A Growing Challenge: Psychosocial and Mental Health Support for Refugees and Migrants in an Urban Setting

Psycho-Social Services and Training Institute in Cairo PSTIC Welcomes you to Cairo!

EMERGENCY NUMBERS Yumna Marwa Nancy PSTIC Emergency Number

CONFERENCE DAILY PLAN DAYS 1 AND 2 9 – 1030Morning Panel 1030 Coffee-Tea Break (Time varies with program) 1100 – 1200Morning Panel 1200 – 1330Lunch / Optional Lunchtime Discussion 1330 – 1500Afternoon Small Group Discussion 1500Coffee-Tea Break 1515 – 1645Afternoon Panel 1645 – 1700Summary DAY 3 Program times vary and conference ends at 1500

LUNCHTIME DISCUSSIONS DAY 1 CHAIR: Peter Ventevogel Editor Intervention Journal Planning publications based on content and discussion from this conference including: A Guide for Best Practices in the Urban Setting A Guide for Best Practices in the Urban Setting YOUR professional publication about MHPSS in urban settings. YOUR professional publication about MHPSS in urban settings. DAY 2 CHAIR: Sarah Harrison Co-Chair of IASC MHPSS Reference Group Co-Chair of IASC MHPSS Reference Group IASC Guidelines On MHPSS in Emergency Settings How effective are they in the urban context? How effective are they in the urban context? What more is needed? What more is needed?

EVENING EVENTS DAY 1: Boat with refreshments on the Nile Leave AUC 17:30pm to walk to boat / 20 minutes Leave AUC 17:30pm to walk to boat / 20 minutes Boat leave from pier outside of Sofitel Boat leave from pier outside of Sofitel End 20:30pm End 20:30pm DAY 2: Theater / Dinner / Music At AUC 18:00 (Refreshments) 18:00 (Refreshments) 18:30 Theater 18:30 Theater 20:00 Dinner / Music 20:00 Dinner / Music End 20:00pm End 20:00pm

SPECIAL ACTIVITIES 10th April / Field activities 13th April / Field activities 1500 – 1700Children’s art activities 1800 – 2000Women’s support group 1800 – 2000Community workshop 14th April / Tourist trip 8am – evening Pyramids / National Museum / Old Cairo

Worldwide process of urbanization In 1950, In 1950, Less than 30% lived in urban area; Now over 50%; Expect 60% by million lived in urban area; 730 million lived in urban area; Now 3.3 billion.

REFUGEE TREND TOWARD URBANIZATION 43.7 million displaced worldwide Includes 15.4 million refugees million under UNHCR million under UNHCR 4.82 million Palestinians under UNRWA 4.82 million Palestinians under UNRWA Of the 10.5 million, half live in urban centers with only one-third in camps.

DAY 1: PANEL PRESENTATIONS 11:00 – 12:00PANEL 1: SPECIAL PROBLEMS of urban context 15:15 – 16:40PANEL 2: RESEARCH about MHPSS consequences of urban life on refugees and migrants

DAY 1: SMALL GROUP DISCUSSION Group 1) INTEGRATION IS IMPOSSIBLE THE NATIONAL PEOPLE HATE ME! Group 2) DEAD DREAMS: THE DISAPPOINTMENT OF RESETTLEMENT Group 3) NO RISK IS TOO GREAT IN THE SEARCH OF A BETTER LIFE Group 4) WHEN IS A CHRONIC MISERABLE LIFE A PREDISPOSITION FOR MENTAL ILLNESS? Group 5) THE HEIGHT OF EXPECTATIONS /No one helps me enough. Group 6) WHO AM I? THE PROBLEMS OF CHILDREN BORN AND RAISED IN SOMEONE ELSE’S COUNTRY

DAY 2: PANEL PRESENTATIONS 9:00 – 10:00PANEL 3: ASSESSMENT of MHPSS needs, problems, resources of refugees and migrants in urban context. 10:00 – 10:40PANEL 4: HOST COUNTRY SUPPORT 15:15 – 16:45PANEL 5: INTERVENTIONS for MHPSS for refugees and migrants in urban context.

