Context

The year 2017 ended in Yemen with continuous fighting across several fronts. The “2018 Humanitarian Needs Overview” was released, showing that 8.4 million Yemenis are now “severely food insecure and at risk of famine,” a 25 percent increase from 2017.

The decline in the public health system is due to non-payment of medical salaries and difficulties in importing drugs and other essential supplies. Yemen is facing an outbreak of cholera of unprecedented magnitude. By the end of December 2017, one million suspected cases of cholera were reported. Access to operational health facilities remains problematic. Rural populations living in remote areas are often unable to move because of security conditions but also financial constraints.

Location

Our response

MdM is active in Yemen since 2007, in response to the armed conflict in Saada governorate. MdM also worked in Hadjah due to the internal displaced people presence from the Saada conflict.  Currently, MdM supports 13 health facilities including rural hospitals and health centers/units in Sana’a governorate (Jehana & Alhaimah Aldakhliah districts), Amanat Alasimah municipality, and Ibb governorate (Yarim district).

Primary healthcare services including sexual and reproductive health and gender based-violence services are being provided in specific health facilities. Mental health and psychosocial support services are given as well.  MdM health team are also working to train health staff and volunteers in communities and to improve the referral to the specialized operational facilities for the most urgent cases. MdM also rehabilitates health facilities and provides health materials and drugs.

Current Partners

• The Cleaning Street Union in Amanat Alasimah governorate.

Context

Egypt hosts thousands of refugees and asylum seekers. The Egyptian Mediterranean coast has become an important departure point to Europe. Among the factors behind the increased movement to Europe, refugees and migrants have indicated the loss of hope, high cost of living leading to deepening poverty, deteriorated psychological and medical conditions, limited livelihood and education opportunities and aid shortfalls. Despite mainstreaming strategy to integrate Syrian refugees into the public health system, these protocols are not fully implemented for all refugees and access to free quality healthcare remains an issue for them. According to MdM assessment conduct at the end of 2016, stigma and discrimination particularly affect African refugees and migrants who are not always welcomed in a professional manner by health practitioners. They have very slim chances to ever access mental health services given the negative cultural connotations and associated stigma.

Mental health and psychiatric services lack appropriate funding on different levels of healthcare and enough numbers of trained competent personnel. However, the tendency now goes towards the integration of mental health into primary health care to ensure its availability for population, as per WHO strategy and Egypt’s 2030 vision.

MdM assessment affirmed the increasing need to enhancing mental health and psychosocial services for refugees and migrants. Depression, anxiety, schizophrenia and post-traumatic stress disorder (PTSD) are most reported mental health disorders.

Location

Our response

MdM is currently implementing a three-year project, entitled “provision of mental health and psychosocial support to refugees, migrants and host communities in Greater Cairo”. It is a continuation of the previous program (2014-2017).The ongoing program is implemented through close collaboration with the Ministry of Health, according to a signed protocol with MdM. The program particularly supports the Ministry’s efforts in integrating mental health services into primary health care, on one hand and to assure equitable access to all, especially refugees and migrants, on the other hand. Program’s operations focus on 12 PHCs that target Syrian and African refugees, supporting WHO/MoH partnership for the provision of MHPSS training, specifically in: East Cairo, West Cairo, New Giza and Old Giza. NGOs working with refugees and migrants are also targeted in the project. The program aims at:

• Integration of mental health in primary care for PHCC to provide early detection, treatment and management of common health disorders; and refer people with complex and/or severe mental health disorders to secondary services, yet to be followed by the PHCC to guarantee positive health outcomes
• Consolidation of community based MHPSS to strengthen community cohesion, support and resilience, with the aim of preventing psychosocial distress and supporting psychosocial well-being through early detection and needed referrals
• Capacity building of civil society providing services to refugees and migrants to provide necessary and tailored psychosocial support

The program is composed of three main axes:

1. Enhancing the target groups access to quality mental health in 12 Primary Heath Care (PHCs)
2. Consolidating access to community based MHPSS services
3. Improving the capacities of local NGO supporting refugees and migrants

Current partners

• Watan
• Etijah

Current Institutional partners:

Local authorities concerned with the program thematic area directly and indirectly are, as follows:

• The General Secretariat of Mental Health, Ministry of Health
• The Central Administration of Integrative Health Cairo- Primary Health Care Sector, Ministry of Health.
• Disability Prevention Department, Ministry of Health

Context

The context in Palestine is marked by 50 years of protracted Occupation with a systematic denial of Human Rights, and continuing conflict punctuated by frequent outbreaks of violence, blockages and restrictions.

