JLI Refugee & Forced Migration Hub – Roundtable 2 Event Summary

JLI Refugee & Forced Migration Hub: Roundtable Series

Between October and November 2023, the JLI Refugees & Forced Migration Learning Hub convened a series of roundtables on thematic issues that intersect with religions, faith, refugees and forced migration. The second in the series, which occurred on 25 October 2023, focused on faith-sensitive and culturally-sensitive approaches to mental health and psychosocial support (MHPSS).

Read summaries for the other roundtables here:

• Capacity building and capacity sharing with refugees and IDPs: case studies and lessons learned
• Engaging with faith actors to support social cohesion for refugees and forced migrants

For this meeting, JLI brought together academics and practitioners to share their experiences of working on MHPSS with refugees and forced migrants in different regions. The speakers included Youstina Mikhail (Ibrahimia Media Centre), Matthew Schojan (HIAS), Dr.Mohammed (Syria Bright Future), Dr. Jennifer Philippa Eggert (JLI), and Dr. Kathleen Rutledge (Queen Margaret University). 

Youstina Mikhail shared the work of the Ibrahimia Media Centre (IMC) in Egypt, a faith-based organisation affiliated with the Evangelical Fellowship in Egypt. IMC primarily works with community development, media training, and media productions. Youstina specifically spoke of an IMC project that aimed to support Syrian refugee children and their families, promoting integration and peaceful coexistence between Syrian refugees and the Egyptian host community. 

Mikhail emphasized that the main project addressed the needs of Syrian refugee children, as they often experience post-traumatic disorders, which deprive them of a normal childhood.

“ As a result, [refugee children] are particularly vulnerable to developing psychological disorders. Additionally, they face severe discrimination based on their nationality and accent, making them the most vulnerable to various forms of abuse such as sexual, physical and moral harassment as well.”  

Youstina Mikhail

The project succeeded in providing a secure environment where refugee children were able to thrive and enjoy fulfilling childhood experiences. Youstina highlighted that one of the primary objectives of the project was also to promote psychological literacy. This was achieved by addressing the lack of accessibility to psychological aid services through providing appropriate interventions and services, as well as challenging the stigma associated with the psychological disorders.

The project employed several strategies to implement interventions with the target groups, such as awareness, empowerment, protection skills, integration activities, capacity building for skills, networking and community partnerships, advocacy, specialized psychological referral, and positive parenting workshops.

Ultimately, the project succeeded in providing psychological support to a total of 50 refugee children, resulting in improved mental health outcomes for them. Additionally, it successfully empowered 200 parents by equipping them with positive parenting methodologies and skills. 

“Another notable impact was the transformative shift in perspectives and beliefs regarding psychological therapy, addressing stigma and stereotypes. Through our efforts, we have successfully fostered a positive change in the way individuals, including parents and caregivers, think about seeking psychological support, and dispelling harmful stereotypes. This shift in mindset has contributed to a more open and accepting society where individuals are more willing to engage in therapy and promote the service for others.” 

Youstina Mikhail

Youstina noted that the initiative has been rooted in the organization’s faith values, with IMC believing that the Bible is the constitution for all its actions. For this project, IMC was particularly driven by Biblical traditions of welcoming the stranger and putting love into action (for example, in Hebrews 16:2 which commands “do not forget to show hospitality to strangers”). 

Youstina acknowledged that a key challenge in the project was a lack of time to implement change, and a lack of capacity to support teenagers, and a limited budget to provide comprehensive support. Nonetheless, she believed this project, particularly its focus on supporting parents, could be a guiding model for future initiatives in the region.

Matthew Schojan from HIAS, a Jewish faith-sensitive organization, shared findings from three research projects which HIAS had completed in Latin America and the Caribbean, and engaged in a broader cross-study analysis of some of the overarching themes that emerged. While the project did not explicitly work with faith actors, it was rooted in faith principles of welcoming the stranger.

HIAS’ interventions have been particularly focused on the impact of the Venezuelan crisis, which has led to more than 7 million Venezuelan refugees, migrants and asylum seekers on the move throughout the region. One of the core programs underpinning HIAS’ interventions in the region focuses on mental health and psychosocial support.

The research projects conducted by HIAS focused on three MHPSS interventions in Ecuador, Panama, Colombia and Peru. These included the Laser Pulse project in Colombia, which employed group problem management, specifically adapting the methodology for displaced women, while also building the capacity of women in the community to facilitate the intervention; the IPC-3 project in Peru, which created a shorter version of interpersonal therapy (IPT), so as to better suit the context of communities on the move, and also explored the impact of remote delivery of interpersonal counseling; and the HEARD project in Ecuador and Panama, where HIAS co-designed self-help interventions (with a protection element) with displaced women in local communities. The latter project generated a manual entitled “Entre Nosotros”.

