INTRODUCTION
Mental health refers to the overall well-being of an individual's emotional, psychological, and social state of being. It encompasses a range of factors, including one's ability to cope with stress and difficult situations, maintain fulfilling relationships, and feel a sense of purpose and meaning in life. Good mental health allows individuals to lead fulfilling and productive lives, while poor mental health can have negative impacts on an individual's daily functioning, relationships, and overall quality of life. According to the definition of World Health Organization ‘Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’.
Mental health is influenced by a variety of factors, including genetics, environment, life experiences like war, calamities and other factors. War and armed conflict can have a significant impact on mental health, both for individuals who directly experience violence and for those who are indirectly affected, such as family members and communities. Some of the ways in which war can affect mental health include Trauma and Post-Traumatic Stress Disorder (PTSD), Anxiety and Depression, Displacement and Loss Economic Instability, Stigma and Discrimination.
The impact of war on mental health can be long-lasting, and that individuals and communities may continue to experience mental health challenges even after the conflict has ended. Access to mental health services and support is an essential part of addressing the mental health needs of individuals and communities affected by war and conflict. Mental health is not simply the absence of mental illness but rather encompasses a positive state of well-being. There are many regions in the world that have been affected by war and conflict, and it is difficult to determine which area has been the most affected. Some of the areas that have experienced protracted conflicts and ongoing violence in recent years include Syria, Afghanistan, Yemen, South Sudan, the Democratic Republic of Congo, Ukraine and others. These are just a few examples of areas that have been heavily impacted by war and conflict. The effects of war and violence are devastating and can have long-lasting impacts on individuals and communities, including mental health issues, physical injuries, and ongoing displacement and poverty.
Psycho-social services in war-affected regions are designed to support the mental health and well-being of individuals and communities who have experienced trauma and violence due to armed conflict. These services aim to address the psychological and social needs of individuals and may include a range of interventions such as Psychological first aid as Immediate support provided to individuals who have experienced a traumatic event, including practical and emotional support, Trauma-focused counselling, Psychosocial support, Mental health promotion and awareness-raising Educational programs designed to increase awareness about mental health and reduce the stigma associated with seeking support, Capacity-building and training.
These interventions may be provided by a range of organizations, including local and international NGOs, community-based organizations, and government agencies. It is important that these services are culturally appropriate and sensitive to the needs of the individuals and communities they serve. Additionally, the provision of these services must be guided by ethical principles and international standards to ensure that individuals receive high-quality and appropriate care. several international agencies that provide psycho-social services in war-affected regions around the world like International Medical Corps, International Rescue Committee, United Nations High Commissioner for Refugees (UNHCR), World Health Organization (WHO), Save the Children, the International Committee of the Red Cross (ICRC). International humanitarian law, which is also known as the law of war or the law of armed conflict, provides important protections for civilians and establishes obligations for parties to armed conflict with respect to the provision of social services, including psycho-social services, in war-affected regions.
Demography at stake: Most affected regions
The World Health Organization estimates that up to 20% of people living in areas affected by conflict are affected by mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD).4
According to the Global Peace Index 2021, an estimated 4.8 billion people, or around 61% of the world's population, were living in countries affected by conflict, violence, or terrorism in 2020.5
Additionally, according to the United Nations High Commissioner for Refugees (UNHCR), as of the end of 2020, there were an estimated 82.4 million forcibly displaced people worldwide, including 26.4 million refugees, 4.1 million asylum-seekers, and 41.3 million internally displaced people (IDPs) who had fled their homes but remained within their own countries.6
The conflict in Syria has had a significant impact on the mental health of people in the country. According to the World Health Organization (WHO), it is estimated that around 12 million people in Syria require mental health assistance due to the conflict. A study published in 2017 in The Lancet Psychiatry journal, which surveyed more than 1,000 Syrian refugees in Lebanon, found that around 78% of respondents reported symptoms consistent with post-traumatic stress disorder (PTSD), while nearly half (48%) reported symptoms consistent with depression. The same study found that more than a third (37%) of respondents reported having contemplated suicide, while 22% reported having attempted suicide. It is important to note that these figures may not reflect the full extent of the mental health impact of the conflict, as many people may not have access to mental health services or may not feel comfortable seeking help.