In the West Bank, settlement expansion, settler violence, houses’ demolitions, Israeli Security Forces violence (excessive use of force and restrictions of movements and access) and the lack of a horizon for ending the Occupation are major sources of frustration and conflict. 2017 has been characterized by an increase in settlement expansion, with the approval of the construction of the first new settlement in 25 years. The accentuation of settlement construction in East Jerusalem and the increase in settler violence are encouraged by impunity linked with these violations. This constant violence is a source of anxiety and has an impact on the psychosocial wellbeing of Palestinians.

2 million Palestinians live in the Gaza Strip, one of the most densely populated territories in the world.  Nearly 11 years of blockade and recurrent outbreaks of hostilities have eroded basic infrastructure, service delivery, livelihoods and coping mechanisms. The permanent scarcity of electricity (8 hours of electricity followed by 12 hours of cut, in the best case), the shortages of drugs and disposables in the health facilities, the difficulties of entering medical equipment and materials as well as the lack of trained staff that cannot exit the Strip have an impact on the Gaza health system.

2.3 million Palestinians still need humanitarian assistance in Palestine mainly in the Gaza Strip, Area C of the West Bank and East Jerusalem.  The 50 year-Occupation, the failure of the Palestinian internal reconciliation, and the lack of vision for a political solution are the main causes of a general atmosphere of frustration and social insecurity.

Location

Gaza: North, Gaza, Middle Area, Khan Younis and Rafah Governorates

West Bank: Salfit, Qualquilia, Nablus and Tubas Governorates

Projects

Reinforcing the access to quality medical, mental and psychosocial emergency response in Palestine

Targeted population

Gaza

• Medical and non-medical staff of the ED of 6 hospitals
• Community members of 20 CBOs
• Staff of local MHPSS providers
• Community members benefiting of MHPSS activities provided by MDM partners
• Patients of the Emergency Department of the hospitals

West Bank

• Direct and indirect victims of Occupation related to these violations (settler violence, Israeli army use of force, demolitions)
• Community members in vulnerable communities affected by these violations
• School counselors

How/Activities:

• Reinforcing the capacity of Health providers (hospitals and PHCC) in responding and managing emergencies.
• Enhancing the capacities of the communities to respond to medical and psychosocial emergencies
• Minimizing the impact of the Occupation on the psychosocial wellbeing of the Palestinian population.
• Advocating for the right to health of Palestinians living under Occupation

Current Partners

• Culture and Free-Thought Association (CFTA)
• Palestinian counselling center (PCC)
• Ministry of Health (MoH)
• Ministry of Education and Higher Education (MoEHE)

Context

Since the beginning of the Syria crisis, massive population movements have taken place across the Turkish border and inside Turkey. The situation has put the local public health system under strain. Although registered Syrian refugees who hold an identification number benefit from free healthcare in public and private health facilities, refugees often have to cover associated costs (for drugs, transportation, etc.), impacting on their already stretched financial resources. Those who do not hold an identification number are entitled to free emergency care only, and have to cover the costs of primary healthcare and other kind of health services.

Location

Our response

In Turkey, MdM is supporting its partner, Dünya Doktorları Derneği (DDD), since it started its operation in 2016. The response aims at ensuring that refugees and migrants have access to the health services they need. DDD provides health services in partnership with Turkish medical organisations.

