You have likely heard of Doctors Without Borders/Médecins Sans Frontières (MSF), the independent, international, medical organization often featured in the news for helping people affected by armed conflict, epidemics, natural disasters and exclusion from health care. You’ve seen the incredible photos of their medical staff performing emergency surgery and bandaging up wounds, but have you ever considered the invisible wounds of patients who endure psychological trauma?

Whether it is dealing with the loss of a family member or reliving the horror of a war or natural disaster, there is a dire need for mental health care in many of the communities that MSF serves.

Because MSF is dedicated to achieving the best outcomes for their patients, they introduced a host of mental health services to complement their physical treatments. In 1998, MSF formally recognized the need to implement mental health and psychosocial interventions as part of their emergency work. They acknowledged that people who have lived through traumatic events can and usually do have severe and lingering psychological consequences.

With the goal of saving lives and helping their patients thrive, MSF provides mental health care during treatment for HIV/AIDS, tuberculosis, consequences of sexual violence, and during disease outbreaks, displacement situations and natural disasters. These services may reinforce or complement mental health care approaches that already exist in the local community. In 2018 alone, MSF teams around the world provided 404,700 individual mental health consultations. MSF psychologists or psychiatrists also provide technical support and clinical supervision, training local counselors to carry out most of the direct treatment.

Trained mental health workers listen to their patient’s stories and help them find ways to cope and live fuller lives. Depression and anxiety are common afflictions for people in extreme situations. These conditions can be debilitating for anyone, but especially so for someone in a migration or refugee context.

Establishing mental health care programs in emergencies is complicated, especially when violence and trauma are ongoing. Not only are the patients in these situations repeatedly exposed to trauma, making closure impossible, it can be difficult to offer continuity of care when all else is unstable. The following excerpt from the spring 2019 issue of ALERT, MSF’s quarterly newsletter for supporters, demonstrates the importance and impact of their incredible mental health work (credit: Myriam Abdel Basit, an MSF cultural mediator):

Moria camp was built on the Greek island of Lesbos to house the influx of asylum seekers making the dangerous journey across the Aegean Sea on flimsy rubber boats to seek safety in Europe.

Many of the children have already experienced trauma and extreme violence in countries at war and are now subjected to ongoing stress and further violence, including sexual violence, in a place where they expected to find safe refuge.

Each week, MSF teams working in the camp see multiple cases of minors who have harmed themselves or attempted suicide. Other child patients suffer from panic attacks, anxiety, mutism, aggressive outbursts, and constant nightmares.

One form of therapy used is storytelling to help children deal with their trauma. The patients worked together to create a book about one or two fictional characters that had gone on a similar journey to them. The books were divided into chapters: before, during, and after the war, the decision to leave their country, and their journey to and life in Moria. Each book had a “happy ending” where the children wrote about their hopes for their lives after they leave the camp.
Although the characters were fictional, the children projected their own experiences onto them. Once the stories were completed and printed, a book reading was held for the children’s friends and families.

Many of the parents were shocked that their children had remembered so much about the war and their journey to Greece. Being able to tell these stories was very important for the children, as they were finally able to express their feelings about what they’d gone through.

MSF spoke at length with the children about their dreams, their aspirations, and what they’re going to do after this experience is over. One teenager shared, “Yes, I have lost six years, but I’m going to make it up. We all have a future ahead of us. We have dreams that we will pursue.”

Work like this helps families begin the long road of healing and piecing their lives back together. MSF also knows that they need to care for the mental health of their humanitarian staff. Systems are in place to offer care before, during and after an assignment. Prior to leaving, MSF prepares staff members to avoid common mental health issues including burnout and not being able to rely on their usual coping methods due to being out of their element. Staff are encouraged to maintain strong social connections both back at home and with their MSF colleagues on location, which helps them deal with the extremely stressful situations. (VIDEO: CARING FOR THE CAREGIVERS)

Direct exposure to a traumatic event (e.g., if a staff member is attacked or directly witnesses violence) can have long- term negative consequences. Secondary exposure can occur when a staff member experiences trauma through a patient. Sometimes, MSF sends psychologists to counsel both local and international staff in the event of a traumatic incident or if teams are dealing with particularly stressful stories day after day. Counseling is always available by phone or videoconference.

When international staff come home to the U.S., MSF provides additional resources, including connecting them to a therapist where they live. For national staff, MSF seeks to hire local psychologists to provide ongoing support.

The World Health Organization defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. There is no health without mental health.” MSF truly understands this and is working every day to provide holistic relief to those in need. Support MSF through your employee giving program and sign up to hear about MSF webcasts and events in your area.

Featured image caption: MSF psychologist Danai Papadopouloy, with cultural mediator Marjan Dana Abidian, in session with a minor from Afghanistan during a mental health consultation outside Moria camp on Lesbos island, Greece. Among those referred to our specialised mental health services, for children between the ages of 1-18, our patients present with changes in behaviour such as aggressiveness or withdrawal, stopping eating, nightmares, bed-wetting, panic and anxiety, developmental regression, as well as self-harm, suicidal ideation and suicide attempts.