COVID-19 Webinar 8: Humanitarian crises
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Organiser: Ananda Galappatti, MHPSS.net
Chair: Peter Ventevogel, UNHCR
Panellists: Fahmy Hanna, WHO, Ken Miller, War Child Holland, Deborah Magdalena, IOM, Phiona Koyiet, World Vision
Ananda Galappatti, MHPSS.net:
Today’s webinar speaks directly to the experiences in humanitarian settings around the world. The way that the COVID-19 crisis plays out in situations of conflict, disaster or pre-existing humanitarian health crises (like Ebola) has been distinct from other settings.
Peter Ventevogel, UNHCR:
This webinar will focus on COVID-19 in pre-existing and ongoing humanitarian situations. Around 71 million people forcibly displaced worldwide (most 41 million internally), the vast majority of which are in LMICs. Today we will specifically focus on humanitarian settings in Africa and the Middle East; all of the panelists are experts in this field.
When we talk about mental health in humanitarian settings we speak of Mental Health and Psychosocial Support - MHPSS. This refers to all activities to promote and preserve psychosocial wellbeing (which can be across multiple sectors) and to activities relating to mental health specifically (which are usually within the health sector)..
Ken has conducted research on caregivers in Syrian families in Lebanon. Ten years ago he wrote an influential article on war exposure and day to day stress in conflict settings. This highlighted the importance of events of the past vs. current life circumstances. Ken, are Syrian refugees “double traumatised” as some people may say (from conflict and now COVID-19)?
Ken Miller, War Child Holland; based in Netherlands, supporting work in Lebanon
Many Syrian refugees are struggling with psychological trauma (flashbacks, intrusive thoughts etc) from their experiences of conflict, but the term “trauma” is often mis-used in relation to COVID-19. I don’t think they are traumatised by the pandemic - not in the sense of PTSD but if it means really distressed then absolutely, of course they are. A defining factor of PTSD is that it persists after horrible events have come to an end. Syrian refugees are extremely stressed because they are living in very tough conditions - close to eviction, barely able to feed children, and now reminded on a daily basis that there is a pandemic that could kill them or make them very sick. They are told what to do to stay safe, but don’t have access to those resources e.g. clean water for hand washing (research shows 40-45% of families do not have access to clean water and soap). This can leave people feeling extremely distressed. We can have a powerful and quick impact if people have the access to basic services that they need to stay healthy.
Peter Ventevogel, UNHCR:
With regards to the stress and fear about how to cope; are there any specific issues?
Ken Miller, War Child Holland
Access to clean water and soap; not evicted from homes. It's important to tailor messages to what people can enact. Social distancing is hard in a refugee camp, but not touching your face is something you can do.
Peter Ventevogel, UNHCR:
Deborah is currently based in Nigeria as MHPSS coordinator for North East Nigeria, and is living in the capital of Borno state (which has become infamous for the violence in the area). How has COVID-19 affected the community?
Deborah Magdenlena, IOM; based in North East Nigeria
Related to the response here, there are a lot of partners, working with the Nigerian government and relevant ministers and we are coordinating with other sector ministries. IOM currently has around 49 MHPSS partners. The conflict has impacted millions; 7.9 million people are in need (81% of the crisis population are women and children). Among this population there is a huge amount of existing conditions, and COVID-19 is increasing the psychological distress of the population, combined with a lack of access to food and economic hardship such as lack of livelihoods. There is an issue of intimate partner violence, and also an increasing use of drugs. There is also concern about movement restrictions and lockdown. This means IOM are having to adapt their MHPSS approach; prioritising remote services and peer to peer support within a household. MHPSS was not in the first wave of priorities but is now more visible.
Peter Ventevogel, UNCHR:
Introduced Phiona, senior technical advisor for World Vision International. How has COVID-19 affected the community in North Kivu in the Northern Democratic Republic of the Congo (DRC)?
Phiona Koyiet, World Vision
Fear, isolation and stigma. North Kivu has been battling with the Ebola outbreak, in the context of violence for over 25 years and over 100 militia groups. COVID-19 has affected the community such as children who were waiting to go back to school post-Ebola and now schools are closed again due to COVID-19. The local community was already feeling a lot of hopelessness before the pandemic. COVID-19 makes the situation more vulnerable for those working with them. In North Kivu in addition to concerns about conflict and armed groups, there are a large number of humanitarian workers who are now also anxious about COVID-19.
