Copyrig

Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria

Intervention 2013, Volume 11, Number 3, Page 340 - 348

Inter-agency coordination of mentalhealth and psychosocial support forrefugees and people displaced inSyria

Liyam Eloul, Constanze Quosh, Rawan Ajlani, Naira Avetisyan,Mouta Barakat, Lidia Barakat, MohammadWaleed Ikram,Louay Shammas & Victoria Diekkamp

The current crisis in Syria has greatly escalated

need, while simultaneously damaging infrastructure

within the country. In order for humanitarian

e¡orts to be e¡ective, understanding the mental

health pro¢le of the population concerned, pre-

existing mental health system, resources and gaps,

as well as an evaluation of the current service situ-

ation is vital. This paper provides an analysis of

the shifting resources and infrastructure available

to the a¡ected populations in Syria, complementing

the systematic review of mental health outcomes

elsewhere in this issue. Assessment results from

Syria are presented, and capacities and gaps

assessed. This article describes how previous,

protracted humanitarian and development centred

inter-agency e¡orts to evaluate and improve the

mental health and psychosocial system in Syria can

be applied as a foundation, and adjusted to address

the current internally displaced persons and refugee

crises in the country.

Keywords: inter-agency coordination,Iraq, mental health and psychosocial sup-port, Syria

IntroductionUnderstanding health and illness, explana-tory models and help seeking behaviour isimpossible without linking them to the localcontext and service systems. In 2011, Syria

ht © War Trauma Foundation. Unautho340

(population 21.8million) hadapproximately80 psychiatrists; 25 times less than the mini-mum ratio recommended by the WorldHealthOrganization (WHO).The dramaticin£ux of Iraqi refugees in 2006 drew intosharp focus the need to develop the mentalhealth system in Syria. Initially, there wasno structured approach to mental healthand psychosocial support (MHPSS) pro-gramming. The refugee emergency hadinstigated a few scattered initiatives, butwithout any systemised coordination orstandardisation. In addition, there was alack of prevention e¡orts and formalisedcommunity care. The onset of the currentcrisis resulted in the £ight of many pro-fessionals and drained capacity in the ¢eldof MHPSS. This paper describes inter-agency e¡orts to evaluate and reinforce theMHPSS system in Syria, in the face of severeand increasing need.

Mental health resources in SyriaDuring the initial systematic review ofthe published and informally published orgrey literature on Syria (Quosh, Eloul &Ajlani, 2013), articles and studies wereidenti¢ed, including information about theSyrian mental health system. Only two,partially outdated, grey literature reports(WHO, 2005; Assalman et al., 2008)

rized reproduction of this article is prohibited.

Copyrig

Eloul et al.

included pertinent information. Brief, butcurrent reviews of the crisis and destructionof mental health services can be found inAbou-Saleh & Mobayed (2013) and Amos(2013). There are no reliable estimates ofpsychiatric morbidity in Syria, due to aninsu⁄cient health information system andlack of systematic research (Matar et al.,2009). Additionally, the high level of socialstigma associated with mental disordersinhibits reporting (Quosh, 2011). (For moreinformation on mental health legislationin Syria, as well as documentation and infor-mation systems, see this article’s appendix,http://links.lww.com/INT/A3) Therefore, inorder to complement the available publishedinformation, structured interviewswere con-ducted with two key stakeholders: a psychol-ogy professor from the University ofDamascus and a psychiatrist (at that timethe Mental Health Director of the SyrianMinistry of Health).Professionals in mental health include:psychiatrists, psychologists, social workers,primary/secondary health care providers,and traditional healers (training and licen-sing requirements, as well as existing mentalhealth education and service systems aredescribed in detail in the web appendix,http://links.lww.com/INT/A3). Both publicand private mental health care exist in theform of hospitals and o⁄ce based care, butare limited and highly medicalised.Additionally, they are directed at seriousmental illness and disability, and restrictedprimarily to urban areas. Primary healthcare (PHC) centres can o¡er mental healthservices, eitherby hostinga rotating psychia-trist, or by having a medical practitioneror resident with training in psychiatry onsta¡. The primary source of communitybased support is extended family.Until recently, there was a clear hierarchyamong professionals that often prevented

