Mental health supervisor, Katherina Molek, at a Doctors Without Borders clinic in Hakimpara makeshift refugee settlement, part of the Kutupalong-Balukali megacamp in Cox’s Bazar, Bangladesh. The camps house more than 700,000 ethnic Rohingya refugees who fled targeted violence in neighboring Myanmar. © Pablo Tosco/Angular

Doctors Without Borders Provides Mental Health Care To People In Need. Here’s What You Should Know.

By Zoë Leverant

When we read news about the consequences of war, natural disasters, and other humanitarian crises, the first things that often come to mind are the physical effects: destroyed homes, displaced people, and life-threatening injuries and illnesses. When catastrophes like these strike, Doctors Without Borders/Médecins Sans Frontières (MSF) is often on the front lines, providing independent and impartial medical care. Last year, they carried out—among many other treatments—over 11.2 million outpatient consultations, 1.4 million measles vaccinations, 104,000 major surgeries, and 74,000 admissions of children to inpatient malnutrition programs in over 70 countries around the world.

What is often missed in headlines after these emergencies happen are the effects that these events have on the mental health of those in the affected communities. Helping to heal the invisible wounds inflicted by war, displacement, or natural disasters can be more complicated than dressing a wound or administering a vaccine. A recent UN report found that one in five people living in conflict zones suffers from mental health disorders. Treatment for these conditions is a crucial element of comprehensive medical care, and yet it is often forgotten in news coverage, or assumed to be limited to addressing post-traumatic stress disorder. But for organizations like Doctors Without Borders, humanitarian efforts are not complete without addressing the mind as well as the body.

Since 1998, Doctors Without Borders has formally recognized the need to integrate mental health care into its emergency medical humanitarian work. In 2018 alone, their mental health teams performed more than 400,000 individual and group counseling sessions in dozens of countries, supporting hundreds of thousands of patients on their journeys towards managing their symptoms and regaining agency in their lives. Partnerships with national health systems are a crucial element of Doctors Without Borders’s approach, and the organization provides ongoing support to clinicians to develop their skills and build capacity to treat more patients.

But Doctors Without Borders can’t do this without your help. To help illuminate the importance of Doctors Without Borders’s mental health work, the staff at Elite Daily took a look at some of the essential services the organization offers, from working with survivors of sexual violence and domestic abuse to caring for people suffering from the loss of family members.

Helping survivors of sexual assault

A sexual assault survivor works on a "body map" during a Doctors Without Borders workshop. Body Maps comprise a life-size outline of the body, on which the survivor "maps" their experiences and emotions. © Melanie Wenger/Cosmos.

Sexual assault is common during war. In Central African Republic (CAR), which has been convulsed by conflict since 2012, some 650,000 people have been displaced by the fighting. Among them were 4,000 patients Doctors Without Borders treated for consequences of sexual assault last year.

In CAR—as in many countries—sexual violence remains a taboo subject. Family members are likely to blame survivors for their experience and worry about potential repercussions for the family’s reputation. Some local languages don’t even have a specific word for “rape.”

As a result, according to the UN, sexual assault is severely underreported in CAR*. There are also no social or legal services for people who survive sexual assault. To overcome the stigmatization of sexual assault and reach people who need this critical care, the staff at Doctors without Borders works with local community leaders to build relationships based on trust and mutual respect, allowing them to reach people who otherwise might not get the treatment they need. Timing is crucial. Doctors Without Borders urges patients to come for care within 72 hours of an assault in order to provide critical emergency care, such as post-exposure prophylaxis for HIV exposure, emergency contraception, and treatment for other sexually transmitted diseases.

"I thought about committing suicide several times,” says Olga*. “I felt ashamed when I walked down the street and I thought everyone was looking at me. I can’t sleep at night.” She’s now being treated by an MSF psychologist at Bangui’s Community Hospital, which hosts a small portion of their CAR team.

Although the majority of assault survivors are women, Doctors Without Borders also cares for men and children, patients who—because of stigma—are often particularly difficult to identify. In addition to emergency care, the program also seeks to provide mental health treatment to survivors who have lived in silence with their assault for years and never had a chance to come forward.