As of 2021, the United Nations estimates that there are 18.4 million people in need of humanitarian assistance in Afghanistan, including 3.5 million internally displaced persons (IDPs). Ongoing conflict has forced many Afghans to flee their homes, with an estimated 5.5 million refugees and 2.6 million IDPs in the country. The ongoing conflict in Yemen has resulted in one of the world's worst humanitarian crises. As of 2021, an estimated 20.7 million people in Yemen require humanitarian assistance, including 4 million internally displaced persons. The conflict has also led to an estimated 3.6 million refugees and migrants, many of whom have fled to neighbouring countries such as Djibouti, Somalia, and Saudi Arabia.
The continued conflict in Ukraine is causing extreme civilian harm and leaving millions without access to food, water and other essential supplies. Innocent civilians have been cruelly caught up in the conflict, with almost 19,000 casualties since February 24th, 2022.
More than 8,000 people have been killed, with the actual number likely much higher. Over 5.4 million have been internally displaced.
Kinds of services provided
War-affected regions are characterized by high levels of trauma, stress, and psychological distress. Individuals living in these regions often experience a wide range of mental health issues, including anxiety, depression, post-traumatic stress disorder (PTSD), and other forms of trauma-related disorders.
In many war-affected regions, people may struggle to access basic necessities such as food and shelter. Humanitarian organizations may provide emergency food assistance, distribute relief supplies such as blankets and tents, or set up temporary shelters. Humanitarian organizations provide medical care and support, including treatment for injuries and illnesses, mental health services, and care for women and children. People in war-affected regions may be at increased risk of violence and abuse, including sexual and gender-based violence. Humanitarian organizations may provide protection services, such as setting up safe spaces for women and children, providing legal support, and monitoring human rights violations, and support for livelihoods and income generation, such as providing vocational training or setting up cash-for-work programs.
In response to these challenges, psychological services are increasingly being provided in war-affected regions to help individuals cope with their experiences and promote their mental health and well-being.
Psychological services provided in war-affected regions can take many different forms, including individual and group counselling, trauma-focused cognitive-behavioural therapy (CBT), psychosocial support, and community-based interventions. These services are typically provided by trained mental health professionals, including psychologists, psychiatrists, social workers, and other specialists. The goal of these services is to help individuals manage their psychological symptoms, reduce their distress, and promote their recovery and reintegration into society.
One of the most common forms of psychological services provided in war-affected regions is individual counselling. This involves one-on-one sessions between a mental health professional and a client, in which the client is given a safe space to talk about their experiences, feelings, and concerns. Group counselling is another common form of psychological service provided in war-affected regions. Group counselling can be particularly effective in promoting social support, reducing feelings of isolation, and building resilience. In group counselling sessions, participants may share their experiences, provide feedback and support to one another, and work together to develop coping skills and strategies.
Trauma-focused cognitive-behavioural therapy (CBT) is a specific form of psychotherapy that is widely used in war-affected regions. This type of therapy focuses on helping individuals understand and manage the symptoms of trauma, such as flashbacks, nightmares, and intrusive thoughts. Psychosocial support is another important form of psychological service provided in war-affected regions. This type of support aims to promote the overall well-being of individuals affected by conflict and includes a range of interventions such as community-based activities, vocational training, and support for social integration.
Psychosocial support is often provided in collaboration with other community organizations and can help to address the social and economic challenges faced by individuals affected by conflict.
Community-based interventions are also commonly used in war-affected regions to promote mental health and well-being. These interventions typically involve the participation of local communities in identifying and addressing mental health issues and may include activities such as peer support groups, community education and awareness campaigns, and community-led mental health services. Community-based interventions are particularly important in war-affected regions where access to formal mental health services may be limited or stigmatized.
Agencies performing psycho-social services
The United Nations (UN) plays a critical role in providing mental health and psychosocial services to individuals and communities affected by conflict and war in different parts of the world. The UN has recognized the importance of addressing the mental health needs of war-affected populations, particularly given the widespread trauma, displacement, and social disruption that often accompanies conflict.
The World Health Organization (WHO) is one of the key UN agencies providing mental health services in war-affected regions. WHO has developed a range of resources and guidelines for addressing mental health needs in humanitarian settings, including those affected by conflict. WHO works in partnership with local health systems and organizations to deliver these services, and also provides training and capacity-building support to local health workers. In 2020, the World Health Organization (WHO) provided mental health and psychosocial support to over 3 million people in humanitarian settings, including those affected by conflict.
The United Nations High Commissioner for Refugees (UNHCR) is another UN agency that provides mental health and psychosocial support services to refugees and other displaced populations affected by conflict. The United Nations High Commissioner for Refugees (UNHCR) provided mental health and psychosocial support to over 1.5 million refugees and internally displaced persons in 2020, many of whom were affected by conflict.
