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'Against All Odds': UNHCR's Mental Health and Psychosocial Support Programme for Iraqi Refugees and Internally Displaced S Against‘ all odds’: UNHCR’s mental health and psychosocial support programme for Iraqi refugees and internally displaced Syrians, Intervention 2013, Volume 11, Number 2, Page 190 - 194 ‘Against all odds’: UNHCR’s mental health and psychosocial support programme for Iraqi refugees and internally displaced Syrians Sarah Harrison, Riwa Dahman, Maha Ismail, Edith Saada, Maysaa Hassan, Rasha Hassan, Adam Musa Khalifa & Marian Schilperoord Intensi¢ed ¢ghting and insecurity in Damascus has gained, territorylost, andthe toll oncivilians. limited the ability of the Iraqi refugees, displaced Sadly, there appears to be little enthusiasm Syrians, partners and sta¡ to physically access many to highlight the important, day-to-day acti- of the ¢xed facilities o¡ering mental health and vities of humanitarian workers continuing to psychosocial services.Those that do, have to travel provide mental health and psychosocial sup- substantial distances through checkpoints and ‘hot port in the midst of this crisis. areas’. However,before the con£ict in 2011,UNHCR Displaced Syrians, who seek shelter within Syria was already in the area, operating a com- host communities or in collective shelters prehensive mental health and psychosocial support across the country, report feelings of fear, programme for Iraqi refugees, building on the anxiety, helplessness, hopelessness, isolation resources and capacities of the refugee population. and profound distress at the events unfolding In 2012, this programme was opened to support around them to outreach volunteers. Syrians a¡ected by con£ict through a mixture of According to the Syrian Ministry of Local (mobile) individualised case management, family Administration, as of 16 April 2013, less than and community level supports provided by outreach 5% of this displaced population live in volunteers, and targeted assistance to displaced per- collective shelters, with the remainder resid- sonslivingin collectiveshelters.So,while notmaking ing within host communities.These commu- the headlines, the quiet, day-to-day activities of nities have shown enormous generosity by humanitarian workers providing mental health opening their homes to fellow Syrians, but and psychosocial support services to an increasingly now are feeling fatigued, over-burdened distressed population continue, against all odds. and ¢nancially exhausted, leading to an overall decrease in their coping capacity Keywords: armed con£ict, internally and resilience levels. Within this environ- displaced persons, outreach volunteers, ment of profound distress of those displaced, refugees, Syria and loss of resiliency and coping within host communities, humanitarian agencies and Introduction organisations are still managing to provide With the con£ict in Syria entering its third assistance and support. Therefore, they are year, it is hard to ¢nd uplifting stories or attempting to alleviate the distress and articles written about the country. There is su¡ering of men, women and children in a daily media diet of bombings, mortar the midst of this unravelling con£ict, against attacks, casualty ¢gures on the rise, territory all odds. 190 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Harrison et al. The mental health and psychosocial support a capacity building project targeting programme of UNHCR. national level service providers, such as the In response to the in£ux of Iraqi refugees to Ministry of Health and Education.This pro- Syria in 2006, the United Nations Refugee gramme has been documented previously Agency (UNHCR) realised an overwhelm- (Quosh, 2011), and more publications on this ing need to provide mental health and psy- programme are in preparation. chosocial support (MHPSS) services to a highly vulnerable refugee population. In Expanding needs: from Iraqi refugees to internally 2008, 8.4% of the Iraqi refugee population displaced Syrians reported severe mental health and psycho- During 2012, the programme was gradually social di⁄culties (UNHCR Syria,2011).This outsourced to UNHCR’s main local partner prompted UNHCR to adopt a radically the Syrian Arab Red Crescent (SARC), di¡erent approach towards MHPSS pro- and at the same time expanded to include gramming for refugees in an urban context. all Syrians (including children) a¡ected by Traditionally, UNHCR would address the the con£ict. National nongovernmental psychosocial and mental health problems of organisations (NGOs), local communities, refugees in an ad hoc manner, referring the operational UN agencies (e.g., UNHCR) few individuals in need of more specialised and government ministries have primarily support to local practitioners. The MHPSS provided the humanitarian response