Doctors Without Borders/Médecins Sans Frontières (MSF) teams offer medical and mental health care to people living through some of the most urgent crises in the world. But how do aid workers treating patients in such dire circumstances look after their own mental health?
MSF’s Psychosocial Care Units (PSCUs) provide mental health support to our staff around the world. To best care for our diverse workforce, most of these teams are designed and managed by experts who come from the same regions as the staff they support. Here, two mental health professionals who have worked with MSF for more than 15 years explain the purpose of the PSCUs and describe the work their teams are doing now.
Based in Nairobi, Kenyan psychologist Habiba Amin is designing and implementing MSF’s PSCU for approximately 300 internationally mobile staff hired across East Africa.
What does psychosocial mean?
At its core, it is the intersection of the psychological—our feelings, thoughts, and behaviors—and the social—the societies we live in, our beliefs, and our culture. A psychosocial perspective allows you to look at a person holistically, considering what they experience mentally and socially as they navigate life.
Why is it important to consider culture?
Culture is important for several reasons. First, connection. For example, if someone is experiencing a loss, it's important to understand the grieving rituals of their culture. If this ritual is missed, they may not be able to process this loss. In this sense, connection also builds trust.
Then, language. It is easier to communicate with and understand someone when you speak the same language. If an expression is unique to that language, the true meaning might get lost in translation.
Finally, context. Knowing the context that a problem or experience is occurring within allows you to better understand where that person is coming from and offer better support.
What are the biggest stressors for staff in East Africa?
There are multiple stressors—homesickness, for example. People are far from the support they usually rely on. Sometimes it’s team dynamics—lots of different cultures living and working together, increased workload, and long working hours, especially in emergencies. We also see burnout, especially when people go on one assignment after another.
But number one is the accumulative exposure to suffering. The huge needs we see versus the capacity we have to respond. Sometimes people blame themselves: “I should have done more; I should have saved that life.”
We need to give our staff the right tools to navigate this.
How does MSF help staff navigate these challenges?
We make sure people are aware of their stress, understand their thresholds, and know their coping mechanisms before they depart for an assignment. Healthy coping mechanisms could include exercise or painting—so encouraging people to carry their paints with them or bring exercise shoes.
Psychoeducation is also key—telling people what they should expect to witness, how their bodies might react, and what signs to watch out for (for example, irritability, conflict with others, or maladaptive coping mechanisms like drinking or smoking more than usual).
We also keep our door wide open to offer a safe space where people can talk about things that have affected them. And we make sure they are aware of the additional support available, for example the peer support network or external mental health sessions. MSF pays for 20 counseling sessions per year for all our internationally mobile staff.
Why is psychosocial support so essential?
We need to take care of the people who are delivering care. Certain words can make people feel guilty about seeking help for the trauma they may take on, words like frontline workers, heroes, et cetera. As humanitarian workers, we move from one difficult context to the next. People call it “resilience,” but is it resilience built in an abnormal way? We don't want our staff to sacrifice themselves, which is why psychosocial support is so essential.
Dr. Bashar Ghassan has managed MSF’s PSCU since 2018. His team is responsible for supporting approximately 10,000 locally hired staff working in 28 of MSF’s projects across the Middle East and North Africa (MENA) region. Dr. Ghassan is from Mosul, Iraq, but studied to be a psychiatrist in Amman, Jordan, where he is now based.
How does MSF provide support to locally hired staff in the MENA region?
The unit is run by myself and my colleague Christiane Chiha, a psychologist based in Lebanon. We have five external psychologists based in Lebanon, Egypt, and Tunis, who travel to MSF projects when needed.
We offer a 24/7 hotline that staff can call or email, individual and group clinical sessions, and training related to staff well-being. Half of this work is remote; half is in person. I’ve been to 15 of our projects in MENA.
What do you do when you visit a project?
We spend time with the staff— live in the same conditions, experience their situation. We focus on group sessions to reach more people— up to 40 per day. At the end of each visit, we draft a report illustrating the main stressors leading to certain behavioral or cogni- tive challenges. We also highlight the team’s coping mechanisms so that management can understand what factors can help them cope with stress. The report also includes recommendations. Even simple recommendations—like improving communications—can make a positive impact on team dynamics.
We've found that what people want out of mental health support is different in different parts of the world. It is important to adapt our support to the culture.
How did the recent earthquakes impact our staff in Syria?
The earthquakes required a totally different psychological intervention to our regular support. It was a traumatic event. The natural response was fear and panic. People can start to develop flashbacks or avoidance; we still have staff that won’t go back to their homes after the earthquakes, even though authorities have declared it safe to do so.
People can also develop hypervigilance (i.e., being on high alert and extremely anxious), which can impact their ability to focus and can affect their performance at work or their lives at home.
What care can be provided after a traumatic event?
First, we provide psychological first aid—a simple training that anyone can do. The aim is to stabilize people: moving them to a safe place to avoid further harm and ensuring they have food, water, shelter, and the medications they need.
Then we focus on the trauma. The most common tool is cognitive behavioral therapy, a psychosocial intervention aimed at reducing distress by changing maladaptive thinking patterns. When people can link their physical symptoms (e.g., hypervigilance) to the mental trauma, they start to recognize that if they can manage the thoughts then the physical symptoms will also start to be manageable.
The most important tool is diffusing sessions between groups affected by the same incident. One objective is to create solidarity between people. The other is to reduce the impact of the trauma. In the beginning it is very painful, the wound is fresh. But by allowing people to talk about their experience, we try to turn it into a scar. Since the earthquakes, we have facilitated three psychological first aid, 10 diffusing, and 12 individual sessions.
How do we plan to continue supporting staff in Syria?
We know how important face-to-face support is, so I plan to visit the area later this month to provide trauma therapy and plan the next steps for how we can best support our colleagues living in northwestern Syria. Unfortunately, the hardships they live through do not begin or end with these earthquakes.
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