From our long history of emergency response, Doctors Without Borders/Médecin Sans Frontières (MSF) knows that mental health is sometimes not prioritized in the critical moments after a traumatic event. Yet mental health support is essential to help people adapt, recover, and rebuild their lives in the wake of an emergency.
Psychological first aid is provided to people experiencing acute distress after a traumatic event, helping them cope with shock, panic attacks, confusion, and changes in appetite and sleep patterns, among other symptoms. “It’s a simple training that anyone can do,” said Dr. Bashar Ghassan, an MSF psychiatrist based in Jordan. The aim is to stabilize the person; secure a safe space; ensure access to food, shelter, water, and medications if needed; and connect them to social support.
Who benefits from psychological first aid?
Doctors Without Borders teams provide psychological first aid in a range of contexts, including after the earthquakes in Türkiye and Syria in 2023, the Ukraine war, and incidents of mass displacement.
In Ukraine, MSF mobile clinic teams have provided psychological first aid to survivors of missile attacks. When people took refuge in Kharkiv’s metro stations in 2022—many coping with the loss of family members, friends, homes, and plans for the future—MSF teams set up mobile clinics to provide psychological first aid. Dr. Morten Rostrup described the scene:
“A seven-year-old girl who had constant nightmares and was afraid of falling asleep. People experiencing physical pains they couldn’t explain. People who felt like they couldn’t breathe. A woman with sky-high blood pressure who was at risk of having a stroke ... An old man who had suffered a stroke and had high blood pressure. He couldn’t sleep.”
We also train people in the places we work on how to provide psychological first aid, since you don’t need to be a mental health professional to do so. Training includes self-care for the providers, which helps them identify when they themselves need help and how to get care.
How is psychological first aid provided?
The first step, upon arriving at the scene, is to identify people already experiencing the psychological impact.
“We always pay attention to those who sit in silence, because it’s clear that this is a state of unresponsiveness which a person needs to be brought out of,” explained Inna Potapenko, an MSF psychologist in Ukraine. “The most important [thing] is to establish contact with the person and make clear that they see you, hear you, and understand where they are.”
In some cases, psychological first aid is followed with cognitive behavioral therapy, a psychosocial intervention aimed at reducing distress by changing maladaptive thinking patterns. When people can link their physical symptoms (e.g., hypervigilance) to the mental trauma, they start to recognize that if they can manage the thoughts then the physical symptoms will also start to be manageable. This form of intervention must be provided by a mental health professional, unlike psychological first aid, which anyone can be trained to provide.
Why is psychological first aid important in emergency response?
Almost anyone will experience psychological distress in the aftermath of an emergency or traumatic event. For most people, symptoms will eventually improve. Receiving timely and proper support can reduce a person’s recovery time from a traumatic event.
“In the beginning it is very painful; the wound is fresh,” says Dr. Ghassan, who provided psychological first aid in the wake of the deadly 2023 earthquakes in Syria. “But by allowing people to talk about their experience, we try to turn it into a scar.”
One in five people who have experienced war or other conflict in the past 10 years will have depression, anxiety, PTSD, bipolar disorder, or schizophrenia, according to the World Health Organization (WHO). People who already have severe mental health disorders are particularly vulnerable during these crises and need support.
“As a medical professional who speaks Arabic and Berber, I was able to talk to people, listen to their stories, and help them express their emotions,” said Fouzia Bara, an MSF nurse who was part of the team that responded to the earthquake in Morocco in September 2023. Generally, holding psychological first aid sessions in Berber is a challenge because Morocco is short on psychologists who speak the language. Given my background, however, I was able to hold group sessions without a translator.”
Where is MSF providing psychological first aid?
Armenia
On September 28, an MSF medical team began receiving patients at a registration center in Goris, a town in Syunik province in southern Armenia, to which people displaced from Nagorno-Karabakh were fleeing. Two psychologists provided mental health consultations and psychological first aid to over 200 people in just a few days.
Lebanon
MSF teams are providing psychological first aid to displaced people who fled the border region between Israel and Lebanon due to fighting between the militant group Hezbollah and Israeli forces. Many of them left their homes with no possessions and are struggling to obtain basic necessities such as food and blankets.
Mediterranean Sea
MSF search and rescue teams—including psychologists and cultural mediators specifically trained to offer psychological first aid—provide care to shipwreck survivors at disembarkation ports, hotspots, or reception centers in Italy. We primarily provide psychological first aid to relatives and friends of the victims of a shipwreck, with the objective to help address their trauma with mental health support. The team also offers basic services to all survivors, including facilitating access to medical treatment, providing information, and referring vulnerable people to the authorities.
Ukraine
In regions near the front lines—such as Zaporizhzhia, Dnipropetrovsk, Donetsk, and Kherson—MSF teams have responded to the acute psychological needs of people who have survived missile strikes or other disasters. In these areas as well as those retaken by Ukrainian forces—often rural areas where people have experienced fighting, violence, and hostilities for months—MSF teams have also set up mobile clinics where psychological first aid is offered among other mental health services. Additionally, we provide self-care and psychological first aid training for railway staff, who often end up acting as psychological first responders, as they serve people who are evacuating areas heavily affected by the war.
