“An emergency makes you forget everything you were taught about how health care is delivered,” says Rut Erdelyiova, a mental health and psychosocial support (MHPSS) consultant working in Slovakia. “It's no longer that sterile environment where you know what you need to deliver. It’s about going out there to meet people who just experienced something that completely reshaped their realities, trying to understand how they’re feeling and what we can do for them in that situation.”
Rut is one of a small but driven team of WHO/Europe experts who have devoted most of their waking hours since the start of the war in Ukraine to coordinating MHPSS activities, which are critical for alleviating suffering and preventing long-term impacts on mental health, such as post-traumatic stress disorder.
“We work naturally with so many sectors, especially child protection, gender-based violence, and health,” says Selma Sevkli, a psychologist deployed to Poland within days of the war. “We also focus on awareness-raising, education and advocacy for these sectors, helping them understand that mental health is not just psychological counseling, but also helping people meet their basic needs.”
WHO/Europe has deployed many such experts across countries receiving large numbers of refugees from Ukraine to coordinate MHPSS services, working with host governments, humanitarian agencies, and especially refugees themselves.
Their tireless efforts have helped many refugees get the services they need.
Why they do what they do
WHO/Europe’s MHPSS experts are a mixture of psychiatrists, psychologists, and humanitarian workers, some of whom have experienced past emergencies.
“I actually started in the early 1990s during the war [in the former Yugoslavia],” says Boris Budošan, who supports Czechia. “I was a regular doctor, I never planned to do it, but it was meant to be. I'm still carrying on because after all this time, I feel a responsibility to share my knowledge and experience.”
Joanna Brzezinska, who supports Poland, volunteered as a psychologist when the war started, but found she needed to help on a much bigger scale. “I realized I am impatient, I cannot just focus on providing counseling for individuals when the emergency is systemic.”
“It becomes like an urge,” says Selma, who entered the field after surviving an earthquake in Türkiye when she was just 18 years-old. “What keeps motivating me? When I see the impact. Like when last year the ministries of health of Ukraine and Poland collaborated to ensure access to psychotropic medication for refugees who need it.”
Sorana Mocanu, a psychotherapist in Romania, needs that connection to the people she is supporting. “I try to stay in contact with our integrated clinics,” she says. “That’s where you can have a reality check. It's not about all the people you have in your spreadsheet – it's about how this boy can now go to a psychologist and his mother can stop crying and have a moment for herself.”
The same is true for Murat Apaydin, one of the team’s coordinators.
“I enjoy working in MHPSS because each person has their own story and strengths and vulnerabilities, and they are full of interesting ideas,” Murat says. “Meeting all these new people motivates me in my work.”
Looking after themselves
Still, the emotional and physical toll of the Ukraine refugee crisis has been steep for the team.
“This was the first time I understood,” says Rut. “What it is like when you hold the hand of somebody who just learned she lost a loved one, to talk to a mother who knows she will not see her oldest son again.”
This makes self-care fundamental. Maura Reap, a psychologist who supports Moldova, uses her free time to make art. “In the short hours I have between sleep and work, I like to do art. I'm not really talented, but I like to do it because it helps me to release the stress of the day.”
This love of art carries over to her work – in January, she partnered with the International Organization for Migration to train psychologists and frontline health workers on how to use art to help refugees express themselves.
For Andrea Paiaito, who supports Bulgaria, managing stress is about looking at the bigger picture. “When humanitarians are able to understand and make peace with their own limits, a lot of the stress is taken off their shoulders.” He admits that it has taken him years to learn this himself.
Olga Khan, who supports Poland alongside Joanna, notes that even if you know how to take care of yourself, it can be difficult to do so, especially when humanitarian work culture often values overwork. “Nobody cares about your burnout – the response is first, everything else comes second.”
This makes her grateful for the presence of her colleague Joanna. “I’m 200% happy that she’s here with me.”
What makes for a good MHPSS expert?
“You have to be genuine,” says Boris. “You have to be what you are. If you pretend, people will immediately notice.”
Andrea elaborates, “A certain degree of likeability, public diplomacy or leadership is required, in addition to being an MHPSS expert.” Indeed, a key element of MHPSS work is engaging affected communities, such as in planning and getting access to services they need.
“Being able to listen, having a true interest in what other people are saying – that's really fundamental,” says Maura. “If we don’t have that capacity to listen... You can read all the books in the world, but if you’re not listening, you won’t be effective.”
Murat also thinks that organizational skills are important. “I'm connected with 8 or 9 countries, sometimes on a daily basis, and I'm hearing so many updates about ministries, NGOs, the people themselves. So, a lot of information is coming to me every day that has to be handled.”
For Joanna and Olga, it boils down to empathy, communication, and keeping things in perspective. “There are plenty of experts in psychology and mental health,” says Joanna. “But not everybody has the vision and strategic insight.”
Future of MHPSS in refugee-receiving countries
WHO/Europe’s coordination of this group of experts enabled the real-time exchange of essential information and mutual support and learning. They are now sharing their experiences on a wider scale, including at a high-level consultation in Bratislava, Slovakia on 18–19 April 2023.
Now that the acute phase of the emergency is over, the team’s efforts are turning to strengthening existing mental health support in refugee-receiving countries.