The United Nations Children’s Fund (UNICEF) is also involved in providing mental health and psychosocial support to children affected by conflict. UNICEF’s services include the provision of play-based and other therapeutic activities to help children cope with the trauma and stress of conflict, as well as the provision of psychosocial support to caregivers and families. UNICEF works in partnership with local organizations and communities to deliver these services and also provides training and capacity-building support to local service providers. The United Nations Children's Fund (UNICEF) provided mental health and psychosocial support to over 7 million children affected by emergencies in 2020, including those affected by conflict.13
One such agency is the International Medical Corps (IMC), which has been working in war-affected regions around the world for over 30 years. IMC's mental health and psychosocial services focus on providing individual and group counselling, community-based support, and other interventions to help people overcome the trauma of war.14 Another agency that provides mental health and psychosocial services in war-affected regions is the International Rescue Committee (IRC). The IRC has been working with refugees and other displaced populations for over 80 years,15 and their mental health programs are an essential part of their work. They provide a range of services, including individual and group counseling, psychoeducation, and referrals to other support services. The International Committee of the Red Cross (ICRC) is a humanitarian organization that has been providing assistance to victims of armed conflict and other situations of violence for over 150 years. Established in 1863, the ICRC is based in Geneva, Switzerland, and operates in more than 90 countries around the world. The organization's mission is to protect the lives and dignity of people affected by armed conflict and to promote respect for international humanitarian law. The ICRC is an independent and neutral organization that is not part of any government or political group. It works closely with National Red Cross and Red Crescent Societies, as well as with other humanitarian organizations, to provide assistance to those in need. The organization's work is guided by the principles of humanity, impartiality, neutrality, independence, voluntary service, unity, and universality.16
In addition to these larger agencies, there are also many smaller organizations that provide mental health and psychosocial services in war-affected regions. For example, the Palestine Trauma Centre (PTC) provides counselling and support services to people living in the Gaza Strip and other parts of Palestine, where conflict and violence have had a profound impact on mental health. Similarly, the Syrian American Medical Society (SAMS) provides mental health services to people affected by the ongoing conflict in Syria, including those living in refugee camps and other displacement settings. The Mental Health and Psychosocial Support Network (MHPSS) is a global platform that brings together over 4,500 organizations and individuals working towards providing mental health support in humanitarian settings. The Inter-Agency Standing Committee (IASC) has developed guidelines for providing mental health support in humanitarian settings, which have been endorsed by over 60 organizations and governments.
Around the clock, global Red Cross teams continue providing critical service to the people of Ukraine. In the past six months, the Red Cross has ensured that 367,000 people have received mental health and psychosocial support. The American Red Cross has deployed 26 international crisis responders to Poland, Moldova, Hungary and Romania to provide humanitarian relief in support of the international Red Cross operation helping families who fled their homes. These highly trained crisis responders—who are lending skills such as information management, cash assistance programming, GIS systems, communications and crisis leadership — are supporting on-the-ground relief efforts alongside local teams, including the Polish Red Cross, Moldovan Red Cross and Romanian Red Cross.The American Red Cross shelters, feeds and provides comfort to victims of disasters; supplies about 40% of the nation's blood; teaches skills that save lives; distributes international humanitarian aid; and supports veterans, military members and their families.
All of these agencies and organizations share a commitment to providing mental health and psychosocial support to people affected by war. They recognize that the trauma of war can have long-lasting effects on mental health, and that addressing these effects is essential to promoting overall well-being and building sustainable, peaceful communities. They also understand the importance of working closely with local communities to ensure that their programs are culturally appropriate and responsive to the unique needs of the populations they serve.
Laws Protecting People
These services can help individuals cope with the trauma and stress of war, and facilitate their recovery and reintegration into society. However, providing mental health and psychosocial services in war-affected regions can be challenging due to the complex and volatile nature of these environments. International laws and guidelines have been developed to protect agencies that provide these services and ensure that they can operate safely and effectively in these contexts.
The provision of mental health and psychosocial support in war-affected regions is governed by international humanitarian law (IHL) and international human rights law (IHRL). These laws recognize the importance of providing these services to people affected by conflict and set out guidelines and protections for those who provide these services.