to this programme in Syria followed a more con£ict. This is due to the fact that inter- innovative and comprehensive approach national NGOs and other humanitarian whereby, for the ¢rst time in the history of agencies have limited, or no, access to UNHCR, UNHCR sta¡ directly imple- Syria. UNHCR’s MHPSS programme was mented and organised a mental health and in a unique position because it was already psychosocial support programme for refu- established within the country and had gees. This pilot programme was built on the developed strong working relations with capacities and resources of the refugee com- local actors, and key line ministries (Educa- munity, and managed to reach vulnerable tion, Health and Social A¡airs). refugees with complex needs, within an Moreover, the programme approach urban environment. focused on optimising local resources, The programme sought to improve the strengthening existing capacities and psychosocial wellbeing and mental health mobilising volunteers from the a¡ected of the most vulnerable refugees, as well as population to aid with outreach activities. Syrians who have also been impacted, This approach is important, because through comprehensive case management, Syria has a very limited number of holistic community based psychosocial trained MHPSS professionals, (psychia- support and capacity building. From 2008 trists, psychologists, social workers and to 2012, the programme comprised three psychiatric nurses) with only 70 psychia- complementary pillars: (1) individual case trists for a population of around 20 million management for the most vulnerable, (WHO, 2009). The number of MHPSS directly implemented by UNHCR case professionals remaining inside Syria has workers; (2) a community based outreach steadily fallen, as many have been targeted, volunteer programme and an outreach forcing them to £ee the country (Abo-Hilal counselling centre run by refugees; and (3) & Hoogstad, 2013). 191 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Against‘ all odds’: UNHCR’s mental health and psychosocial support programme for Iraqi refugees and internally displaced Syrians, Intervention 2013, Volume 11, Number 2, Page 190 - 194 Additionally, the psychiatric hospitals in the refugees, displaced Syrians, partners and country have su¡ered severely1.Capacity sta¡ to physically access many of the ¢xed building activities that originally focused facilities (such as SARC-primary health on providing MHPSS support to refugees clinics) o¡ering mental health and psycho- in a stable urban environment have had to social services. Refugees and Syrians are adapt their focus more towards providing understandably very scared and reluctant MHPSS in emergency settings. Capacity build- to leave their houses or collective shelters to ing activities are also now aimed at local travel substantial distances across the city, communities, NGOs and Syrian psycho- through checkpoints and ‘hot areas’, to access social outreach volunteers, in addition to services. In an attempt to make services more national level partners previously included accessible, UNHCR plans to provide ¢nan- under the refugee programme. cial and technical support to SARC’s mobile psychosocial and mental health teams, to Opening the programme for Syrian internally identifyand refer cases requiring more inten- displaced persons sive case management, and to provide struc- Due to security issues, the outreach counsel- tured social and recreational activities for ling centre in Damascus had to close for men, women, boys and girls living within two months during the summer of 2012. It collective shelters and host communities. reopened in another Damascus neighbour- hood during the autumn of 2012, but once Working through partners again had to close due to security issues Psychosocial support (PSS) is also inte- arising in the area.This prevented both out- grated within the work of partner run com- reach volunteers and bene¢ciaries (Iraqi munity centres (sometimes called outreach refugees and Syrians) from accessing the counselling centres), which are planned to centre. Psychosocial support is now increas- open in: Aleppo,Tartous, As-Sweida, Homs, ingly integrated into SARC run centres, Damascus and rural Damascus, as well as where regular activities for refugees and partner run shelters for survivors of gender Syrians take place, such as: yoga, peer sup- based violence, monitored by UNHCR’s port groups for women and men, awareness protection and community services teams. raising sessions, story sewing (where women PSS is also increasingly integrated into and girls use embroidery as a means in which the education, community mobilisation to convey their life story) and sewing. Acti- and livelihood activities conducted by the vities are monitored by a Psychosocial community
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