March 28, 2018
Dilshad Jaff, MD, is the program coordinator for solutions to complex emergencies in the Office of Research, Innovation and Global Solutions at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. He also is an adjunct assistant professor in the School’s Department of Maternal and Child Health – and a Baghdad-trained physician with extensive experience in international conflict zones.
On March 27, the journal Medicine, Conflict and Survival published a commentary written by Jaff with the title, “Mental health needs in forcibly displaced populations: critical reflections.”
In the essay, Jaff responds to Trauma and Mental Health in Forcibly Displaced Populations, a briefing document at the core of a recent global initiative led by the International Society for Traumatic Stress Studies (ISTSS). The initiative aims to help mitigate mental health trauma among members of displaced populations, and the briefing document offers an overview for key stakeholders on the mental health impacts – such as post-traumatic stress disorder – that often are part of the refugee experience.
“The effort behind this document is laudable,” Jaff wrote, “for acknowledging the challenges facing these highly vulnerable populations. In the spirit of constructive critique, however, I would make two observations.”
He goes on to clarify the five distinct groups that make up forcibly displaced populations. While the ISTSS authors focus primarily on refugees and asylum seekers, the ~22.5 million people who fall into those categories make up only one-third of the estimated total number of displaced people around the globe. Three other distinct groups include internally displaced peoples (more than 40 million), stateless people (about 10 million) and returnees (about 7 million).
“These unacknowledged categories may have different needs, and this omission may undermine efforts to address mental health among all forcibly displaced populations,” Jaff explained in his commentary. “For example, long-term internally displaced populations who have moved as a community, but remain in resource poor environments, are likely to face different challenges than asylum seekers who struggle with the uncertainties of their legal status. Returnees, on the other hand, come home to complex issues like widespread damage to infrastructure, the presence of land mines, and the lack of basic services and security.”
Jaff also highlighted a missed opportunity in the fact that all ten authors of the briefing document are from developed countries, when it is developing countries that currently host 84 percent of the world’s refugees. Given that the ISTSS document advocates for the importance of local collaboration and working with local service providers, policymakers and academics, Jaff questions why representatives of these groups were not engaged in the development of guidelines and recommendations so pertinent to their work.
“Professionals and community leaders from even the most violent regions continue to be engaged in efforts to assist displaced populations, and their contributions would likely enhance both the understanding of these challenges and related implementation strategies,” Jaff wrote. “Academics and professionals of affected countries are well-placed to advise on best practices regarding the provision of services with available resources, the integration of mental health care within existing government services, and cultural considerations that might increase uptake of mental health services among local populations.”
“Put simply,” he continued, “the key to effective interventions and their implementation is to involve a wide range of local and global expertise. While it is always useful to raise the visibility of unmet mental health needs – and while the world is obliged to address this massive refugee problem – careful consideration of how strategies are formulated is always welcome.”