DDD supports health facilities in Istanbul (Sultangazi), İzmir and Hatay (Reyhanli). Due to the transition of the primary healthcare clinics (for example: the Migrant Health Centre by the Ministry of Health), DDD is expanding their services with the opening of the Mental Health and Psychosocial Support (MHPSS) centers in İstanbul (Bağcılar) and İzmir as well as the MHPSS and Physiotherapy and Rehabilitation Centres (PTRC) in Gaziantep and Hatay during 2018 to respond to the need of the refugees in these fields.

Current Partners

• UOSSM (Union of Medical Care and Relief Organizations)

Context

2020 has been a very challenging year over the world and especially for Lebanon. The country has been hit by a dire economic and financial crisis, by the COVID-19 pandemic and a massive explosion on August 4th. Collapse of the currency, fueling prices and medication shortages hinder access to healthcare and endanger people’s basic rights. More and more Lebanese, Syrian refugees, Palestinian refugees and migrant workers are pushed further into poverty.

Locations

Our Response

Since 2012, in cooperation with civil society organizations as well as national and local authorities, Médecins du Monde’s (MdM) intervention aimed at increasing access to quality primary healthcare and strengthening the national primary healthcare system. Moreover, MdM has been actively engaged in providing access to mental health and psychosocial support (MHPSS) services and in reducing the impact of the wide range of crisis on the mental and physical health of the Syrian and Palestinian refugees, vulnerable Lebanese and migrant workers.

Improving Access to Primary Healthcare Services 

The improvement in access to primary healthcare (PHC) services aims at ensuring that host communities and refugees are able to receive critical preventive and curative services including health and mental health services, while enhancing the meaningful exercise of their rights and promoting their resilience and well-being through the services provided at PHC centers and community levels.

Médecins du Monde supports three partners’ PHC centers , which are part of the Ministry of Public Health’s National Network. The support is through the subsidization of services that include medical consultations by general and specialized physicians, acute essential medication, laboratory & imaging, physiotherapy, and Sexual and Reproductive health including family planning. MdM Team also builds the capacity of partner staff to improve the quality of services following the national accreditation standards provided by the Ministry of Public Health.

Furthermore, we are working on supporting the development of a multidisciplinary response to identify GBV survivors based on the principles of protection, gender and inclusion mainstreaming. The latter is achieved through the provisions of sensitization sessions to all healthcare workers as well as safe identification and referral to specialized case management agencies.

Improving Mental Health and Well-being of all People Living in Lebanon

Médecins du Monde contributed to the development of community-based mental healthcare services, opening and running community mental health centers (CMHCs) in Beirut and North Bekaa. 

Multidisciplinary teams composed of case managers, psychotherapists, psychiatrists and nurses provide individualized and recovery-oriented services and consultations to people with mental health and substance use issues, based on personalized care and recovery plans.

MdM is also working on integrating mental health in the primary healthcare system. This involves strengthening the capacity of healthcare staff by providing training in techniques which will help them to identify mental health conditions and provide adequate care to patients. We are currently working closely with eight PHC centers in order to improve access to care through awareness sessions, trainings and shadowing of health care professionals.

Community – based Interventions 

The Médecins du Monde team is supported by community outreach volunteers who are raising awareness on health and mental health topics and provide support by directing people to the appropriate facilities within their communities.

Supporting Mental Health Research 

Médecins du Monde is also working in partnership with regional and international academic institutions to expand mental health research in the Middle East.

In 2019, we implemented two research projects in Lebanon in partnership with local and international institutions:

• BIOPATH is a project seeking to understand how environmental and biological risk and protective factors interact in the prediction of children’s resilience following war and displacement. This project is led in collaboration with Queen Mary University of London and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC).

• t-CETA is a pilot project to trial the development, management and evaluation of a psychological intervention delivered by phone for Syrian refugee children in Lebanon. This project is led in collaboration with Queen Mary University of London, the American University of Beirut, Johns Hopkins University and Medical School Hamburg.
• Two studies will be published during 2021; (1) Gender determinants and how they affect access to mental health and substance use services among adults with mental health and/or substance use needs in Lebanon, the research findings will inform MdM in future interventions, as well as contribute to discussion with national stakeholders on policy and legal environment, (2) CMHC model documentation that presents the lesson learnt process of MdM on the experience of opening and running a CMHC, in order to identify successes, review challenges and have a list of recommendations.

