Since the start of the conflict in Lebanon, hundreds of thousands of people lost their homes and became displaced in areas considered to be less dangerous. In Beirut alone, more than 100,000 internally displaced persons (IDPs) have sought refuge in schools as well as parks, stadiums and parking-lots. Two MSF mobile teams, apart from providing basic medical care, began to offer mental health support in a number of IDP sites.
Lebanese psychologist Marie A. Salem explains how she is starting up mental health care in west Beirut's Safa Stadium where about 250 people from southern Lebanon and the capital's southern suburbs have gathered.
Many children experienced shelling, bombings and violence. How does that affect them?
"They are still very afraid. Usually, they have problems to sleep, not only because of what they went through but also because of the constant noise here in the centre which is an additional stressor. You can also see that they are hyperactive and overly aggressive. The smallest fight instantly makes them start crying which is not normal.
"Other typical symptoms of stress that we see among children and adults are headaches, shivering of the hands, heart palpitations or stomach pains."
I imagine you cannot provide a one-to-one therapy for the people here. What is possible under the current circumstances?
"We are providing psychological first aid. The aim is to destress children as well as adults with very simple methods such as breathing and relaxation exercises. We help people to restart normal daily activities. We also apply some techniques of cognitive behavioural therapy whereby people learn how their physical distress is related to the traumatic experience – and how they can handle by themselves.
"We are also setting up group sessions where one or several families are sitting together to discuss what problems and fears they are having. Most times, listening and sharing experiences with others is an important first step which is being felt as very supportive. In addition, an MSF psychiatrist provides care and medication for people who already had chronicle mental diseases such as chronicle depression or psychosis."
Do you have a specific approach for children?
"We are setting up a special programme which is to start in the coming days. The children here don't have anything to do, they don't have toys and they are not going to school. So, we will bring them toys and empower community members to play and interact with the children. Some children with more severe signs of emotional distress will be seen in consultations by MSF psychologists.
How do symptoms of stress develop if left untreated?
We are very concerned that some people with high levels of distress could develop chronic psychiatric disorders. And that is why we believe that our activity in this emergency phase is of medium and long term relevance as well. If we support the people now, we expect to prevent the long term psychological consequences of the traumas that they have been going through or witnessing.