Hundreds of thousands of Rohingya refugees fled from Myanmar to Bangladesh. The greatly increased mental health needs are paired with limited resources for mental health care, particularly human resources. Therefore, UNHCR, the refugee agency of the United Nations, designed a programme to integrate mental health within refugee primary health care, using the Mental Health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) as the central tool. The aim was to scale up mental health services through capacity building of medical staff in refugee health facilities to enable them to identify and manage people with mental, neurological and substance use conditions. This paper is a process description of the programme, using direct experience of the authors, analysis of training evaluations and data from the refugee health information system and clinical supervision reports. Sixty-two primary health care workers were trained. Participants of the mhGAP training showed clear improvements in the post-training knowledge test. These trained staff started providing mental health and psychosocial services after the training in primary health care centres in the refugee camps. Fifteen of them participated in a bi-weekly supervision/on-the-job training visit. Within this period of time, almost 1,200 mental health consultations were realised in the primary health care facilities. Supervision reports of mhGAP-trained participants showed that in order to become effective mental health providers, the participants need to strengthen various skills including performing mental state examinations, providing psychoeducation and using psychosocial support techniques. In conclusion, the integration of mental health within the Rohingya refugee settings faced many challenges but proved to be feasible.
Key implications for practice

• Health system preparation and readiness is an important pre-requirement for integration of mental health into primary health care services. This is particularly significant in humanitarian settings in which the health system is fragile and struggling to keep services at a minimally acceptable level.
• Capacity-building efforts alone cannot guarantee the success of the integration process, that is, adequate attention should be paid to communication with health policy and decision makers especially on facility and local level to foster the process of integration and support scaling up.
• On-the-job supervision is a critical factor in mental health capacity building of non-specialist health providers. Without supportive clinical supervision, any plan for integration of mental health into primary care should be considered deficient and ineffective.

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Introduction: This pilot study investigated asylum seekers’ needs and expectations in the mental health field to develop a culturally sensitive psychosocial intervention. Method: Participants were residents of a certain asylum-seekers centre in the Netherlands, with most of them from the Middle East crisis. Needs and expectations were identified using therapy expectations questionnaire (11 participants) and two focus groups (17 participants). Results: Participants associated mental health problems with post-migration stressors more often than with past traumatic experiences. Often, health problems were silenced due to shame, guilt, anxiety and the fear of negative stigma. Individuals and communities were limited in their ability to provide support for those suffering from psychosocial distress due to heavy stigma and the burden of multiple stressors. Conclusion: We underscore the importance of considering the local knowledge of mental health in developing emergency interventions and emphasise the need to reach beyond the trauma-focused approach to strengthen capacities within the community. Key implications for practice

• Developing a culturally sensitive mental health intervention for asylum seekers requires local knowledge of mental health issues
• Mental health interventions in emergencies should reach beyond the individualistic trauma-focused approach to address the whole context of forced displacement
• Because armed conflict often leads to a disruption of the social ecology of a community, mental health interventions should build on existing local support and services and strengthen capacities within the community.

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A main gap in the delivery of mental health and psychosocial (MHPSS) services to Rohingya refugees in Cox’s Bazar district in Bangladesh is the limited coverage of psychotherapeutic interventions. There is a shortage of mental health professionals who can provide culturally adapted and linguistically appropriate psychotherapeutic interventions that are congruent with the refugee experience. This article describes preliminary work on training Bangladeshi psychologists and para-professionals in applying a novel group-based psychological intervention for refugees, Group Integrative Adapt Therapy (IAT-G). This is a pragmatic, eclectic and transdiagnostic approach, based on the Adaptation and Development After Persecution and Trauma (ADAPT) model. It aims to help refugees to develop resilience and capacities for managing maladaptive reactions to trauma and post-migration living difficulties. This paper describes the key strategies and challenges during the first phase of the project. Activities included an extensive desk review, a one-week training workshop with competency assessments, cultural adaptation of the treatment manual and assessment measures, training on digital literacy and electronic data collection and a blended supervisory model (involving onsite and online sessions). It proved to be generally feasible but not easy to introduce IAT-G in this population. Key implications for practice

• The introduction of a brief scalable psychological intervention within an acute and ongoing emergency was feasible, but faced considerable challenges including high staff turnover.
• Implementation involves multiple components including stakeholder engagement, contextual adaptation of tools and materials, training and supervision and setting up a monitoring system.
• Setting up a supervision is of critical importance but can be complicated in the context of an unfolding emergency.

