In a highly informative and moving panel, a diverse group of experts discussed strategies for addressing the mental health challenges posed by human-made and natural disasters.

Mental health problems nearly double in crises. In a world increasingly affected by armed conflicts and natural disasters, providing mental health support for affected populations has become more relevant. While humanitarian emergencies require a short-term response focused on saving lives and reducing acute suffering, they can have devastating, long-term effects on the mental health and psychosocial well-being of survivors. Timely and easily accessible interventions are key to prevent the development of mental disorders and to support people in dealing with the injustice they have experienced.

To bring mental health into focus at this year’s World Health Summit, the Federal Ministry for Economic Cooperation and Development (BMZ) hosted a high-level panel discussion titled Addressing the mental health burden in and after crises – Seeing the Unseen. This event brought together a diverse group of experts, each offering a unique perspective on different crises settings. This blend of professional expertise and personal experience enriched the discussion and highlighted the multifaceted challenges to addressing mental health in both immediate crises situations and the long-term recovery process.

Making mental health a priority

In his opening speech, Parliamentary State Secretary Niels Annen underlined the importance of providing mental health and psychosocial support (MHPSS) in and after crises. A multi-stakeholder pledge, co-initiated by BMZ at the Global Refugee Forum in December 2023, aims at raising awareness on the importance of providing quality MHPSS to displaced populations across the Humanitarian-Development-Peace-Nexus. Commitments within this pledge range from policy reform to financial and technical support.

Mr. Annen observed that although it is natural to prioritise visible physical injuries and basic needs in an acute crisis, the profound psychological impacts of such events are too often overlooked. Many countries lack the capacity to provide MHPSS services in the aftermath of an emergency and to care for resulting longer-term mental health needs.

Strong health systems, from our point of view, are key to ensuring access and service coverage at the community level. Countries with strong health systems are more resilient in times of crises – Parliamentary State Secretary Annen

He noted that Germany actively promotes health system strengthening and mental health through bilateral and multilateral programming.

Addressing MHPSS needs in emergencies and crises

Following Mr. Annens remarks, the panel started by focusing on the immediate needs during emergencies. Malawi’s Minister of Health, Khumbize Chiponda, reflected on her country’s response to the severe flooding caused by cyclone Freddy last year. When disaster struck, Malawi did not have sufficient capacities or a strategic plan to respond to the mental health needs of its affected population. Looking back, the Minister emphasised the importance of integrating MHPSS services in the emergency response. To strengthen the country’s crisis preparedness, Malawi has since included mental health in its community health roadmap.

Dr. Zeinab Hijazi, Global Lead on Mental Health for UNICEF, highlighted the unparalleled levels of vulnerability faced by children: “Over 200 million children live in areas affected by armed conflict, 43 million children have been forcibly displaced. We know that these children are at high-end risk of mental health issues and require early intervention”. She further outlined that governments need to be proactive, rather than reactive, but are often ill-prepared to care for the most vulnerable. Despite these devastating numbers, she shared a hopeful message: Unlike ten years ago, evidence-based solutions to support children and affected individuals exist. Now the capacities and financing within health systems and beyond must be strengthened to scale these measures.

A survivor’s journey

In the second part of the panel discussion, moderator Ananda Galappatti shifted the attention towards the impacts on individuals enduring ongoing crises, particularly those that seem to have no end in sight. One of the panellists was Ahmad Helmi, a Syrian human rights campaigner, who survived three years of detention and torture. He is the co-founder of the Ta’afi Initiative, a survivor-led organization supporting victims of enforced disappearances and torture. Mr. Helmi highlighted the complexity of “ambiguous loss”, a grief that is difficult to define and process for those left behind. He stressed that for many affected persons, mental health may not initially be seen as a priority amidst the immediate struggle for survival and the longing for justice.

During the conflict people want the atrocities to stop, they want justice. Mental health is often seen as something secondary – Ahmad Helmi

Despite these perceptions, mental health needs to exist across all immediate and mid-term interventions, which is why he advocates for a community-level approach. Therefore, building on local capacities and cultural practices is essential when designing mental health interventions.

The role of displaced health professionals

Dr. Valentyna Mazhbits spoke on the unique role that displaced health workers can play in supporting both their countries of origin and other displaced communities. “They know the culture, have key insights, and can support sustainable solutions,” she said. Dr. Mazhbits who fled from the war in Ukraine to Germany and started working with Charité in 2022, is engaged in the SOLOMIYA network. This initiative, involving over 60 Ukrainian and German health institutes, works together to support the provision of mental health, traumatology, and emergency medicine. It is expected to be expanded to other health professions.

In Ukraine, I could support hundreds of patients, but from here [through the SOLOMIYA network], I can support thousands – Dr. Mazhbits

Cross-cutting issues require cross-cutting solutions

Dr. Mark van Ommeren, Head of Mental Health Unit at WHO, highlighted that mental health is a cross-cutting issue presenting significant challenges for coordination during emergencies. He outlined the importance of having ‘cross-cutting technical working groups’, which consist of actors from the health sector as well as from other sectors, such as education and child protection. The number of these working groups has increased drastically in the last years, with currently 59 operating.

Building on this, Dr. Zeinab Hijazi reaffirmed that a cross-sectoral collaboration, for instance in national preparedness and response plans, is critical for addressing the needs of the most vulnerable groups, such as children and young adolescents.

Building back

After the immediate crisis is over, the rebuilding process is often challenging. In order to address the emerging mental health needs, Dr. Mark van Ommeren outlined four critical aspects: 1) Early recovery measures should aim for long-term impact from the first day of the crisis; 2) Addressing broad mental health needs that go beyond post-traumatic stress disorder (PTSD); 3) The government and associated actors must play a leading role in coordinating efforts; and 4) Advocacy must create a long-term commitment and momentum for the topic.

The availability of well-trained health workers, as outlined by several participants, is the backbone of any activity both within acute crises and in the aftermath of crises. Dr. Zeinab Hijazi highlighted that mental health needs often become more complex after the acute crisis has ended, especially for children and their caregivers. She emphasised the importance of training both health and non-health workers to ensure they can effectively reach and support children during these critical phases.

Investing in Mental Health

Dr. Mark van Ommeren concluded by reminding the audience that the three main reasons to invest in mental health are 1) public health, 2) human rights (as mental health is a human right itself, and mental health-related human rights are often violated), as well as 3) socio-economic reasons (with each dollar invested returning five in benefits to society).

Ananda Galappatti, Co-Director of mhpss.net and himself an expert in the field, closed the panel discussion by sharing his hope that mental health interventions will be designed and implemented together with those who have been affected (“nothing about us without us”) going forward.

For those interested in viewing the full panel discussion, you can find the video here: https://www.youtube.com/watch?v=zv0evRPsY3s

Julia Long & Timo Weis
October 2024