Response to communities in humanitarian crisis
"Do the most for the most"

Respuesta a comunidades en crisis humanitaria
"Hacer lo mas para la mayoria"

Today some 1.8 billion people live in countries undergoing different degrees of instability, from outright war, to severe destabilisation or transition to post-conflict situations. The majority of these countries are low-income. Women and children form the majority of these populations. The heaviest burden of suffering falls on the most vulnerable: children, adolescents, physically and mentally chronically ill and disabled, and victims of torture and rape.

The prevailing opinion is that without earliest psychosocial support 180 million people will suffer from serious mental health problems. This number could be doubled if those who would develop cognitive, psychosocial and economic dysfunctions that would jeopardise own and national reconstruction and are added.

To date, most of the responses are psychiatric, piecemeal and impose the stigma of mental illness. They oscillate between extremes: some, usually urban populations, receive excessive attention and others none. This is accentuating socioeconomic inequities and even mental health risks. These approaches are neither empowering nor sustainable, as communities are not usually concretely involved in needs assessments, strategy conceptualisation or programme implementation.

WHO believes that given the nature and magnitude of the problem, new approaches must be developed to "do the most for the most". A public health model associated with active community participation, with multisectoral and pluridisciplinary capacity building must be used. It is established that local, non-mental health personnel and community workers can be effective in providing the needed community-based psychosocial support once they have adequate training, technical guidance and the political and financial support. WHO believes that this approach will reduce the risk of pathologising suffering, will stimulate resilience and empower the concerned communities to work towards personal and community reconstruction, poverty and vulnerability reduction in a more efficient, cost-effective and sustainable manner.

We need to remember that the impact of increased mortality, of multiple losses, of uprooting and suffering will remain through generations. That the existing vicious circle linking the economic and socio-cultural roots of armed conflict (conflict => suffering and hatred => aggravated poverty and dependency => local and external economic interests => conflict) will be broken by the response of the international community.

The Director-General of WHO, Dr G. H. Brundtland has summarised the current situation and has sent a few ideas which aim at improving our work in her key note speech at the WHO International Consultation on Mental Health of Refugees and Internally Displaced Populations, Conflict and Post-Conflict Situations, From crisis through Reconstruction, in October 2000. I will fully present and describe those ideas in my presentation.

In an effort towards improved response in this field the Organisation has recently created two important instruments through vast internal and external consultation.

The first is the Declaration of Cooperation in Mental Health of Refugees, Displaced, and Other Populations Affected by Conflict and Post-Conflict Situations, as a contribution towards international consensus in policy, strategy and programmes, and as the guiding principle for our efforts in this field. The Declaration was endorsed by theInternational Consultation mentioned earlier. I strongly recommend its endorsement by this conference as well as definition of concrete steps for its wide implementation. The second instrument is the tool for the "Rapid Assessment of Mental Health Needs of Refugees and Displaced Populations in Conflict and Post-Conflict Situations" as a contribution towards improved mental health responses through a broaden reflection concerning mental health needs in emergencies; it aims at bringing about a population-oriented perspective that should be a more adequate basis in efforts for construction of community-based psychosocial action.

To conclude, no organization alone can respond to the plight of millions of people. Many can be proud of what they have achieved to date. And I include in this group many of the efforts of the International Society for Health and Human Rights.

At this very minute almost two billion people are struggling against imposed vulnerability, against even greater poverty, hunger, diseases and psychological misery in hostile places. Of course we cannot help them all. But I am convinced that stronger partnerships and cooperation based on the comparative advantage of each Organization will maximise the impact of the work of all of us to a much larger scale than that achieved by each one of us alone. I am convinced that this is the way to make the meaningful difference in the lives of those who are less fortunate than others.

Ms Mary Petevi. 1967-1973 MA in General, Comparative, Social Psychology, Psychophysiology specialised in Clinical Psychology. 1973-1979, Assist. Prof. in Cognitive Psychology, in the team of Jean Piaget, Geneva University. 1978-1980, consultant at UNHCR for community social services, education, resettlement. 1981-1995, UNHCR Sr Resettlement Officer for Vulnerable Groups. 1993-1995, appointed also as Focal Point for Mental Health. 1996-2000 in WHO, Dept of Mental Health and Substance Dependence, in charge of Mental Health of Populations Affected by Conflict and Post-Conflict Situations. January 2001 to date in WHO, Dept of Emergency Humanitarian Action in charge of Psychosocial Aspects of Humanitarian Emergencies. From 1978 to date undertook over 80 official missions for UNHCR and WHO, to some 50 countries for emergency, reconstruction and development operations. Ex- Officio member of many international professional associations including the ISHHR. Organised, and represented UNHCR and WHO as keynote speaker in many conferences worldwide . Visiting professor in several Universities. Authored over 80 United Nations official reports and numerous articles, training and other working tools, guidelines etc. Organised the first WHO International Consultation on " Mental Health of Refugees and Displaced Populations in Conflict and Post-Conflict Situations, From Crisis Through Reconstruction". Conceived and developed the WHO DECLARATION OF COOPERATION in Mental Health of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations. The WHO tool for RAPID ASSESSMENT of Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations, and Available Resources with internal and external consultations.