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The Ebola virus disease (EVD) epidemic killed almost 12,000 people across Sierra Leone, Liberia and Guinea, causing significant psychological distress and suffering. This paper describes International Medical Corps’ innovative and comprehensive model for integrating mental health and psychosocial support (MHPSS) considerations and activities into Ebola treatment units (ETUs) across Sierra Leone and Liberia. This includes staff capacity building as well as psychosocial considerations and activities to address needs and challenges at the ETUs. This model was aimed at reducing patient and family distress and promoting healthy behaviours and recovery. We also include data describing mental health-related symptoms reported by our ETU patients, as well as psychosocial support interventions utilised. We discuss recommendations and lessons learnt and conclude that in line with global guidelines, MHPSS considerations and activities should be integral to all aspects of EVD care. Key implications for practice

• Patients admitted to ETUs face several stressors and challenges related to the ETU environment and procedures, separation from families and effects of EVD
• Mental health and psychosocial support considerations should be an integral part of all aspects of care provided at the ETU
• Paraprofessional psychosocial support workers can play a key role in meeting patient needs at the ETU in line with global mental health and psychosocial support guidelines.

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As a consequence of prolonged exposure to the high levels of cumulative trauma such as war, gross human rights violations and traumatic loss, refugee adolescents are at significant risk of developing psychological and behavioural complications. During resettlement in Australia, they are often faced with social challenges. It is vital to provide support at this vulnerable stage to reduce future setbacks. In response to the high rates of truancy, challenging behaviour in school and negative relationship with teachers and peers, Capoeira Angola programme was implemented to help them better settle in school life, build resilience, using individual strengths and kinesthetic movement for personal growth and recovery. The main aim of this qualitative evaluation was to establish efficacy and ascertain the impact attributable to the programme on psychological and social issues. Positive changes were observed by participant and teacher’s accounts, demonstrating improvements in resilience, self-esteem, interpersonal relationships and school attendance. The significance and benefits of the programme was established and was endorsed its continuation.

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In response to the overwhelming need for mental health and psychosocial support as a result of the humanitarian crisis in Cox’s Bazar, the Directorate General of Health Services, Ministry of Health and Family Welfare Bangladesh, in collaboration with the World Health Organization, the National Institute of Mental Health and the National Institute of Neurosciences, implemented the World Health Organization’s Mental Health Gap Action Programme in November 2017. Over the course of two trainings and supervision visits, general physicians, counsellors and other health professionals from both government facilities and nongovernmental organisations, working with both the host and Rohingya populations, have improved their capacity to assess and manage priority mental, neurological and substance use conditions using the Mental Health Gap Action Programme intervention guidelines. After the first training, over 75% of participants reported feeling confident to apply their learning to their work. Participants receiving the supervision visit valued this follow-up modality and demonstrated a high level of competency during an observed consultation. This was the first instance of the Mental Health Gap Action Programme implementation by the government of Bangladesh following a humanitarian crisis. Our findings suggest that trainees are providing better quality services to assess and manage mental health conditions and that mental health is being integrated into primary health care service delivery.

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Sex and gender are important considerations within refugee studies. Risks to health and wellbeing may manifest differently for refugee women and men, as may the use of health and social services and responses to interventions. Since the 1980s, increased attention has been paid to the experience of girls and women in refugee and humanitarian research, however, much less attention has been paid to boys and men. The purpose of this systematic scoping review was to investigate whether there is a gender bias in refugee and humanitarian research on refugee trauma. Findings demonstrate that since 1988, fully 95% of gender focused refugee research addressed women’s issues, while only 5% addressed the experience of refugee men. This article offers possible explanations for this gap and discusses its ramifications for both research and clinical practice.