Under IHL, medical personnel and facilities, including those providing mental health and psychosocial support, are considered protected persons and objects. This means that they must be respected and protected by all parties to the conflict, and must not be targeted or attacked. This protection extends to all personnel involved in the provision of these services, including social workers, counselors, and other support staff. The Geneva Conventions and their Additional Protocols also require that parties to the conflict allow and facilitate the free passage of medical personnel and supplies.
International human rights law also provides protections for those providing mental health and psychosocial support in war-affected regions. The right to health, as enshrined in the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights, includes the right to access mental health and psychosocial support services. States have an obligation to ensure that these services are available and accessible to all, including those affected by conflict. The United Nations Convention on the Rights of the Child also recognizes the right of children affected by armed conflict to receive appropriate and specialized assistance, including mental health and psychosocial support.
There are also guidelines and best practices for agencies that provide mental health and psychosocial support in war-affected regions. The Inter-Agency Standing Committee (IASC) has developed guidelines for mental health and psychosocial support in emergency settings, which provide a framework for agencies to plan and implement these services in a coordinated and effective manner. These guidelines emphasize the importance of cultural sensitivity, community participation, and the need for ongoing monitoring and evaluation of services.
Challenges in Providing Aid and Facilities
One of the key challenges faced by UN agencies providing mental health and psychosocial services in war-affected regions is the limited resources available for these services. Mental health services are often underfunded and overlooked in humanitarian settings, despite the high levels of need. This means that UN agencies and their partners must work to prioritize mental health and psychosocial support within the broader humanitarian response, and advocate for increased funding and resources for these services.
Another challenge is the need to ensure that services are culturally appropriate and sensitive to the needs and experiences of the communities they serve. This requires a deep understanding of local cultures and traditions, as well as the ability to adapt services to meet the specific needs and contexts of different communities. UN agencies and their partners must work closely with local organizations and communities to ensure that services are culturally appropriate and responsive.
Despite these challenges, the work of UN agencies in providing mental health and psychosocial services in war-affected regions has had a significant impact. By addressing the mental health needs of individuals and communities affected by conflict, these services can promote resilience, reduce the risk of long-term mental health problems, and support recovery and social stability. However, there is still much work to be done to ensure that all those in need have access to these critical services, and that mental health and psychosocial support is fully integrated into the broader humanitarian response to conflict and war.
Conclusion
Achieving a world that is free of conflicts or wars is a complex and challenging task, and it requires a collective effort from individuals, communities, and governments around the world. Conflicts often arise due to underlying issues such as poverty, inequality, political oppression, or discrimination. Addressing these root causes can help prevent conflicts from occurring in the first place. This can involve promoting economic development, social justice, and human rights, as well as addressing issues of governance and democracy. Reducing the availability of weapons and promoting non-violent conflict resolution can help prevent conflicts from escalating into violence. This involves promoting disarmament efforts and supporting the use of non-violent strategies such as mediation, negotiation, and dialogue. Collaboration and cooperation between countries and international organizations can help prevent conflicts and promote peaceful solutions to disagreements. This includes strengthening international institutions such as the United Nations, promoting international cooperation on issues such as climate change and global health, and encouraging cross-border cooperation and exchange. Educating people about the value of peace, conflict resolution, and the costs of war can help promote a culture of peace and reduce the likelihood of conflicts. This can involve promoting peace education in schools, encouraging public awareness campaigns, and supporting civil society organizations that work towards peacebuilding.
Agencies and organizations that provide mental health and psychosocial services in war-affected regions play a crucial role in promoting healing and resilience among vulnerable populations. Their work is essential to helping people overcome the trauma of war and build brighter futures for themselves and their communities. As the world continues to face conflict and displacement, it is more important than ever to support these agencies and ensure that they have the resources they need to continue their vital work.
International laws and guidelines play an important role in protecting agencies that provide mental health and psychosocial support in war-affected regions. These protections recognize the importance of these services in promoting the health and well-being of individuals affected by conflict, and provide a framework for agencies to provide these services safely and effectively. Despite the challenges, agencies must continue to prioritize the provision of mental health and psychosocial support in conflict-affected settings, and work collaboratively with local communities and other stakeholders to ensure that these services are accessible and culturally appropriate. These challenges can include insecurity, limited resources, cultural barriers, and stigma surrounding mental health issues. To address these challenges, agencies must work collaboratively with local communities and other stakeholders, and must prioritize the safety and well-being of their staff and clients.
Trauma-focused CBT typically involves a structured program of therapy sessions, in which the client learns skills and strategies to manage their symptoms, such as relaxation techniques, cognitive restructuring, and exposure therapy.
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