Ladies and Gentlemen,
The hope that the end of the cold war also would
reduce the risk of actual war around the globe has been cruelly
shattered by the events of the last decade. Not only have new and
brutal conflicts cropped up, on almost all continents, including in
our own neighbourhood in Europe, these conflicts have systematically
targeted civilians in a way not seen since the most vicious episodes
of the Second World War.
Ethnic cleansing, systematic massacres and
maimings, organized mass rape and concentration-camp style
incarceration of innocent civilians have all become part of the
fighting-tactic repertoire of modern day warlords. For civilians,
armed conflicts have become events of limitless horror. They are no
longer accidental victims. They are often the main targets of
aggression. There are no sanctuaries.
Displacement and exile are in themselves causes of
stress and trauma. The survivors of today’s conflicts carry, in
addition, the burden of terror of sexual abuse and often of having
lost close relatives and friends – sometimes even having watched
their execution. Considered one by one, these are experiences that
need much attention and care for those affected, if they are to have
the possibility of surviving. But we are not talking about isolated
cases here. We are talking about tens of thousands, hundreds of
thousands – and, in instances such as in Rwanda, millions of cases.
Add to this the severe limitations of extreme
poverty in many parts of the world, and the fact that more than half
of the 50 million refugees and displaced people in today’s world do
not even receive basic assistance or protection – and we are all
humbled by the task facing us.
And yet I remain optimistic. For rarely have we
seen such willingness to work with and for people in complex
emergencies. The number of humanitarian groups has grown, and people
are increasingly willing to help: to give their time, and - as we so
tragically have seen, sometimes their lives – in an effort to
alleviate suffering and safeguard peace.
Our accumulated experience and knowledge has grown
over the past decade. We know more about what needs to be done – and
what must be avoided. You who sit here today are the guardians of this
accumulated knowledge. Your task is to make sure that the knowledge we
together possess can be operationalized for use by the thousands of
emergency field workers, by governments and the national leaders whose
day-to-day decisions can mean recovery or continued disaster for
millions of people in camps, shelters and centres world wide.
Of today’s 50 million refugees or displaced, some
5 million represent the chronically mentally ill. They were either ill
prior to the war or they were seriously traumatised as a consequence
of the war; they would need specialized care if it were available.
Another 5 million people suffer from psychosocial dysfunctioning
affecting their day to day lives and that of their community.
To address the mental health needs of such large
populations, we need definite strategies and plans Ad hoc arrangements
and improvisations in response to each emergency will no longer be
acceptable. Specific management ability, strong field experience and
evidence based approaches are required.
Given the magnitude of the problem, the limited
funding, the fact that the majority of the refugees’ reactions are
the expected reactions to an extraordinarily abnormal situation,
individual psychiatric care has a limited impact and is not realistic.
strongly recommends the establishment of community-based mental health
care from emergency through reconstruction. Earliest integration of
mental health within the public health care system available in camps
and national services is the most efficient, and cost-effective
strategy. The concerned communities must be mobilized and actively
involved to decrease psychiatric morbidity and increase
Projects must be holistic, seek multisectoral
cooperation, be sensitive to gender, culture and context; they have to
take into account the aggravated poverty, the deepened dependency of
people and the feeling of loss of dignity due to the ongoing human
rights violations. Ethics, and financial equity - locally and
internationally - should be inextricably linked to every action.
There are already examples of good cooperation
between international agencies and institutions. One such example is
the collaboration which led to the creation of the Rapid Assessment
WHO did the first literature review and prepared
the outline, based on its own field experience in many humanitarian
emergencies and its own understanding, of the needs, constraints and
potential benefits of a tool used by as many as possible in
The Disaster Mental Health Institute of the
University of South Dakota with its academic strength and concrete
experience in crisis management undertook a thorough literature review
and prepared the second draft of the tool.
The International Federation of Red Cross and Red
Crescent Societies provided input at all stages. It brought in the
knowledge and experience gained in this field through its own work.
Many others made important contributions: some are here today. The
team worked as one and with one goal. The best came out of each
partner. A very useful and enriched product is today in our hands.
Global norms and standards are not useful if they
are not evidence-based, and evidence is in countries, in the field.
This is even more true in emergencies. Policy guidelines, norms,
standards and tools proposed in these situations should be based on
programmatic field work and experience so that countries, agencies and
others who are expected to use them find that they are adequate,
specific to the situation and feasible. The development of the three
instruments presented at this Consultation are special efforts towards
One of these documents is the Declaration of
Cooperation in Mental Health of Refugees, Displaced, and Other
Populations Affected by Conflict and Post-Conflict Situations. We are
proposing this document as a contribution towards obtaining
international consensus in policy, strategy and programmes, and as the
guiding principle for our efforts in this field. With the endorsement
of the Declaration during the Consultation, we should define the next
steps for its wider adoption.
This Consultation is an important step forward in a
long-term process. We expect that a technical meeting will be
organized in 2003 to assess the results of further testing of the
instruments presented in this meeting, and to prepare the new ones for
I believe that the lessons learned, and experience
coupled with commitment will enable us all to play an early and
constructive role in alleviating the suffering of millions of people.
It is our moral and professional obligation to provide the resources,
to preserve mental health, restore dignity, and create hope and
self-confidence for fellow human-beings.