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Intimate partner abuse (IPA) is one of the most common forms of gender-based violence worldwide. Risk for IPA can increase during periods of displacement, especially for refugees and other forced migrants. The current study explores patterns of IPA, its correlates and help-seeking behaviours among Rohingya refugees in Malaysia − a group that is particularly marginalised and vulnerable, being stateless and often unable to legally work or access various services. As part of a larger study, a multinational team collected information about IPA among displaced Rohingya in Malaysia through structured household interviews and focus groups, including women, men, community leaders and service providers (n = 75). Results indicated high rates of IPA. Respondents also reported numerous chronic stressors and suggested links between stressors, mental health and IPA. Social norms emphasising the acceptability of IPA and discouraging help-seeking were also common. These data have broad implications, including for development of a ‘healthy relationships’ intervention integrating social norms and mental health approaches to address IPA in Rohingya communities, with potential for scale-up within Malaysia and elsewhere.
Key implications for practice

• Practitioners will better understand intimate partner abuse among Rohingya communities, including links with historical and chronic stressors, social norms and mental health.
• Practitioners will better understand preferred sources of help-seeking and barriers to help-seeking for intimate partner abuse among Rohingya communities.
• Practitioners will better understand how to develop interventions for intimate partner abuse, including healthy relationship workshops and public health messaging campaigns based on social norms.

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Introduction: This article outlines the results of a participatory action research project to (a) understand stigma experienced by family members of people with intellectual disabilities (IDs) in Kinshasa, Democratic Republic of the Congo and (b) identify strategies used by these family members to mitigate or cope with stigma. Methods: We conducted 20 semi-structured interviews with family members of people with ID. Results: All participants in this study discussed experiencing stigma. This stigma was most commonly felt when people directed negative looks, used negative language and names, or refused to touch their family member with ID. Stigma was also directed at the family members as being the ’cause’ of the ID. Family members noted engaging a range of coping mechanisms or strategies to minimise the stigma. Conclusion: Insight from this study could be used to develop interventions benefiting families affected by ID. A sample of suggested interventions include creating opportunities for targeted, local contact with stigmatised persons; reducing or eliminating use of negative and stigmatising names (e.g. kizengi) for people with ID; and promoting self-help and self-advocacy groups for people with ID and their families. Key implications for practice

• Families of people with intellectual disabilities in Kinshasa, Democratic Republic of the Congo experience personal and family-level stigma
• Family members use a range of coping strategies, such as referencing religion; educating others; and participating in self-help associations
• Future interventions might create opportunities for targeted, local contact with stigmatized persons; reduce or eliminate negative and stigmatizing names for people with ID; and promote self-help for people with ID and their families.

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Using Canada and Ukraine as examples, this article asserts the importance of moving beyond addressing posttraumatic stress disorder as the major mental health focus in peacebuilding, to a more global whole health strategy as a way of building resilience in communities, preparing them better to deal with conflicts of different kinds, and generally providing habitus for people of all health and abilities to thrive. Authors who are academics, mental health service users and service providers examine current barriers to and movements toward mental health and wellness in their countries. Using a needs-based approach, authors assert the importance of using the social determinants of health, understanding engaged community membership requires good, supportive mental health. The social determinants of health provide the basis to move from a reactive medical model of health which seems prevelant globally to focus on proactive community, considering what it means to be a community member, including the importance of individual empowerment not only for their own community engagement but also for the actualization and development of their communities and the wider world. Key implications for practice

• It is important to move beyond treatment of posttraumatic stress disorder in response to trauma.
• Peacebuilding must include proactive mental health strategies.
• Global responsibility for individual health as described by the social determinants of health.