ht © War Trauma Foundation. Unautho

cooperation and coordination. The pre-judices held between psychiatrists andpsychologists further hindered multi-professional training and interactiveeducation, perpetuating the lack of com-munication. Several international agenciesand the Ministry of Health have takenan increased interest in mental health inrecent years, and implemented a numberof trainings to build capacity, which hasbolstered cross discipline cooperation(Quosh, 2011). While priorities changed,due to the emergency context, mentalhealth remains high on the agenda andinterdisciplinary trainings are increasinglybeing conducted. This has encouragedpractitioners and clinics to adopt a bio-psycho-social-spiritual approach which,in turn, has eased the shift from protracteddisplacement to emergency mode. Thereremains, however, limited formal struc-ture for collaboration. Most coordination,particularly outside of humanitarianprogramming in Damascus and ruralDamascus, is based on personal initiativesand the coordination network of 17 remain-ing master trainers1 (Quosh, 2011).

Inter-agency coordinationIn 2009, several agencies on the groundbegan taking the initiative to fosterimproved MHPSS services. Two workinggroups facilitated coordination of MHPSSfor refugees from Iraq:

1) T

rize

he Response Coordination Work-ing Group (chaired by the SyrianArab Red Crescent (SARC) and theUnited Nations High Commissioner forRefugees (UNHCR)), and

2) T

he Interagency Working Group onCapacity Building (chairedbyUNHCRand the Ministry of Health2), whichtransitioned into a National Mental

d reproduction of this article is prohibited.341

Copyright

Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria

Intervention 2013, Volume 11, Number 3, Page 340 - 348

342

Health Council at the end of 2011(chaired by the Ministry of Health,with rotating co-chairs among memberorganisations).

With the onset of the current Syrian crisisin 2011, a di¡erent response structure wasrequired as part of the cluster systemapproach. A technical MHPSS workingand reference groupwas established, chairedby UNICEF and UNHCR. The purposeof this group was to facilitate sectoral andcross-sectoral coordination, informationsharing, contingency planning,mainstream-ing of MHPSS across sectors, and provisionof technical support and capacity buildingto other coordination groups (particularlyhealth, education and community ser-vices). The working group members from13 di¡erent organisations, including UNagencies, international nongovernmentalorganisations (INGOs) and national organ-isations, met regularly. The group preparedand approved: a national MHPSS frame-work with minimum standards, a guid-ance document for mainstreaming MHPSSacross sectors, a framework for MHPSSassessments during the emergency, andregularly updated 4Ws (who is where,when and doing what) mapping. Theworking group bene¢ted from the exist-ing close inter-agency cooperation, andreferral pathways were strengthened andexpanded.TheMHPSSworkinggroupwas operationaluntil December 2012, when the two sta¡members from the co-chairing agenciesleft the country. After that, the group wasdivided between working groups for Com-munity Services (led by UNHCR) andHealth (led by WHO). As a result of thissplit coordination,MHPSShasbecome frag-mented. A newMHPSSTechnical ReferenceGroup (TRG) was established in June

© War Trauma Foundation. Unautho

20133. Its members are technical experts,and the group provides advocacy and tech-nical input across sectors, whilemaintainingbasic coordination functions. Lack of accessto many geographical areas and of technicalMHPSS capacity has re-emphasised theneed for capacity building and inter-agencypartnerships. In particular, reinvigorat-ing the National Mental Health Council(instituted in 2011), which never functioneddue to the onset of the current crisis, becamea priority.

Interagency 4Wmapping resultsSystematic mapping of services

Regular mappings of available mentalhealth services and support structuresaccessible to the refugee population havebeen conducted, in order to gain improvedunderstanding of the mental health needsand resources, as well as the overall mentalhealth system. In addition to the 4W map-ping [Inter-Agency Standing Committee(IASC), 2012] these mapping exercises havealso included: service capacity, quality andtraining needs, as well as referral structures.Mapping exercises have been conductedwith yearly updates. In 2011, facilitated bythe inter-agency MHPSS working groupand a WHO consultant, the updatedinformation was transferred into the IASC4Ws mapping format (see O’Connell et al.,2012).

Results and conclusions

The mappings in 2008 and 2009 indicatedthat, despite the advancements thathad been made, there still remained anumber of major gaps. These included anincreasingly limited capacity of the mentalhealth care system, marked by the completelack of community mental health services,rehabilitation and integrated day careprogrammes for those with severe mental

rized reproduction of this article is prohibited.