The three research projects specifically aimed to see what the common barriers and facilitators were for successful MHPSS interventions. The research also explored factors that supported or diminished the reach (entry into an MHPSS program) and retention (completion of an MHPSS program) of HIAS’ interventions. Matthew noted that dropout rates were highest in the period between enrollment into a program and the first session of the intervention. 

Matthew highlighted some of the key barriers and facilitators to reach and retention of project participants. These included: 

1. Outer context: barriers included competing priorities and responsibilities (e.g. childcare, work, health issues), lack of resources, gender norms and GBV, mobility, weather conditions, while facilitators included participant motivation
2. Inner context: barriers included a lack of privacy, while an important facilitator was the familiarity and trust participants enjoyed with HIAS. Location had a mixed impact depending on the setting, with some locations being considered inconvenient, but also a safe community space.
3. Individual: key facilitators to the programs’ successes were the fact that providers were local community members, and therefore enjoyed a great deal of rapport and trust with participants 
4. Intervention: barriers included difficulties comprehending the material, sessions being too long or too few, concerns around confidentiality, lack of financial support, while facilitators included the trust and social support of a group setting, 

“The key aspect of what we were learning pertained to reach and retention. The importance of community involvement and outreach strategies to gain initial buy-in, as well as the location of the services, was key. Additionally, we found that multisectoral or integrated approaches were critical to having a more person-centered approach and encourage people to participate in these groups while accessing other services that HIAS provides.”

Matthew Schojan

Schojan also highlighted the importance of regular communication, constant access, and flexible methods of engagement, and networks, were crucial to supporting retention.

Dr. Mohammed Abo-Hilal founded Syria Bright Future (SBF), an organization which co-founded and co-chairs the JLI Syria Hub on MHPSS and Culture for Syrian refugees. SBF has worked with Syrian refugees and IDPs within Syria and neighboring countries for over ten years. However, in recent years SBF began to recognise that mental health programmes and services were not sufficient to address the problems faced by displaced Syrians. In particular, existing services failed to include faith or cultural adaptations to local needs.

SBF began investigating the possibility of developing culturally-adapted MHPSS services for Syrian refugees. First, they conducted a survey with 180 people to determine the level of interest or need for such interventions. The survey revealed that while people were interested in culturally-adapted and faith-sensitive MHPSS services, there existed a number of barriers – for example, there were fears of breaching humanitarian principles of neutrality, and of alienating donors.

“People fear that this component will not be favored by donors if included. Additionally, we found that people tend to hide any mental health activities involving faith components from their donors. From the report they raised and as everybody knows that Syria is a very complex context where we had ISIS and Islamic groups that are classified easily. Including faith, which is mainly Islam, in the programs will result in labeling. Any organization could work on that, and this is another layer of why people are trying to avoid it.”

Dr. Mohammed Abo-Hilal

Following the survey, SBF engaged in research with Islamic Relief Worldwide, Queen Margaret University, and the University of Birmingham exploring how Syrian women drew on faith as part of their coping mechanisms to overcome trauma. SBF then began its partnership with JLI, engaging in a literature review to map existing research on cultural adaptation of MHPSS in the Syrian context, as well as interviews with mental health practitioners on the subject of cultural adaptation and faith inclusion in mental health programs. The latter two research papers have since been published in partnership with JLI.

Dr. Jennifer Eggert, from JLI, expanded on Dr Abo-Hilal’s presentation, focusing specifically on SBF’s partnership with JLI for the JLI Syria Hub on MHPSS and Culture. The Hub was established to address the lack of evidence, practice, and awareness on culturally-adapted MHPSS interventions in the Syrian context. The Hub’s activities were developed with collaborative, participatory, fair and equitable principles in mind – actively seeking to mitigate inequalities and colonial legacies which may have affected their work.

Dr Eggert shared how SBF expressed their intention to lead their own research on faith-sensitive and culturally-adapted MHPSS for Syrian refugees, yet did not have research expertise. As such, JLI and SBF engaged in a collaborative research capacity-sharing program, whereby SBF shared its expertise on MHPSS and the Syrian cultural context, and JLI its shared expertise on research skills and methodologies. This has led to numerous publications on MHPSS and culture in Syria being co-produced by JLI and SBF.