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This umbrella review used a systematic approach to examine the state of the evidence regarding the nonspecialist health worker (NSHW) workforce in mental health and psychosocial services in low- and middle-income countries (LMICs). Seventeen review articles were included in this analysis. Most reviews defined nonspecialists by their lack of formal mental health experience. Less than half of the reviews reported their qualifications and roles. Findings indicated that NSHWs were trained and supervised in a range of skills with variability in approaches, duration, format and topical focus. The evidence supporting NSHW-delivered interventions was mixed but mainly favourable, particularly for depression, anxiety and posttraumatic stress disorder; additionally, studies identified implementation challenges with the nonspecialist workforce. In conclusion, NSHWs are widely used in LMICs to address mental health needs and some indicators suggest the interventions they deliver are beneficial, yet little is known about their needs and requirements. Further work is needed to prioritise nonspecialists as a critical workforce in global mental health. This includes developing best practice models, new policies and investments and conducting further research.

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The Refugee Health Information System (RHIS) for humanitarian settings was developed by the United Nations High Commissioner for Refugees (UNHCR) in 2004. As of 2009, it contained seven categories related to mental, neurological and substance use (MNS) conditions: epilepsy/seizure, alcohol/substance use disorder, mental retardation/intellectual disability, psychotic disorder, severe emotional disorder, medically unexplained somatic complaint and other psychological complaint. During a recent overhaul of the RHIS, the MNS categories were revisited. This article describes the revision process and provides insights into how and why changes were made. Two rounds of consultations involving 34 expert reviewers in humanitarian mental health led to nine case definitions for MNS conditions in the new integrated RHIS (iRHIS): epilepsy/seizure, alcohol/substance use disorder; intellectual disability/developmental disorder; psychotic disorder (including mania); delirium/dementia; depression or other emotional disorder; other emotional complaint; medically unexplained somatic complaint; and self-harm/suicide. The use of additional specifiers enables dedicated mental health professionals in humanitarian settings to document a more refined diagnosis with a total of 22 different categories that made the system compatible with the modules of the Mental Health Gap Action Programme, without additional complexity.
Key implications for practice

• The new iRHIS contains nine broad categories for MNS problems, reflecting consensus among humanitarian mental health practitioners.
• iRHIS allows health workers in refugee settings to more accurately classify patients with MNS problems.
• Specialized mental health workers in refugee settings can use additional specifiers in iRHIS to categorise their patients more precisely.

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Contemporary scalable psychological interventions utilise task-shifting approaches that enable non-specialists such as social workers, nurses and lay persons to deliver structured interventions after a brief training and ongoing supervision by professionals. This field report describes a training-implementation approach we used to train lay counsellors to implement a psychological intervention, Integrative Adapt Therapy (IAT), with Rohingya Refugees in Malaysia. IAT is a theoretically guided programme based on the Adaptation and Development After Persecution and Trauma (ADAPT) model. Unlike existing cognitive behavioural treatment (CBT)-based interventions, IAT helps refugees trace their emotional and behavioural problems to the underlying psychosocial disruptions (reflected in the core ADAPT ‘Pillars’) they experience. We assessed implementation outcomes by conducting a focus group with the twelve lay IAT counsellors who completed a training workshop followed by six-month supervised implementation of the IAT programme with Rohingya refugees. The implementation outcomes focused on the value and benefits of the programme to the counsellors’ clients and broader community, implementation challenges, cultural acceptability, and recommendations for improvement in training. There was a strong agreement amongst the counsellors that both the clients and they themselves benefited from the programme. Furthermore, the general consensus was that the clients reported improvements in their relationships with people (ADAPT Pillar 2: Bonds and Networks), in having a more realistic view about their Roles and Identities (Pillar 4) and in gaining a sense of purpose and meaning in life (Pillar 5: Existential Meaning). In addition, the focus group agreed that the programme fitted well with the culture and values of the Rohingya people. Implementation challenges include ensuring that the intervention team reflects gender balance, that the programme is sustainable and refining strategies to facilitate programme attendance and adherence.

