WQ Fall 2024 - Unprecedented Humanitarian Needs: Ukraine's Invisible Scars

EPISODE TRANSCRIPT

• WQ Fall 2024 - Unprecedented Humanitarian Needs: Ukraine's Invisible Scars

  THIS IS AN UNEDITED TRANSCRIPT

  Hello, I'm John Milewski and this is Wilson Center NOW, a production of the Woodrow Wilson International Center for Scholars. My guest today is Stephanie Bowen. She was editor of the award winning publication The Wilson Quarterly. The fall 2024 issue is titled Confronting Unprecedented Humanitarian Needs. And Stephanie, as you know, I love this every quarter we get together and talk about the new issue of the terrific work that you do with your contributors.

  
  And we usually feature a contributor. So with us today is Claire Whitney. Claire is a senior advisor for mental health and psych psych psychosocial support. Let me get that right for International Medical Corps. She coauthored the article Healing Ukraine's Invisible Scars. And we'll hear more about that in just a moment. But first, Stephanie, I'd like you to tell us in general about the focus of the issue and the range of topics that you explore.

  
  Thanks, John. It's always great to be here with you. And this issue is, as the title suggests, we are in a time of increasingly unprecedented humanitarian needs. We're seeing protracted conflicts and environmental disasters. Both of those things are driving unprecedented numbers of immigrant migrants who are leaving their countries to find safety and security. And it's it's really over the last decade or so, you can really see how the humanitarian needs have just multiplied and they've become more difficult to address.

  
  So we thought it would be a great time to look at the state of humanitarian response, what is going on with the sector and look at a few specific interventions, if you will. And I am thrilled that we have some terrific contributors. We have the head, the director general of the International Organization for Migration who talks about migration as a solution and not just an outcome of humanitarian crises.

  
  We have the former US aid administrator Andrew Natsios, who takes a look at how the U.S. aid humanitarian response budget has just ballooned to be one of the biggest components of the agency and what that means. We have a recently retired deputy secretary general of the U.N., U.N. Humanitarian Coordination. That's a very long title. I think I got that right.

  
  But very big guy in the U.N. humanitarian response system who joins in conversation with the board chair of a 160 member humanitarian NGO network and a Wilson Center fellow who also spent about 26 years at U.S. aid working in a variety of roles there. And together, they have a pretty unfiltered conversation about what's working and what isn't working.

  
  We take a deep look at some facts and figures to say, okay, what has happened over the last decade, what is moving in, what direction? What we have found by looking at those numbers with a woman named Abby Stoddard, who co-founded an organization LEA, to use data and research to inform humanitarian response policy. What she uncovers for us is that there are more complex emergencies, more protracted conflicts, more aid workers being targeted and killed, more money being spent, yet more money is needed.

  
  And the what also is it? It's the same number of countries that are giving to aid, giving to the appeals that the U.N. sends out and other, I guess, bank accounts, if you will, that that help to to address humanitarian needs. We but it's not all bleak. And I think we'll hear from Claire. I think one of the things that we also really wanted to address in this issue are some of the things that are working really well.

  
  And in many ways, over the last couple of decades, the humanitarian sector has become quite professionalized. And I think that there are really some dedicated, educated people, professionals who are working day in and day out to provide logistics support and make sure that supplies get there on time to They have their masters and PhDs and they're working to apply evidence based knowledge to make sure that the sector is meeting the needs as best as it can.

  
  There are local community members that are stepping up and figuring out how to fill the gaps that the large NGOs just can't do, whether it's because they don't have the access, because there's it's not safe in a conflict ridden area or they just have better, better connections. And so we take a look at that. One of the pieces that I love is we did an interview with the CEO of a company called Zip Line in.

  
  They started, I think, in the 2013, 2016 with delivering blood and medical supplies by drone in Rwanda, mountainous Rwanda, where it's really hard to get around and make sure that people who live in remote communities or are just not, you know, not near a hospital or a clinic can get the supplies that they need and they have a really cool they've grown it now to deliver.

