Inside a Bangladeshi psychologist’s journey through the hidden wounds of Palestine, Yemen, Liberia and Syria

For hours, Fazle Elahi would sit by a small window in a remote corner of Yemen and watch a lone figure descend a mountain.

The journey was slow. A shepherd, sometimes accompanied by a handful of goats or sheep, would make his way down the rocky slope, disappearing into the valley below before beginning the long climb back up.

“It would take two to three hours just to come down,” Elahi recalled.

Day after day, the scene unfolded outside the compound where the Bangladeshi mental health professional S M Fazle Elahi was stationed with Doctors Without Borders, known by its French acronym MSF.

The mountains were barren, the villages isolated and the war-ravaged country seemed suspended in time.

The shepherd’s routine offered a glimpse into a life reduced to survival.

“He would come down to fetch water, or maybe find some grass or herbs,” Elahi said. “That was their food.”

Years later, after working in some of the world’s most troubled places – from the Rohingya refugee camps of Bangladesh to Yemen, Liberia, Palestine and now Syria – the image remains with him.

Not because it was dramatic….because it was ordinary. War, Elahi has learned, is also found in the erosion of dignity, hope and human connection.

It is found in fathers who can no longer feed their children, mothers carrying impossible burdens and generations growing up without certainty about tomorrow.

For more than eight years with MSF, Elahi’s work has been to sit across from those people and listen.

People often think mental health is separate from everything else. But Elahi learned in some of the most violent places on earth that mental health is intertwined with life itself.

Nomadic and passionate by heart

Born in Bangladesh’s northeastern district of Moulvibazar and educated at Jagannath University and the University of Dhaka, Elahi began his professional journey as a counsellor before joining MSF in Cox’s Bazar in 2018, working with Rohingya refugees who had fled violence and ethnic cleansing in Myanmar.

At one point he qualified for a government job through the country’s competitive civil service examinations. Family members encouraged him to take it. He declined.

“MSF is in my blood and in my vein,” he said. The decision would take him far beyond Bangladesh.

His first international assignment was Yemen. The country had already endured years of conflict. Political fragmentation and economic collapse had pushed millions into hardship and hunger.

In the areas where Elahi worked, many families struggled simply to find enough food. Among the patients were fathers who had reached the edge of despair.

One man told him he could no longer bear watching his children go hungry. “He said, ‘I have only two options,’” Elahi recalled. “He said, ‘either I have to leave this world, or I have to run away and try to find something.’”

Some stayed, some chose to leave…because they could not endure their suffering while being unable to do anything about it.

At the same time, Elahi would meet women abandoned by husbands who had disappeared in search of work or survival. One person saw abandonment, the other saw escape.Neither was free from pain.

“It’s not only about food,” Elahi said. “It’s about the relationship with your husband, your wife, your children, your relatives, your community. It’s about everything.”

That insight lies at the heart of his profession. Psychologists cannot end wars. Neither they could create jobs nor could they rebuild economies.

“Many people mistakenly think that we give suggestions or guidance. That’s not how it works,” he said. “We try to support the patient.”

Rather than offering answers, mental health professionals help people rediscover hope, explore possibilities and regain parts of themselves they have lost. Sometimes that means helping someone find a reason to keep living. Sometimes it means helping them regain a sense of control after losing everything else.

Liberia presented a different kind of challenge.

Challenging assignments

The West African nation was still struggling to rebuild after years of civil conflict and repeated shocks, including Ebola outbreaks that strained an already fragile health system.

Elahi joined what he described as one of the largest dedicated mental health programmes in MSF’s global network. At its peak, the programme handled roughly 10,000 consultations a month, ranging from counselling and community outreach to psychiatric treatment and medication.

Yet the thing that stayed with him was the void left by years of violence. “When a country goes through 20 years of civil war, who teaches the next generation?” he said. “Who becomes their motivation?”

If Yemen taught Elahi about survival, Palestine taught him what it means to live like a caged bird under the pressure of Israeli settlers.

For ten months, the Bangladeshi psychologist worked in the occupied West Bank, where MSF treated severe mental health cases. Unlike a natural disaster or a war with a clear beginning and end, he witnessed a trauma that was constant, cumulative and passed down across generations.

“It’s not that there is no suffering when there is no war,” he said. “It is a process.”

From the outside, many of the Palestinians he met appeared ordinary. They went to work, studied, raised children and shared meals with family. Yet beneath that surface, Elahi found lives shaped by fear, humiliation and uncertainty.

“You see a beautiful person walking down the street,” he said. “But when you understand their life, you feel like they are a bird in a cage.”

The Palestinian trauma stemmed from the steady erosion of freedom and dignity.

A family could wake up one morning unsure whether their business would survive, whether they would be allowed to travel to another town, or whether a loved one would return home alive or be subjected to humiliation at checkpoints.

Elahi saw patients dealing with settlers moving into neighbourhoods, destroying olive farms, taking over houses and fining owners tens of thousands of dollars for living in their own homes.

For families who had spent generations cultivating the same land, displacement came in the form of a loss of identity.

A regular day for a Palestinian, he said, might involve a settler checkpoint just beyond their home, turning a short walk to a nearby road into a journey over hills and through lengthy security checks.

“If you are Palestinian, you cannot cross the road easily,” he said. “Maybe you stay there for hours and hours and hours.”

The delays were only part of the burden. What stayed with his patients, he said, was the humiliation.All of this, of course, was besides the daily bombings and killings.

Some patients arrived carrying the scars of detention. One former prisoner had spent 26 years behind bars. “When he came out, everything was different,” Elahi said. “He lost everything in his life. He didn't know where to start.”

The man no longer trusted anyone. The world he returned to was unrecognisable. Relationships had vanished, routines had disappeared and decades of his life were gone.

“They kill the person inside,” Elahi said. “They kill their brain. They kill their humanity and everything.”

Unbearable burdens

Others had spent far less time in detention but emerged carrying similar psychological wounds. Some became suspicious of family members, friends and neighbours. Others struggled to rebuild even the most basic human relationships.

For Elahi, one of the most heartbreaking realities was seeing how despair became normalised.

He recalled patients who had become so hopeless that they deliberately confronted soldiers at checkpoints.

“They knew what could happen,” he said. The goal, he believed, was often not confrontation itself but escape from a life that had become unbearable.

By the time many patients reached his office, they were carrying the cumulative trauma of lifelong humiliation, distrust, hopelessness and a profound loss of control over their own lives.

What affected Elahi most was not the restrictions placed on him as an MSF professional, nor the security protocols that governed his movements. It was witnessing what his patients endured.

“The suffering of our patients impacts us the most,” he said.

Today, Elahi is based in Damascus, where Syria is attempting to rebuild after more than a decade of war. The conflict has left deep scars across society.

In Syria, Elahi’s work extends beyond patient care. He is also involved in building local capacity, training teams and helping develop mental health programmes that can be sustained by local communities.

The challenges are immense, but so are the needs. Yet after years spent listening to stories of loss, displacement, torture and grief, Elahi remains committed to the work.

Partly because he believes in the mission of MSF. Partly because he believes people are capable of extraordinary resilience. And partly because, despite everything he has seen, he continues to find hope.

Back in Yemen, the shepherd kept making the same journey. Down the mountain. Across the valley. Back up again. The path was difficult, repetitive and uncertain. But he kept walking.

In many ways, Elahi’s patients have spent years doing the same.