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Following violence in Arakan State in Myanmar in August 2017, many Rohingya refugees arrived in Bangladesh with tremendous mental trauma. They also arrived with health problems, along with psychosocial distress shaped by their experiences in Myanmar. Mental health conditions and psychosocial problems have made life more precarious than ever to them. To come to another country (Bangladesh) and to adjust here was a major change to their lives. However, people can also be resilient in the face of adversities and some are able to continue and thrive in the context of perspective hardship. In this personal reflection, the first author, Mr. Arafat Uddin, shares his experiences as a community psychosocial volunteer at the makeshift refugee camps in Bangladesh. He describes his own experience as a Rohingya refugee and shares his personal experience of becoming a psychosocial volunteer. He has also reflects on his role as a community psychosocial volunteer, discusses the challenges he faces, describes perceptions of the community around his work, and shares his future expectations. In the last part of this piece, Hasna Sumi, a female Bangladeshi psychologist with UNHCR, describes her experiences in training and supervising community psychosocial volunteers.

• This personal reflection contains the life history of Arafat Uddin as told to Hasna Akter Sumi, Psychosocial Associate with UNHCR’s Mental Health and Psychosocial Support team in Cox’s Bazar. When the call for papers for this special issue was launched, Sumi had the idea to record a life story from the perspective of a Rohingya refugee. She works closely with a team of Rohingya psychosocial volunteers and asked who among them would volunteer to share their story. Arafat willingly came forward. Sumi and Arafat sat together on 29th April and 2nd May 2019 in camp 4 in Kutupalong Mega Camp. They spoke in the Rohingya language. Arafat told his story while Sumi wrote it down in an English version. The various drafts of this article were discussed with Arafat and he has given his consent to publish this story.

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Frequently, community based strategies include engagement with local faith leaders. However, there have been few systematic attempts to document how faith leaders themselves define their roles in these initiatives. This study examined local faith leaders and their spouses, in flood affected areas of Malawi, who had been oriented to child protection issues through World Vision workshops aimed explicitly at relating protection concerns to religious teachings. Many participants reported that attending a workshop had been transformational in terms of their perspectives regarding the protection of children. The key child protection issues identified by participants included child marriage, lack of attendance at school, child labour (including forced labour), harsh physical punishment and sexual abuse. Many faith leaders − and their wives − became active in addressing child protection issues as a result of the programme, although the form of this action varied widely and was significantly influenced by their varied status and capacities.

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This article explores the ongoing impact of the genocide in Rwanda on marital relationships. Its specific focus are genocide related factors that generate relational trauma and the consequences of this trauma for the everyday lives of spouses affected by it. The qualitative study that informs this article was conducted within the context of a community based sociotherapy programme. The factors found to be contributing to traumatic marital conflict are categorised as those related to genocide perpetration and its consequences, refugeehood, victimisation by genocidal violence and its consequences, intermarriages, and being a descendant of a genocide survivor or a genocide perpetrator. Study participants give a relative high prevalence to factors regarding genocide perpetration, while they assume that the prevalence of traumatic marital conflict among the second generation may continue unless sufficient preventive measures are taken.

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Yezidism arguably remains one of the most oppressed religions in Iraq, with the population historically confronted by many attempts at genocide. These atrocities have left many survivors displaced and affected by trauma, yet little research has been conducted on experiences of trauma among this population. In the context of an internal evaluation of the Free Yezidi Foundation’s mental health intervention in the Kurdistan Region of Iraq, 200 Yezidi women were screened at the beginning and end of a six-month mental health intervention using the World Health Organization (WHO)-5 well-being scale and the Harvard Trauma Questionnaire (HTQ). Qualitative data were obtained from sixteen focus group discussions (FGDs) among service users of the project as well as six in-depth qualitative interviews conducted with members of the project team. The results of the WHO-5 indicate a 74% increase in self-reported well-being among service users who completed the programme. According to the results of the HTQ, the baseline prevalence rate of posttraumatic stress disorder was 81.25%, which decreased to 45% upon completion of the programme. A qualitative analysis of interviews and FGDs highlighted that a significant impact on mental health were collective, multiple losses and separations (including family members who sought refuge abroad), the fact that not all Yezidi held in captivity have returned, fear of ongoing attacks and daily stressors related to poor living conditions. The results highlight the substantial impact of the political, legal and sociocultural environment on both the prevalence of trauma as well as processes of psychosocial rehabilitation. The implications for interventions include utilising socioecological frameworks for research and practice, engaging in advocacy and establishing agendas for mental health practice and psychosocial support that emphasises individual and collective self-determination.
Key implications for practice

