68.5 million. That’s the number of forcibly displaced people in the world in 2018. Displaced people deal with violence, loss, precariousness and the daily uncertainty of tomorrow. They find a source of resilience in psychosocial support.
They are 40 million internally displaced people, 25.4 million refugees and 3.1 asylum-seekers, according to the United Nations High Commissioner for Refugees (UNHCR). Displaced people often escape dangerous situations and undergo violence and stress. Once they reach refugee camps, they face precarious living conditions and uncertainty concerning their own future. From psychological first aid to the treatment of more severe psychiatric pathologies, the mental health assistance provided near conflict zones and in welcome centers help them overcome adversity.
“Normal distress” and severe disorders, the unseen wounds of exile
Many people suffer from the events they went through in their native country: the loss of a friend or family member, the loss of material possessions, the violence suffered through before and during their migration. In Bangladesh, mental health first aid for Rohingya refugees consists of collective sessions that help them process their new situation, understand they are now in a safe space, and start mourning their losses. Post-Traumatic Stress Disorder (PTSD) is the “normal distress” of displaced people: it affects about one in five individuals within this population. According to Handicap International technical advisor Guillaume Pegon, traumatic experiences such as wars and urban violence doubles a person’s risk of alcoholism and triples their risk of drug addiction. Getting psychological assistance right upon arrival in the refugee camp increases the chances of overcoming these disorders.
Precarious living conditions
But psychosocial aid professionals also stress that the precarious living conditions in refugee camps affect displaced people about as much as the trauma they underwent in their home country. In Chatila camp, Lebanon, Médecins Sans Frontières (MSF) psychologist Miriam Slikhanian explains: “To be a refugee generally means to struggle every day to find something to eat, to be in a safe place.”
This precariousness takes a toll on people who had a clear social function in their native country and for whom exile is experienced as a form of degradation. Homeless, deprived of material possessions, of a family and sometimes even of basic services… Exile can question displaced peoples’ entire identities. “When you have no identity, even sleeping loses meaning”, testifies Jamal, a refugee interviewed by MSF.
MSF psychologist Aliki Meimaridou explains the enormous gap between the refugees’ great expectations upon arrival and the reality of their situations in the camps. Without means or the political will to simplify the asylum-seeking process, some refugees are blocked in refugee camps for years on end. In Greece, they are 50,000. Jamal is one of them.
Displaced and “surprisingly resilient”
It’s important to keep from labelling a whole population of displaced people as “mentally ill”, says HCR expert Pieter Ventevogel: “We can use other words instead of trauma. We can say that people have experienced bad things, they have lost a lot–that is much less pathologizing.”
“When I’m visiting refugee settings, I’m surprised by the resilience of people, the way people are able to continue and to thrive in the context of adversity.”
Pieter Ventevogel, UNHCR Senior Mental Health Officer
Psychosocial aid helps people be more resilient, especially because it includes a community-based protection policy. Group therapy and community support help refugees recreate lost social bonds and redefine their place or their function within a group. They help the most closed-off people open up and help populations affected by conflicts reconstruct in the long term. Community-based therapy can take on different forms, even the most surprising. Art therapy with young children is most effective in creating a safe space for them to rebuild trust and find their voice. NGOs such as Play International work towards including sports in the psychological reconstruction of refugees. In Rwanda, installing a poultry farm in a camp proved the best therapy for Congolese widows.
Training more people to psychosocial first aid
The number of displaced people reaches new heights each year. One in 110 people in the world is displaced. Field workers get good results when psychosocial help is implemented in its many possible forms, but they also stress that more means are needed to deal with the constant rise in the number of refugees. In Bangladesh, Mahmuda is the only therapist for hundreds of thousands of prospective patients. Just like Pieter Ventevogel, she feels that training the entire medical staff in refugee camps so they can apply psychological first aid could already help a lot. In time, securing first aid could lead to the development of other reconstructing activities such as sports, arts and farming.