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Mental health and psychosocial support after the recent violence in Gaza
Christine Gale, UNICEF JerusalemRaijah Abu Sway, WHO Jerusalem
11 February 2009IASC Weekly
Mental health and psychosocial support after the recent violence in Gaza
Christine Gale, UNICEF JerusalemRaijah Abu Sway, WHO Jerusalem
11 February 2009IASC Weekly
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MHPSS IssuesMHPSS 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/capacitiesMHPSS 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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ContextContext
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
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 challengeThe 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
Planned MHPSS in humanitarian coordination in Gaza
HumanitarianCoordinator
Health Cluster Education ClusterProtection Cluster(with Child protection
Sub-cluster)
MHPSS inter-sectoralcoordination subgroup
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Key Coordination actionsKey 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 ChallengesIntervention 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 ProgrammingMHPSS 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 opportunitiesKey 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