• "I feel like I am less than other people": Health-related vulnerabilities of male migrants travelling alone on their journey to Europe

      Arsenijević, J; Burtscher, D; Ponthieu, A; Severy, N; Contenta, A; Moissaing, S; Argenziano, S; Zamatto, F; Zachariah, R; Ali, E; et al. (Elsevier, 2018-05-23)
      During 2015 and 2016, an unprecedented flow of approximately 800,000 migrants coming from Turkey towards Western Europe crossed the Balkans. Male migrants are perceived as being less vulnerable compared to other migrants and they are not given priority in service and support provision. This qualitative study examines the self-perceived vulnerabilities of male migrants travelling alone along the Balkan route to Europe. Twenty-four individual in-depth interviews, two group interviews and participant observation were conducted with male migrants in Belgrade, Serbia in 2017. Data was coded manually, and analysed thematically. Male migrants traveling alone face the cumulative vulnerability of various traumatic events and migration-related contextual circumstances. Three main themes emerged: the ongoing desperate journey, the better treatment of 'traditionally' well recognised vulnerable sub-groups and the impact of the continuous stress on mental health. Deterrence measures imposed for border control purposes in the form of push-backs, expulsions, detention and degrading, inhumane treatment amplify the psychological distress of male migrants. Feelings of hopelessness, desperation, lack of self-value and self-esteem were reported. 'Traditionally vulnerable' populations were said to have had better treatment throughout the journey from smugglers, border state authorities, governmental officials, civil society and international organizations. The devastating experiences of male migrants, as well as the better treatment offered to other groups of migrants like women and children, results in a perceived neglect of the needs of men in humanitarian response, rendering them vulnerable and exposing them to further health and protection risks. In a context where needs are unmet and people's dignity and health are at risk, specific strategies should be developed to include men in the assistance and protection offered, particularly in relation to exposure to violence.
    • "I prefer dying fast than dying slowly", how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal

      Eleftherakos, C; van den Boogaard, W; Barry, D; Severy, N; Kotsioni, I; Roland-Gosselin, L (BioMed Central, 2018-09-05)
      Background In 2015 and early 2016, close to 1 million migrants transited through Greece, on their way to Western Europe. In early 2016, the closure of the “Balkan-route” and the EU/Turkey-deal led to a drastic reduction in the flow of migrants arriving to the Greek islands. The islands became open detention centers, where people would spend months or years under the constant fear of being returned to Turkey. Syrians were generally granted refugee status in Greece and those arrived before the 20th of March 2016 had the option of being relocated to other European countries. Afghans had some chances of being granted asylum in Greece, whilst most migrants from the Democratic Republic of Congo were refused asylum. In a clinic run by Médecins sans Frontières on Lesbos Island, psychologists observed a deterioration of the migrant’s mental health (MH) since March 2016. In order to understand the MH needs for this stranded population it was essential to explore how, and by what factors, their mental health (MH) has been affected on Lesbos Island due to the EU/Turkey-deal. Methods This was a qualitative study in which eight service providers’ interviews and 12 focus group discussions with male and female Syrian, Afghan and Congolese migrants in two refugee camps on Lesbos Island. Thematic-content analysis was manually applied and triangulation of findings was undertaken to enhance the interpretation of data. Results Three main themes were generated: 1) Institutional abuse, 2) Continuous traumatic stress (CTS) and 3) MH service provision. Institutional abuse was expressed by inhumane living conditions, lack of information in order to make future decisions, humiliation and depersonalization. This led to CTS that was expressed through being in a state of permanent emergency under lack of protective measures. Delays in appointments, lack of psychiatric care and differences in MH perceptions amongst migrants highlighted the provision of MH services. Conclusion The EU/Turkey-deal reduced migrant flows at a very high price. Decongestion of the camps and the elimination of institutional abuse is urgently needed to reduce CTS and improve migrants’ MH.
    • Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines

      Mueller, Y; Cristofani, S; Rodriguez, C; Malaguiok, R; Gil, T; Grais, RF; Souza, R; Epicentre, Paris, France; Médecins Sans Frontières, Geneva, Switzerland; Médecins Sans Frontières, Mindanao, Philippines (2011-03-07)
      ABSTRACT:
    • "Losing the tombola": a case study describing the use of community consultation in designing the study protocol for a randomised controlled trial of a mental health intervention in two conflict-affected regions

      Shanks, L; Moroni, C; Rivera, I C; Price, D; Clementine, S B; Pintaldi, G (BioMed Central, 2015-06-02)
      Community consultation is increasingly recommended, and in some cases, required by ethical review boards for research that involves higher levels of ethical risk such as international research and research with vulnerable populations. In designing a randomised control trial of a mental health intervention using a wait list control, we consulted the community where the research would be undertaken prior to finalising the study protocol. The study sites were two conflict-affected locations: Grozny in the Chechen Republic and Kitchanga in eastern Democratic Republic of Congo.
    • Maternal Perception of Emotional Difficulties of Preschool Children in Rural Niger

