Mental Health in Humanitarian Emergencies: The Forgotten Refugee Crisis
By Mercy Kachenge
Dau Machar Jok is a refugee twice over, a status that has shaped not only where he lives but also how he feels inside. His journey from South Sudan to Uganda and later to Kenya’s Kakuma Refugee Camp shows the deep emotional wounds caused by war and displacement.
It is a crisis that is often ignored by the global humanitarian system, which focuses mostly on physical needs like food, water, and shelter, while neglecting the invisible wounds of the mind that is the mental wellbeing.
Dau’s life as a displaced person began in 2002. His first memory of leaving South Sudan is not one of organized travel, but of panic. “The sound of guns, people running, you being carried and scattered,” he recalls.
Dau Machar Jok A Refugee from Kakuma Camp
‘’ That moment of chaos marked the start of years filled with fear. Life in the Ugandan refugee camp that followed was unstable, with frequent arrests and the constant worry about what would happen next.’’
By 2010, Dau had moved again, this time to Kenya which was driven by continuing insecurity and the lack of schooling back home. Having experienced some education in Uganda, he found none when he returned to South Sudan. So, he came to Kenya alone in search of learning and a future.
But upon arriving in Kakuma brought new challenges, the unknown environment, the different culture, and uncertainty about whether the aid system could truly protect him. “You can never be sure what your next day, next time, next minute will look like,” he says. That sense of fear and uncertainty became his daily companion.
The psychological burden he carried was far heavier than the physical hardship. Years of exposure to violence had created a deep emotional wound. “You hear the sound of guns and then you say another person has died… I am waiting for my time to die,” he says quietly.
This belief that death was only a matter of time shaped his outlook for years. Being alone made it worse. “It is you and you alone. If you don’t make it, you are done,” he explains.
Yet, even after arriving in safety, Dau found little mental health support. Counseling offered in schools focused only on academic success, not emotional healing. “They talk to you about passing exams, not about what is in your heart,” he says.
Over time, he realized that trauma doesn’t disappear on its own. “You have to build new, stronger memories to replace the old painful ones,” he reflects. A process that requires psychological care that few refugees can access.
Dau’s story shows a clear disconnect in the humanitarian system, aid organizations pay attention to the “hardware” that is food, tents, and water but ignore the “software” , the inner life, emotions, and mindset of refugees. “What is affecting you inside is far much bigger,” he says. In the absence of formal mental health services, Dau and others turned to faith-based organizations for help. Local churches and spiritual leaders became their source of comfort and hope, comparing their struggles to biblical stories to remind them that there is “light at the end of the tunnel.”
For Dau, faith provided the only dependable emotional anchor. His message to aid agencies is clear, treat mental health as a necessity, not a luxury. He urges organizations to “shift focus from the hardware of refugees and look deeper into the software.” The key to healing, he insists, is giving refugees education and skills so they can have hope for tomorrow and feel useful, valuable, and human again.
According to the World Health Organization, it estimates that one in five people living in conflict-affected areas suffers from a mental health condition, with severe disorders like Post-Traumatic Stress Disorder (PTSD) being significantly higher than global averages.
Yet, humanitarian funding for mental health remains below 1% 0 per capita to mental health ($0.5of total global aid which is below the recommended $ 2 per capita for low-income countries. In Kenya, the situation is worsened by an overstretched healthcare system and chronic underfunding.
Clinical psychologist Tracy Korugyendo agrees with Dau’s perspective. She explains that in humanitarian crises, the mind immediately enters a “crisis state” that can lead to clinical mental health problems. The most common conditions, she says, are anxiety, hypervigilance (the constant fear that bad events will repeat), and worsened depression.
Korugyendo warns that in Kenya, many people have learned to normalize stress and trauma, which leads to neglect. “People think that giving refugees shelter and food is enough. They forget that these people need emotional care too,” she says. She stresses the need for Psychological First Aid (PFA) after traumatic events support that must be provided by trained professionals who can understand both verbal and non-verbal signs of distress.
Unfortunately, access to such help remains extremely limited in rural and crisis-prone areas. The few available services are often blocked by cost and language barriers, leaving refugees without culturally sensitive care. Korugyendo recommends community-based mental health programs, where local staff trained in counseling can provide affordable support in languages people understand.
