Help Refugees and People in Health Crises


What is Psychological First Aid?

The wounds of war can often be invisible. Psychological First Aid offers a simple way to strengthen mental resilience during moments of crisis.

By Pamela Londoño Salazar

With heartbreaking violence spreading in Gaza, Haiti, Sudan, and around the world, the need for mental health support has never felt greater. Conflict weighs on people’s mental health in different ways, and for some affected people, the consequences can be both serious and long-lasting.  

According to the World Health Organization, one in five people who experience war or conflict develop depression, anxiety, post-traumatic stress disorder, or see an increase in symptoms of bipolar disorder or schizophrenia.  

When a camp for displaced people was bombed in Rafah, Gaza on May 26, I silently wept for those who had died, mainly women and children who had already been displaced from their homes and likely already lost loved ones. But most of all I wept for the children who survived and are still living through the horror of war. I thought about the deep and invisible wounds this will leave on their lives and mental health, and about the urgent need to help them feel safe, calm, and connected with others to prevent negative mental health outcomes after the crisis. 

Providing support in the first hours after violent events is crucial. Responding to people’s emotional needs in those difficult moments strengthens resilience and helps people begin the recovery process. Having someone who can listen, understand the needs, and provide guidance gives the person receiving support a sense of security that facilitates the expression of emotions and becomes a protective factor for developing mental health conditions.

Two young boys posing together in Gaza
Together with local partners, Project HOPE is helping children in Gaza access mental health support like play therapy to help them navigate the current conflict. Photo by Motaz Al-Aaraj for Project HOPE, 2024.

One way to respond to emotional needs in moments of crisis is through Psychological First Aid (PFA). PFA is a basic psychosocial intervention that provides human, supportive, practical, and culturally adapted support after a crisis. It is a recommended first-line response as it reduces high levels of acute stress and prevents symptoms of emotional distress from worsening over time. This intervention can be provided by anyone at the crisis site and does not require a professional background on mental health to be implemented, however it does require training to develop skills on communication, active listening, and the identification of people in emotional distress. 

Disasters, armed conflicts, and emergencies are often chaotic and need urgent action. However, it is crucial to be prepared and learn about what is happening before entering the crisis site. Understanding available services and supports — as well as safety and security concerns — is crucial to effectively providing PFA. 

The WHO’s Psychological first Aid: Guide for field workers provides a framework to help people affected by crisis using three principles of action: Look, Listen, and Link. 

Emergency contexts can rapidly change. Therefore, the first step to providing PFA is to LOOK for safety and for the most affected people. This first principle involves observing the conditions of the site, making sure it is a safe place to intervene, and identifying people with urgent basic needs and serious stress reactions. People may react in various ways to the same event, and it is important to identify signs of emotional distress and the people who may need special attention (children, people with disabilities, pregnant women, and people at risk of discrimination).  

The second principle of PFA is to approach people who may need support and LISTEN to their needs and concerns, as well as strengthen their coping skills by helping them to feel calm and regain control of their emotional reactions. As people in distress can feel confused and overwhelmed with worries and fears, it is crucial to help people to prioritize their most urgent needs to address them. Therefore, this principle entails active and empathetic listening to people’s emotional and basic needs, while respecting their willingness to speak and express themselves.  

The final step is to LINK people with practical support. Addressing basic needs such as shelter, food, sanitation, information, and helping people contact their loved ones is critical to reduce the acute stress people are experiencing. This last principle of action involves connecting people with support networks, services, or institutions that can provide the additional support they require.  

women hugging in front of tent
Project HOPE began providing mental health support shortly after the earthquake. Now, our long-term work includes MHPSS programs on both sides of the Türkiye-Syria border through partners. Photo by James Buck for Project HOPE, 2023.

At Project HOPE, we believe in the importance of providing psychosocial care to strengthen people’s resilience in times of emergency and crisis. We are also committed to continuing to train the courageous health workers, nurses, community health workers, and anyone who helps their community with tenacity and determination, even when they themselves have been displaced by violence and are affected by the same situation.  

When the war in Gaza ends, the people left to tell the story will have deep psychological wounds from the countless traumatic events they have experienced. So will those forced to live through war in Ukraine, Sudan, Haiti, and other crisis settings around the world. My hope is that many of them will be able to rebuild their lives, believing that a future is possible for them and their children. Others, however, will have psychological consequences that will be difficult to heal without professional help, and for them, it may be harder to resume their lives.  

Project HOPE’s teams in Gaza and around the world will continue our work providing PFA and training team members to provide it in times of crisis. We also continue our call for peace — including an immediate ceasefire in Gaza — so that children and innocent civilians can have hope for the future, feel well, and heal the invisible wounds left by war. 

Pamela Londoño Salazar is a mental health advisor for Project HOPE.  

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