  
  They deliver medical supplies and blood to every hospital in Rwanda. They work in Ghana and Nigeria and Kenya, other African countries other and are growing and even Western countries are taking note, too, to what they're doing. But it's amazing to see some of the innovation out there and just the passion. I think the other yes. We also, of course, we deal with climate and we deal with community led approaches.

  
  That's sort of sprinkled throughout in several of the pieces. We talk with different experts who who give some ideas about how things can continue to be improved. It's it's really, I think, a and of course, a topic that is near and dear to my heart. Maternal and newborn health, which is something that for a long time is has taken a backseat in humanitarian crises, Although I think more and more it is getting recognition as something that still needs to be prioritized on its own within a humanitarian response.

  And so we take a look at that with a handful of experts from the Interagency Working Group on reproductive health and crises. And one of the communities there is Sarah Barnes, our own Sarah Barnes, right. From the Turtle Health Initiative at the Wilson Center. Yes. She is the mastermind behind that piece. And she and she sits on that interagency working group and engaged with a number of people that she works with on a regular basis to bring, you know, new ideas and evidence and to to humanitarian response for women and newborns.

  
  Yeah, there's a lot of really great, I think, Wilson Center expertise that is sprinkled throughout this issue. And it showcases, I think, just the breadth of the work that the Wilson Center is doing that touches humanitarian response. It's humanitarian response is not one of our, you know, core issues, but it it it is part of of what we do.

  
  And it it touches a lot of what we do in terms of migration and climate effects of climate change and security and all of those things. So and as you said, it may not be on the marquee, but it's certainly woven throughout all of those things. Exactly. Exactly. Yeah. So, Claire, you know, I look under the hood here whenever we plan one of these episodes on the latest issue of the WQ, Stéphane and I talk about, well, what are the options?

  
  Stephanie usually has a lot of ideas of. And when she talked about your piece and inviting you, I really got excited because, you know, it's one of those things we talk about almost the list mental health, right? We talk about drones as the new warfare or we talk about food shortages or we talk about the number of troops and troop movement, the number of casualties.

  
  But maybe other than the loss of human life itself, the thing that will have the most lasting impact are the psychological impacts of these disasters that have people in in dire straits or on the move. So if you would, tell us about in the world of of addressing humanitarian needs, is this mental health component a fairly new piece?

  
  Thank you and a great question. What's been really incredible to see over the years is actually there has been increased recognition of the mental health needs of affected populations. So those that have been affected by conflict and emergencies as well as host communities that are hosting refugees and the understandable impacts on those societies as well. So from when I initially came into the field to now, there's been tremendous progress in terms of the recognition of mental health being a priority, as well as dedication of funding to really try and ensure that people are properly trained to scale up services, to better understand what services are needed, what approaches might work best.

  
  So we've seen a really positive trend, which is really encouraging. That being said, it can get overlooked quite easily and that's why we call this sort of the invisible wounds, right? It's not something you can easily see with the eye, but everyone that goes through adversity, conflict, emergency is touched in one way or another by loss, by trauma, by displacement, by economic constraints, by those that are going to war.

  
  And then the impact on the family and when they come home and what happens in the period of readjustment. So the needs are so significant, it's great to see an increased attention, but there's still a lot of advocacy to really make sure that those that have those needs are getting the services that they so deserve. My guess is that unless someone has lived through such traumatic circumstances that they can't really imagine what it's like.

  Right. I mean, I think the closest you could get in a in a situation that people can relate to is maybe when a storm's approaching a potential hurricane or a tornado and you're sitting there with anxiety, not knowing for sure if you're prepared or if you could be you, who's in the eye of that storm with that in mind, is there any way you could quantify using Ukraine as the case study in this case, what you wrote about?

  
  Is there any way to quantify the scope of the problem that the amount of need that's out there? Great question. So what we do know from meta analysis is that about one in five impacted by a crisis or an emergency will have a mental health condition. That's about as close as we can get because there are a multitude of other factors that go into understanding those that may have preexisting mental health conditions that may also be exacerbated by the conflict, especially if there's a rupture and treatment.