Doctors Without Borders helps to treat survivors and give them a voice by having them participate in psychosocial support therapy using a process called Body Mapping. In this modern therapeutic tool, individuals draw pictures, symbols, and words to represent their lived experiences and celebrate their hopes and aspirations for a better future.

You can help support the work of Doctors Without Borders in CAR and around the world by making a donation today.

Treating depression in challenging conditions

Moria camp, on the Greek island of Lesbos, was designed to house 3,100 migrants and refugees. It currently hosts 9,000. Doctors Without Borders teams provide medical and mental health support outside Moria and run a clinic for severe mental health cases in Mytilene, the island’s capital. © Robin Hammond/Witness Change

Moria, on the Greek island of Lesbos, is one of the most densely populated refugee camps in the world. Nine thousand refugees, mostly from Syria, are crammed into an area designed to house just over three thousand people. Its population has swelled as a result of a controversial 2016 agreement* between the European Union and Turkey to prevent refugees from entering Europe.

Conditions inside the camp are bleak. Food is scarce; space is scarcer. The people in these camps have often already faced traumatic events at home, so the tense and crowded conditions in these camps offer little reprieve.

Depression and anxiety are common in Moria. Some people in the camp suffered from these conditions before they fled their homes. Others developed them as a result of experiences on their journeys. But it is the post-migration experience that determines whether they become chronic, says the WHO*, and the trauma of living in a camp like Moria combined with anti-migrant hostility in host countries makes for a grim prognosis.

The needs in Moria are so great that the Doctors Without Borders mental health clinic serving the camp, which is located in nearby Mytilene, operates at full capacity and can still only treat patients with the most dire needs. Doctors Without Borders is the only organization offering mental health care for residents of the camp.

George,* a young man from west Africa, has been seeing a Doctors Without Borders psychologist and psychiatrist since April. His whole family was killed in a terrorist attack in 2015 and he was captured and tortured until he managed to escape. “When he first came to our clinic, George had thoughts of suicide, he had hallucinations and he would often become disassociated from reality,” explains MSF psychologist Greg Kavarnos. Post-traumatic stress disorder often goes ignored in areas where medical resources are low. Doctors Without Borders works to fill this void by offering both group and individual consultations provided by trained counselors or psychologists and psychiatrists when available.

But more treatment and resources are needed. “After we stabilize a patient, they have to go back to Moria, where they face a lot of triggers which bring back memories of their horrific past experiences," says Kavarnos. "For someone who has experienced torture, even the sight of barbed wire or soldiers can induce paranoia.” With your support, Doctors Without Borders can continue providing essential medical and mental health care to people in Moria and around the world, to help them cope with trauma and be better prepared for what lies ahead.

The work continues

A Doctors Without Borders mental health team conducts a therapeutic workshop with Venezuelan migrants and asylum seekers at the Jardim Floresta shelter, in Boa Vista, capital of Brazil's Roraima state. © Victoria Servilhano/Doctors Without Borders.

In most places where Doctors Without Borders offers mental health care, the needs far outpace capacity. Stigma against mental health disorders and sexual assault often prevent patients from coming forward, and local health care providers commonly lack the training to provide adequate care. Ongoing cycles of violence and trauma also complicate treatment and recovery.

But with your help, Doctors Without Borders can continue to increase its mental health response, and provide lifesaving care to people in over 70 countries around the world. Individual donations allow them to deliver critical physical and mental health resources where they're needed most, providing care to millions of patients each year. Your donations allow Doctors without Borders to continue their work and reach people who need them the most. Consider making a gift today.

This post is sponsored by Doctors Without Borders.

*The Panel of Experts on the Central African Republic, in its report for 2018 (S/2018/1119), noted that conflict-related sexual violence is largely underreported, mainly owing to victims’ fear of retaliation. Source

*Names have been changed to protect the patients' identity

*In March of 2016, European leaders met in Brussels and ruled that every person arriving irregularly on Greek islands – including asylum-seekers – should be returned to Turkey. Source

*Once a mental disorder has become manifest in a refugee, post-migration factors are critical to whether the disorder (in particular depressive disorders) will become chronic. Source

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.