sajada walked into the Doctors Without Borders (MSF) clinic in Butterworth, Penang, with her two young children, she was clearly disoriented – shouting at the top of her lungs and showing signs of a manic episode.
The single mother of Rohingya ethnicity had travelled more than 300 kilometres to the clinic, fleeing not violence or war, but a deep mental health crisis she could no longer endure.
Sajada’s case is one of many seen at the MSF clinic this year, as mental health struggles become increasingly visible among Malaysia’s refugee community, particularly the Rohingya. Barred from working legally or accessing public healthcare, many suffer in silence until the burden becomes unbearable.
The Rohingya make up nearly 60 per cent of the 200,260 refugee population in Malaysia, according to the United Nations Refugee Agency’s latest data in May.
Dr Sara Zachariah, MSF’s medical activity manager, said over 90 per cent of the mental health patients at the clinic were Rohingya refugees. Many had fled persecution in Myanmar or spent years confined to refugee camps.
“The numbers are rising. We’ve been collecting data and we are seeing an increase in cases requiring psychiatric treatment,” said Dr Sara.
She attributes the rise not only to worsening conditions but also to greater awareness following MSF’s community outreach efforts since its presence in Malaysia in 2015.
“They live in constant fear, have no legal protection, and are barely surviving economically. And all of that has taken a toll on their mental wellbeing,” she said.
Malaysia is not a signatory to the 1951 United Nations Refugee Convention or its 1967 Protocol. As a result, refugees have no access to legal employment, public healthcare, or education.
Even for those with documentation, barriers such as cost, stigma, and language prevent consistent treatment. For the undocumented, the fear of arrest often keeps them from seeking help.
A quiet surge, an invisible struggle
Since January, MSF has held 381 mental health consultations at its clinic in Butterworth, handled by two psychologists and five lay counsellors who were recruited from within the refugee community.
It also runs a weekly mobile clinic serving areas across Penang and Kedah, improving access for those living further away.
“Most of them cannot speak Malay or English. That is why we have lay counsellors who speak their language so we can better understand their problems,” Dr Sara told Twentytwo13.
Some of the refugees, she said, came complaining of physical ailments such as headaches, back pain, or stomach trouble that did not respond to medication. These were eventually discovered to be signs of trauma.
“We’ve seen men come in over and over with symptoms that didn’t get better. They’re carrying trauma, but it shows up in the body. It’s only when they finally open up that we can refer them for proper care,” she said.
MSF currently monitors around 100 patients with diagnosed psychiatric conditions that require medication – including depression, anxiety, and psychotic disorders. These are often severe cases in which individuals can no longer sleep, work, or care for themselves.
“We have had cases where they cannot even function at all. The trauma had crippled them,” said Dr Sara.
Meanwhile, milder cases receive daily counselling sessions at the clinic. Although many have come forward to seek treatment, there are still those who suffer in silence.
“Poverty, stigma, and lack of support still push many into isolation,” Dr Sara said.
All they need is to be treated like humans
At the heart of MSF’s mental health response are people like Ashad, one of the clinic’s lay counsellors.
Now 37, he has lived in Malaysia for eight years and has worked with MSF since 2022. His job is to listen. He helps patients find the words to describe what they feel.
“Helping patients with mental health issues is both a deeply rewarding and humbling experience,” Ashad said.
“Each individual’s journey is unique, requiring empathy, patience, and adaptability to provide meaningful support.”
He said the work challenges him to grow.
“Each day brings new challenges that require us to think differently. What I enjoy most is learning alongside the team and being part of something that actually helps people move forward.”
For many patients, the session with a lay counsellor may be the first time anyone truly listens.
“Sometimes they tell us, ‘This is the only place where I feel like a human being.’ That stays with me.”