DAY 2: SMALL GROUP DISCUSSION Group 1) BUILDING COMMUNITY AWARENESS IN REFUGEE COMMUNITIES ABOUT MHPSS Group 2) IDEAS FOR MANAGING COMMUNITY CONFLICTS: REFUGEES AGAINST REFUGEES Group 3) ACTIVITIES FOR REFUGEE CHILDREN IN THE URBAN SETTING Group 4) BUILDING POSITIVE RELATIONS BETWEEN REFUGEES AND NATIONAL POPULATIONS Group 5) ADVANTAGES AND DISADVANTAGES OF TRAINING REFUGEES TO BE THE PSYCHOSOCIAL WORKERS ASSISTING THEIR OWN COMMUNITIES Group 6) THE MHPSS CONSEQUENCES FOR REFUGEES AND MIGRANTS DUE TO THE PRESSURE TO CHANGE CULTURE AND TRADITION DUE TO URBAN LIFE

DAY 3: PANEL PRESENTATIONS 9:00 – 9:45PANEL 6: INTERVENTIONS for MHPSS continued 9:45 – 10:45PANEL 7: INTERVENTIONS for MHPSS continued 12:00 – 12:20PANEL 8: TRAINING AND SUPERVISION of urban MHPSS Teams

DAY 3: SMALL GROUP DISCUSSION BEST PRACTICIES GUIDE for providing MHPSS support in the urban context: What should be included? Group 1)PROBLEMS Group 2)ASSESSMENT Group 3)HOST COUNTRY SUPPORT Group 4)COORDINATION Group 5)TRAINING / INTERVENTIONS Group 6)RESEARCH / MONITORING – EVALUATION POST CONFERENCE MEETING Small group facilitators review key findings to be included in Best Practices Guide publication.

UNHCR policy on refugee UNHCR policy on refugee protection and solutions protection and solutions in urban areas in urban areas September 2009 September

UNHCR in million, almost half refugees under its mandate displaced at least 5 years. 7.2 million, almost half refugees under its mandate displaced at least 5 years. Only 197,600 people were able to return home; lowest number since Only 197,600 people were able to return home; lowest number since /5 world's refugees hosted by developing countries. 4/5 world's refugees hosted by developing countries.

IASC MHPSS Guidelines (2007) developed to fill the gap and provide a global framework from which to help organizations work alongside affected communities to offer mental health and psychosocial support across all sectors of assistance. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings GUIDE AND CHECKLIST FOR FIELD USE

IASC MHPSS Guidelines (2007) : IASC MHPSS Guidelines (2007) : Armed conflicts and natural disasters cause significant psychological and social suffering to affected populations. The psychological and social impacts of emergencies may be acute in the short term, but they can also undermine the long-term mental health and psychosocial well-being of the affected population. The psychological and social impacts of emergencies may be acute in the short term, but they can also undermine the long-term mental health and psychosocial well-being of the affected population. These impacts may threaten peace, human rights and development. One of the priorities in emergencies is thus to protect and improve people’s mental health and psychosocial well-being. Achieving this priority requires coordinated action among all government and non-government humanitarian actors.”

As MH / PSS response increased became obvious that “a significant gap existed in how to provide a multi- sectoral, inter-agency framework that enabled effective coordination, identified useful practices and flagged potentially harmful practices, and clarified how different approaches to mental health and psychosocial support complement one another… (IASC MHPSS 2007)

21 The guidelines were prepared at the request of the Inter Agency Standing Committee (IASC). Inter Agency Standing Committee (IASC). The IASC was established in response to General Assembly Resolution, which called for strengthened coordination of humanitarian assistance. Formed by heads of broad range of UN and non-UN humanitarian organizations and the Federation of Red Cross/Red Crescent Societies, the International Committee of the Red Cross, and consortia of international NGOs.

The IASC MHPSS “guidelines reflect the insights of practitioners from different geographic regions, disciplines and sectors, and reflect an emerging consensus on good practice among practitioners.

