In large-scale emergencies, such as the Türkiye-Syria earthquake, mental health has become a recognized priority for humanitarian agencies and first responders. As the lead health agency, alongside governments and NGOs, WHO assesses needs and plans for the psychosocial and mental health response. This goes hand in hand with critical services such as dispatching emergency medical supplies and establishing strong disease surveillance systems to prevent major epidemics.
As someone who spent many years working in humanitarian crises, I embrace the prioritization of psychosocial and mental health services. Mental health disorders are no less real than infectious diseases or injuries; they are simply less visible and more difficult to quantify, particularly during emergencies. When WHO reviewed studies from 39 countries, it concluded that in the 10 years following conflict, one in five people experienced a range of mental health problems, including depression, anxiety, post-traumatic stress disorder and schizophrenia. The COVID-19 pandemic has taught us that isolation, fear and loneliness create a spike in depression, anxiety and related mental health disorders, particularly in young people. Natural disasters and extreme weather events can also have a major effect on mental well-being.
We live at a time when emergencies are no longer rare. Humanitarian challenges are, sadly, everywhere. Climate change is accelerating the rate and intensity of floods, drought and extreme weather events across the world. Heat stress alone is known to affect our mood and exacerbate anxiety; as tempers flare, aggression increases and pre-existing mental health conditions are heightened by the distress of living in a degraded environment. Notably, there is a clear relationship between increased temperatures and the number of suicides that occur.
People in places as far apart as Somalia, Spain and China are coming under pressure from drought; wildfires are escalating from Canada to Australia; flooding is worsening in Sudan, in Pakistan, and in North America, to name only a few. Such crises frequently force people to leave their homes behind, breaking the chain of social support they would rely upon in times of stability. Every year, on average, it is estimated that more than 20 million people worldwide are displaced as a result of climate-related changes. An ill-conceived emergency response in such situations, that fails to address psychosocial needs, can do further harm. Children, it is known, are particularly likely to have prolonged trauma-related symptoms.
In high-income settings, quality mental health services can be difficult to find. In places facing multiple stressors, everything from diagnosis to treatment to ongoing care suffers. After the Ukraine invasion, for instance, huge numbers of doctors, nurses and other health professionals sought safety in other countries, leaving critical gaps in provision. In Sudan, violent attacks on health facilities denied even routine healthcare, let alone being able to meet the increased needs of a traumatized population. At times like this, agencies need more resources to offer relief to the people affected, including humanitarian and health workers themselves.
Humanitarian workers operate in emotionally challenging environments, offer support to people in great distress, and alleviate their pain through compassion, practical help and shared humanity. Being witness to violence, death and injuries affects their psychological well-being. It takes a great deal of emotional intelligence and professional training to succeed. This wasn’t always recognized, with damaging consequences for both humanitarian workers and the people they were there to serve. Rest and recuperation, which was once seen as the magic formula for burn-out and mental distress among humanitarians, was only ever partly adequate. Measures shown to be effective in alleviating anxiety and mental health conditions like PTSD, include training in mental and psychosocial support before deployment, online counseling during an emergency operation and regular debriefs with trained specialists after responding to an emergency.
Compared with even five years ago, the UN and other international organizations today are better at acknowledging the mental health needs of workers during emergencies and beyond. This, hopefully, reflects that the stigma surrounding mental health is beginning to recede. The availability of digital tools to support people in emotional distress is also a positive sign. We can celebrate this progress; however in a world threatened by the climate emergency and by the exacerbation of conflicts, the demand for quality psychosocial and mental health support is bound to grow exponentially. My key question for the 2023 World Mental Health Day is therefore whether the UN and other organizations are ready to invest even more in this critical area of work to truly promote and protect the precious psychosocial and mental well-being of people affected by emergencies, including their own humanitarian workers.