• Utilising eco-social frameworks for research and practice
• Engaging in political advocacy as part of MHPSS interventions
• Establishing agendas for mental health practice that emphasise individual and collective self-determination
• Addressing the social, cultural and political perspectives of trauma as part of MHPSS interventions
• Implementing interdisciplinary approaches to rehabilitation from trauma.

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Acceptance and assistance from the host community is crucial to ensure support for refugee populations. This article explores attitudes of the host community about Rohingya refugees in Bangladesh. In total, 202 respondents from Ukhiya in Cox’s Bazar participated in a questionnaire survey about their attitudes towards Rohingya refugees. Respondents from the host community demonstrated mixed attitudes. This article discusses these attitudes and their likely future impacts on the two populations. Findings may contribute to planning strategies towards preventing conflict escalation and increasing integration in the provision of assistance to the Rohingya in Bangladesh. Key implications for practice

• The findings provide a baseline on host community attitudes and beliefs regarding the refugees, which may prove useful in tracking and understanding changes over time.
• It orients the readers to the need to consider a host community perspective in providing refugee care.
• This article calls for action to improve host–refugee relationships to avert possible conflict.

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The internal conflict in Syria has displaced large numbers of the population into neighbouring countries since the uprising in 2011. The large influx of displaced people into Jordan poses great challenges to the international community as well as local authorities, with increasing competition for already scarce resources and services creating rising tensions between refugee and host communities. In this context, the non-governmental organisation, Action Contre la Faim, implemented a programme aimed at improving psychosocial well-being, fostering resilience and promoting positive interactions between the members of both communities. Through the participation of support groups within community-based organisations, dialogue was facilitated, and interactions took place in a safe and therapeutic environment. Participants reported improved perception of well-being and self confidence, as well as improved mutual understanding and communication, reduced isolation and the extension of social support, enhanced empathy and reduce prejudice.

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Socio-ecological interventions assume that there are ‘links’ between the individual process that determines disaster mental health and the social context one lives in. However, there is insufficient empirical basis for this claim. This paper summarises the main findings from a research programme, in which two advanced statistical techniques on data from two floods were applied, respectively Uttar Pradesh, India 2008 and Morpeth, England, 2008. By means of multilevel structural equation modelling it was found that individual psychosocial resources (coping behaviour and social support) are employed more parsimoniously and effectively when disaster affected individuals can rely on a trustworthy and effective social community. Additionally, using multilevel confirmatory factor analyses to address screening outcomes yielded two methodological problems: nested variance due to the disaster context and poor construct validity. These can be illustrated, but not dismissed without applying advanced statistical analyses. The findings strongly suggest that community interventions promoting social context and individual interventions not only share the same objective, but also impact mental health via the same individual mechanisms.

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Jordan has been a host country to many refugees from neighbouring countries for many years and has recently become a place of refuge for thousands of Syrians. The Syrian crisis has resulted in millions of Syrians fleeing their homes, uncertain of When they will return. Most of those seeking refuge have witnessed and/or experienced traumatic events that have affected their mental well-being in addition to starting over as refugees. Despite the large number of non-profit organizations providing free mental health services to refugees, not everyone has equal access to these services. This report, based on a literature review and a focus group discussion, highlights the different gender dimensions of mental health among Syrian refugees in Jordan. These risk factors include access to and use of mental health services, manifestation of mental health and psychosocial problems, treatment by mental-health workers and the socio-economic outcomes of living with someone suffering from mental health. Key implications for practice

• To highlight the gender disparities in mental health among Syrian refugees residing in Jordan
• To highlight the gender differences in mental health needs and services among Syrian refugees in Jordan
• To provide insight about the level of mental health services provided for Syrian refugees in Jordan.