  
  And then those that might go on to develop a new mental health condition because of the adversity that they're living through. What we do know for sure is that governments and societies that are hosting conflict affected populations are generally unprepared to meet the increase in demand for services and also for a country like Ukraine. You have a lot of these highly educated individuals that have links and opportunities to leave that unfortunately due for understandable reasons.

  
  So the question becomes how to best address an increase in need and an insufficient what we call mental health workforce, or the ability to properly respond. And another thing I want to ask you about and then, Stephanie, I want to turn it over to you to see what questions you have for Claire. But, Claire, I want to ask you about the whole stigma that's often attached to mental health.

  
  And you in the article you reference a survey where 38% believe that the main contributor to psychological distress was a flaw of character, you know, blaming the victims, essentially. And in the face of war, there's this need to be strong. I've interviewed some folks in Ukraine and they talk about all of them talk about they're trying to find their best, strongest selves to face what they're facing.

  
  And this narrative of strength makes Ukrainians worry. You say in the piece that seeking mental health support is a sign of weakness in many ways. I thought by year 2024 we'd be beyond this. But apparently we're not. Exactly. And this is what's interesting. We see stigma everywhere we work in in any country around the world, Right? The idea of someone having a psychological problem or more acute psychiatric need, there's a lot of stigma associated with it.

  
  But despite the fact that we've seen and as well with the pandemic, a bit of a normalization that people go through quite difficult times and do need professional support. What we found specifically in Ukraine is, yes, with sort of embroidered in that culture is this propensity to to be as strong as possible. And and a lot of the messaging and advocacy that we're trying to do is to link help seeking behavior with strength of character.

  
  So it's not a weakness that actually shows strength to say, wow, I've gone through a tremendous amount of distress, potential trauma, adversity, and I need support and I am a strong person for doing so. So that's a big catalyst as well that we try and use this idea of strength of character to actually help increase the help seeking behavior for those that need those supports.

  
  So, Stephanie, I'm going to hand it over to you for a period here for any questions and thoughts that you want to add. And I will tell you, Claire, that Stephanie's input now will not lead to any further edits to your piece. Okay. Now, this is all that's already done. This is going to be a different type of editorial input.

  
  Thank you, John. Yeah. You know, one of the things that really struck me so, first of all, in full disclosure, I used to work at International Medical Corps years ago and not know that I did. I did. And I was one of the things that interested me was the mental health work that International Medical Corps was doing, and a lot of others weren't doing it.

  
  So I think there's a strong sound, very strong foundation. And I was interested to read specifically about the work in Ukraine and how you came into this already, You know, a mental health system that had some bones to it, unlike other countries where there's not much at all. But then there's also that Soviet legacy that, you know, so this was a very complex system that you were navigating in the midst of conflict.

  
  Can you talk about that a little bit? Absolutely, yes. Ukraine is a quite unique humanitarian setting to be working in. As you've correctly identified many other settings. There may not necessarily be a robust mental health care system or policies and strategies developed that can look quite different across a multitude of countries. With Ukraine, it it had been quite well-established, but in a way that is not necessarily the most beneficial and accessible for those that really need supports across a variety of types of supports that would be available as well as in terms of geographic reach and ease of access of those services.

  
  So when we talk about some of the legacies of the Soviet model on the mental health care system and as we write about in the article, they're quite highly centralized, meaning in cities quite highly institutionalized. So really looking at hospitals and what they call neuropsychiatric centers to be sort of the optimal entry point and or treatment point for those that have chronic moderate to severe mental health conditions and neurological conditions.

  
  And then the other aspect of that is that it's highly medicalized, meaning that with the luxury of actually having more psychiatrists available in the country, which we don't typically see and lower and middle income countries that we typically work in, and with the influence of this sort of institutionalized process, there historically has been a higher reliance on psychiatric approaches as the first line of treatment and for a number of reasons, that actually isn't the recommended approach, and especially when there's been conflict and displacement and a multitude of stressors.

