Building Better Mental Health for Palestine Refugees in Lebanon

“Being part of caring for the health and wellbeing of another human being is really the highest form of human calling and here it also represents a deep privilege that people trust my services and build a therapeutic alliance with me. I have seen how many people are in need of this service that was absent for years and how much we all need a better psychological life,” said Zeina Fayad.

Zeina works with Palestine refugees in Lebanon, which is experiencing the worst economic crisis in living memory in a region riddled with conflict heavily impacted by the COVID-19 pandemic. Since 2019, these growing crises have affected all segments of society and contributed to rising poverty, unemployment and food insecurity. Today, nearly three-quarters of the population lives below the poverty line. These factors have undoubtedly increased the need for mental health and psychosocial support among Palestine refugees.

Zeina has been a clinical psychologist with the UNRWA Mental Health and Psychosocial Support (MHPSS) Programme for the past four years. Her area of intervention goes beyond individual psychotherapy and is part of ongoing work that aims to mainstream mental health in the UNRWA health programme through training of UNRWA primary health-care doctors, nurses and midwives on the identification and management of priority MHPSS conditions and on the provision of specialized psychological and psychiatric services. “Psychological wellbeing is not the absence of problems, it is the presence of effective skills that help you to better deal with various problems,” she says.

In 2019-2020, UNRWA health centres screened over 12,000 Palestine refugees for MHPSS conditions across Lebanon.  In addition, over 2,500 beneficiaries received mental health consultations by specialists and primary health-care centre staff for various mental and neurological disorders, including depression, anxiety, psychosis, post-traumatic stress disorder (PTSD), developmental problems, behavioral problems, dementia, interpersonal and family related issues, and other concerns.

“The increase in demand for psychological services is probably due to multiple factors such as the impact of COVID-19 pandemic on the health and socio-cultural life of the Palestine refugee community. Another factor is the impact of the economic crisis in Lebanon on Palestine refugees. The psychological problems may have been present prior to these above-mentioned events. However, the increase of stressors makes it difficult for people to maintain over-burdened, pre-existing coping strategies,” notes Fayad.  

Both Palestine refugees from Lebanon (PRL) and Palestine refugees from Syria in Lebanon (PRS) face many challenges accessing MHPSS services, either because there are no services close to where they live or because they encounter long waiting lists. UNRWA works to ensure that a comprehensive primary health-care package is delivered to PRL and PRS, including essential MHPSS services.

UNRWA also engages community members on MHPSS through prevention and awareness activities, ensures access to free-of-charge psychotropic medications dispensed through UNRWA primary health-care centers, and facilitates coverage for mental health hospitalization for acute and severe mental health conditions when needed. This is part of wider UNRWA efforts to streamline MHPSS activities and services across its programmes in Lebanon, including health, education, protection, and relief and social services, which is made possible with generous support from the United States government.

“The integration of mental health into health, and other programmes not only impacts people’s lives on an individual level, but also affects the community in general. Our awareness-raising and community-based activities help to build knowledge and skills and decrease the stigma around mental health and other related cross-cutting issues such as gender-based violence and child protection. It allows people to reach out for the services they may need and protects their right to be heard and to receive the appropriate support,” says Zeina.

“The interesting part of our work at UNRWA is the multidisciplinary component,” underscores Zeina. “The ‘Stepped Care’ approach allows the beneficiary to benefit from multi-level interventions within UNRWA health centers, starting with screening during a regular medical check-up with a staff nurse, followed by further well-being assessment and psychosocial support by the nurse, to consultation with a medication officer in collaboration with the psychiatrist and the psychologist, if needed. However, if a more specialized assessment and intervention are required, then the patient will be referred to either myself or my colleague Dr. Claude, a psychiatrist, for individual or family intervention." Through a comprehensive, Agency-wide referral system, beneficiaries may also be connected to social workers for case management and social work services as well as protection, legal and other services, as needed. Meanwhile school counselors and special education specialists address the psychosocial and special education needs of school children.