Innovation summary

The prolonged crisis in Syrian has heavily affected the psychological well-being of the population. The vast majority of population are suffering from stress whether from trauma, loss or realistic fear. WHO estimates that 1 in 30 Syrians is suffering from a severe mental health condition such as severe depression, psychosis, or a disabling form of anxiety and that at least 1 in 5 Syrians is suffering from a mild to moderate mental health condition such as mild to moderate depression or an anxiety disorders1. 

The first community center started in Aleppo in 2016, with the aim at the provision of mental health and reproductive health services for survivors of gender based violence (GBV) and people suffering from trauma-related distress. Through time, project implementation, lessons learnt and long chain of discussion with partners, the project concepts developed to suit the current needs and situations in 2019, focusing on returnees side by side with IDPs and their hosting community, in addition to strengthening the linkage between mental health and other health areas (public health and beyond).

Impact summary

In 2019, approximately 89,507 MHPSS services were provided through family well-being centres, MHPSS mobile teams, and other integrated emergency response teams

“ The value of making a slight difference in someone's life, couldn’t be explained enough by words. It is a learning experience for both sides, as well as being an existential maturity with a lasting impact over time and place.”

- Lubna, Trainer and supervisor at WHO Syria office since 2014

“I had never thank anyone in my entire life, cause [because] I have always believed that no one do[es] a favour or good things in these hard days, but now I feel that you have a pure heart who helps everyone, so thank you from the bottom of my heart.”

- A woman who is a widow and mother of two children killed in the war

“For me as a psychosocial counselor in the mobile team I have learned during my work patience and dealing with all people. I have learned that the smile and the good words and the real empathy can make the people love you and they are the best thing you can do to them. I have learned to feel in the way the people feel , and to found the strength in the poorest things that we have. My work in human field change my life and change my way of thinking, and I start to achieve the self- realization, and find a lot of abilities that I have, and it make me believe that success [is] not necessarily a great achievement, it can be an honest smile from a wounded person or a hope in the eyes of a disabled child and a simple thanks from a person who was seek to help and human sympathy.”

-Iman Zouhri, psychosocial counselor wrote

Innovation details

The conflict situation affecting the Syrian population has over time become a continuous process of multiple exposure to trauma, displacements and has disrupted the environment for psycho-social well-being. Many children and adolescents exhibit symptoms of mental distress, 20% of children and adolescents suffer from disabling mental illness, 1 out of 10 need professional help2. In addition, approximately 50% of all neuro-psychiatric disorders in adults have an onset before the age of 14, while the access to mental health services remains scarce2. Therefore, there is a huge need to provide services for general population, Internally Displaced Persons (IDPs) and the returnees.

The goal of the current project is to enhance MHPSS services at community level through family well-being centers established at the heart of the community and where MHPSS services are most needed.

Family wellbeing centers structure:

The project consists of two main categories:

  1. The family wellbeing center that hosts the family friendly space
  2. The mobile teams tailored according to the partner's capacity and the prior assessed needs of the hosting community

Family Friendly space

It lies at the heart of the family well-being center, with the aim to provide MHPSS service to the whole family as a unit instead of focusing on one individual and to strengthen the resilience in the whole family.

The "Family-focused-approach" is situated within the community centers run by the NGOs that WHO is supporting. It aims to contextualize the delivery of fully integrated services where MHPSS is not a stand-alone programme operating outside other emergency responses according to IASC 2007 guidelines. Family counselling in emergency settings, and family communication techniques, are conducted for the project’s committed workers consistently with the emerging of the supportive supervision. Services include:

  • MHPSS for people with mental health and psychosocial conditions as well as victims of domestic violence and GBV survivors at the community level through evidence-based interventions and best practice in the field of MHPSS
  • Vocational activities designed to reduce psychological distress and encourage well-being. These services are linked between mental health and other components, with capacity to integrate into general health training. With an additional vocational capacity building component, the project aims to support the next stages of health services extension by investing in and strengthening the necessary human resources throughout project timeline.
  • General health services, including family consultations, psychiatric assessments and strengthening the linkage between public health and mental health services by mhGAP-trained doctors

