Innovation summary

As a result of the protracted Arab-Israeli crises affecting the region, Lebanon has overtime experienced an influx of Palestinian refugees displaced within the region due to it's geographical proximity to the conflict. Humanitarian conflicts within the region have displaced millions; in 2015, the refugee population of Lebanon alone represented 30% of the total population1. Individuals with refugee status often have trouble accessing health care within camps due to an already overburdened healthcare system and complex political tensions within the country2.

This Mental Health and Psychosocial Services (MHPSS) programme addresses a critical gap in services for both Palestinian Refugees from Lebanon (PRL) and Palestinian Refugees from Syria (PRS) in Lebanon, through the delivery of non-specialized mental health services by doctors, nurses and midwives, supported by a network of psychologists and psychiatrists, at 27 PHC centers. The intervention involves training, technical support/supervision sessions, community engagement and awareness, psychosocial and psychotropic treatments options and peer support groups for all involved staff. 

  1. A stepped-care intervention model providing varying levels of care: starting from self-care and community sensitization, to screening, psychosocial services assessment and intervention by PHC workers, mhGAP assessment and intervention by PHC workers, specialists’ assessment and intervention, and referrals to other UNRWA departments or external actors.   
  2. Collaborative referral system on MHPSS outlining roles, procedures and tools, and connecting health workers to other staff in the agency and to external actors, including the development of a Mapping of external partners with services open to Palestinian refugees.
  3. Development of an MHPSS filing and documentation system, which will form the basis for integration of MHPSS data into the agency-wide e-Health Information System.
  4. Adoption of regular peer support groups for all staff involved in the MHPSS programme.

Impact summary

  • Successful integration of MHPSS services within 27 primary health care centers in Lebanon over the last 2 years
  • A total of 4,094 patients at PHC centers provided mental health screening
    • 275 patients provided MHPSS support
    • 82.8% of all files closed (40.3% of total) were due to symptom improvement

“Mental health and psychosocial interventions are essential to addressing the mental and emotional wellbeing of Palestine refugees in Lebanon. We are keen to ensure the provision of comprehensive health care services at our PHC centers, with MHPSS services as an integral component. This work responds to the needs of our beneficiaries, strengthens resiliency, supports community mental health awareness and provides tools for positive coping.”

  • Dr Abed Al Hakim Chanaa, Chief Field Health Programme, UNRWA Lebanon

Innovation details

In Lebanon, Palestine refugees face restricted access to state-provided services such as health, education and social services. The challenging conditions for Palestine refugees in Lebanon (PRL) have further deteriorated with the influx of Palestinian refugees from Syria (PRS) after the Syrian crisis into the already overcrowded camps in Lebanon. In Lebanon, refugees from Palestine face restricted access to state-provided services such as health, education and social services. A vulnerability targeting exercise conducted by UNRWA in 2016 found that the 89% of PRS in Lebanon are living in poverty, including 9% living in extreme poverty, unable to meet their basic needs including health care. Additionally, violence and abuse against girls and boys in the home, communities and schools are recognized as the main protection concerns affecting PRS and PRL.

MHPSS is a key priority for service provision in the Palestine refugee context in Lebanon. A 2015, a survey on the Socioeconomic Status of Palestine Refugees in Lebanon reveals that self-reported poor mental health and psychosocial wellbeing reached 51.3% for PRL3. Respondents with poor wellbeing were more likely to report feeling worried about not being able to provide for their families, losing their source of income, and fearing for the safety of their families. Moreover, an assessment mission in 2014 showed that exposure to situations which exacerbate psychological distress, including recurring violence, insecurity, and restricted possibilities of employment, travel and free movement, is high, with 86% of PRL and 88% of PRS reporting moderate or high exposure to severe stressors, whether as one-off events or more commonly, as chronic conditions4. The mission noted that depression, anxiety and hopelessness are common among Palestine refugees. These conditions disrupt social networks and negatively impact quality of life and the potential for self-empowerment. The limited MHPSS services available to Palestine refugees in Lebanon exacerbates the problem, with services being geographically distant or costly, in addition to the community shame and reluctance to seek out these services.

In response to the MHPSS needs of Palestine refugees in all UNRWA’s fields of operation as well as the limited opportunities for Palestine refugees to access mental health services, UNRWA launched an Agency-wide MHPSS Framework, and developed Health Department Technical Instructions on MHPSS in 2017. Following an internal situational analysis of sample health centers (based on the WHO/UNHCR Assessment Toolkit), UNRWA Lebanon began training multi-disciplinary staff on MHPSS in 2013 supported by various funding sources, and later initiated a full systematic integration of MHPSS services within its PHC centers starting December 2017. The integration was gradual, with 2-4 PHC centers being included into the programme every quarter. To date, all 27 health centers are providing MHPSS services through trained doctors, nurses, midwives, as well as contracted mental health specialists on a part-time basis. To support this work, UNRWA Lebanon has developed filing, documentation & monitoring tools for mental health that are being applied at all health centers in the meantime, until the full absorption of this MHPSS reporting system under the agency’s general e-health system (UNRWA’s Heath Information System). 

