Why Dorcas considers mental well-being to be a priority

Poverty, disaster and violence impact communities and countries worldwide and have a devastating impact on millions of people’s mental health and psychosocial well-being. Yet humanitarian assistance often just focuses on providing tangible health services, food and shelter. In this article, Dorcas argues why mental health and psychological support (MHPSS) should also be an integral component of both short- and long-term humanitarian assistance.

The importance of mental well-being

Evidence has consistently shown that people with mental illness have greater physical health morbidity and mortality compared to the general population. Heleen Berends, Humanitarian Assistance Expert at Dorcas Ukraine, explains how mental health issues in a conflict situation affect people’s resilience and ability to cope. ‘For example, a few months after the war in Ukraine started, we noticed that teenagers and young adults were having such a hard time. Especially those who had fled from the contact lines. Suddenly they were without school or work, experienced uncertainty about their future and lacked a purpose in their lives. On top of that, they had experienced traumatic events, such as life-threatening bombing, having to leave home and losing loved ones. One of the awful consequences of losing hope like this is an increase in the suicide rate.’

Likewise, millions of other people around the world are confronted with a whole range of mental health issues. Without sufficient support, people can experience long-term or recurring setbacks. This can lead to more serious mental health complaints such as anxiety, depression and (post) traumatic stress that can have a negative impact on a person’s ability to work, earn an income or care for their children, for example. Therefore prevention and early treatment are much better than cure when it comes to mental health.

Dorcas’ approach

Dorcas has a long track record with MHPSS in humanitarian assistance, especially in Lebanon and Syria. Our MHPSS programmes aim to protect or promote psychosocial well-being and prevent or treat mental health complaints. We offer individual therapy, group sessions and creative approaches. Our focus is primarily on people with specific needs, such as older people, children, minority groups and people with disabilities.

MHPSS is integrated into all existing programmes of Dorcas. For example:

Removing the stigmas associated with mental health issues

An important part of our approach is removing the stigmas associated with mental health issues. We see how many individuals are hesitant to seek help as they might face stigma. This applies to both very severe traumas (for example, due to sexual violence) and minor traumas (for example, when a child has seen its parents in a panic). Social and cultural beliefs regarding mental health cause a lot of preconceptions. The long-used community-based approach of Dorcas provides a solution to this challenge. Heleen: ‘In our group sessions, the participants share experiences, connect with each other, recognise similar mental health issues, and learn that these are a normal reaction to an abnormal situation. This is how the social cohesion – including mutual trust – that has often been damaged is restored again.’

Example from Yemen

Yemen is facing the largest humanitarian crisis worldwide with ongoing armed conflict, displacement, depleted health delivery systems, a fuel and economic crisis, and a shortage of humanitarian funding. In Yemen, mental health and psychosocial support is underfunded and lacks prioritisation. The population of Yemen lives in extreme poverty and with high fragility. These years of conflict, displacement and emotional distress after traumatic experiences cause a wide range of mental health issues and chronic stress for both adults and children.

Adriaan Jagersma, interim Country Director in Yemen, explains: ‘War brings all kinds of trauma, especially in Yemen where thousands of children have starved to death and many people live in refugee camps and have experienced rocket attacks. All these things take their mental toll. At the same time, we also see a lot of resilience and a great desire to look beyond this crisis. So when we are looking for ways to support people in rebuilding their lives, one of the most important questions to ask is simply: how do you feel? How can we support you in finding hope, confidence and motivation again?’

Staff care

Humanitarian staff may experience direct or indirect exposure to trauma and therefore many stressors in their work. An increased risk for burnout and depression is seen among local and international humanitarian workers. As an employer, Dorcas ensures that all staff have access to supportive tools so that they are self-aware, find a healthy work-life balance and can process intense emotional experiences. This also applies to staff working in situations of extreme and chronic poverty.

In conclusion, mental health is a critical emergency health tool and protection intervention for everyone involved in humanitarian work and development. It is crucial to the overall well-being, functioning and resilience of individual project participants and staff, as well as communities and societies recovering from emergencies and poverty. Dorcas invests in professionals with sufficient psychological knowledge and experience. We believe this is an essential part of structural recovery after poverty, disaster and violence.

The Resilience and Contributions of Older Women

A Dorcas inquiry on the situation of older persons in Eastern Ukraine shows that a relatively large number of older people stay at home even when they live close to an area with active fighting. Sometimes this is out of choice, often it is out of necessity, being unable to flee or start a new life elsewhere.

Older people are resilient and resourceful albeit often not by their own choice. It is a sometimes brutal necessity to just survive. The recent Dorcas report on older people and conflicts and the earlier Dorcas report on COVID-19 and the rights of older people address two global challenges – conflict and COVID-19 – that force older people to be resilient. Resilient whether they like it or not.

A key call to action in both reports is to: ”Listen to the voices of all older people and acknowledge their wisdom, knowledge and experience.” Older people have the right to be seen and listened to. They have the right to participate in priority setting and decision making about topics that matter to them, including humanitarian and other assistance.