Current partners

• Lebanon Ministry of Public Health (National Mental Health Program and Primary Healthcare Department)
• Rafic Hariri University Hospital (Beirut)
• Skoun
• Embrace
• International Committee of Red Cross
• Abaad
• Humanity and Inclusion (HI)
• Amel Association International
• The Parish El Qaa
• Beit El Baraka

Research partners

• Queen Mary University of London
• American University of Beirut
• John Hopkins University
• IDRAAC (Institute for Development, Research, Advocacy and Applied Care)
• University of Hamburg (Germany)

In 2019, Médecins du Monde’s activities in Lebanon were funded by the French Development Agency (AFD), the Crisis and Support Centre (CDCS) of the French Ministry for Europe and Foreign Affairs, the Humanitarian Coalition, Humedica International Aid, Ministère des Relations internationales et de la Francophonie (MRIF) du Québec, United States Agency for International Development (USAID), Start Network, Fonds Aubrac, all MdM Chapters  and donations from generous supporters.

Context

Mass population displacements throughout Iraq have put the country into an emergency situation. Although combat operations against the Islamic State of Iraq and the Levant (ISIL) has officially ended in December 2017, insurgent groups are still active in certain areas of Iraq.

Public services are overwhelmed and under tremendous strain. The health system and access to health facilities are further compromised by insecurity in many areas, putting at risk both host and displaced communities. Access to primary healthcare is reported to be one of the top priorities for Internally Displaced Persons (IDPs) and those who are returning to their areas of origin after the ISIL defeat, as well as for host population in areas where Primary Health Care Centres are overcrowded or depleted by lack of resources (medical staff, medical supplies…).

Location

Our response

In Iraq, MdM provides primary healthcare services and mental health support to displaced persons and host communities, particularly the most vulnerable individuals in IDP camps and communities.

MdM is currently working with health authorities to go beyond an intervention strategy based on mobile clinics and provide support to health facilities, in close coordination with Directorates of Health at district and governorate levels.

In Dohuk Governorate, MdM supports the PHCC of the most inhabited IDP camp in the governorate (Chameshku camp – hosting 27,400 individuals). In Ninewa governorate, MdM is transiting from managing two mobile clinics to supporting four PHCCs. In Kirkuk governorate, MdM is running mobile clinics in a camp and PHCCs and is planning to bolster a PHCC in Hawija district with rehabilitation, equipment drugs and trainings.

Medical consultations and essential medication for both adults and children are available. The PHC package that MdM provides includes comprehensive SRH services that specifically target women and adolescent girls with antenatal and post-natal care as well as family planning services. MHPSS group and individual sessions are held in each medical mobile unit. Beneficiaries who present symptoms / mental health disorder or who express a need of mental health support are referred by the medical doctors to the mental health teams for individual counselling or group sessions.

Current Partners

• Directorate of Health Ninewa governorate
• Directorate of Health Dohuk governorate
• Directorate of Health Kirkuk governorate
• Doctors Aid Medical Activities (DAMA-local Iraqi NGO)

Context

The magnitude, duration and complexity of the conflict has had far reaching effects on the health situation in Syria. More than 13.2 million people are in need of immediate medical assistance across the country, according to the United Nations Office for the Coordination of Humanitarian Affairs (Humanitarian Needs Overview 2018).

Health infrastructures have been put under tremendous strain with access to and availability of health services further compromised by insecurity, mass displacement of population as well as targeted attacks on health facilities and critical infrastructure on which health services depend.

Critical shortages of medical staff, equipment and supplies are severely impeding the delivery of the essential medical assistance. Furthermore, the lack of sustained and predictable access to UN-declared besieged and hard-to-reach areas continues to exacerbate health needs in these areas.

Access to comprehensive Primary Health Care

Syria is facing a critical lack of access to quality Primary Health Care – including Sexual and Reproductive Health and Mental Health services – especially for groups with specific health needs: forcibly displaced populations, children under 5, pregnant and lactating women, people suffering from chronic disease, disabled people and elderly.

