Solidarity in the face of global fragility

Welcome to the first issue of Intervention in 2020. I am writing this editorial at the end of March and clearly I must first acknowledge the unprecedented challenge that is facing us all in the form of COVID-19. Quite how things will be looking when this issue is published online is difficult to say. One thing is sure. This coronavirus is no equaliser, as some commentators have suggested. For many people impacted by conflict, there is little or no opportunity for social distancing to keep them and their families safe from contagion, and the economic slowdown resulting from containment measures makes their situation even more insecure. This is a truly awful situation for displaced and war-affected populations and raises enormous challenges too for agencies seeking to offer humanitarian assistance. Turning to this first issue of the year, we have seven articles, four field reports, a commentary and a book review. The topics range from broader based reviews and reports relating to service provision around MHPSS to more specific initiatives aimed at distinct groups. In rereading the work documented here today, I am struck by the ever more powerful relevance of finding solutions to support people in distress in a time of global fragility in the face of the pandemic. We have decided to devote space to articles and reports about the pandemic and mental health and psychosocial support in the next issue of Intervention, due out in October 2020. The first article by Haroz, Nguyen, Lee, Tol, Fine and Bolton (pp. 3-17) presents a systematic review of the effectiveness of psychosocial programming in humanitarian contexts in low- and middle-income countries. They structure their analysis by the breadth of programming delivered, population served and outcomes targeted. Recognising the importance of strengthening this evidence base, they recommend research initiatives focusing on replicating interventions in multiple contexts or stages of response in order to strengthen programming future options. The second by Budosan, Mahoney, Dorego, Aziz and Ratnasabapathipillai (pp. 18-27) identifies common challenges in scaling up mental healthcare services post disaster, by looking at mental health programming across Sri Lanka, Haiti and the Philippines. They compare and contrast three different models of scaling up mental health services, providing a perspective from practitioners on the programmes implemented in post disaster settings. Key challenges concern the sustainability, quality and effectiveness of services in the long term for mental health services. Using Canada and Ukraine as examples, in our third article Flaherty, Sikorski, Klos, Vus and Hayduk (pp. 28-36) underline the importance of moving beyond addressing posttraumatic stress disorder (PTSD) as the major mental health focus in peacebuilding to a more global whole health strategy as a way of building resilience in communities. They call for a global focus on developing mental health strategies using a ‘whole health’ perspective that addresses all individuals in the context of their own communities. Our fourth article, written by Haroz, Decker, Lee, Bolton, Spiegel and Ventevogel, (pp. 37-44), is another systematic review, this time considering the evidence base for suicide prevention and response programmes in refugee settings. Of the eight documents identified which met the search criteria, none provided conclusive evidence of effectiveness. One of the key implications for practice articulated was that despite a lack of evidence for displaced populations, multitiered and public health approaches to suicide seem most promising. They suggest that rigorous evaluations of suicide prevention efforts are needed to better inform practice. We are considering a special section of papers on this important topic in 2021. Maisha, in the fifth article in this issue (pp. 45-51), reflects on the therapeutic care of child survivors of sexual violence in conflict-affected areas and draws specifically on the cultural context of the eastern region of the Democratic Republic of Congo. He presents two case studies to illustrate the challenges facing helpers and survivors. His observations drawn from the literature as well as from the field indicate that child survivors need treatment for their psychological distress as well as ‘solution-driven creativity’ to meet psychosocial needs. Veale, Shanahan, Hijazi and Osman (pp. 52-60) examine the impact of an intervention called ‘Engaging Men’ in their article which describes a 12-week programme which was implemented in three annual cycles with 1500 Syrian and Lebanese men in Lebanon. Findings indicate that programmes facilitated a safe emotional space for men to talk about their problems, to become more reflective about their relationships with their wives and children, which resulted in improved patterns of interaction and communication, and increased openness and greater tolerance by men of changing gender roles in families as a result of displacement. In the final article in this section, Jalal, Kruger and Hinton (pp. 61-65) describe the efficacy and acceptability of culturally adapted cognitive behaviour therapy (CA-CBT) in a randomised pilot trial with South Africans belonging to the Sepedi cultural group. They found great improvement across a range of measures, including PTSD, anxiety symptoms, depressive symptoms and culturally salient, somatic symptoms and syndromes. There are four field reports in this issue. The first by Almoshmosh, Jefee-Bahloul, Abdallah and Barkil-Oteo (pp. 66-70) reports on the Syrian Tele-Mental Health Network, a form of telemedicine that provides mental health assessment and treatment at a distance. The network linked with 19 primary health centres in Syria providing psychiatric consultations over a period of three years using ‘store and forward’ technology (i.e. clinical information is collected and sent to others for consultation). The field report details the many obstacles to sustaining a platform for tele-mental health, not the very least of which being the impact of the targeting of Syrian health clinics by military forces. Our second field report takes us to a very different setting. Levy, Farchi, Gidron and Shahar (pp. 71-77) describe an intervention called the ‘SIX Cs’ model used in Preševo camp in Southern Serbia during the period of intense forced migration along the ‘Balkan Route’ in 2015 and 2016. Drawing on different theoretical strands around stress and resilience, this intervention provided a means of empowering adults and children on the move in very challenging circumstances. The next field report documents the experience of Action Contre la Faim in implementing ‘baby-friendly spaces’ targeting Central African refugees in Cameroon. The report, written by Dozio, Le Roch and Bizouerne (pp. 78-84), reinforces the centrality of maternal mental health and capacity for nurturing to child health and development for war-affected populations. The last field report in this issue focuses on a group of children affected by the Great East Japan earthquake and tsunami in 2011. Fukuchi (pp. 85-91) provides an account of supporting the children who were inpatients in a psychiatric ward at the time of the earthquake and who initially were unaware of what had happened in their region. She outlines an evaluation of psychoeducation offered to the children in these extraordinary circumstances. A few weeks before this issue went to press, we received a commentary on the COVID-19 response from Weine and Bunn (pp. 92-93). They reflect on the contribution global mental health approaches bring to responses in low and middle income countries in the face of COVID-19. Ton Haans closes our journal this time with his lively book review of ‘diversity competence’ by Edwin Hoffman and Arjan Verdooren, published by Coutinho in 2018 (pp. 94-95). I trust you will enjoy it. On behalf of the entire Editorial Board, I would like to thank Dr. Mark van Ommeren, WHO, for his support of Intervention over the years. He is now stepping down in his capacity as international advisor. We will miss you, Mark, but are glad of your continuing encouragement of Intervention. A final note. Whatever is happening where you are, I hope we are all able to find ways of acting in solidarity with one another. We all need support, compassion and kindness at this time. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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