  What's typically recommended, you know, by the World Health Organization and as utilized by International Medical Corps, is a system where you're actually starting from understanding what are the basic needs and ensuring that people's basic needs can be met. Knowing that addressing those basic needs can actually already start reducing some of the psychological distress that people are understandably feeling if they don't have a safe place to live or, you know, ability to put food on the table or to understand where to access appropriate health or protection services, nutrition and services, and then understanding as you go up how to then think about those that can be sufficiently supported with more community based approaches, group and family

  
  oriented approaches, and then some approaches that don't necessarily need psychiatric care, whether you have a psychologist that can deliver psychological intervention or those that we train as sort of paraprofessional counselors to really help ensure that those supports are there and reserving psychiatric evaluation and treatment for truly those that are in need of that advanced level of care. And that's important not only from promoting a holistic approach to mental health care and psychosocial well-being, but also, as we were talking about before, because we know that the mental health needs are going up, we need to make sure that those that have those more severe conditions and complex cases are able to get the services they need

  
  from those psychiatrists so that the psychiatrist isn't overburdened and trying to handle all cases. So that's a bit of a summary of the approach and how we're trying to help in collaboration with Ukrainian colleagues and other actors and stakeholders really accelerate the transformation that they already had in mind even prior to this invasion of transitioning their mental health care system to a more community based and holistic model of care that that actually leads into.

  
  What I wanted to ask you next. It seems so obviously nobody asked for the war, but maybe a silver lining is that there is a jump start on pushing the mental health care system forward a little bit. And I'd like to hear, you know, what the experiences have been in terms of working with Ukrainian officials and others to, I guess, improve the system while also responding to needs and how that those two things are coming together.

  
  Absolutely. Absolutely. And that's really where we endeavor to have a sort of dovetailed approach so that we're helping in terms of scaling up services that for example, International Medical Corps and other actors can provide to make sure there are enough services available to those in need. But then also thinking about the medium to longer term mental health system strengthening.

  And a key way that we play a role in these coordinated efforts is through. And as you may be aware, in the humanitarian system, we have these cluster systems and coordination mechanisms. So there is a nationwide mental health and psychosocial support, technical working Group, an international Medical Corps co-chairs, this group with the World Health Organization. And this provides a critical opportunity to bring key stakeholders together from Ukrainian ministries to local NGOs and CBOs to international organizations, so that we can collectively understand what are the needs, what have already been the plans or strategies that have been created, perhaps not yet passed through legislation or, you know, additional transformation and reform that they've envisioned that the

  
  government has envisioned? And how can we play a role knowing our own strengths as as various actors and organizations, to be able to contribute and really help advance the vision that the Ukrainian government has already intended for their own population? And how can we play a role in contributing to those efforts and helping that succeed? And it's been really incredible.

  
  I have to say the recognition even within Ukraine, the first lady has been an advocate for mental health from pretty much the very beginning, and that has also accelerated efforts in terms of putting a spotlight and a sort of catalyst for this mental health reform and investment in mental health care and mental health system strengthening. So it's been, despite the tragedy around us, quite inspiring to also see an opportunity to help strengthen those efforts.

  
  And like rebuilding infrastructure, this work will not be over when the war is over, Right? It's going to continue for, in some cases, a generation more than anything else. You wanted to bring up Stephanie, before I have a question for both of you. Okay. So my question for both is, you know, a theme that emerges both in the in the micro example of Ukraine and then throughout the issue is that, you know, we have all kinds of things that are causing instability and causing problems and causing need, and the demand appears to be outpacing the supply of aid.

  
  And then also in the subtitle of The Art of the the the issue talks about a rapidly changing world and making is making complex humanitarian emergencies even more complicated and current responses less sustainable new approaches can benefit. Could could both of you talk about, you know, what is this inflection point? What are we learning about how we used to apply aid and what are some of the new models that are emerging that, as you mentioned in your opening comments, Stephanie, that it's not all bad news, Right.