Key drivers

  • The approach of WHO’s office in Syria focused on community strengthening and engagement through partnership with NGOs in health projects. This facilitated the success of the MHPSS services integration into the health project through establishing family centres.
  • The role of donors played an imperative role in establishing and sustaining the services provided in the centres
  • A benefit for the family well-being centers is that they are part of the referral pathways in the health system through various MHPSS partners in addition to being part of the preparedness and response plan to the emergencies across the country

Challenges

  • Long wait for approvals from the local authorities
  • Sustainable funding has remained one of the main obstacles in sustaining the services provided in the centres
  • Challenges in accessibility for mobile teams in new catchment areas
  • It was not easy to collect and analyse the data of mhGAP trained doctors in the family centers as this was a new role for the doctors in the MHPSS system

Continuation

The engagement of key NGOs in the health sector that provide integrated health services secures sustainability to the family well-being centers, given the effective communication and trust channels that these NGOs would have built. This enables the NGOs to continue the service delivery with WHO technical support and coordination.

The success of pilot family well-being centers encourages application in newly accessible areas which host a considerable number of IDPs and targets for returnees in addition to the already exhausted host communities. Within its comprehensive structure, family well-being centers will be of a persistent need that it met through the WHO and NGO partnership.

Partners

Main partners are NGOs working actively in health and mental health domain, to name few:

  • HAMA: Society Care and Kindness Act Association
  • Lattakia: Syrian Association for Children with Special Needs
  • Al-Hassakeh : NES
  • Al-Hol camp: Archbishopric of Syria Catholic Center Mar Assia and Al-Yamama
  • Dez: Syrian Pulse NGO
  • Aleppo : Syrian society for social development, GOPA and ASSLs

Funders

  • Norwegian Agency for Development Cooperation (NORAD)
  • Department for International Development (DFID), United Kingdom
  • European Commission
  • European Civil Protection and Humanitarian Aid Operations – ECHO
  • United States Agency for International Development (USAID)

Evaluation methods

Monitoring and evaluation on the technical level happened through the MHPSS M&E global frame work:

  • Supervisory field visits were conducted by MH experts that trained and supervised community workers, NGOs team across the country and WHO officers.
  • Main indicator monitored were the number of services provided at NGOs level, through the family well-being centres and the mobile teams.

On the project level:

  • A monthly 4W's was provided from each NGO to World Customs Organization NGO unit with detailed information about each activity in family center, with the support of health information systems and focal points across the country.
  • All detailed information was gathered and reflected on mental health KPIs which are WHO’s key performance indicators per programs on a monthly, quarterly and annual basis at different levels and location across Syria i.e. North-east Syria; North-west Syria; Southern Syria.

Cost of implementation

  • Supporting the first time establishment of the family well-being centres including operational costs for 6 months ranges from USD$70,000-100,000.
  • The cost of supporting NGO’s through only operational costs for 6 months ranges from USD $60,000-75,000.
  • Capacity building activities with supporting supervision is always taken from the MH programme fund as well as through multiple resources.

Impact details

In 2019, approximately 89,507 MHPSS services were provided through family well-being centres, MHPSS mobile teams, and other integrated emergency response teams. These included:

  • 55,477 MHPSS group sessions
  • 9,069 MHPSS individual sessions
  • 21,816 mental health awareness raising sessions
  • 985 vocational training sessions
  • 815 psychosocial support services for family units
  • 252 sessions of low intensity psychological interventions and/or First Aid
  • 175 specialised mental health consultations
  • 615 recreational activities for well-being

References

  1. World Health Organization, Eastern Mediterranean Region Office (2016) Mental Health in Emergencies [Link]
  2. Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD. Global burden of disease in young people aged 10–24 years: a systematic analysis. The Lancet. 2011 Jun 18;377(9783):2093-102

Tools

Multimedia

Reports

Associates

Nabil Samarji Principal Investigator
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Country

Syrian Arab Republic

Affiliated organizations

World Health Organization

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