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The aim of this study is to assess the levels of anxiety, depression and post-traumatic stress disorder (PTSD) in national aid workers in Central African Republic as well as to evaluate the effectiveness of a stress management group in reducing those symptoms. Twenty-seven stress management groups were evaluated in two international non-governmental organisations in which 197 national humanitarian aid workers took part. There was a significant decrease in the intensity of every psychopathological variable tested despite a decrease in the sample between the pre- and post-tests. At post-test, 8.1, 5.1 and 11.1% of the participants had scores indicating anxiety, depression and PTSD compared to 25, 18.9 and 26% at pre-test. The group intervention has demonstrated to be a realistic, effective and cost-effective way to respond to mental health problems in national aid workers living in a context of ongoing violence and where access to specialised services is extremely limited. Key implications for practice

• Documenting the mental health of national humanitarian staff working in unsecure environment in Central African Republic
• A one session stress management group protocol can reduce the levels of anxiety, depression and PTSD in this population and hence demonstrating that it is feasible and cost-effective for organizations to honour their duty of care towards national humanitarian workers
• Further research is needed to confirm these preliminary results, especially in other cultural and humanitarian contexts.

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Humanitarian workers experience high symptom burdens of common mental health problems. This requires action from the organisations they are employed with. However, many studies have documented continuing weaknesses in organisational staff support, as well as disparities in access to the services for national and international staff. Systematic data capturing suggestions from humanitarian workers on how to tackle this situation within a specific crisis setting is rarely available. This study addresses this gap through qualitative content analysis of the suggestions from the 210 humanitarian workers based in South Sudan collected through an online survey in 2017. Five major themes emerged regarding proposed improvements: ‘Competitive benefit and salary packages’; ‘internal work climate and organisational culture’; ‘equality within and between organisations’; ‘skill enhancement and personal development’ and ‘physical safety and security’. For both national and international staff, improved access to psychosocial support services was the most frequent proposal. Apart from this suggestion, their top priorities for improvement of staff support differed greatly. National staff emphasised improvements related to training and greater equality between employees. International staff emphasised improvements related to time off and team cohesion. Findings provide a clear case for organisations to assess their services and offer a potential framework to inform future interventions that better address the priorities of the humanitarian community as a whole.
Key implications for practice

• Organisations need to ensure staff have adequate access to psychosocial support services
• National and international staff have different priorities regarding staff support and organisations need to reflect these in their provision of services
• A unified understanding of staff support is required to manage expectations of staff and hold organisations accountable.

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This paper explores the effects of war in Iraq in the period between 1991 and 2003, with a focus on the effect of economic sanctions on mental health services. The authors, Iraqi psychiatrists with direct contact with patients and events during this period, review literature and reports published contemporaneously. They describe how the mental health system in Iraq was deteriorated, not only by war, but also by United Nations imposed sanctions during the period between the first and second Iraq war.

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By learning to identify feelings and express emotions, children can better cope with the difficulties they face, as well as increase their personal resilience. As the Syrian crisis has entered its seventh year, it has had a negative effect on vulnerable populations, especially children. It should be noted that while not all children have been traumatised, many have experienced conflict and crisis, and in turn face challenges expressing and regulating their emotions and behaviour. The aim of the small study, described in this field report, is to explore the power of using drama and art as tools for Syrian children to help them learn to identify their emotions. The qualitative study was conducted at an informal education centre in southeast Turkey, with 10 children, over the course of five workshops. Basic drama and creative art skills were used to raise awareness about emotions as the first phase of emotion regulation.

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