The Syria Hub also facilitated Listening Dialogues with Syrian MHPSS professionals, in order to ascertain the experiences and needs of practitioners. The Hub also engaged in awareness raising activities, regular meetings, webinars (in both Arabic and English, for Syrian and global audiences). The activities of the Hub has led to increased awareness of the need for culturally-sensitive MHPSS among practitioners in the region, as well as establishing SBF as an evidence-leader in this field, resulting in ongoing funding for SBF being secured to continue and expand its activities.

“There are sensitivities of working on faith in the Syrian context. That’s the reason why we referred to the Hub as the MHPSS and Culture Hub. But then, faith is part of culture – it was one of several aspects which we touched upon. The focus on culture also helped with inclusivity, as it meant we could include traditional healers.”

Dr Jennifer Eggert

Dr Eggert also highlighted a particular benefit of the JLI and SBF partnership, in that JLI’s position as a US-based international partner provided SBF the protection they needed to engage in research on faith-inclusivity in MHPSS programming. She reflected that participatory, collaborative, fair and equitable research partnerships were possible, but they took time, trust, and resources to be successful. Finally, Dr Eggert expressed the intention of the Syria Hub to expand its engagement with non-Muslim Syrian communities in the region. 

Dr. Kathleen Rutledge from Queen Margaret University presented research on the role of faith in mental health among displaced and violence-affected Muslim women in Iraq. This was part of a larger study engaging with 246 Muslim women across Iraq, Syria, Tunisia, and Türkiye, co-led by Queen Margaret University, the University of Birmingham, Syria Bright Future, and Islamic Relief Worldwide. Dr. Rutledge drew on the Inter Agency Standing Committee (IASC) Guidelines on MHPSS (2007), which underscores how essential faith beliefs and practices are for the majority of people globally. The Guidelines emphasize that engaging with cultural healing practices can increase psycho-social well-being, while, conversely, ignoring cultural healing practices and coping mechanisms can prolong distress and potentially cause harm – which would actually violate humanitarian principles of neutrality and impartiality. The IASC Guidelines instead specifically call on humanitarian actors to facilitate conditions for appropriate cultural, spiritual, and religious healing practices. 

The study led by Dr Rutledge and her partners sought to investigate the diverse and complex relationship between faith and mental health for women in different contexts, recognising that such approaches could not be generalized. Three key findings from Dr. Rutledge’s research focusing on Iraq were:

1. Faith practices were widely prioritized as personal and communal means of coping and recovery, with both the daily stressors of life, and the trauma of conflict overall.
2. Faith beliefs both buffered and contributed to distress in measurable ways. 
3. Support from influential persons of faith (e.g. faith leaders, formal and informal) is prized, but there are barriers to accessing the type of support desired – often within local and international NGOs.

Some of the practices which offered comfort and protection included reciting specific Qur’anic scripts or listening to Qur’an on their phones; engaging in both daily prayers as well as making special dua, engaging in repetitive prayers, or reciting the 99 names of Allah helped some women cope with anxiety; fasting brought a sense of closeness with Allah and with others.. Dr Rutledge highlighted that for many women, having a clean space to pray at home, as well as gender-segregated community spaces (including spaces where they could access electricity to listen to Qur’an on their phones) were a priority. 

Dr Rutledge identified the dual role that faith beliefs played in women’s psychological distress or comfort, with women who believed that God cared about their life displaying lower levels of psychological distress, while women who believed that God did not care about their life displayed higher levels of psychological distress (both compared to the camp average).

“There is a difference between those who believed God cared about their life and  those who didn’t. The women that felt that God did not care about their life and situation expressed that with intense anxiety – their distress levels were off the charts…When the women struggled with questions about whether they were punished specifically for a lack of devotion…this elevated their distress, and it was compounded by the fact that some of them felt they couldn’t do their required [religious] practices in the camp context – so the normal things they would do to restore that intimacy were out of reach, because aid workers had never asked the women what spaces or materials they need. Faith beliefs of the people that we’re working with have a direct association with issues like depression and anxiety.”

Dr Kathleen Rutledge

Dr Rutledge outlined a number of ways in which MHPSS interventions for women could be improved. Firstly, identifying and supporting ‘invisible’ women who are faith leaders to instruct and console others. Secondly, creating faith-sensitive, women-friendly spaces and ensuring their freedom of religious belief and expression is well protected. Thirdly, protecting the needs of people of no faith, or people from minority groups.