Elderly Bhutanese refugees face among the most acute challenges of any group within the resettled community. Arriving after decades in camps, often without English proficiency, and having lost the social roles that sustained their sense of worth, older adults in the diaspora experience elevated rates of isolation, depression, and health complications. A growing body of academic research and a handful of community-led programmes are beginning to address these needs.
When the third-country resettlement programme relocated Lhotshampa refugees from Nepal's camps beginning in 2007, it relocated them as a community that included all ages — including elderly adults who had spent fifteen to twenty years in camp conditions and who arrived in Western countries in their sixties, seventies, and sometimes eighties. For this generation, resettlement represented not a new beginning but an extraordinarily disorienting late-life transition. The structural supports that had organised their existence — the camp community, the extended family network, the social roles of elder and grandmother and religious elder — were fragmented by the dispersal of resettlement. What replaced them, in many cases, was an apartment, a government benefit, and a world conducted in a language they had no possibility of learning.
Academic researchers, public health practitioners, and community workers have described the situation of elderly Bhutanese refugees as one of the most challenging unmet needs within the broader resettlement population. A 2022 study published in Aging & Mental Health (PMC) documented the compounding effects of past trauma, resettlement stress, and pre-existing health conditions on the mental health of older Bhutanese adults in the United States and Canada. A 2023 study in PMC found that mental health challenges among older Bhutanese refugees included depression, anxiety, and suicidal ideation at rates substantially above both the general US population and younger Bhutanese refugee cohorts.
Challenges
The challenges facing elderly Bhutanese refugees are structural as well as individual:
- Social isolation: Elderly community members who cannot drive, read English street signs, or navigate public transit systems are effectively confined to their apartments when younger family members are at work or school. The community's tradition of multigenerational cohabitation provides some protection, but in resettlement cities where apartment sizes limit crowded living, the elderly may spend much of the day alone. A 2022 PMC study on coping and meaning-making among older Bhutanese used the phrase "we are all under the same roof" to describe the communal orientation that camp life had reinforced — an orientation that resettlement's spatial dispersal directly undermines.
- Loss of social role: In Bhutan and in the camp communities, elders held respected and functional positions — as religious leaders, as grandparents who managed household religious practice, as community mediators and storytellers. In resettlement cities, these roles are structurally unavailable. Elders who cannot communicate with neighbours, teachers, or service providers find their social role reduced in ways that carry profound psychological consequences.
- Mental health: The Bhutanese refugee community as a whole has experienced elevated suicide rates, with CDC research documenting rates significantly above the US average. Among the elderly, this risk is compounded by isolation, loss of role, grief for lost homeland and community, and the particular difficulty of accessing culturally appropriate mental health care. A 2025 SAGE/PMC study on socioeconomic status and cognitive health among older resettled refugees documented that Bhutanese elders show "diminished returns" — lower cognitive health outcomes relative to their socioeconomic level — compared to non-refugee populations, a finding attributed to the cumulative effects of displacement.
- Healthcare navigation: Western medical systems, with their emphasis on individual decision-making, written consent forms, digital appointment booking, and specialised care pathways, are extraordinarily difficult to navigate without language proficiency and cultural familiarity. Preventive care appointments are frequently missed; chronic conditions including diabetes and cardiovascular disease — prevalent among older Bhutanese due to years of inadequate camp nutrition — are managed less effectively than in the general population.
Research and Programmes
The academic response to the needs of elderly Bhutanese refugees has been substantial. Project Bhalakushari, an NIH-funded study led by researchers including Dr. Bhuwan Gautam at Harvard and Boston College, has examined the wellbeing of ageing Bhutanese refugees in the US and Canada, producing research that has informed both clinical practice and community programme design. Community health worker models — in which bilingual community members are trained to provide health information, navigation assistance, and social support to elderly community members — have been developed in several cities and evaluated in academic literature as among the most effective interventions for this population.
Parangkush Subedi's mental health training programmes, which have addressed elder mental health as a specific priority, represent another community-led response. Faith communities — Hindu temples and Buddhist practice groups — also provide informal social support and structured occasions for elderly community members to participate in meaningful communal activity.
See also
- The Problem Was Never the Home Care
- Child Care and Protection Act of Bhutan 2011
- Child Care and Protection Act of Bhutan
- Bhutanese Diaspora Youth in Higher Education
- Lhotshampa Name Reclamation in the Diaspora
References
- "Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience." Aging & Mental Health, PMC, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9386683/
- "'We are all under the same roof': Coping and meaning-making among older Bhutanese." PMC, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9412077/
- "Mental Health Among Older Bhutanese with a Refugee Life Experience: Mixed Methods Latent Class Analysis." PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10330824/
- "Socioeconomic Status Among Older Resettled Refugees: Older Bhutanese Refugees' Diminished Returns on Cognitive Health." SAGE / PMC, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12264397/
- "Addressing the mental health needs of older adult refugees." PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10559761/
See also
Bhutanese Diaspora Entrepreneurship: Restaurants
The emergence of Bhutanese and Nepali restaurants in resettlement cities across the United States, Canada, Australia, and beyond represents one of the most visible expressions of Bhutanese diaspora entrepreneurship. From momo shops and dal-bhat restaurants to catering businesses, Lhotshampa entrepreneurs have leveraged culinary traditions rooted in southern Bhutan and the refugee camps to build businesses that serve both their own communities and broader audiences, functioning as cultural ambassadors and economic anchors.
diaspora·8 min readLhotshampa Name Reclamation in the Diaspora
Since the mid-2010s, resettled Lhotshampa families in the United States, Australia, Canada and Norway have begun restoring the standard Nepali spellings of names distorted on Bhutanese official records, through naturalisation, court orders and the naming of children born in exile. The movement is widely practised but unevenly documented.
diaspora·17 min readBhutanese diaspora
The Bhutanese diaspora consists overwhelmingly of Lhotshampa — Nepali-speaking southern Bhutanese — who were expelled or fled in the early 1990s and were later resettled around the world. Of roughly 108,000 refugees in camps in eastern Nepal, about 113,000 were resettled between 2007 and 2018 under a UNHCR-led programme, the great majority to the United States, with smaller communities in Canada, Australia, the United Kingdom and Europe.
diaspora·2 min readBhutanese Diaspora Youth in Higher Education
Bhutanese diaspora youth have emerged as first-generation college students in growing numbers across the United States and other resettlement countries, navigating the complexities of college admissions, financial aid, and academic life while bridging cultural expectations from their refugee families and the demands of American higher education. Their achievements in fields ranging from public health to engineering represent a generational transformation within a community that arrived with limited access to formal education.
diaspora·8 min readCensus of Bhutan 1988
The Census of Bhutan 1988 was a national population survey conducted in southern Bhutan that became one of the most controversial administrative exercises in the country's history. The census introduced a classification system using categories F1 through F7 to categorise residents according to their perceived nationality and citizenship status. Its implementation led to the mass reclassification of Lhotshampa (ethnic Nepali-speaking Bhutanese) as non-nationals, directly precipitating the Bhutanese refugee crisis of the 1990s.
diaspora·6 min readCountries That Accepted Bhutanese Refugees
Eight countries participated in the third-country resettlement program for Bhutanese refugees from Nepal between 2007 and 2023. The United States accepted the vast majority — over 90,000 individuals — while Australia, Canada, New Zealand, Norway, the Netherlands, Denmark, and the United Kingdom collectively resettled an additional 23,000.
diaspora·7 min read
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