Snapshots from MSF mental health programs in Kashmir, Democratic Republic of Congo, and Iraq show some of the complex issues confronted by those who seek counseling.
Doctors Without Borders/Médecins Sans Frontières (MSF) provides emergency medical aid in catastrophes all over the world—during armed conflicts, for example, or after natural disasters, or in the midst of famines and epidemics. MSF doctors and nurses are often seen bandaging the war-wounded, rehydrating a cholera patient, performing an emergency cesarean section, or treating some other physical ailment. But for more than 20 years, MSF has also been caring for patients’ mental health.
For people who have lived through terrible events, the psychological consequences can be severe. Depression and anxiety can immobilize them, often just when they need to take action for themselves and their families.
MSF’s mental healthcare aims primarily to reduce people’s symptoms and improve their ability to function. Often this work is done by local counselors specially trained by MSF. MSF psychologists or psychiatrists provide technical support and clinical supervision. When appropriate, MSF’s counseling services may reinforce or complement mental healthcare approaches that already exist in the local community. And specialized clinicians can treat severe mental illness, in the event that cases arise.
The severe cases are rarer, but overall, the needs are high. MSF, therefore, has continued to expand its mental health programs. In 2009, MSF’s mental health teams around the world performed more than 100,000 consultations.
People sought help for many reasons—the agonizing loss of a child in an earthquake, the trauma of sexual violence, the anxiety resulting from being in or near a violent conflict. MSF mental health workers listened to their stories and helped them find ways to cope and move on with their lives.
What follows is a series of snapshots from MSF mental health programs. They are taken from Kashmir, Democratic Republic of Congo, and Iraq, and they illustrate some of the complex and painful issues confronted by those who seek counseling, as well as some of the challenges encountered by MSF in providing these services.
Kashmir: People Traumatized By Decades Of Violence
MSF counselor Madina Bukhari works in Kupwara district, where for years the population suffered the consequences of the ongoing Kashmir conflict. Most of the people she counsels are direct victims of this violence who now suffer from depression, anxiety, and post-traumatic stress.
“I’ve had women telling me how they were having dinner with their families when someone burst in and shot their husband in front of their eyes,” she recalls. “Others have lost family members or witnessed violence. Some of the youth were tortured. All these memories are often very vivid in their minds.”
Madina finds it rewarding to aid in the recovery of fellow Kashmiris. Many of the people she counsels report feeling better afterwards. “Counseling helps them live in the present and shows them how the present can be better than the past,” she asserts. “We encourage them to take part in their community’s activities, which can help get them back on track and get on with their lives.”
MSF’s mental health program in Kashmir carried out more than 5,800 consultations in 2009. One patient, a man named Gulam, suffered from depression for years before being referred to MSF. He endured headaches, sleep disturbances, and memory loss, and was lonely, withdrawn, and unable to work. Counseling helped him get his life back on track.
“Since I’ve seen a counselor, I’ve made so much progress,” he says. “I started by writing about my emotions regularly and it helped to be able to express them. Now I’m reading and writing a lot, I can concentrate very well and I’d like to continue studying and improve my education. I know I can do it now.”
