Empowering Syrians, Iraq internal displaced populations and institutions in Jordan and Iraq
Action Against Hunger
No Lost Generation is marking the 10th year of crisis inside Syria with a series of blog posts shedding light on the comparative situation of children. Publishing one blog post a day, we will underline the needs of children and youth affected by the Syrian crisis and share the experience of our partners responding to their plight. We need to redouble our efforts and rethink our interventions, to shape a better future for 10.7 million children.
Jordan and Iraq have been heavily strained from the Syrian crisis: over 650,000 Syrian refugees live in Jordan with the majority outside camps; 82% of Syrian refugees in Jordan live under the poverty line1 and face multiple intersecting needs. In Iraq, 6,700,000 people remain in need of humanitarian or protection assistance, especially IDPs, host communities, returnees, and Syrian refugees. Conflict, displacement, and deprivation along with protection risks and negative coping strategies all impact psychological and psychosocial wellbeing. Various service access barriers exist, including stigma and a lack of capacity of Public Health Centres (PHCs) to address Mental Health and Psychosocial Support (MHPSS) needs. Despite efforts to integrate MHPSS services, there remains inadequate MHPSS capacities of PHC staff and resistance from social stigmas in communities.
In response, Action Against Hunger implemented a regional MHPSS project in Iraq (Dohuk) and Jordan (Irbid) from 2018-2021 as part of a multi-sectoral MHPSS and WaSH intervention funded by Agence Française de Développment and the European Union’s Regional Trust Fund in response to the Syrian crisis, the ‘Madad’ Fund.
The MHPSS pilot aimed to strengthen access and quality of public MHPSS services and reinforce resilience by:
- Reinforcing local institutional capacity to provide MHPSS services by training 135 health workers on mhGAP and supervising implementation in 81 PHCs through referral and follow up. Through this initiative, 4,077 patients were served with a 95% average well-being improvement reported.
- Training 3 Community Based Organisations (CBOs) on awareness raising and Problem Management+ (PM+) for 30 volunteers providing services to 6,419 beneficiaries.
One woman engaged through the CBO volunteer training is Ameera, the director of Our Step, “Kutwitna,” a local CBO in Jordan providing support and advocacy for individuals with MHPSS needs. Ameera explained that through her work, “I was able to discover that I had a psychological disability, and because of this, my life was turned upside down before I gained self-independence and entered the working field.” People did not always take kindly to her struggles. “People would tell me that I was cursed or that people targeted me with negative or malicious intentions,” said Ameera.
Since then, Ameera participated in Action Against Hunger’s workshops and trainings, including as a speaker at a 2019 World Mental Health Day event in Irbid. She is now part of the Committee for Mental Health in Jordan and has become an advocate for the cause.
“I was able to discover that I had a psychological disability, and because of this, my life was turned upside down before I gained self-independence and entered the working field.”
By the end of the project, notable country similarities include the acquisition of technical competencies on MHPSS for non-specialists, health worker challenges implementing mhGAP, and the effect of the interventions towards patients. The countries’ contexts and structural institutional factors have differing impacts on the integration of mental health services in PHCs. Based on community and ministry consultations and lessons learnt and best practices, Action Against Hunger recommends the following actions to provide quality clinical interventions, and increased MHPSS resources and improvements:
- Investing in long-term, comprehensive programming, in full coordination (MoHs, DoHs, MHPSS working groups, institutional, INGOs, and CBO partners), and focused on a mental health system strengthening development strategy.
- Mental health system strengthening diagnosis and planning, focused on the 7 WHO building blocks and inclusion of priorities into national action plans.
- Capacity building with long-term trainings and frequently diversified supervision modalities focused on scalable and recognised psychological interventions adapted to roles and responsibilities of specialists (psychosocial workers, psychologists, psychiatrists) and non-specialists (health workers, educational workers). Aligned with mhGAP, the training and supervision plan should include essential care and practices, case opening / closure, problem solving, self-care, and coping and social strategies; and specialised topics related to complex conditions and difficult cases requiring specialised care. These topics are recommended to target approaches, guidelines, and protocols for all ages.
As COVID-19 cases continue to rise in both countries, the situation remains unstable and increases feelings of anxiety and stress. In response, throughout 2020, Action Against Hunger provided awareness and psychological counselling phone calls for beneficiaries and health workers. The added stress and anxiety as a result of health, economic, and familial concerns (among others) maintain and increase the relevance and necessity of MHPSS programming in Jordan for vulnerable communities.
 Only the WHO-5 Well-Being Index was proposed to measure the general level of mental well-being and assess pre and post mhGAP intervention improvements for patients. This Index is well used by health workers.
About Action Against Hunger
Action Against Hunger is a global humanitarian organization that takes decisive action against the causes and effects of hunger. Our staff of nearly 8,500 people served more than 17 million people in 46 countries last year.