The country’s health system has been severely disrupted since the beginning of the conflict, leaving less than half of health facilities fully operational in 2017 and resulting in thousands of avoidable deaths from injuries or illnesses.

At least one in five suffers from mild to moderate mental health conditions such as depression or anxiety disorders

Conflict-affected population across the country, especially those forcibly displaced, continue to struggle to access life-saving medicines and regular treatment for noncommunicable diseases such as diabetes, hypertension and other chronic conditions. According to WHO, noncommunicable diseases were responsible for almost half of all deaths in Syria in 2017, exceeding the number of deaths caused as a direct result of war-related trauma injuries (WHO. Beyond the bullets and bombs: Saving the lives of chronic disease patients living in conflict settings. 23 November 2017. Website, retrieved on February 18, 2018.).

Mental health

Prolonged exposure to conflict, stress and uncertainty have had a clear and devastating impact on the psychological wellbeing of conflict-affected Syrians, especially children (Save the Children. Invisible Wounds. The impact of six years of war on the mental health of Syria’s children. 2017. URL: Link, retrieved on February 18, 2018.). WHO estimates that one in thirty people living in Syria today suffers from severe mental health conditions and at least one in five suffers from mild to moderate mental health conditions such as depression or anxiety disorders (Humanitarian Needs Overview 2018). Additional support is urgently needed to address increasing mental health needs inside the country, where there is a critical shortage of mental health and psychosocial professionals.

Violence against health infrastructures, health staff and patients

Seven years into the conflict, medical facilities, health staff and patients continue to be victims of targeted attacks.

In 2018, Syria was said to be the most dangerous country in the world to be a health worker. Health professionals are working in extremely difficult conditions, putting their lives on the line to save others.

The continued damage and destruction of health infrastructure is putting existing health facilities under yet additional strain, limiting the ability of people to access sufficient medical assistance and critically affecting readiness of remaining facilities and availability of staff to provide services.

Locations

Our response

MdM has been providing health services through partners in Syria since 2008, and scaled up activities following the outbreak of the conflict in 2012.

Today, MdM is responding to the immediate health needs of more than 500,000 conflict-affected individuals, while engaging in durable solutions to support the   strengthening of the health system in collaboration with local health actors. In 2018, MdM supported the provision of around 624,483 consultations.

©AFP

Alongside our partners, MdM is tackling the critical issue of access to health services and continuity of care by securing financial means to ensure health services are maintained, by addressing the shortage of life-saving medicines and essential medical supplies, by supporting rehabilitation of damaged health infrastructures and by providing incentives and specialized trainings to more than a hundred health professionals inside Syria.

In 2018, MdM is ensuring the provision of comprehensive primary health care services in Idlib, Aleppo, Rural Damascus, Dar’a and Hasakeh governorates, through direct service provision and by supporting local health facilities and partners. As of January 2019, MdM is supporting directly and indirectly 17 health centers and mobile teams.  

MDM is responding to the immediate health needs of more than 500,000 conflict-affected individuals

A wide range of essential services are provided to individuals with specific health needs exacerbated by the long-lasting conflict, including displaced populations and host communities:

• Women of reproductive age – especially pregnant and lactating women – and children under 5 require adapted medical follow up and services, which can have severe consequences when interrupted by displacement or by limited access to specialized health services. Sexual and reproductive health is an integral component of the health care package provided facilities supported by MdM, and includes antenatal care, postnatal care and family planning services.
• Displaced people – especially elderly – already suffering from chronic diseases prior to the conflict may have severe exacerbations due to the inability to access life-saving drugs or treatment. Populations living in areas where health infrastructures have been destroyed are facing similar risks. MdM is responding by expending its package of primary health care services to improve access to quality treatment of non-communicable diseases.
• MdM recognizes the necessity to improve the availability of psychosocial support and mental health services in all areas of intervention. In Idlib and Hasakeh governorates, we are directly providing psychosocial services – adapting our intervention to the distinct needs of men, women, boys and girls. MdM considers mental health as an integral and inseparable part of primary health care.