Copyrig

Eloul et al.

illness. MHPSS had not been su⁄cientlymainstreamed across sectors when thecurrent crisis began, and lacked multi-disciplinary coordination, including theappropriate integration of basic mentalhealth and case management into PHC.Collaboration between mental healthprofessionals, religious leaders and healerswas also extremely limited. Mental healthcare remained highly centralised, inpatientcare based, and available only in urbancentres.MHPSS casemanagement was non-existent, as was specialised care for survivorsof torture and extreme violence, a steeplyincreasing need. There was no communitybased psychosocial support, e.g., commu-nity centres, outreach, psycho-education,safe spaces, nor psychosocial activities inschools.Geographically,ruralareasremainedthe most disadvantaged in regard toservice structures. These results in£uencedthe design of the previously instituted,inter-agency multi-professional training ofmaster trainers and MHPSS programmingin Syria (Quosh,2011; Quosh,2013).The latest 4W mapping exercise, conductedat the end of 2012, in addition to strengthen-ing service delivery andaccess tomonitoringmechanisms, brought up further constraintsdue to the current crisis. Most signi¢cantly,the increasing attrition of mental healthprofessionals since 2012, combined with theburnout of remaining practitioners andthe understandable reticence to provideservices in insecure areas, is greatly limitingprogramming. This is further exacerbatedby the lack of psychotropic medicationavailable, particularly in areas with highcon£ict intensity. Interrupted supplies haveimpacted hospitals. Furthermore, manyclients cannot a¡ord to buy medicationas prices increased after the collapse ofthe local pharmaceutical industry, whichproduced 90% of required medications

ht © War Trauma Foundation. Unautho

before the crisis (Kutaini & Davila, 2010).Although the primary psychiatric hospi-tal (Ibn Sina) and addiction centre inDamascus are still functioning, in othermajor cities psychiatric wards are o¥ine,and emergency patients are treated undergeneral care.4 There are few monitoringe¡orts, or contingency plans in place forconstrained access to centralised care andmedication management. Of particularconcern is the closure of the psychiatrichospital in the embattled city of Aleppo.5

Evenwhere services do exist, physical accessby professionals and patients alike isproblematic, due to limited mobility causedby increasing insecurity. Many psychiatristshave stopped visiting their local PHCcentresbecause of increased risks.Therefore,services have become even more urbancentred, and mainly restricted to Damascusand some parts of rural Damascus. Thebreakdown of infrastructure has reducedaccess to safe spaces, resulting in over-crowded collective shelters with insu⁄cientprivacy; lack of doors or windows, and insome cases 70 people sharing a single toilet.Community based psychosocial supportsystems are hindered by separation fromfamily and traditional support systems, aswell as an initial capacity building focus onpsychological ¢rst aid (PFA, more than1800 trainees), which, while valuable, doesnot include training on extended supportnor more advanced MHPSS skills. Thereremains little awareness within the generalpopulation of mental health and psycho-social support issues, particularly withinthe context of emergency events. Finally, alack of joint needs assessments, commonassessment and planning tools, as well as¢eld coordination have hampered responsee¡orts.Based on these results, the MHPSSworking group decided to re-emphasise

rized reproduction of this article is prohibited.343

Copyrig

Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria

Intervention 2013, Volume 11, Number 3, Page 340 - 348

coordination and capacity building. Theresponse planningwas adjusted for the ident-i¢ed gaps.While coordination and responseto the new crisis bene¢ted from the estab-lished refugee response, more £exible andemergency relevant models have been devel-oped that can respond quickly and e¡ec-tively to the continuously changingsituation.These include:

� D

ht344

eveloping and advocating for contin-gency plans at multiple service levels forvarious scenarios;

� S

trengthening ¢eld level coordination,community messaging and informationdistribution systems, monitoring andassessment systems (particularly in col-lective shelters);

� E

xpanding community outreach andcommunity based support;

� S

afe spaces, health centres, communityand psychosocial centres remaining opendepending on security situation andaccess;

� E

xpanding individual, family andcommunity support, cash assistanceand general assistance distributions,integration of livelihood and incomegeneration strategies for the most vulner-able individuals and families;

� E

xpanding the number of schools,child friendly spaces, psychosocial sup-port integrated educational and remedialactivities;

� P

revention of family separation andenhancement of tracing systems;