Mental health advocate and a Lead at Vilgro Africa Warenga Kamau adds that trauma caused by emergencies is like an “invisible wound”, it can’t be seen but it hurts deeply. She says that mental health remains an afterthought in most emergency responses instead of being part of the first aid kit. “If someone breaks a leg, we rush them to a doctor. But when someone breaks inside, we tell them to be strong,” she says.
Mental health advocate and a Lead at Vilgro Africa Warenga Kamau speaking on a panel on lived eperiences at the 2nd National Mental Health Conference, organized by the Ministry of Health./Nairobi
Kamau highlights serious gaps in Kenya’s emergency and health systems. Stigma continues to silence those suffering, while low government funding keeps mental health services weak and underdeveloped.
Most facilities are found in big cities, leaving areas like Kakuma and Dadaab underserved. “There is still a lack of political will,” she says. “We can have all the laws and policies, but without funding and follow-up, they mean nothing.”
According to UNHCR’s Global Report 2024 and a recent humanitarian funding review, mental health receives under 1% of humanitarian health budgets in East Africa, leaving millions of refugees without adequate psychosocial support “We have the policy frameworks, including Kenya’s Mental Health Act of 2022 and the Refugee Act of 2021,” says Kamau. “What we lack is implementation, coordination, and prioritization.”
WHO calls for mental health access in every health system that is safe, culturally aligned care, legal protections and safe housing that is truly of inclusive communities
Still, stigma remains one of the biggest barriers. “In many refugee cultures, mental illness is seen as a curse or weakness,” Kamau explains. “People would rather hide their suffering than seek help.” He urges humanitarian agencies to invest in awareness campaigns and mental health literacy programs to normalize care-seeking behavior.
In Kakuma, for example, women face post-traumatic stress often intersects with gender-based violence and loss of family roles.
Children, she warns, are at even greater risk. “If a child’s trauma is ignored, it does not go away, it changes form,” Kamau says. “What we call PTSD or schizophrenia in adults often begins as untreated trauma in childhood.” The mental health crisis in refugee settings, she argues, is not just a failure of the present, but a betrayal of the future.
Policy experts argue that addressing refugee mental health aligns directly with Sustainable Development Goal 3 (Good Health and Wellbeing) and Goal 16 (Peace, Justice, and Strong Institutions). Without mental well-being, social cohesion and peacebuilding efforts risk collapse. “You cannot talk about integration or rehabilitation when people are psychologically broken,” says Korugyendo.
The Kenyan Ministry of Health has recently partnered with Johnson &Johnson partner to strengthen Kenya’s mental health system through training more primary healthcare workers in mental health and to establish community support centers in refugee-hosting countries. But the rollout remains slow due to funding limitations. “Mental health programs are often the first to be cut when budgets shrink,” Kamau laments. “We need donors and policymakers to understand that mental health is not a side issue, it is a foundation for stability.”
According to Dr Mercy Karanja, Head of the Division of Mental Health and representative of the Ministry of Health identified limited funding as one of the biggest challenges facing mental health services, noting that the sub-sector receives only 0.01 percent of the national health budget which has led to gaps in infrastructure, personnel, and access to treatment.
WHO recommends investing in evidence and community-based interventions that will address immediate mental health needs, foster long-term recovery, and empower people and communities to rebuild their lives and thrive.
The stories and expert views converge around a clear truth, the crisis of the mind is real, deep, and urgent. Refugees like Dau may find safety from bullets, but without healing their minds, they never find peace.
‘’Investing in the mental health of refugees is more than an act of compassion, it is a humanitarian responsibility and a social investment. When refugees are mentally healthy, they can learn, work, and contribute meaningfully to society. But when their trauma goes untreated, it limits their potential and keeps them trapped in cycles of pain.’’
As Dau puts it, what refugees need most is not pity, but purpose. “If you give us education and skills, we can rebuild our lives,” he says. “We can be useful and important again.”
Dau’s words note what policy reports often fail to capture the humanity behind statistics. The refugee crisis is not only about tents and rations, but about minds in distress seeking healing and dignity. Without targeted policies and funding for mental health in humanitarian emergencies, the world risks nurturing a generation of survivors who are physically safe but emotionally broken.
Mental health experts agree that healing the mind must become part of every humanitarian plan. Trauma may be invisible, but its effects shape entire communities. True recovery will only begin when aid agencies and governments treat mental well-being as essential, not optional.
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