Humanitarian crises not only destroy infrastructure and livelihoods, they also erode certainties, bonds and identities, leaving invisible scars that take their toll on the body, on memories and on community life.
When daily life is defined by violence, loss or displacement, what is at risk is not only physical integrity, but also the way in which individuals and communities perceive themselves and the world. Trust in others, the ability to envisage a future, and even the very foundations of justice or dignity can be undermined.
This is why it is wrong to view mental health as a secondary issue or as one that only has an impact at the individual level; rather, it must be understood as a fundamental human right that cuts across all aspects of the humanitarian response. In practice, however, mental health is often treated as a less pressing concern and as an individual matter, obscuring the role of contexts and structures in causing distress.
The World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”. Although criticised for being overly idealised, this definition represented a step forward in terms of understanding mental health as an integral part of overall health. Later, the organisation clarified that mental health is “a state of well-being where individuals realise their abilities, cope with normal life stresses, work productively, and contribute to their community” (WHO, 2013).
In humanitarian contexts, this concept takes on critical importance. Crises deal a double blow: they destroy the material conditions of life and, at the same time, weaken the emotional and community foundations that underpin well-being. The Inter-Agency Standing Committee (IASC) points out that mental health issues should not be understood solely as clinical diagnoses, but as expected human responses to extreme and stressful conditions. These responses manifest not only as immediate emotional distress, but also profoundly transform people’s experience of safety, their relationships and their sense of belonging.
Prolonged crises erode people’s sense of belonging, distort social roles and perpetuate narratives of insecurity or devaluation. Over time, communities may internalise frameworks that perpetuate vulnerability: living in a state of high alert, distrusting others, and believing that they do not deserve well-being or justice.
In Palestine, the bombings in Gaza do not merely destroy people’s homes, and the restrictions in the West Bank do not merely limit people’s mobility. They also impinge upon people’s private lives and threaten the way communities understand their own identity. Living under the constant threat of losing a loved one or having one’s home demolished means there is never any real peace: even in moments of silence, fear remains. Daily checkpoints, arbitrary detentions and the possibility of losing land inherited from previous generations… These things do not merely disrupt routines; they fragment families, alter intergenerational roles, and generate a state of perpetual mourning: for what has already been lost and for what may be lost tomorrow.
In terms of mental health, this involves people living in a constant state of alert, with their bodies primed to flee or defend themselves, unable to rest or trust that the future will be any different. At the community level, it entails growing up in an environment where anguish, loss and resistance form part of a shared identity. Grief is not limited to the death of a loved one: it also encompasses the loss of stability, of territories, of life plans. Thus, the pain becomes both personal and historical, passing from one generation to the next and deeply affecting the way families and communities imagine their future.
In this context, vulnerability should not be seen as something inherent to individuals, but rather as the result of social and historical processes that expose certain groups to harm in a disproportionate manner. Factors related to risk and access to protection depend to a great extent on inequality, living conditions and the strength of community networks. For this reason, organisations such as Doctors of the World advocate a comprehensive approach that not only alleviates individual suffering, but also addresses the collective conditions that cause and perpetuate it.
This involves recognising the fractures in identity caused by violence or displacement, facilitating processes of remembrance and reframing that restore dignity, strengthening social bonds as a form of protection, and avoiding the pathologisation of human reactions that are to be expected in extreme situations. Mental health interventions and psychosocial support Although humanitarian aid tends to prioritise tangible needs such as shelter, food and medical care, organisations such as the WHO and the IASC have emphasised that emotional suffering is a key factor that impacts all these areas (WHO, 2013; IASC, 2007, 2021). It is not enough simply to save lives in the immediate term: for recovery to be sustainable, mental health and psychosocial support must be integrated into the response.
To this end, the IASC developed an Intervention Pyramid, a model that organises the different levels of care in humanitarian crises:
Rather than isolated measures, these interventions make up a complementary framework which connects basic needs with specialised care and which, in practice, determines the effectiveness of any humanitarian action. After all, it is not enough simply to set up shelters if social ties are not nurtured: a family may be physically safe yet, at the same time, feel uprooted and alone. Nor is it enough to provide clinical services if people do not access them due to fear of stigma or a lack of trust in institutions. Even increasing the provision of psychological support is insufficient if daily life continues to be characterised by insecurity, poverty or exclusion.
Ultimately, each layer of the intervention only makes sense when it is linked to the others, because well-being cannot be rebuilt by focusing on isolated elements, but rather within an approach that encompasses physical health, personal relationships and the environment.
The psychosocial approach is based precisely on this comprehensive vision. Providing care in humanitarian contexts should not involve treating individuals in isolation but rather recognising that trauma is experienced and processed within a social context, that living conditions determine well-being, and that communities are not passive recipients but agents of their own recovery.
A clear example of this approach can be seen in Syria. After more than a decade of war, many people have lost not only family members and homes, but also their confidence in the future. To address this prolonged deterioration of mental health, Doctors of the World has provided training and support to local healthcare staff so that they can identify and treat common emotional issues, such as anxiety or depression, within the same centres where general medical care is provided. In addition, community activities have been organised with the aim of strengthening social cohesion and providing spaces for mutual support, which are essential in a context where isolation and fear have fragmented community life. Such interventions demonstrate how, when mental health is integrated into health systems and linked to community work, real possibilities for recovery emerge that go beyond the immediate situation and help sustain people’s lives in the midst of a crisis.
Far from competing with other areas of humanitarian intervention, the inclusion of Mental Health and Psychosocial Support actually enhances them. Providing water or shelter saves lives in the immediate term; however, if people remain in a state of emotional insecurity or isolation, those measures will be fragile and difficult to sustain.
Adopting a psychosocial approach means ensuring that each intervention has a broader impact and is sustained over time. Restoring emotional security and rebuilding the social fabric are not secondary considerations, but rather the conditions that enable other forms of support to be truly effective.
Failing to address mental health compromises the effectiveness of other humanitarian aid measures. There is a risk of investing in structures or services that are not used, are abandoned or fail to achieve their objective, because individuals and communities lack the emotional and relational capacity needed to sustain them.
From a human rights perspective, ensuring psychosocial well-being cannot be treated as either an afterthought or a luxury. It is a prerequisite that must be met for fundamental rights such as health, education, work and participation to be exercised.
Ultimately, rebuilding the invisible world – referring to things such as trust, security and social ties – is what brings stability to what we might call the visible world. Mental health and psychosocial support is, therefore, the silent foundation that sustains life, dignity and the possibility of a future. By definition, it is thus also a humanitarian action.