      Marquer, C; Grais, RFF; Moro, MR (SAGE Publications We regret that this article is behind a paywall., 2016-05-31)
      Mental health care for infants and young children is often greatly limited in low-resource settings. The purpose of this study was to describe maternal perception of emotional difficulties of preschool children in a rural area of Niger (Maradi). In this context, both mental health awareness and services were scarce. This research was part of a larger cross-cultural validation study of a screening tool for psychological difficulties in children aged 3 to 6 years old. Data collection included group discussion and individual interviews. A total of 10 group interviews and 83 individual interviews were conducted. The results highlight mothers' perceptions concerning their children's psychological difficulties. Sleep difficulties were considered significant by the mothers and were used often as an entry point for further discussion of concerns. Peer and sibling relationships, separation anxiety, and reactions to difficult events were also described. Identification of mothers' perceptions of children's main difficulties through a mixed-method approach shows promise as a way to inform interventions to provide culturally appropriate care for children in need.
    • Medecins Sans Frontieres: mental health in post-tsunami Ache Province, a field report

      de Gryse, B; Laumont, B (2007)
      This article describes a mental health program in Ache Province, a conflict area in Indonesia. The intervention aimed to normalize community life, through activities such as construction of a volleyball field and the organization of a tournament, as well as organizing talking groups to reinforce solidarity and mutual support. On an individual level, offering counselling services supported normalization. The beneficiaries appreciated the communities based group activities the most. As for individual psychological support, counselling proved to be an unknown approach for the majority of the population, and therefore did not always meet their expectations of a fast, practical resolution of their problems.
    • Mental disorders, disability and treatment gap in a protracted refugee setting

      Llosa, A E; Ghantous, Z; Souza, R; Forgione, F; Bastin, P; Jones, A; Antierens, A; Slavuckij, A; Grais, RF; Augusto E. Llosa, PhD, Epicentre, Paris, France; Zeina Ghantous, MPH, Médecins Sans Frontières, Geneva, Switzerland; Renato Souza, MD, Médecins Sans Frontières, Geneva, Switzerland, and Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Fabio Forgione, MSc, Pierre Bastin, MD, Alison Jones, MSc, Annick Antierens, MD, Andrei Slavuckij, MD, Médecins Sans Frontières, Geneva, Switzerland; Rebecca. F. Grais, PhD, Epicentre, Paris, France. (2013-09-12)
      Studies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal.
    • Mental health and deprivation of liberty: experience report as a psychiatrist in a refugee detention center

      Schmid, PC (Centro Brasileiro de Estudos de Saúde, 2019-08-05)
      The experience report refers to the author’s work, for six months, as a psychiatrist for Médecins Sans Frontières (Doctors Without Borders - MSF) in a refugee detention center in Nauru, an island country in Oceania. The report provides descriptions of the field work and theoretical reflections. The author discusses the issue of suicide and the specificity of such issue for the group of refugees and asylum seekers attended, as well as the discovery of a new clinical diagnosis called resignation syndrome. It’s also sought to reflect on the role of mental health professionals in dealing with deprivation of liberty and discusses ethical challenges experienced in the field, regarding Australia’s refugee policy, its economic importance to Nauru and the impact on the refugee population; obstacles encountered until MSF team was expelled by the local government on October 5th, 2018.
    • Mental Health and Trauma in Asylum Seekers Landing in Sicily in 2015: A Descriptive Study of Neglected Invisible Wounds

      Crepet, A; Rita, F; Reid, A; Van den Boogaard, W; Deiana, P; Quaranta, G; Barbieri, A; Bongiorno, F; Di Carlo, S (BioMed Central, 2017-01-13)
      In 2015, Italy was the second most common point of entry for asylum seekers into Europe after Greece. The vast majority embarked from war-torn Libya; 80,000 people claimed asylum that year. Their medical conditions were assessed on arrival but their mental health needs were not addressed in any way, despite the likelihood of serious trauma before and during migration. Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014-15.
    • Mental health care for refugees from Kosovo: the experience of Médecins Sans Frontières.

      de Jong, K; Ford, N; Kleber, R; Médecins Sans Frontières, Amsterdam, The Netherlands. (Elsevier, 1999-05-08)
    • Mental health in HIV-positive pregnant women: results from Angola.

      Bernatsky, S; Souza, R; de Jong, K; McGill University, Montreal, Quebec, Canada. sasha.bernatsky@mail.mcgill.ca (Taylor & Francis, 2007-05)
      Our objective was to assess the mental health status of pregnant women who are HIV-positive, compared with other groups of pregnant women. We evaluated pregnant HIV-positive women attending the Medecins Sans Frontiers (MSF) HIV clinic in Malanje, Angola (N = 23). The control group consisted of pregnant women coming for antenatal clinic consultations who were not known to be HIV-positive (N=134). To assess mental health, the 12-item General Health Questionnaire (GHQ-12) was used. A score of three or greater was considered to indicate significant emotional distress. We also examined determinants of emotional distress in logistic multivariate regression models. We found that the mean score on the GHQ-12 for the HIV-positive group was more than twice the mean score of the controls, indicating poorer mental health in the HIV-positive group. Two-thirds of HIV-positive women had significant emotional distress, more than twice that in the control group. As well as HIV status, marital status was a strong independent predictor of mental health status, with married women experiencing less emotional distress. Thus, in our sample, pregnant women who were HIV-positive had a much poorer mental health status than the controls. Strategies to improve the mental health of HIV-positive mothers must be implemented and evaluated; efforts to decrease the levels of stigma and discrimination in this population are of key importance.
    • Mental Health Problems Among Conflict-Affected Adults in Grozny, Chechnya: a Qualitative Study