� M

obile MHPSS services in order toincrease accessibility, hotline servicesestablished;

� A

rea based approaches in serviceprovision:, policies for reimbursementadjusted to allow access to services inclose proximity that were not previouslypart of referral systems;

© War Trauma Foundation. Unautho

� I

riz

ncreased emphasis on mainstreamingMHPSS into other sectors;

� C

apacity building focus shifted fromPFA to more advanced MHPSS trainingand building capacity for coordination,as well as mental health among medical(in particular PHC) sta¡;

� E

xpanding specialised programmesfor survivors of sexual and gender basedviolence, and other forms of extremeviolence;

� S

caling up MHPSS and integrated casemanagement and care coordination;

� I

ntensifying attention paid to developing¢rst responder support systems.

Inter-agency responseThe coordinated response by agencieshas focused on collaborative national andcommunity capacity building and serviceprovision, according to areas of responsi-bility and expertise. Key criteria that guideinter-agency coordination are:

� U

rgent response to basic needs gaps: MHPSSprogrammes and activities are based onassessments and prioritisations that payparticular attention to timely responsesto basic needs gaps and mainstreaming.

� M

ultidisciplinary and integrated approaches:

Development, training and implementa-tion of interagency guidelines, main-streaming guidelines and training;systembuilding for coordination.

� I

ntegrating independent initiatives into compre-

hensive programmes and building partnerships:

Activity coordination, joint assess-ment, planning and fundraising throughconsolidated appeal and creating referralpathways.

� A

rea of mandate, expertise, resources, capacity,

and standardised approaches: Di¡erentagencies created di¡erent MHPSS casemanagement systems that each ¢lled a

ed reproduction of this article is prohibited.

Copyright

Eloul et al.

particular gap in the care coordinationsystem; e.g., mental health case manage-ment in PHC as well as early childhooddevelopment programmes, multidisci-plinary units for children and womenin polyclinics and MHPSS clinical casemanagement in four polyclinics focusingon identi¢cation, outreach, access toservices and follow up. The UN agenciesengaged in policy development withthe Ministries of Health, Educationand Social Welfare. Through overallcoordination, standardised approacheswere applied.

� G

eographic location and population size of most

vulnerable populations: Joint identi¢cationof community centre locations andcoordination of centre work.

� E

ven distribution of limited resources, avoiding

duplication and creating e¡ective systems:

Avoiding having already scarce mentalhealth professionals ‘recruited away’between agencies, maintaining aninteragency pool, and capacity buildingnetwork of master trainers, coordinationwith regard to national consultant fees.

� S

trengthen programmes that facilitate national

capacity building and community based support

systems: Inter-agency MHPSS training ofmaster trainers (Quosh, 2011).

Challenges and lessons learnedChallenges

� L

ocating a technical sub-working/refer-ence group within the cluster, or workinggroup system that balances technical,strategic and political considerations.Integrated coordination (as recom-mended by the IASC Guidelines) is pre-ferred, however, humanitarian responseplans commonly separate mental healthand psychosocial support into di¡erentsectors, based on levels of specialisation.The new MHPSS TRG is an e¡ort to

© War Trauma Foundation. Unauthoriz

maintain this balance by emphasisingmainstreaming as well as coordination.

� A

ssessment of internally displacedSyrians in the current context is enor-mously challenging due to the localisedand highly £uid nature of the con£ict,high levels of insecurity for aid workersand lack of access to community leaders.This is further complicated becausemany a¡ected Syrians stay in mixedaccommodationarrangements (host com-munities, collective shelters, extendedfamily homes, etc.) making the conven-tional assessment methodology di⁄cultto apply.

� B

urnout among mental health pro-fessionals and ¢rst line responders.

� I

mplementing mental health into PHCtraining during an emergency where thehealth system has collapsed and otherpriorities are considered more urgent.

� I

nternal requirement to work withgovernment institutions in order to beoperational versus the implications ofassociationwith the government.

� T

he online coordination forum provedto be di⁄cult to establish, primarilydue to a culture that relies heavily onverbal communication, aswellas a settingwhere electronic communication is regu-larly disrupted.

� A

n assessment framework, as well ascontextualised assessment instruments,were developed and endorsed by theMHPSS working group, yet joint assess-ment proposals did not gain approvaldue to di¡ering priorities.

