The journey to Armenia from Karabakh put over 100 000 refugees through a gruelling ordeal, leaving many in urgent need of mental health support. A WHO team spoke to refugees who had recently arrived at a temporary shelter. Their individual voices tell a shared story:
“We will never forget that terrible journey to Armenia. This experience will stay with me forever and is repeated in my dreams over and over again.”
“We saw dead people on the road that we had to go around.”
“I have flashbacks of the fighting that drove us from our home, and my daughter is more aggressive after what she experienced.”
“I feel like my world has fallen apart around me.”
“When the shooting began, all of us ran to school, where the shelter was, and all the children were there. The children were very scared, they were crying. We heard of one kid who had a heart attack out of fear.”
The impact of emergencies on mental well-being
The immediate need for mental health and psychosocial support (MHPSS) in Armenia is acute, as displaced people attempt to deal with a range of emergency-induced social problems that include family separation, lack of safety, loss of livelihoods and disrupted social networks.
In the longer term, studies suggest that almost everyone affected by emergencies will experience some form of psychological distress. Among those who have gone through war or other conflict in the previous 10 years, 1 in 5 (22%) will go on to experience depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.
Applying these estimates to the situation for refugees in Armenia, WHO expects that approximately 22 500 Armenian refugees may experience a mental health condition.
Meeting the mental health needs of all refugees is a key component of WHO’s Armenia refugee response. To achieve this, WHO is scaling up its MHPSS services by training psychologists, primary health-care workers and volunteers.
Psychological support for burns survivors
One of the most urgent tasks is to provide MHPSS services for the survivors of the fuel depot explosion that occurred on 25 September, which killed more than 200 people and injured over 300. As of early November, over 100 burns survivors require medium- and long-term mental health services.
Naira Azatyan is one of 10 WHO-trained psychologists working with burns patients at the National Center for Burns and Dermatology and other hospitals across the country. She explains, “Our patients are extremely emotional, having flashbacks, and they need sustained psychological support. First of all, we work with them to stabilize the situation, we do relaxation exercises, and then focus on the future steps they can take. We work not only with patients but also with their families and relatives.”
Marietta Khurshudyan is a clinical psychologist and technical expert in MHPSS with the WHO Country Office in Armenia. She has been leading the work to scale up MHPSS, hand in hand with the Armenian Ministry of Health and local implementing partners. One of these projects has involved training the 10 psychologists on how to treat burns survivors.
“We know that 100 people are currently in hospital receiving treatment for their severe burns. Not only are they facing extreme levels of pain, but they are also naturally anxious for what the future brings,” she says.
“WHO has begun to train Armenian psychologists working with burns patients, so patients receive the care they so critically need. MHPSS is an important part of pain management. By recognizing, understanding and managing the thoughts, emotions and behaviours that accompany their pain, this can help them cope more effectively.”
As a first step, psychologists must help patients accept their new reality, adds Khurshudyan. “This is something that will impact them for the rest of their lives. In some cases, people might fully recover, but most of them will never recover to the full. Some will never recognize themselves in the mirror.”
Helping affected people learn to value their own resources is a core component of MHPSS. “The next step is for them to appreciate that they are alive and to come to appreciate their individual internal and external resources. For example, we remind them that they are strong, they have a family who supports them, they have people who love them.”
Relieved, but traumatized
According to WHO/Europe’s public health situation analysis for the Armenia refugee response, while many refugees expressed relief at reaching Armenia, they remain traumatized and confused about the future.
Gohar Gyurjyan is a social worker and also a recent refugee. She joined a WHO-supported MHPSS mobile team to assess the needs of a refugee community of 140 people. She is a crucial link to other refugees.
“Because I am one of them, because I come from the same place as them, this helps improve my ability to communicate with them. They see that I am in the same situation as they are and, together, we try to find a way to move forward.”
She emphasizes, “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.”
Building stronger mental health support systems
WHO is also training 10 psychologists to serve on a mental health helpline, offering callers empathy and helping to defuse painful feelings related to the crisis.
Khurshudyan says, “Isolation can intensify feelings such as stress, trauma and depression, so people should reach out for help as soon as possible. The helpline gives them the opportunity to shed that sense of loneliness and connect with a caring professional.”
Marthe Everard, the WHO Regional Director for Europe’s Special Representative to Armenia, points out, “Investing in mental health in the frame of the humanitarian response pays dividends, not just in helping people survive extreme distress and hardship, but also in supporting a nation’s recovery.”
WHO has launched an emergency donor appeal for Armenia for a total of US$ 2.9 million, running from September 2023 through February 2024. Part of these funds will ensure that WHO can continue to offer specialized care for burns survivors, assess their rehabilitation needs, and extend the existing MHPSS programme to affected refugee and host populations.
