Mental health and psychosocial support

after the recent violence in Gaza

Christine Gale, UNICEF Jerusalem

Raijah Abu Sway, WHO Jerusalem

11 February 2009
IASC Weekly

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 MHPSS Issues
 Recent violence comes on top of years of occupation, restriction,
loss and economic deprivation

 Unprecedented scale and type of violence during recent conflict has

created profound and enduring sense of despair, indignity and fear

“This was different this time”

 Multiple sources of ongoing fear and anxiety: Continuing insecurity,

difficulties in meeting basic needs and uncertain future

 Demand for accountability. If not delivered likely to undermine

belief in justice and rule of law

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 MHPSS problems/capacities
 Rates of mental disorders very difficult / too early to
measure but severe disorder projected to be 3-4 %

 All reactions to be seen in context of pre-existing mental

and social problems, including misuse of the substance
tramadol

 Resiliency: Despite intense sadness and distress, many

members of the population continue to function and
provide social support to each other

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 Context
Strong pre-existing mental health and psychosocial services and
supports
• Well developed, experienced programming on MHPSS
• Most government mental health services have resumed function
as before
• Same is true for most psychosocial activities
Extremely restricted humanitarian access
• Poor and highly unpredictable access for UN international staff
(due to IDF changing rules and tight UNDSS rules)
• Very restricted access for INGOs (due to severe IDF restrictions)

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 Key determinants of Mental Health and
Psychosocial Wellbeing
 Safe and secure environment is foundation of Mental Health and
Psychosocial Wellbeing

“The improvement of human security is the probably the most important

psychosocial boost you can give the population. If there is no change
towards a political solution and people remain under threat, the
provision of psychosocial support alone will have limited impact”
Member of the MHPSS working group

 Need to reestablish basic services in a way that supports Mental

Health and Psychosocial wellbeing e.g. safe and supportive
education

 Need to provide mental health and psychosocial interventions,

integrated in other sectors

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 The coordination challenge
 Numerous actors in mental health and psychosocial
supports (MHPSS) (eg more actors than in "Health or
Education Cluster")

 Largest Flash Appeal ever for MHPSS (38 million dollars)

 Need to update the coordination mechanism to address

new challenges
– Strengthen collaboration between mental health and
psychosocial
– Reinforce coordination capacity in Gaza to deal with scale of
challenge

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 Planned MHPSS in humanitarian
coordination in Gaza
Humanitarian
Coordinator

Protection Cluster
Health Cluster (with Child protection Education Cluster
Sub-cluster)

MHPSS inter-sectoral
coordination subgroup

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 Key Coordination actions
 Dedicated MHPSS coordination group established building on existing
coordination mechanism

 MHPSS coordination group under health and protection clusters

 Gaza coordination lead by UNICEF WHO UNWRA

 Technical Support Unit will provide strengthened capacity to Gaza

group

 Liaison between West Bank and Gaza MHPSS coordination groups

ongoing

 Roll-out of IASC MHPSS Guidelines to provide strategic planning

framework and technical guidance on good practice
 Mapping of responses and identification of gaps ongoing

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 Intervention Challenges
 Intense, multiple and sustained stressors to wellbeing

 Existing referral and support systems and services severely strained

 Access almost non-existent for necessary additional human resources to

support coordination, provide technical expertise, training and staff support

 Changing poor practice e.g. Psychological debriefing widely used despite

its ineffectiveness and possible harmful effects when misapplied;
counselling training initiatives without supervision

 A relative over-focus on services provision vis-à-vis other supportive

interventions outlined in the IASC Guidelines e.g. community mobilisation

 Difficulty of consistent inter-agency planning for support and services in

highly politicised, restricted environment

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 MHPSS Programming
 Build capacity of primary health care (PHC) workers to address MH issues

 Building overall mental health system (early recovery)

 Integration of psychosocial support in Early Childhood Development

centers

 Psychosocial support through education system (teachers, school

counsellors)

 Recreational and sporting activities and child friendly spaces

 Range of counselling activities (individual, group)

 Awareness raising on MHPSS issues

 Staff care: support to professionals and front-line workers

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 Key opportunities
 Strengthen sustainable systems for MHPSS

 Planned interagency assessment based on pre-existing baseline

 Operationalise MHPSS intersectoral group as per IASC MHPSS

guidelines

 Expand MHPSS interventions to other sectors not previously

addressed e.g. shelter, food, nutrition

 Opportunity to strengthen community mobilisation

 Prioritise information to the population

 Highlights the need to address environment as part of MHPSS

response
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