Task force members who developed guidelines include: Action Contre la Faim (ACF)Church of Sweden Global Psycho-Social Initiative (GPSi)Christian Children's Fund (CCF) InterAction (through: American Red Cross (ARC) CARE Austria International Catholic Migration Commission International Medical Corps (IMC) International Rescue Committee (IRC)Mercy Corps Save the Children USA (SC-USA) Inter-Agency Network for Education in Emergencies (INEE) International Council of Voluntary Agencies (ICVA)Oxfam (GB) Action Aid InternationalHealthNet-TPO Médicos del Mundo (MdM-Spain) Médecins Sans Frontières Holland(MSF-Holland) World Vision International (WVI) Refugees Education Trust (RET)Save the Children UK (SC-UK) International Federation of Red Cross and Red Crescent Societies (IFRC) International Organization for Migration (IOM)Terre des hommes (Tdh) Office for the Coordination of Humanitarian Affairs Queen Margaret University Institute of International Health and Development (IIHD) Regional Psychosocial Support Initiative for Children (REPSSI) United Nations Children's Fund (UNICEF) United Nations Population Fund (UNFPA) World Health Organization (WHO) World Food Programme (WF United National Relief and Works Agency (UNRWA) United Nations High Commissioner for Refugees (UNHCR)

Different ways to use the guidelines Advocacy for better practice. Advocacy for better practice. Resource book on specific interventions Resource book on specific interventions Coordinating tool Coordinating tool Checklist to identify gaps Checklist to identify gaps Structure to facilitate agencies to work together to address diverse needs Structure to facilitate agencies to work together to address diverse needs Programme planning and design Programme planning and design

The IASC guidelines provide a comprehensive framework for Mental Health and Psycho Social Support (MHPSS) by: Mental Health and Psycho Social Support (MHPSS) by: Protecting or promoting psychosocial well-being and Preventing or treating mental disorder.

Guideline framework: Focus on MINIMUM FIRST RESPONSE and COMPREHENSIVE RESPONSES OVERTIME.. Focus on MINIMUM FIRST RESPONSE and COMPREHENSIVE RESPONSES OVERTIME.. Focus on practical actions and social interventions. Focus on practical actions and social interventions. Provide action sheets on 25 key interventions by different sectors. Provide action sheets on 25 key interventions by different sectors. Recommended to be implemented flexibly in accordance with context and culture and in cooperative inter-agency manner. Recommended to be implemented flexibly in accordance with context and culture and in cooperative inter-agency manner.

Guidelines not intended solely for mental health and psychosocial workers. Protection of psychosocial well-being recommended as shared responsibility of all sectors of humanitarian response. Designed for use by all humanitarian actors, including community-based organisations, government authorities, United Nations organisations, non-government organisations (NGOs) and donors operating in emergency settings at local, national and international levels.” IASC MHPSS 2007 IASC MHPSS 2007

IASC MHPSS Core Principles: Human rights and equity Human rights and equity Participation Participation Do No Harm Do No Harm Building on available resources and capacities Building on available resources and capacities Integrated support systems Integrated support systems Multi-layered supports Multi-layered supports

… People have different responses to emergencies even if they are similar situations. Different responses require a range of support and intervention…

IASC MHPSS recommends use of multiple layers of intervention to be done simultaneously. Pyramid describes a layered system of complementary supports and the likely scale of demand for each of those layers. These supports should be offered simultaneously.

Basic services and security Community and family supports Layer 4: Specialised Services Layer 3: Focused Non-Specialised Supports (person-to-person) Layer 2: Community and family supports Layer 1: Social considerations in basic services and security Layer 1: Wellbeing of most people protected by re establishing security and providing basic services. Possible services: Advocacy for basic services that are safe, socially appropriate and protect dignity to enhance wellbeing and avoid doing harm. Layer 2: Community - family support is valuable for all but necessary to reestablish wellbeing for some who cannot access these alone. Possible services: Facilitation of traditional, cultural, religious, leisure activities. Mobilization / facilitation / activation of community leadership and social support structures. Layer 3: About 10-20% require additional help. Services: Psychological first aid Basic mental health care by primary health care workers. Basic counselling by community workers. Layer 4: Small percentage (3-4%); but desperate need and problems in daily functioning. Possible services: Mental health care by specialized mental health staff. IASC MHPSS Intervention Pyramid