Lessons learned

� I

nter-agency coordination is crucialforaccountability, transparency, avoidingduplication, information sharing, ande⁄cient use of limited resources. Thisincludes those available locally within

ed reproduction of this article is prohibited.345

Copyright

Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria

Intervention 2013, Volume 11, Number 3, Page 340 - 348

346

communities, as well as for targetedplanning and response.

� T

he various programmes implementedby di¡erent agencies ¢lled particulargaps and became part of the coordi-nated humanitarian response, avoidingduplication.

� T

he availability of few Syrian MHPSSprofessionals requires inter-agency coordi-nation that should include local NGOsand community based organisations. Thiswill avoid shifting national professionalsbetween agencies, while not actuallybuilding overall national capacity.

� A

vailability and continuity of work-ing group coordinators with su⁄cienttechnical competence is important fore¡ective and sustainable coordination.

� E

¡orts areneeded forbettergeographicalcoverage of MHPSS services nationwide,particularly in under served, rural areas.

� I

t is important to regularly updatemappings. and use these data to conti-nuously inform coordinated MHPSS pro-gramming. The current Excel based 4Wmapping formats are di⁄cult to updateregularly and share in real time, especiallyin dynamic and rapidly changing emer-gency contexts. An online system withreal time updates is recommended, withadequate human resources responsible forthis speci¢c task.

� C

reating ownership for inter-agencyguidance and contextualised standards isvital, for example, through participatoryplanning and capacity building. Aware-ness rising on the inclusion of MHPSSinto other sectors is essential for anintegrated response.

ConclusionThis adaptation of a protracted, humani-tarian inter-agency collaborative model ofprogramming may serve as an example for

© War Trauma Foundation. Unautho

future programming initiatives. However,the escalating need for accessible com-munity based MHPSS services, as well asmore specialised mental health systemsrequires an increasingly e⁄cient use of mini-mal resources. This is currently primarilyprovided by humanitarian programmes,which were, as of August 2013, only approxi-mately 40% funded (O⁄ce for the Coordi-nation of Humanitarian A¡airs (OCHA),2013). The current centralisation ofservices in certain urban areas restrictsaccess. E¡orts are needed to have a bettergeographical coverage of MHPSS servicesnationwide, which requires advocacy ande¡ective involvement of the existing infra-structure. The further development ofholistic MHPSS services and e¡ectiveinter-agency cooperation systems is crucial,and requires a response that is coordinatedand inclusive of all stakeholders, including:humanitarian agencies, nationalNGOs, com-munity based support groups, and traditionaland religious healers. Improved coordinationwill remain a primary need among nationalpartners working in the protection, health,social services, education, and livelihoodsectors, in order to maximise the e⁄cacy oflimited resources and the sustainability ofrequired MHPSS programming.

ReferencesAbou-Saleh, M. & Mobayed, M. (2013). Mental

health in Syria. International Psychiatry, 10(3),

58-60.

Amos, V. (2013) Under-Secretary-General for

Humanitarian A¡airs and Emergency Relief

Coordinator, Security Council Brie¢ng on

Syria. Available at https://docs.unocha.org/

sites/dms/Documents/USG%20Amos%20

Security%20Council%20on%20Syria%2018

%20April%202013%20CAD.pdf (accessed

June 2013).

rized reproduction of this article is prohibited.

Copyrig

Eloul et al.

Assalman, I., Alkhalil, M. &Curtice,M. (2008).

Mental health in the Syrian Arab Republic.

International Psychiatry, 5(3), 64-66.

Inter-Agency Standing Committee (IASC)

Reference Group on Mental Health and

Psychosocial Support in Emergency Settings

(2012). Who is Where, When, doing What

(4Ws) in Mental Health and Psychosocial

Support: Manual with Activity Codes (Field

TestVersion). Geneva: IASC. Retrieved from:

http://www.who.int/mental_health/publications/

iasc_4ws.pdf

Kutaini, D. & Davila, C. (2010). Pharmaceutical

Industry in Syria. Journal of Medicine and Life,

3(3), 348-350.

Matar, H. E., Almerie, M. Q., Adams, C. E. &

Essali, A. (2009). Publications indexed in

Medline and Embase originating from the

Syrian Arab Republic: a survey. Eastern

Mediterranean HealthJournal, 15(3), 648-652.