1 October is the International Day of Older Persons. The 2022 edition celebrates the resilience of older people and gives special attention to the resilience and contributions of older women who constitute the majority of older people worldwide.

Older people manage to successfully navigate today’s myriad of global challenges. These global challenges are manifest: the COVID-19 pandemic, the increasing number of conflicts, climate change and major socioeconomic challenges including the current exorbitantly high fuel and energy prices.

The effects of these challenges are felt globally and continue to be significant, particularly for many older women in low-and middle-income countries, who bear the burden of cumulative disadvantage. Recognition of the vital contributions of older women and inclusion of their perspectives and needs is critical to creating policies responsive to local, national and global challenges.

Older women, in particular are the unsung heroes embodying often unseen resilience in living through and responding to climate disaster, pandemic and conflict. They do so as they experience and manage the physical and emotional disruption due to losses of family, income, and social connectedness.

The meaningful contributions and experiences of older women remain largely invisible and disregarded due to gendered disadvantages accumulated throughout the life course. The intersection between discrimination based on age and gender compounds new and existing inequalities, including negative stereotypes that combine ageism and sexism.

Dorcas calls on all governments – in particular the Dutch government – and all private sector and civil society actors, to include older women and other people who are marginalised in all policies.

“All older people have the right to be seen, to be valued for who they are, to be listened to, to participate in all decisions that matter to them, to be protected and supported.”

Nico Smith, Thematic Expert Social and economic Inclusion

In 2021, Dorcas portraits older women using their powerful personalities to advocate for change in their communities: at economic, social and political levels. These normal yet extraordinary women are portraited in word and images in Dorcas’ Portraits of Power. Be inspired by their resourcefulness, their hope and their resilience.

https://dorcas.org/olderpeople

Written by: Ioana Lungoci, Ioana Ghiurau – Dorcas Romania

In December 2019, the world heard about the first “pneumonia” cases of unknown cause in China. On 7 January 2020, a novel coronavirus was identified: 2019-nCoV.

Since then, the world has changed beyond imagination. Over 6 million people have died[1] and many who contracted the virus are now suffering from the effects of long COVID. The secondary social and economic effects across the world are still hard to fully comprehend.

Healthcare workers were the frontline heroes in the battle against the COVID-19 disease. Organisations around the world responded to decrease the negative impacts of the COVID-19 pandemic on society, especially amongst vulnerable communities.

One of these communities is represented by the Roma people. Roma form the European Union’s largest ethnic minority. While there is no official number for the Romani population worldwide, 10 – 12 million Roma people[2] live in Europe. Approximately 6 million of them reside inside the European Union.

These people, already scarred by extreme racism, social exclusion and poverty, saw their situation worsen under the pandemic.

According to the Second European Union Minorities and Discrimination Survey of 2018, every third Roma child lives in a household where someone went to bed hungry at least once in the previous month. Only 53% of Roma children attend early childhood education. This is typically less than half of the proportion of children their age in the overall population. Between 2011 and 2016, the number of Roma children in segregated, inadequate schooling climbed by half, from 10% to 15%, in just five years[3].

Only 30% of Roma are able to work for a living, compared to the average EU employment rate of 70% in 2015. Furthermore, 41% of Roma report they have been discriminated against in everyday situations, such as looking for work, housing, health and education over the last five years[4].

In this environment, the COVID-19 pandemic has adversely impacted the already challenging lives of Roma communities. During the pandemic, the Roma population continued to endure prejudice and unequal access to essential services. They encountered problems in five areas: housing, health, employment, education, and discrimination.

Infographic “How the COVID-19 pandamic adversely affected Roma communicties” © Dorcas
  1. Housing

Overcrowded living conditions make it impossible for Roma to adhere to hygiene, social distancing and isolation standards in informal settlements. In the European Union, 30% of Roma do not have access to running water and up to 80% live in densely populated areas with overcrowding[5].

2. Health

Due to a high prevalence of long-term chronic conditions, Roma are more likely to not only catch the virus but also to develop health issues and die prematurely.

They face challenges in obtaining healthcare since few have health insurance and the majority reside in segregated neighbourhoods. Many of them are vulnerable to malnutrition, which was already prevalent prior to the pandemic. Their life expectancy is ten years lower on average than that of the general population in the countries where they dwell[6].

3. Employment

Unemployment and low work intensity have long been a problem for Roma, particularly among women. Many Roma lost their daily sources of income and face limited access to social services, which are sometimes made more difficult by quarantine restrictions.

Their daily or occasional job in the informal sector, such as collecting and selling waste materials, small trading, digging in landfills, scavenging for food in garbage cans or even begging, has historically been their source of income. The current situation has driven them even further into poverty. Due to their unstable employment and lack of a formal residential address, Roma were frequently denied social security benefits. Most employment assistance policies to reduce the impact of the COVID-19 crisis impact did not specifically target or include them.

4. Education

Socially isolated and digitally excluded Roma children found it difficult to participate in distance learning. They often lack access to digital media and an internet connection, so they could not follow lessons or communicate with educators. In addition, parents, who often have a low level of education themselves, could not offer educational support.

