K.M. Parvez Geopsychiatry 3 (2026) 100091 belonging, and statelessness; mental health and emotional well-being; gender-specific vulnerabilities and protection concerns; and percep­ tions of the future, including aspirations and uncertainties surrounding repatriation. This thematic focus ensured that the data captured both structural and experiential dimensions of the crisis. The data analysis was conducted using thematic analysis, a widely used qualitative method for identifying, analyzing, and interpreting patterns within textual data [26]. The analytical process involved mul­ tiple stages. First, interview transcripts were carefully reviewed and subjected to open coding, during which recurring ideas, expressions, and narratives were identified. Second, these initial codes were organized into broader categories through axial coding, allowing for the identifi­ cation of relationships between different themes. Finally, selective coding was employed to integrate these categories into a coherent analytical framework that connects individual experiences with broader structural conditions. This iterative process enabled the identification of core themes such as trauma and uncertainty, humanitarian dependency, identity and statelessness, and gendered vulnerability. To ensure analytical rigor and credibility, the study adopted several qualitative validation strategies. Consistency in coding was maintained through repeated review of transcripts and refinement of thematic cat­ egories. Attention was given to capturing diverse perspectives within the sample to avoid overgeneralization. Furthermore, the interpretation of findings was guided by the study's analytical framework, which in­ tegrates insights from international relations, humanitarian governance, and geopsychiatry. This triangulation of theoretical perspectives strengthens the validity of the analysis by situating individual narratives within broader structural contexts. Ethical approval for this study was obtained from the relevant institutional review authority prior to data collection. Given the vulnerability of the refugee population, ethical considerations were central to the research process. Participation was entirely voluntary, and informed consent was obtained from all participants before interviews were conducted. Strict measures were implemented to ensure confi­ dentiality and anonymity, with no identifying information recorded. Particular attention was given to minimizing the risk of retraumatization during interviews, especially when discussing experiences of violence and loss. Participants were allowed to decline to answer any question or withdraw from the study at any point, ensuring that their safety, dignity, and well-being were fully protected throughout the research process. “We escaped death, but we are not living in peace. Every day we think, what will happen next?” (Male refugee, age 42) Another participant emphasized how fear has shifted from physical violence to existential uncertainty: “In Myanmar we feared soldiers, here we fear the future. There is no end to this fear.” (Female refugee, age 35) These accounts illustrate that trauma is no longer anchored in past events but is reproduced through ongoing structural conditions. The concept of “chronic uncertainty” emerges as a central analytical lens, where the inability to anticipate outcomes, plan for the future, or access stable pathways to resolution generates sustained anxiety and emotional exhaustion. This condition is further intensified by the absence of legal status and the stagnation of repatriation processes, which reinforce a sense of temporariness that has become permanent. Unlike conventional models of trauma recovery, which assume the possibility of stabilization and healing over time, the Rohingya context reveals a cyclical dynamic in which uncertainty continuously reactivates and reshapes psycholog­ ical distress. This supports the reconceptualization of trauma not as a post-event condition but as an ongoing, complex, and structurally embedded process. At the collective level, trauma is experienced as a socially distributed phenomenon that permeates family structures, community relations, and intergenerational dynamics. Participants described how emotional distress is shared, transmitted, and reinforced within households, affecting parenting practices, social cohesion, and the development of children who have grown up entirely within camp environments. This suggests that the camps operate as “trauma-producing ecosystems,” where structural conditions sustain psychological vulnerability across time and generations. From a policy perspective, these findings chal­ lenge the marginalization of mental health within humanitarian pro­ gramming. Psychosocial distress is not a secondary outcome but a central feature of protracted displacement, requiring integrated in­ terventions that address both individual and structural drivers. This includes expanding mental health services, embedding psychosocial support within education and community programs, and addressing the root cause of uncertainty through credible political pathways. Without such integration, humanitarian responses risk treating symptoms while leaving the underlying conditions of distress intact, thereby perpetu­ ating cycles of psychological vulnerability within displaced populations. 4. Results and discussion 4.2. Humanitarian containment, restricted agency, and structured dependency 4.1. Trauma, chronic uncertainty, and geopsychiatric distress The qualitative findings demonstrate that trauma among Rohingya refugees cannot be adequately conceptualized as a discrete psycholog­ ical response to past events, but must instead be understood as an evolving and structurally sustained condition shaped by ongoing un­ certainty, spatial confinement, and political stagnation. Participants' narratives consistently indicate that while the violence experienced in Myanmar constitutes the initial rupture, the psychosocial burden has been transformed and prolonged through conditions of indefinite encampment and lack of future orientation. This supports geopsychiatric perspectives which argue that mental health outcomes in forced migration contexts are not merely clinical phenomena but are deeply embedded in geopolitical arrangements, governance systems, and environmental insecurity [22]. The camps in Cox's Bazar function not only as sites of protection but also as spaces where uncertainty is insti­ tutionalized, producing a form of temporality characterized by suspen­ sion, where individuals are neither integrated nor able to return. Within this suspended condition, psychological distress becomes normalized and chronic, as individuals are unable to construct stable narratives about their future or regain control over their life trajectories. One participant captured this condition by stating: The findings indicate that humanitarian governance in Cox's Bazar has evolved into a complex system of containment that simultaneously enables survival and constrains agency, producing a condition that can be analytically described as “regulated dependency.” While participants acknowledged the critical role of humanitarian assistance in sustaining life, their narratives reveal a deep sense of frustration with the re­ strictions imposed on mobility, livelihood opportunities, and decisionmaking autonomy. This reflects a structural paradox identified in hu­ manitarian governance literature, where systems designed for emer­ gency relief gradually transform into long-term mechanisms of population management [17,27]. Within the camps, governance prac­ tices are characterized by regulatory controls that limit movement, restrict economic participation, and centralize decision-making au­ thority, effectively shaping everyday life through external structures rather than individual agency. One participant articulated this condition by stating: “We receive food, but we cannot choose how to live. Everything is decided for us.” (Male refugee, age 38) Another emphasized the erosion of dignity embedded within this system: 5