Ricerc@Sapienza

According to UNHCR in 2016 there were 67.75 million people displaced worldwide: about 17 million are refugees, 2.826.508 are asylum seekers and 36.627.127 are internally displaced. The reasons for these massive displacements vary from natural to man-made disasters and, even if extremely different, both these two situations are characterized by the involvement of entire populations. For this reason, literature on mental health labels these two degrees of events “collective traumas”, indicating in a such way “shared injuries to a population’s social, cultural, and physical ecologies” (Saul, 2014) “or “social suffering” described as “interconnected adversities on the level of individual, family, community and society” (Kleinmann, 1997).
Nevertheless, the disasters that motivated migration are not the only adversities that refugees face: the processes of migration and resettlement, whether in another village of the same country or in a hosting country, are two other challenging situations that may threaten their physical safety and worse their psychological condition.
Different considerations are instead to be made for those people who decide not to leave their context since the occurrence of a disaster, especially if man-made, may change the society into a “Complex humanitarian emergency” (CHE) or rather in a situation characterized by: “...a protracted emergency situation with massive population displacement and destruction of social networks and ecosystems; insecurity, often based on armed conflict, affecting civilians and others not engaged in fighting; and the emergence of ‘predatory social formations’ with high levels of social insecurity threatening the ability of the population to sustain livelihood and life” (Ventevogel, 2017 pp. 21).
Generally speaking, the intervention on mental health, whether in a hosting country or in a Complex Humanitarian Emergency, should encompass three domains (Ventevogel, 2015): the first one is related to a psychosocial level, while the second and the third concern respectively the common and severe psychological disorders related to the different adversities faced.
In hosting countries, the psychosocial level of intervention may be declined in the sense of social integration of refugees (e.g. professional and school achievement, civic engagement, participation to social networks). Differently, in CHE it may concern the development of community resilience, defined by Norris et al. (2008) as a process made of four adaptive capacities: economic development, communication and information, community competence, social capital.
The second and third level of intervention require instead a specific focus on mental health. In hosting countries this consideration suppose the construction of services able to take in consideration the cultural background of immigrants, their way to express psychological suffering and also the meaning that they attribute to their psychological conditions; for these reasons it is fundamental, in this field, to create multidisciplinary equipes that involve the presence of specialized cultural mediators (Beneduce, 2001).
In CHE situations the management of common and severe mental health disorders may face instead the paucity of mental health services (often placed exclusively in big cities difficult to be reach) and qualified professionals; therefore, literature suggests that in these contexts efforts should be made in order to train mental health professionals and to decentralize the related services (Ventevogel, 2011).
Whatever the level of intervention, in CHE contexts the construction of local services often rely on external aid, nevertheless the involvement of local communities is fundamental in order to provide effective cultural-grounded interventions (Ventevogel, 2011; 2012; Murray, Dorsey, Bolton, Jordans, Rahman, Bass and Verdeli, 2011; Ager, Strang, Abebe, 2005).
Training project in Central Africa Republic