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Mental health: Healing the hidden scars

21-01-2014 Feature

To the untrained eye, the psychological effects of armed conflict and violence can be hard to recognize. The ICRC is stepping up its efforts to highlight psychological trauma and help those who suffer from it.

Over the past two years, the ICRC has almost doubled the size of its Mental Health and Psychosocial Support team, which now consists of some 55 staff.

The team supports 23 programmes around the world, training and coaching doctors, nurses, community and religious leaders, National Society volunteers and teachers to recognize the psychological impact of armed conflict and violence, and to help the victims cope.

"These are the individuals people traditionally turn to for help," says Milena Osorio, an adviser on mental health and psychosocial support. "We make sure that they're aware of basic mental health and psychosocial issues, and that they know how to offer proper support that doesn’t stigmatize the victims or cause further harm."

Strengthening community support

The ICRC set up the Mental Health and Psychosocial Support team seven years ago, with the aim of reducing the emotional and social elements of psychological suffering.

We combine psychological help in the form of counselling or psychotherapy with activities that help communities cope with the psychological effects of conflict and violence.

Eastern Province, Democratic Republic of the Congo

In the DRC's Eastern Province, the ICRC is supporting people working with children who have been involved with armed groups.

For many of these children, the experience of being in an armed group has been traumatic, and we teach members of the community about after-affects like anxiety, insomnia, flashbacks, nightmares, fatigue and aggression. They also learn how to listen to the children and get them to talk about their experiences.

"The children were very aggressive at first. They caused problems at school, and teachers would kick them out of class, separate them from their classmates or beat them," says Erica Pellizzari, an ICRC delegate based in Dungu, DRC.

"We sat down with the teachers and encouraged them to try talking to the children and engaging them in conversation. We told them how important it was to avoid making them look bad in front of others. Since then, the number of beatings has gone down."

Supporting victims of violence

Our work also involves supporting victims of sexual violence: women, children and men.

For many years, the ICRC has been training communities in the DRC's North and South Kivu provinces to support victims of rape and other forms of violence who attend the 40 or so maisons d'écoute in the region. A maison d'écoute – literally a "house of listening" – is a counselling centre where victims of violence can come and talk about their experiences in confidence.


Since 2012, the ICRC has been working with the Mexican Red Cross to provide psychosocial support in Ciudad Juarez to first-response teams facing situations that are highly dangerous for them and their patients. In January 2013, the ICRC and the Mexican Red Cross launched a mental health and psychosocial support programme in nine Ciudad Juarez schools, to help pupils aged 11-16 cope with the consequences of daily violence in their communities. Over 6,500 students and 600 teachers have already taken part in the project.


In Nepal, death rituals are an important part of the grieving process, but many families of missing persons have been unable to perform these rituals, as they do not have the bodies of their relatives. Without these rituals, families may find that others fail to recognise their loss. In 2010, the ICRC launched the Hateymalo (joining hands together) accompaniment programme to help families cope with the uncertainty and to rebuild bonds within communities.

Support groups enable people to talk about their experiences and decide how to remember their missing relatives. One of their conclusions is that there is a need for public recognition of those who have gone missing.

"Mothers came up with the idea of building a memorial to the missing person, such as a resting place, a well or trees," says Yubaraj Adhikari, the ICRC reference person for the Hateymalo programme in Nepal.

"Others have performed traditional prayer ceremonies where priests or healers say prayers to appease the gods and ensure the souls of the missing find peace. Whole communities attend, to commemorate the missing and to show solidarity with their families. So far, around 1,000 families have benefited from the project."

What's next?

Earlier this year, around a dozen members of the Mental Health and Psychosocial Support team met in Geneva to discuss the challenges ahead. They recognised the importance of sharing their practices and experiences, and of harmonizing their ways of working.

"We also hope to expand mental health care for detainees," says Pierre Bastin, an adviser on mental health and psychosocial support. "In addition, we'll be stepping up our support for victims of sexual violence and including more mental health and psychosocial support in our health programmes."


A woman talks to a psychosocial worker. 

Maison d'├ęcoute, North Kivu, Democratic Republic of the Congo.
A woman talks to a psychosocial worker.
© ICRC / P. Yazdi / v-p-cd-e-01036

The centre looks after children who have been involved with armed forces or armed groups. 

CAJED Transit and Orientation Centre, North Kivu, Democratic Republic of the Congo.
The centre looks after children who have been involved with armed forces or armed groups.
© ICRC / P. Moore / v-p-cd-e-01322

A family support group discusses activities with ICRC staff. 

Banke district, Nepal.
A family support group discusses activities with ICRC staff.
© ICRC / N. Shrestha / v-p-np-e-00245

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