International Activity Report 2002
Mental health care within MSF activities

In any MSF medical project, in any part of the world, there is always a psychological component to the work, if only in the personal interaction between doctor and patient, the ability to listen and the chance to be heard. People living in unstable political situations or living through a natural disaster suffer severe trauma. No one would deny the psychological impact of living with disease, poverty or in conflict settings.

MSF considers that psychological programs are not only an essential response to human suffering, but part of an integrated approach to medical care. In March 2002, it sponsored an international symposium on "Trauma, treatment and culture," drawing some 600 humanitarian and healthcare practitioners to Paris to discuss this issue, share experiences of successful projects and debate how best to provide psychological support across different cultures.

In Angola, women carry their starving children for days, trying to reach help. Many walk into feeding centers with their last surviving child in their arms. MSF teams fight to save thousands of malnourished children, but the needs are immense and many die. There is no time to listen to the stories of suffering, to offer more than emergency care, but there is no denying the look on each woman's face as she cradles her child in the feeding tents. At night there is weeping. – Bunjei camp, Angola, 2002

From counseling to psychosocial support

In some places MSF has developed projects that specifically seek to provide mental health care. In the West Bank and Gaza Strip, for example, MSF teams visit Palestinians in their homes, counseling people trapped in the ongoing conflict, where stress and trauma create a complicated mix of physical and psychological reactions. In Rwanda, MSF works with women survivors of the 1994 genocide, many of whom continue to suffer trauma associated with rape and torture eight years on.

In other settings, MSF has developed programs with a broader approach, focusing less on individual counseling and more on an integrated mix of social, psychological, legal and medical activities. Examples of multidisciplinary "psychosocial" programs can be found in Guatemala, Guinea and the Philippines, where MSF works with street children. Building trust is central to these psychosocial programs, which strive to reintegrate homeless children into existing social structures and to support their transition in various ways.

Limits and capacity

Every MSF project has limits. There is always a struggle to identify the most urgent needs and the best way to respond to medical emergencies with finite resources. In what situations should mental health care become a priority? Should every project have an element of psychological care? When MSF responds to massive famine and displacement (as in Angola and Afghanistan) should including mental health care even be considered?

For MSF, the question is not whether mental health care should be a part of our missions or not, but rather how and when to focus on mental health.

In a house that sits across from an Israeli settlement, an MSF psychologist offers crayons and paper to children while listening to their mother. She tells the story of the night her 12-year-old son was wounded and she fought to stop the bleeding, the smaller children clinging to her legs in terror. While they talk, the two-year-old makes heavy marks on the paper and the sound of bullets, "tar, tar, tar," while the five-year-old colors a red spot, over and over. – Abu Sneina district, Hebron, West Bank, 2002