  
  There is some good news here and Stephanie, you've been very clear. You've been talking about some of the things that you're doing in the area of mental health that are innovative and new and haven't been done before. So if both of you could, you know, any examples you want to give and Claire, I don't want to limit you to your experience in Ukraine and the article you've written.

  
  You can certainly speak beyond that as well. Who are you thrown to first? It's up to you. Well, let's flip a coin. We're going to get the editor prerogative. You can go first. Our website. That's a great question. And I think it is sprinkled throughout the throughout the issue. And I think it's it's both new approaches and also adhering to those principles that we know work.

  
  I immediately thought of one piece that I didn't mention in the beginning that really talks about the international humanitarian law that has been established that is increasingly being ignored and the head of delegation for ICRC, the International Committee Committee, thank you committee for a Red Cross, wrote a terrific piece about this and how those those long established laws of war really are meant to protect those people experiencing crises and those who are bringing aid and aid workers.

  
  So that is something we need new ways to figure out how to enforce those laws that are already there. That's an innovation that I think is needed. But we're also seeing there's a lot of a lot of talk throughout about community led approaches. And there's this buzzword that's been going around for a while called localization. But I think really what it means if I put my, you know, editor's plain speak hat on, it's really about making sure that the people who are in need of aid are at the center of those responses so they can best direct what they need.

  
  And I think that's something that some groups have been very good at all along and other groups are coming around to, I think, understanding the value of that. And it's, you know, I think I just think that the innovations that are on the horizon are a combination of things like tech, you know, and being able to use a debit card, give a debit card to someone, or just like transfer money to their flip phone so they can spend money at their local market and feed their families instead of handing out aid and also thinking, hey, this hasn't been working, you know, innovation of thought, you know, And that's I think it's that combination that is

  
  really going to bring about the changes that are needed to it. And also, you know, it's a lot of it is about the money, too. I mean, it's increasingly unsustainable because there are enough people who can keep people, entities, governments, if you will, contributing to the effort. And it's putting an uneven burden on the countries that are continually step up.

  
  So I know I sort of back ended your question a little bit, but I don't know that simple to say, yes, this innovation is on the horizon in this because it's just, you know, and especially when you're you know, one of the things that I think the professionalization of the sector, what has happened because of that, one of the negative things is an increased bureaucratization that I think now there needs to be like, okay, we got all the people, but how do we kind of shake some things loose to make sure that we're cutting through the red tape and getting things done?

  
  It's hard. It's hard because as Claire can tell you and you know, when you're in there doing it every day, you know, it's very hard to respond to these, especially as needs are intensifying. So it's important, I think, to have a collections like this that can help us think at that bird's eye view and and think about those solutions and innovations that, you know, you mentioned another one earlier when you were talking about drones, not just delivering bombs, but delivering supplies, medicine, blood and things of that nature.

  
  Yeah, it's a it's a big question, Claire. And, you know, you just heard a lot of thoughts from Stephanie. What it what comes to mind in for you? Absolutely. You know, first I would say I agree with the the point and an inherent benefit and really placing affected communities at the center of the conversation because when you ask them what their needs are, they will tell you there's been a lot historically with humanitarian aid of these assumptions that we come in and we know what your needs are.

  
  We know how to best deliver aid in a way that's most appropriate. And there has been such a missed opportunity over the years to really systematically engage with communities, to ask them what do you need and what would be most helpful, and how could this be the most effective and and accessible for you? And on a parallel level, when we're looking at high quality mental health and psychosocial support care, you're putting the individual at the center of their care.

  
  And this principle applies equally. So, you know, you can have very highly trained mental health staff that can still make assumptions on what to prioritize, but the truth of the matter is, when you have someone that's going through significant psychological distress, multiple symptoms associated with it, but then a multitude of stressors based on the adversity they've lived through and and, you know, basic needs not being met, human rights violations, gender based violence, a number of different stressors and risks and needs.

  
  We need to put the client at the center of their care and they will tell you, look, I have so many different needs to be met right now, but I'd like to prioritize A and B and, you know, a good holistic affective approach to helping this person is to take their priorities and their needs on board and prioritize your treatment plan accordingly, collaboratively.

