The need for mental health and psychosocial support during and after displacement crises is crystal clear, but it often gets “thrown to the bottom of the barrel” in aid responses, as one speaker put it in a discussion convened by The New Humanitarian.
Building on insights from the recently published Lebanon Displacement Diaries, we convened an online discussion to explore the deprioritisation of these needs in places like Lebanon – where around one million people were displaced at the height of Israeli bombing late last year – and to find out what lessons have (or haven’t) been learned.
The 3 June conversation was moderated by Annie Slemrod, Middle East editor at The New Humanitarian, director and editor of The Lebanon Displacement Diaries. She was joined by experts with personal and professional experience of Lebanon’s ongoing displacement:
Touching on what it was like to work on the ground with displaced people, as well as the needs of marginalised groups and the search for sustainable long-term funding and solutions, here are some takeaways from the discussion, which you can also watch in full here:
Overwhelming need, varying experiences
Chamoun, the coordinator of The Lebanon Displacement Diaries – herself forced to flee her home due to Israel’s bombings – said it was clear from the people who told their stories of displacement in the project that the extreme violence, loss of homes, and personal tragedies had clearly taken an emotional toll. “You can tell from their words and emotions that there is an immense need for psychosocial support,” she noted. “You can feel that there is a real internal struggle and a need to grieve and process their own stories.”
“People said we didn't just lose a loved one, we also lost our home. They lost their routines, their land, their sense of safety.”
Sawli, who was also displaced, coordinated much of the ICRC’s on the ground support during the crisis, which was at its height between late September and 27 November, when a ceasefire between Hezbollah and Israel began (although Israel still bombs Lebanon regularly and is occupying part of south Lebanon). Sawli helped to establish community support groups, train volunteers to help their peers in shelters, and set up a hotline for people to contact when they needed help.
She mentioned that people were facing multiple traumas at once: “People said we didn't just lose a loved one, we also lost our home. They lost their routines, their land, their sense of safety.”
But not everyone was impacted in the same way, or had the same access to services.
Diab said her research, which focuses on the stories of displaced people from marginalised communities – including people with disabilities, LGBTQI+ people, and Syrian and Palestine refugees – showed that “their encounters with displacement were certainly traumatic… and their experiences when it came to access to services, including mental health support is… 10 times more challenging – a million times more challenging – than it was for the mainstream groups that the humanitarian space focuses on.”
Finding help
Mawed said the aid response to Lebanon’s mental health crisis was delayed and disorganised, in part because more people had to flee their homes in a shorter period than anyone expected.
When help did arrive, Sawli noted, people wanted to talk about a whole range of issues: from dealing with anxiety to coping with parenting problems to resolving conflicts with their partners. She said many displaced people were distressed and anxious, constantly trying to find out if their homes had been destroyed, or if people they knew had been killed. One stress-reduction strategy was to encourage people to avoid watching the news and social media constantly, and to try to limit their information to trusted sources.
Mawed, who ran support sessions for displaced people sheltering in the northern Lebanese city of Tripoli, also mentioned that despite the massive traumas people experienced, many are not ready to talk about trauma when they are still going through it, and it isn’t necessarily best practice to do so.
Like Sawli, Mawed pointed out that once people became comfortable talking – which in itself took time – they wanted to talk about things like communication issues, parenting problems, or conflicts with their partners. “They were not touching on the recent, and most recent ‘hot’ trauma… the thing that is really affecting them.” This in itself is not negative, from the practitioner’s perspective, Mawed explained: “It’s a good thing that they are speaking about anything, about any challenges that they are facing… You could see that they were really aching, but are still not very comfortable to share their pain and talk about the displacement, and loss and grief.”
Whether people wanted to talk at all was often related to various factors, including backgrounds and past experiences. Mawed mentioned that in her work she found that for Syrian refugees who had been in Lebanon for more than a decade, or for Palestinian refugees (a community she is a part of) who have been there for generations, people tend to feel more comfortable identifying what help they need themselves, and asking for help that is available.
Part of this, she mentioned, may be that people are not immediately ready to identify themselves as displaced or as refugees, or as people who need help at all. Other participants mentioned the need to present as strong and “resilient”, given the ongoing war with Israel, and stigma around seeking mental health support.
Chamoun said that in her community in south Lebanon – majority Shia Muslim – people sometimes find it hard to seek out support because of stigma, or due to a sense that they should be seeking comfort from religion rather than from a professional.
Short-term solutions, long-term problems
It can take years to process what happens during any trauma, but the vast majority of aid programmes are only funded for the short term, which makes it hard for people to access support once they go back to their homes – not to mention the fact that for many people in Lebanon, the traumatic “event” is still happening: Some 90,000 have not been able to return home, and the regular Israeli bombing and sounds of drones overhead have not gone away.
This support is hard to come by given aid funding shortages across the globe, and the way aid programmes are funded – often for short-term interventions that end when a crisis is “over”. It’s doubly hard given that, as Diab said, “mental health gets thrown to the bottom of the barrel” and is often one of the first things to go when cuts are made.
Mawed argued that the short-term funding cycle doesn’t make sense in a country like Lebanon, where there has been some sort of crisis – war, financial, political – since at least the start of the civil war in 1975.
She advocated for solutions that are run by local people, “responding to their own needs to empower the creation of safe spaces, collectively. Because it’s not that one person is facing a crisis… It's like a whole nation is having a crisis. We have collective traumas. And to address collective traumas, we need collective solutions”.
This indicates the need for aid responses that do not come pre-packaged from aid agencies or international NGOs, but take into account local dynamics.
Diab said that “intersectional conversations remain completely absent from the aid response,” which is part of a larger picture of the lack of prioritisation of the conversation on mental health, let alone the complexities of who needs help and how best to provide it.
She pointed out that while many aid services have already disappeared – and on a national level mental healthcare is extremely difficult to access – there are “pockets of support” run by groups like the queer community, refugees, and migrants. But Diab also noted that these psychosocial services, while crucial, are a “Band Aid on a larger problem, because these are often the organisations that struggle the most with securing sustainable funding. They are the ones with the most limited resources.”
Who helps the helpers?
A thread that ran throughout the conversation was the fact that – as is the case in almost all humanitarian crises – the people who stepped up to provide aid, to listen to and tell stories, and to conduct crucial research had themselves been impacted by the deep and ongoing distress of the war and forced displacement.
Chamoun mentioned that, at the time, “It was very hard for me to take the space to reflect on what was happening. The war, the escalation of the war was very abrupt. And suddenly we found ourselves having to move, having to find a place to stay and having to maintain our needs. I felt this sense of responsibility towards myself and toward my family.”
In her case, she described collecting stories of displacement in a trauma-informed manner as “cathartic and healing”. But it is important to keep in mind that this is not always the case.
Chamoun mentioned that some people expressed a sense of “story fatigue”: They felt that journalists, aid workers, and researchers were asking for their stories multiple times and that – given the potential for re-traumatisation – it’s key that everyone involved in the process keep in mind the emotional toll involved. That means finding ways to support those giving aid, but also respecting when people don’t want to talk at all.
