Authors: Mike Wessells
In this, our 14th issue, we present “Do No Harm: Challenges in Organizing Psychosocial Support to Displaced People in Emergency Settings”, a thoughtful and stimulating paper by Mike Wessells that was originally published in Refuge in 2008 (see links below).
Using illustrative examples derived from different countries and cultural contexts, Mike demonstrates how the structure, delivery and constraints of international aid efforts in emergency situations may lead to psychosocial interventions that result in harm rather than healing. The causes are many, complex and interrelated. The paper goes beyond nominating causes to include suggestions on practical ways in which both institutions and individuals can better follow the humanitarian imperative of ‘do no harm’.
Mike considers a number of key issues. The first of these relates to the difficulties in coordinating service design and delivery among different agencies in such a way that psychosocial programs appropriately identify and reach those in most need; avoid unnecessary duplication and collaborate with, and learn from, each other. The need for a single coordinating structure, as outlined in the IASC guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007), is made abundantly clear.
The paper also illustrates how psychosocial programs that are conceptualized and delivered without utilizing community strengths and capacities run a number of risks. These include the creation of external agencies that will disappear once short-term emergency funding terminates; the fostering of a dependency culture; inadequate long term support for local staff; and a failure to appreciate the relevance of local knowledge and understanding for successful healing. In addition to advocating longer term funding to promote more durable programmatic support, Mike argues that community resilience will best be fostered by programs that are planned, implemented and evaluated with the full involvement of community members. At the same time, he warns against an over-simplistic idealistic reification of the ‘community’ in a way that ignores local power groupings and social hierarchies. These latter groupings may seek to impede the impartial and independent delivery of services based on the criteria of need and respect for all – a reminder that international aid has political, cultural and social dimensions at the local as well as country and international levels.
Other areas explored in the paper include protection issues that arise in relation to confidentiality, informed consent and the excessive targeting of at risk groups. Psychosocial interventions can too often have a narrow focus on trauma healing. Mike reminds us that community harmony will benefit from the promotion of non-violent conflict resolution alongside therapeutic healing practices when victims and perpetrators of violence live alongside each other.
To visit the journal Refuge go to: www.yorku.ca/refuge;
For Wessells paper go to: http://pi.library.yorku.ca/ojs/index.php/refuge/issue/view/1270