  
  And that's something that, you know, is also at the heart of our approach. We have what we call a mental health case management approach. And this is something that we've been also introducing a bit more within Ukraine and also helps with that more community based holistic approach is from a sort of social work perspective and a, you know, person and environment perspective.

  
  How do you enable and empower that individual to really drive the discussion about the best way to help them and we've seen a lot of success with it. So it's promising. It makes so much sense that you wonder why it took us this long to get here. Right. You know, instead of doing things just for people doing with people, it makes so much more sense.

  
  Before we close, first, thank you for today's discussion and thanks for the issue. But you know, Stephanie knows that I love to kind of open the left, the hood or pull back the curtain and see the inner workings of how something like this comes together. And I thought I was having, as I was hearing, Stephanie, you talk about this, another impressive list of contributors, one of whom is with us today.

  
  Now is what is it like when you make the initial ask of people, Are they interested in writing a piece for for the WQ? You know, is it a high success rate? You don't have to do much arm twisting. They're happy to contribute. And we have a life specimen here who could tell us what her experience was when she was approached as well?

  
  Yes, for the most part, I'd say people are very pleased and and it a lot of times it's really do they have the time and, you know, does the timeline work for them? The in the case of Claire and her coauthor, Matthew Stearns, I went through the communications department at International Medical Corps and we worked through a few ideas and they I told them what we were doing.

  
  I did this with a number of people because, you know, taking on a subject like humanitarian response, we knew we wanted to get a combination of practitioners at the country level and also some thought leaders like like those at ICRC and IOM and USAID, but also people that are really doing things. And so we looked at a variety of ways that we could source those authors and find the stories.

  
  And I have always been drawn to mental health is as a hidden, hidden issue in crises. And I think that I thought, particularly with Ukraine going in the you know, we're almost at three years of of the or two and a half years of of the war in Ukraine. And so that was something when it was pitched to me, I immediately stood out as something that would I would love to bring to our readers.

  
  And thankfully, Claire was willing to take time out of her busy work to to do it. So, yeah. So, Claire, what's the experience like from the outside looking in, working with Stephanie, working with the Wilson Center on a project like this, and if it's something negative, we'll just edit it out because we already discourage future contributors. Positive things to say.

  
  We honestly, it's an honor for us to receive an invitation. I am such an advocate for global mental health. I'd be happy to talk about it all day to anyone that wants to hear. And it's just it's a tremendous opportunity. You know, sometimes we are so focused just on the actual programing that we're supporting that we don't actually seize opportunities or have opportunities to be able to talk with the wider world about what we're doing, what the needs are, how to raise awareness and help build some momentum for support and really recognition of those crucial mental health needs out there.

  
  So it's an absolute pleasure for me. Thank you. Well, well, thank you for us as well. And thanks for your ongoing good work and for your contribution to this issue. Stephanie, can you give us a preview of what's up next? Is that are we ready for primetime in that regard? we're working on it. And, you know, I do want to disclose the issue, saying that the last issue in the piece is a Q&A that I did with someone from the LDS Church about the role of religious faith based organizations.

  
  And I just wanted to say that I really I ended up putting that piece last because I thought it was such a hopeful look at how different organizations, different faiths, can come together to address the needs of a community. And I think it really does speak to the power of compassion and the unending compassion that we have, whether you're religious or not, whether you have faith or not, to bring to help people in need.

  But in terms of the next issue, let's just say it's coming together. Okay, Stay tuned. Stay to 70 Bo and editor of the Wilson Quarterly, Claire Whitney from the International Medical Corps. Thank you very much for joining us today. Thank you, sir. We hope you enjoyed this edition of the Wilson Center now and that you'll not only join us for our next issue, but they also log into Wilson quarterly dot com and dot com or dawg Stephanie did I get that right is it dot.com dot com.

  
  I got it right the first time where you can read the issue free of charge. You can also subscribe and so you'll know when Stephanie's ready to tell us what the next issue is about. You'll be first in line. Thanks. Thanks for your time and interest.