      Nguyen, AJ; Feo, C; Idrisov, K; Pintaldi, G; Lenglet, A; Tsatsaeva, Z; Bolton, P; Bass, J (BioMed Central, 2016-08-03)
      A decade of conflict in Chechnya destroyed infrastructure and resulted in widespread exposure to violence. Amidst substantial reconstruction, periodic violence has contributed to an ongoing atmosphere of insecurity. We conducted a qualitative study to understand the mental health and psychosocial problems affecting adult Chechens in this context to inform development of assessment tools for an evaluation study related to individual counseling.
    • Mental health services for children exposed to armed conflict: Médecins Sans Frontières' experience in the Democratic Republic of Congo, Iraq and the occupied Palestinian territory

      Lokuge, K; Shah, T; Pintaldi, G; Thurber, K; Martínez-Viciana, C; Cristobal, M; Palacios, L; Dear, K; Banks, E; The Australian National University, Canberra, ACT, 0200, Australia (W.S. Maney & Son Ltd, 2013)
      Armed conflict has broad-ranging impacts on the mental health and wellbeing of children and adolescents. Mental health needs greatly exceed service provision in conflict settings, particularly for these age groups. The provision and targeting of appropriate services requires better understanding of the characteristics and requirements of children and adolescents exposed to armed conflict.
    • Mental Health Status of Vulnerable Tsunami-Affected Communities: A Survey in Aceh Province, Indonesia.

      Souza, R; Bernatsky, S; Reyes, R; de Jong, K; Medecins Sans Frontieres-Holland, Amsterdam, The Netherlands. (2007-06)
      The authors determined the prevalence of severe emotional distress and depressive symptoms using the Hopkins Symptoms Checklist-25 (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) in tsunami-affected communities that had experienced armed conflict arising from the ongoing independence movement in Aceh Province, Indonesia. We also evaluated determinants of severe emotional distress. The data were collected for the purposes of a mental health assessment. In our sample (N = 262), 83.6% demonstrated severe emotional distress, and 77.1% demonstrated depressive symptoms. In multivariate regression models, severe emotional distress was positively associated with the number of tsunami-related deaths among household members. Our data suggests a need for effective interventions in this vulnerable population.
    • Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur

      Souza, R; Yasuda, S; Cristofani, S; Médecins Sans Frontières, Geneva, Switzerland; UNIFESP. Federal University of Sao Paulo, Sao Paulo, Brazil (2009-07-21)
      BACKGROUND: There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. METHODS: A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. RESULTS: Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. CONCLUSION: The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.
    • Mental Illness Is Not a State of Mind

      Balinska, M (BMJ Publishing Group, 2016-10-05)
    • Monitoring and Evaluating Psychosocial Intervention Outcomes in Humanitarian Aid

      de Jong, K; Ariti, C; van der Kam, S; Mooren, T; Shanks, L; Pintaldi, G; Kleber, R (Public Library of Science, 2016-06-17)
      Existing tools for evaluating psychosocial interventions (un-validated self-reporting questionnaires) are not ideal for use in non-Western conflict settings. We implement a generic method of treatment evaluation, using client and counsellor feedback, in 18 projects in non-Western humanitarian settings. We discuss our findings from the perspective of validity and suggestions for future research. A retrospective analysis is executed using data gathered from psychosocial projects. Clients (n = 7,058) complete two (complaints and functioning) rating scales each session and counsellors rate the client's status at exit. The client-completed pre- and post-intervention rating scales show substantial changes. Counsellor evaluation of the clients' status shows a similar trend in improvement. All three multivariable models for each separate scale have similar associations between the scales and the investigated variables despite different cultural settings. The validity is good. Limitations are: ratings give only a general impression and clinical risk factors are not measured. Potential ceiling effects may influence change of scales. The intra and inter-rater reliability of the counsellors' rating is not assessed. The focus on client and counsellor perspectives to evaluate treatment outcome seems a strong alternative for evaluation instruments frequently used in psychosocial programming. The session client rated scales helps client and counsellor to set mutual treatment objectives and reduce drop-out risk. Further research should test the scales against a cross-cultural valid gold standard to obtain insight into their clinical relevance.
    • Neglected tests for neglected patients.

      Usdin, M; Guillerm, M; Chirac, P; MSF Campaign for Access to Essential Medicines, 4 rue St Sabin, 75011 Paris, France. (2006-05-18)