Many distance-learning programmes need a variety of resources that Roma children rarely have at home. And even if such resources were available, then studying at home in tiny houses with large families was a considerable challenge.

5. Discrimination

Roma continue to endure intolerable levels of prejudice in everyday life, whether they seek a job, are at work or in school, need healthcare, interact with administrative entities, or visit a store. In the past five years, nearly 41% of Roma felt discriminated against in at least one of these areas due to their ethnic origin. However, one-quarter of Roma (26%) say the last incident of perceived discrimination occurred in the 12 months prior to the survey[7].

Racism is common, exacerbated by the fact that many Roma individuals have returned to Eastern Europe after losing their employment due to lockdowns in Western Europe. In some communities, they were even blamed for bringing the virus home with them[8].

[1]https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates

[2]https://ec.europa.eu/info/policies/justice-and-fundamental-rights/combatting-discrimination/roma-eu/roma-equality-inclusion-and-participation-eu_en

[3]https://fra.europa.eu/en/publication/2016/second-european-union-minorities-and-discrimination-survey-roma-selected-findings

[4]https://fra.europa.eu/en/publication/2016/second-european-union-minorities-and-discrimination-survey-roma-selected-findings

[5] Roma in the COVID-19 crisis: An early warning from six EU Member States – Italy | ReliefWeb

[6] https://www.eesc.europa.eu/en/news-media/presentations/roma-health

[7] https://fra.europa.eu/sites/default/files/fra_uploads/fra-2016-eu-minorities-survey-roma-selected-findings_en.pdf

[8] https://www.euractiv.com/section/coronavirus/opinion/the-roma-are-among-most-threatened-by-covid-19-in-europe/

Seventy per cent of the 1.3 billion people living in conditions of poverty are women. In urban areas, 40 per cent of the poorest households are headed by women. Women predominate in the world’s food production (50-80 per cent), but they own less than 10 per cent of the land. Eighty per cent of the displaced by climate related disasters and changes around the world are women and girls. Climate change may lead to more gender-based violence, an increase in child marriages, and worsening sexual and reproductive health.

Looking at these data published by the United Nations, it would be easy to view women – and in particular older women – as victims. Dorcas has a different message on International Women’s Day. 

Women are not helpless victims, but they do experience – more than others – the impact of injustice and gender inequality. Advancing gender equality in the context of the climate crisis and disaster risk reduction is one of the greatest global challenges of the 21st century. Women are increasingly being recognised as more vulnerable to climate change impacts than men, as they constitute the majority of the world’s poor and are more dependent on the natural resources which climate change threatens the most.

At the same time, women and girls are effective and powerful leaders and change-makers for climate adaptation and mitigation. They are involved in sustainability initiatives around the world, and their participation and leadership results in more effective climate action.

Every day Dorcas meets strong older women who live in difficult circumstances. A current example are Ukrainian women who for the past week daily cross the border with Romania to help and comfort those who flee from the war in Ukraine. At the end of each day, they return to their own homes in Ukraine.

Despite their circumstances, these women have chosen to empower others and to help them develop – not only themselves, but also the people around them. These women use their strength to advocate for changes in their communities, on an economic, social and political level. Women such as Nabila from Lebanon, Ana from Moldova and Martha from Tanzania inspire us with their resourcefulness, their hope and their resilience. You can read their portraits on the Portraits of Power website.

Structural injustice and gender inequality leading to poverty, marginalisation, stereotyping and discrimination of women – and in particular older women – needs to be unpacked and called out for what it is: unjust. All of us need to recognise that women are the ones that across the globe daily experience the subtle and overt effects of injustice and gender inequality. Most importantly all of us need to live out the fact that we all have a role to play in addressing this injustice and gender inequality. And that women – in particular older women – are the ones that lead the way in this when we listen and pay attention. Without gender equality today, a sustainable future, and an equal future, remains beyond our reach.

Meet Jane (57), a strong senior woman from Tanzania – a country known for its beautiful wildlife reserves and for being home to a large variety of ecological systems ranging from Alpine deserts to rainforest areas. Tanzanian women are generally marginalised, a fact that is even more often the case for older women. Older women are usually impoverished, stigmatised and they have limited access to healthcare. Be inspired her story of courage and creativity as she stands strong in the face of poverty and the effects of HIV/AIDS.

“You never know how strong you are until being strong is your only option”

Jane, Tanzania

My name is Jane and in 1995, my life changed completely. My husband passed when I was pregnant with our fourth child. We seemed to have a good life  – I was married to a soldier, we were blessed with wonderful, healthy children and we lived in an apartment on the military base in Monduli. We had hopes and dreams, just like any other couple.

But, shortly after the funeral, I discovered that my husband had died from AIDS. I was tested and my results came out positive. I felt utterly crushed. Nobody knew anything about HIV in those days, most of the information we had at the time was false. We did hear a lot of rumours and these rumours turned victims into outcasts.

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