O’Connell,R., Poudyal, B., Streel, E., Bahgat, F.,

Tol,W. & Ventevogel, P. (2012).Who is where,

when, doing what: mapping services for

mental health and psychosocial support in

emergencies. Intervention, 10(2),171-176.

O⁄ce for the Coordination of Humanitarian

A¡airs (OCHA) (2013). Humanitarian Bulle-

tin: Syria, 31, July 30-August 12. Geneva:

OCHA. Retrieved from: http://reliefweb.int/

sites/reliefweb.int/¢les/resources/Syria%20

Humanitarian%20Bulletin%20Issue%2031_0.

pdf

Quosh, C. (2011). Takamol: Multi-professional

capacity building in order to strengthen

the psychosocial and mental health sector in

response to refugee crises in Syria. Intervention,

9(3), 249-264.

ht © War Trauma Foundation. Unautho

Quosh, C. (2013). Mental health, forced displace-

ment and recovery: integrated mental health

and psychosocial support for urban refugees

in Syria. Intervention 11(3).

Quosh, C., Eloul, L. & Ajlani, R. (2013). Inter-

agency coordination of mental health and

psychosocial support for refugees and people

displaced in Syria and surrounding countries.

Intervention 11(3).

World Health Organization (WHO) (2005).

Mental Health Atlas. Geneva: WHO.

Retrieved from: http://www.who.int/mental_

health/evidence/mhatlas05/en/

World Health Organization (WHO) (2011).

Mental healthof refugees, internallydisplaced

persons and other populations a¡ected by

con£ict. WHO. Retrieved from: http://www.

who.int/hac/techguidance/pht/mental_health_

refugees/en/

1 Of the original 40 master trainers, approxi-

mately 50% remain in Syria. The authors con-

¢rmed 17 personally in July 2013. A coordination

network among the master trainers was estab-

lished in 2012, but discontinued in 2013.2 Inclose cooperationwithDeutscheGesellschaft

fˇr Internationale Zusammenarbeit (GIZ/EU)

and supported by UNICEF.3 Co-chaired by the International Organization

for Migration, UNHCR and the International

Medical Corps.4 The general hospitals in Homs and Aleppo

are at time of press closed. Supplies to Ibn Sina

and other psychiatric care facilities are frequently

interrupted during episodes of ¢ghting. Access is

thereby limited, and new admissions have been

reduced by approximately 70%.5 Patients from Ibn Khaldoun psychiatric

hospital in Aleppo were relocated to a safer area.

UNHCR has provided urgently needed relief

items to the 300 patients since April 2013.

rized reproduction of this article is prohibited.347

Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.

Liyam Eloul (MA), worked as Associate Community Services O⁄cer (Psychosocial) with the

Mental Health and Psychosocial Support Programme, UNHCR Syria.

email: mlle.eloul@gmail.com

Constanze Quosh (MSc) was head of the Mental Health and Support Psychosocial Programme

of UNHCR in Syria from 2008 to 2013. She is currently the urban refugee programming specialist

for UNHCR in Sudan.

RawanAjlani(MSc),wasaPsychosocialCaseWorkerof theMHPSSProgrammeUNHCRSyriafrom

2009 to 2011.

Naira Avetisyan (MD), worked at UNICEF Syria O⁄ce as Child Protection Specialist, Head of

Child Protection Section (2010^2012).

Mouta Barakat (PhD) was assistant professor in Mental Health at the Psychological Counseling

Department, University of Damascus, from1994 to 2012.He has worked as a psychotherapist in private

practice, and as expert and trainer for various Syrian institutions.

LidiaChylewska-Barakat (PhD),workedwith theTerre deshommesLausanneand SSCC in Syria as a

psychotherapist and trainer

MohammadWaleed Ikram(MD), is theMedicalDirectorof the InternationalMedicalCorps inSyria.

Louay Shammas (MD), worked as a psychiatrist with multidisciplinary mental health teams of the

Syrian Arab Red Crescent andTerre des hommes / SSCC (since 2009 in Syria).

Victoria Diekkamp (MA), works for the Deutsche Gesellschaft fˇr Internationale Zusammenarbeit

(GIZ) as Senior Manager. She worked for the EU ¢nanced Health SectorModernisation Program in

Syria from 2008 to 2010.

Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria

Intervention 2013, Volume 11, Number 3, Page 340 - 348

348