Peter Ventevogel, UNHCR:
Thanks Fiona. Introduced Fahmy Hanna, technical officer of WHO and co-chair IASC reference group for MHPSS and closely involved in country level coordination groups. What do you hear from colleagues in the field? Do the remarks you have heard today resonate with you?
Fahmy Hanna, WHO:
The mental health impact of COVID-19 in humanitarian settings is a catastrophe within an already existing emergency. In the first 10 days of March, as part of my role in WHO and supporting IASC, I had a mission to Yemen. The mission was meant to end on March 9th but there was a lockdown in the country and so I was not able to leave and so stayed an additional week. When the mission started on March 2nd COVID-19 was barely mentioned. Yemen was the biggest humanitarian crisis globally, with the largest number of people in need, with ongoing disease outbreaks as well as famine and fighting. But over the course of the mission, there was a steadily growing fear and distress over COVID-19. Therefore I witnessed the psychological impact on the population; based on WHO modelling, there are 7 million plus people in Yemen who require mental health support. Those who need support are both the population of Yemen and the humanitarian staff supporting them who are not able to go back and forth to see their families.
Peter Ventevogel, UNHCR:
In what way are you adapting MHPSS to the new situation?
Ken Miller, War Child Holland
We had to adjust our methodology to manage post-implementation data collection from 240 caregivers while Lebanon was in lockdown. We did this entirely using phone based methodology of data collection - we put phone credit on all the mobile phones and did the assessments in 7 days using a team of 17 across multiple time zones. We were able to support one another through this challenging project, and the experience shows how we have adapted from a research perspective. From an implementation point, we are sending recorded messages to participants’ phones - we don’t yet know if they are using the content. When lockdown ends then we will continue the project by maintaining social distancing for caregiver support groups.
Deborah Magdalena, IOM:
High levels of stigma and misinformation e.g. African’s have more immunity than white people, it is not a disease but rather a way for the government to take advantage of poor people. Therefore community engagement is very important. We are working across 140 Internally Displaced Persons camps and urban areas, we need to adapt risk communications and develop appropriate public health messaging. Some areas are inaccessible, therefore we use radio programmes using jingles and local languages, using collaboration with mobile phone providers.
Phiona Koyiet, World Vision:
Communication is very important on COVID-19. We are using radio programmes to communicate to community members. Also addressing stigma by working with community structures e.g. faith leaders. This has been important in the Ebola response; where we used MHPSS community level workers to identify and refer to people where help is needed. Problem management plus is one tool that is being used.
Fahmy Hanna, WHO:
From early February humanitarian actors have developed materials under the IASC MHPSS reference group. See here. We have adapted materials for different target groups e.g. children's book (now available in 86 languages and in different formats including audio and video). Fahmy is now receiving requests for remote coordination support e.g. Syria, Albania, and key materials have been developed. See here.
Peter Ventevogel, UNHCR:
Go to IASC MHPSS Reference Group website. It has been remarkable how the COVID-19 pandemic has accelerated attention for MHPSS - it doesn’t stop us at all. What are the key messages you want the listeners to take home?
Ken Miller, War Child Holland: We need to tailor our protective messages to the specific contexts people live in and ensure people have the resources to stay safe. Otherwise we are raising awareness of a threat they cannot prepare themselves from. We need to focus on stress management during COVID-19 - e.g. overcoming domestic violence - and need to minimise the negative consequences of shelter in place [lockdown].
Debora Magdalena, IOM: COVID-19 exposes the vulnerabilities already in society; we need to build a strong system of MHPSS. We need to support and enhance resilience of the community as an essential part of the response to COVID-19.
Phiona Koyiet, World Vision: Integrating MHPSS in COVID-19 and task shifting to use community led MHPSS interventions. Appreciate during lockdown communities need proper MHPSS training and supervision where they are supporting their peers etc.
Fahmy Hanna, WHO: MHPSS is an essential basic need; it should be an integral part of every country's COVID-19 humanitarian response plan, building back better and also building better before the next crisis.
Peter Ventevogel, UNHCR:
I hear you say that MHPSS should be integrated and not an afterthought. The pandemic forces us to strengthen resources within communities, which we should be doing anyway but now we have no choice. We hope that some good comes out of it.
