In late September 2023, an explosion at a fuel depot in the Karabakh region killed and maimed several hundred refugees. WHO’s Country Office in Armenia immediately recognized the extreme mental health toll on the refugee community that would result from a mass burn casualty – a crisis in which large numbers of people undergo burns trauma – and convened with its partner nongovernmental organization, the Armenia Psychiatrics Association (ArPA), for support. Within a day, a group of volunteer professional psychiatrists and psychologists arrived on scene, aiding traumatized survivors, their families and the overwhelmed medical teams charged with their care. A year later, with funding for the programme now exhausted, many ArPA responders continue to volunteer their time to support survivors and refugees.
The ArPA is one of hundreds of NGOs in the WHO European Region that partner with WHO to provide specialized, direct assistance in ongoing priority situations, and to respond urgently in crises. These NGOs provide a reliable network of experts at country, regional and global levels that help WHO/Europe meet the public health goals for the Region.
“When we were approached to devise a solution to meet the mental health needs resulting from this tragedy, I knew immediately that I could rely on our partner NGO, the ArPA, to rush experienced, dedicated professionals onto the scene. This kind of a relationship gives us the peace of mind that important work will be handled rapidly, thoughtfully and with care. This is the type of partnership the Country Office and WHO/Europe will continue to prioritize and support for the betterment of our communities and Region,” said Mareitta Khurshudyan, clinical psychologist and Technical Expert in mental health and psychosocial support (MHPSS) with the WHO Country Office in Armenia.
Long-term support is crucial
Teams of psychologists, coordinated by WHO and ArPA, were engaged in hospitals at all levels in the aftermath of the explosion. They offered immediate and continuous MHPSS to affected groups, including those in high-trauma situations with severe burns. The WHO Country Office in Armenia, along with the Ministry of Health for Armenia, were able to procure temporary funding to support the volunteers, which continued for 9 months. It included free in-person care at hospitals and continued with MHPSS mobile teams providing pivotal support to displaced and vulnerable populations. During their 9 months of involvement, the teams provided psychosocial support to 1350 survivors, 484 family members and 300 health-care workers. Additionally, the teams gave psychiatric support to 120 burns survivors.
Early and consistent psychosocial support minimized severe mental health problems for traumatized individuals. There are no known cases of ongoing major depressive disorder or post-traumatic stress disorder among those who received psychosocial support from the ArPA. However, chronic stress, anxiety, depression and assimilation are enduring issues requiring ongoing intervention.
Severe burns to the faces and hands of survivors, resulting in visible disfigurement, can lead to significant emotional distress and social stigma, impacting individuals’ confidence and hindering their ability to engage in social interactions, work and community activities. Continued access to MHPSS significantly helps survivors overcome these new struggles as they question how they can fit into society and what will happen to them.
“One year ago, burns survivors were in worse physical condition and needed immediate emotional support. Their physical conditions didn’t let them feel the emotional intensity or the long-term consequences of the situation yet. Now that the physical condition of most survivors has improved, we need to concentrate on helping them build a better picture of their future. Today, many of them feel depressed and struggle in adjusting to their new physical appearance. It’s impossible to imagine what they went through, but being a source of hope for them is important,” explained Naira Azatyan, Clinical Psychologist at Yerevan State Medical University’s (YSMU) Department of Medical Psychology.
‘Nobody is hopeless’
The teams from the ArPA included professionals who themselves were recent refugees. Gohar Gyuriyan is a social worker and recent refugee who joined the WHO-supported MHPSS mobile team. She is an important link to other refugees navigating the challenges of displacement.
“Because I am one of them, because I come from the same place as them, this helps improve my ability to communicate with them,” said Gohar. “They see that I am in the same situation as they are and, together, we try to find a way to move forward. With a little help from the outside, everybody here can move on, ready to work to start creating and improving their lives. Nobody is hopeless.”
Trained psychologists from the ArPA continue to serve as a safe harbour and support system for many refugees needing continued care. 9 months on from the explosion, WHO continued to support refugees with mobile MHPSS teams, free of charge for affected people and the host population. With funding for MHPSS at an end, there are no affordable options. Members of the response teams who built a sense of responsibility for the burns survivors and their families continue to offer their guidance and expertise, as volunteers.
“We have continued contact with [the burns survivors]. We call to check in and see how they are and they turn to us if they need anything. It is our duty to do it. They have gone through so much, and any of us could have gone through this. We have to do whatever we can,” said Ani Yeghiazarayan, Clinical Psychologist at YSMU’s Department of Medical Psychology.
Preparing for the future
Doctors, nurses and rehabilitation therapists, many of whom were refugees themselves, benefited from MHPSS as they struggled to keep up with the large number of burns patients. Perceptions have changed from scepticism about the need for mental health support to requesting ongoing training in MHPSS to manage future emergencies.
A year after the acute need for these support services arose in a country where such needs are often stigmatizing, ongoing support has now been requested by hospitals throughout Armenia for doctors, nurses and physical therapists. Building the basic mental health and psychosocial support skills of health-care providers is fundamental in emergencies, to help bolster the mental and emotional well-being of those affected by trauma, stress and crises, while also addressing their physical health needs.
“Since our work addressing capacity-building began, the stigma about mental health has decreased. It’s slow progress and stigma still exists, but we are making strides and allies. By including health-care professionals in our training, they understand the value and are starting to collaborate with us,” explained Armen Soghoyan, President of the ArPA.
Increased funding and general support for MHPSS for survivors of emergencies, refugees and the host communities welcoming them will be a powerful step forward for Armenia and the Region. Strengthening mental health care strengthens and prepares whole communities to face future emergencies.