© Anna Surinyach/MSF

Mental health

This World Mental Health Day, we share how MSF is supporting refugees living with psychological trauma

The psychological impact of a humanitarian emergency can be severe.

Our teams provide emergency medical aid in catastrophes all over the world — armed conflicts, natural disasters, famines and epidemics.

However, for people who have lived through these terrible events, survival goes beyond ensuring physical wellbeing.

Worldwide, around one in four people will suffer from a mental health problem during their lifetime, yet around 60 percent will not seek help.

These figures increase dramatically when factors such as violence, persecution, the need to flee, disasters or a lack of access to healthcare are involved.

For this reason, in 1998 MSF formally recognised the need to provide mental health and psychosocial care as part of our emergency work. 

World Mental Health Day 2018

This World Mental Health Day, we focus on two MSF projects working to support refugees dealing with the lasting psychological impact of their past, as well as the uncertainty of life inside camps in Bangladesh and Greece.

In late August 2017, a violent campaign was unleashed by the Myanmar military on the Rohingya minority living in the country’s Rakhine State. Over the following weeks and months, 706,000 people were forced to flee into neighbouring Bangladesh.

More than a year on from the outbreak of violence, MSF is providing vital mental health support for many of those living with the lasting psychological trauma of these events.

© Robin Hammond/Witness Change

Having fled war, persecution and hardship, thousands of refugees and migrants are now stuck in squalid camps in Greece, unable to leave or to rebuild their lives. 

In Moria, on the Greek island of Lesvos, mental health needs are now so widespread that only the most severely unwell patients can access care. Liz Clark, a family doctor from the UK, shares her experience.


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Our response to mental health

Depression and anxiety

People caught in the wake of a humanitarian crisis can suffer from debilitating depression and anxiety, including conditions such as post-traumatic stress disorder (PTSD). 

Many patients seen by MSF will have been separated from their families or witnessed the deaths of loved ones. Others may have been forced to flee, searching for shelter, supplies and safety. These events can immobilise people with depression and anxiety at just the time when they need to take action for themselves and their families.

MSF professionals are there to listen and support so that traumatic experiences do not come to define our patients' lives.

Our support for patients

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Last year, our mental health teams provided 404,700 individual consultations across our projects.

Mental healthcare also forms a key part of our services for HIV/AIDS, tuberculosis, malnutrition, sexual violence and during disease outbreaks.

Our primary aim is to reduce people’s symptoms and improve their ability to function. Often this work is done by local counsellors specially trained by MSF, while our psychologists or psychiatrists provide technical support and clinical supervision. 

At the same time, specialised clinicians are available to treat severe mental illness, however, this accounts for a minority of the cases seen by MSF.

Increasing capacity

People seek mental health support for many reasons — the agonising loss of a child in an earthquake, the trauma of sexual violence, getting caught up in a conflict. MSF mental health workers listen to their stories and focus on helping them find ways to cope and continue with their lives.

In the Philippines, an MSF mental health team works with children following the Battle of Marawi in 2017

Being forced from home is a particular problem for people already suffering from mental health problems. They can lose access to existing treatment and routine care, which may cause them to develop further symptoms or more severe conditions.

However, treating severely disturbed people remains a challenge for MSF teams given the complexity of managing psychiatric medication and treatment. Increasing our capacity to treat these illnesses remains a priority for MSF.

Establishing mental healthcare programmes in emergency situations is not straightforward, particularly when violence and trauma may be ongoing, or language and cultural barriers may prevent people from seeking support. Our community outreach teams increasingly play an important part in tackling this.

It is often difficult to guarantee continuity of care in unstable and dangerous settings. However, the needs are high, and MSF continues to expand its mental health programmes.

MSF staff and mental health

For MSF's emergency response work to be carried out, there is another important issue: the mental health of our staff.

Often away from home for long periods of time, working under pressure and required to process traumatic events, it is vital that humanitarian aid workers are also given the professional support and headspace they need.

Local MSF staff will often come directly from the communities receiving our care. While this is useful for our teams to better understand social and cultural issues, it also means that these staff members are closer to the same traumatic events experienced by our patients. Psychological support is therefore provided for our local staff. 

For international team members, coming home from an assignment is often the time when mental health support becomes the most necessary. Many struggle with the knowledge that, for their patients, returning home may not be an option. However, MSF remains committed to helping our staff re-adapt to their normal routine and process their experiences. 

This page was last updated on 10 October 2018.

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