The ongoing implementation of the MHPSS programme at UNRWA health centers includes the following components:

  1. Training and supervision of PHC staff based on: PAIR PSS approach (prevention, assessment, intervention and referral); & WHO’s MHGAP approach (4 selected modules from mhGAP)
  2. Community engagement through awareness sessions on MHPSS
  3. Regular peer support groups implemented in each health center, including both an emotional support component as well as a case discussion component
  4. Ensure supply of psychotropic medications at the health centers, in line with the WHO’s essential medicine list
  5. Coordination and joint work with UNRWA’s Education, Relief and Social Services, and Protection Units (including on child protection and GBV)
  6. Coordination with the National MHPSS Taskforce (MOPH/WHO) as well as organizations providing MHPSS services

Key drivers

Successful engagement and participation by key actors

  • Support of the Chief of Health Department and UNRWA HQ, as well as recent increased focus on MHPSS within the agency, including the finalization of an agency-wide MHPSS Framework
  • Participatory and collaborative approach between management and frontline staff created sense of ownership and commitment to the programme
  • Strong joint work between the Health Department and Protection Unit on cross-cutting issues, as well as coordination with other UNRWA departments, and external actors

Successful advocacy efforts

  • Advocacy to have on-board a number of mental health specialists to support the development of technical capacities and skills of trained PHC staff
  • Advocacy to have on-board coordinators for MHPSS to oversee the implementation process, monitor the quality and follow-up on emerging challenges
  • Pooling of multiple funding resources towards a unified and coherent MHPSS vision and programme 
  • Building on previous accomplishment and MHPSS work within UNRWA 


Logistical difficulties

  • Difficulties to secure privacy settings in a considerable number of PHCs

Sustainable human resources

  • High workload of PHC staff (average 110 consultations/doctor/day)
  • Turn-over of staff (due to relocation, retirement) and the presence of many ‘daily paid’ staff at several health centers contribute to interruptions of workflow and challenges to sustainability
  • Mental Health specialists and project coordinators are on project contracts, challenges to sustainability for longer-term planning


  • Community stigma towards mental health issues and reluctance to seek services for some beneficiaries


The first phase of the intervention involved the integration of basic MHPSS services into UNRWA PHC centers, focusing on psychosocial support interventions, as well as 4 selected mhGAP modules (depression, epilepsy, stress-related disorders and OTH). Next steps include consolidation of knowledge and skills, as well as building on achievements through continued follow-up and technical support, and expanding staff competencies and skills to other mhGAP modules (starting with suicide/self-harm followed by child and adolescent mental health problems). In addition, this project is connected with other PSS initiatives taking place within our Education, Protection and Relief and Social Services departments, mostly in relation to referrals and cross-departmental collaborations. 

Evaluation methods

The following tools were utilised to monitor the programme's progress:

  • MHPSS PHC center and MHPSS programme registry
  • Filing tools (GHQ-12 screening tool, general MHPSS assessment form, referral forms)
  • MH Specialist monthly reports
  • E-health HIS system (psychotropic medications)
  • Peer support group reports  

Evaluation methods utilized included the following:

  • Client satisfaction surveys
  • FGDs (planned for early 2020)
  • Training pre-post tests
  • Training evaluation forms

Cost of implementation

The intervention is supported through various funding sources, pooled towards a coherent and unified programme for MHPSS.


Estimation of cost is based on a 17-month duration (April 2019 to August 2020): USD 692,540 (Project funding)

Note: This intervention is also supported by UNRWA’s regular programme budget which covers PHC staff salaries at 27 health centers (not included in above estimation).

Impact details

Data based on 2018 annual figures covering 17 health centers:

  • 4,094 PHC patients screened for mental health conditions
  • 275 (6.7%) PHC patients registered with MHPSS treatment files by PHC workers after screening 
  • 40.3% of the total files were closed out of which 82.8% were closed to due mental health symptom improvement (based on staff clinical evaluation and client feedback)
  • A total of 2,096 consultations by psychiatrists and/or psychologists registered (including new and follow-up cases) 
  • A 21.18% increase in the learning of PHC staff through pre-post tests during training (from 60.3% to 81.4%)

Data based on full project duration covering 27 health centers (Dec 2017 – June 2019):

  • A total of 188 frontline PHC staff trained and supervised on MHPSS (including doctors, nurses, midwives, pharmacists) 
  • A total of 90 non-frontline health staff receiving orientation on MHPSS (including dentists, clerks, lab technicians, cleaners) 
  • Approximately 400 women and men received awareness sessions on MHPSS 


  1. Blanchet, K., Fouad, F. M., & Pherali, T. (2016). Syrian refugees in Lebanon: the search for universal health coverage. Conflict and health10(1), 12.
  2. Parkinson, S. E., & Behrouzan, O. (2015). Negotiating health and life: Syrian refugees and the politics of access in Lebanon. Social Science & Medicine146, 324-331.
  3. UNRWA & American University of Beirut (2015) Survey on the Socioeconomic Status of Palestine Refugees in Lebanon. 
  4. GIZ (2014) Mental Health and Well-being among Palestinian Refugees in Lebanon.
How useful did you find this content?: 
Your rating: None
No votes yet
Log in or become a member to contribute to the discussion.

Submit your innovation

Create your own page to tell the MHIN community about your innovation.




Similar content