Economic and social impacts of untreated trauma

The consequences of the psychological stress suffered by those who flee are not limited to the individuals themselves; there are also economic and social implications. In eco­nomic terms, the long-term psychological consequences of displacement and the experience of violence are reflected in increased pressure on health and social sys­tems. Untreated trauma symptoms such as depression, anxiety disorder and PTSD lead to an increased need for medical care, which puts additional strain on the often-limited resources of the host countries. At the same time, many of those affected are unable to work in the long term or only to a limited extent; and this makes it difficult for them to become economically independent, reducing the economic potential of societies. There are also harmful conse­quences in the field of education. Mental stress impairs the ability of forcibly dis­placed persons to learn and thus reduces their participation in education, which, in the long run, has a negative impact on their professional qualifications, their employment prospects and their income.

In addition, societies with a large share of traumatised persons often see an in­crease in domestic and sexualised violence. This causes not only further human sufferi­ng but also additional social and economic costs – for example, through increased health expenditure and lower labour prod­uc­tivity. In addition, untreated trauma is often “passed on” to subsequent generations: children of traumatised parents are more likely to develop behavioural prob­lems or mental disorders.

Furthermore, untreated trauma can jeopardise the social cohesion and stability of societies. Symptoms such as mistrust and social withdrawal make it difficult for refu­gees and IDPs to build stable relationships in their new environment. Many of those suffering from such symptoms also experi­ence discrimination and exclusion – for example, on the housing or labour market or in the education system. All such factors can increase social tensions between the forcibly displaced and the host population, making integration processes that much more difficult.

In the countries of origin, the psycho­logical stress experienced by returnees can hinder post-conflict reconstruction. Persons with displacement trauma who do not receive psychosocial support are frequently able to participate constructively in peace processes and institutional or economic reconstruction only to a limited extent. In particularly fragile contexts, this can con­tribute to the remobilisation of violence. Former combatants, survivors of sexual vio­lence and marginalised groups who remain in a state of unresolved trauma are more susceptible to retraumatisation, re-recruit­ment or retreating into narratives that legitimise violence. A lack of trust in fellow human beings and state institutions is a breeding ground for renewed escalation of violence.

Psychosocial support in crisis and conflict contexts

Studies show that early and continuous psychosocial support can prevent long-term post-traumatic consequences. The inter­nationally established term “mental health and psychosocial support” (MHPSS) encom­passes all measures designed to strengthen the psychosocial well-being of individuals and prevent mental disorders. MHPSS com­prises a broad spectrum of approaches that address emotional, social, spiritual, cogni­tive and behavioural dimensions without following an exclusively medical treatment model. These are often easily accessible, community-based measures implemented in the health, education and social work sectors by teachers, social workers and civil society actors. At the same time, MHPSS includes specialised clinical care.

Since 2007, a pyramid model developed by the Inter-Agency Standing Committee (IASC) has served as the international refer­ence framework for psychosocial work in situations of crisis and conflict. It visualises four types of intervention. The different layers of the pyramid are to be understood not as forming a hierarchy but rather as complementing one another. Ideally, they should be implemented in parallel.

HDP nexus – A strategic frame­work for displacement situations and MHPSS

The humanitarian-development-peace (HDP) nexus provides a suitable conceptual frame­work for integrating MHPSS into inter­national cooperation with the Global South. To date, however, it has not been used sys­tematically enough.

The HDP nexus was developed in 2016 to overcome the traditional separation between humanitarian aid, development cooperation and peacebuilding. It is in­tended to create synergies between short-term emergency aid and efforts to ensure long-term development and sustainable stabilisation. Through the coordination of measures to address the structural causes of humanitarian emergencies, lack of devel­opment and violent conflicts, the nexus is aimed at making humanitarian aid un­necessary in the long term and enabling those affected by such situations and cir­cumstance to regain control over their own lives. Progress made in this area must be secured through peacebuilding.

The HDP nexus is particularly well suited for addressing displacement situations. That much is evident from the two traditional durable solutions that apply to the larger number of people: local integration into the host country and return to the place of origin (resettlement being the third such solution). While humanitarian aid is needed in immediate emergency situations, inte­gration into the host society – just like reintegration into the society of origin – requires development approaches that enable refugees, IDPs and returnees to lead independent lives without external assis­tance. But while integration can lead to tensions between the forcibly displaced and the host society, return to the place of origin requires the establishment of peace and security. It is therefore necessary that the two processes be accompanied by peace­building measures.

Until now, MHPSS has been integrated into the nexus only in a selective manner. However, all three pillars of the nexus could benefit directly or indirectly from MHPSS. In the field of humanitarian aid, psychosocial support can directly contribute to alleviating suffering, ensuring pro­tection and lowering the hurdles to access­ing other services. In the area of development cooperation, MHPSS can facilitate access to education and integration into the labour market and thereby help secure incomes by breaking down the psychological and psychosocial barriers. And in peace­building, MHPSS strengthens social cohe­sion, trust in institutions and the ability to resolve conflicts without violence – all of which are key prerequisites for sustainable peace.

The contribution that MHPSS services can make to peacebuilding is particularly relevant in displacement contexts – whether it be the harmonious coexistence of displaced populations and host societies, the establishment of sustainable return processes or the creation of peace, security and stability in the country of origin.

MHPSS and peacebuilding

The positive link between MHPSS and peace­building is widely recognised today, not least as a result of the comprehensive con­ceptual integration of the former into the latter that has taken place over the past 20 years or so.

The first international reference point was the publication of the IASC Guidelines on MHPSS in Emergency Settings in 2007. Those guidelines established the first cross-sectoral standards for psychosocial support in acute crises, without, however, considering the longer-term effects on post-war societies or explicitly linking MHPSS to peacebuilding. Similarly, the WHO’s Comprehensive Mental Health Action Plan 2013–2020 (later extended to 2030) put emphasis, above all, on the need for psychosocial care in fragile and post-conflict contexts. A major step towards the strategic linking of MHPSS and peace­building was the publication of the 2018 Pathways for Peace report by the World Bank and the United Nations, which identified psychosocial stressors as a risk factor for violent escalation and discussed MHPSS as one of several preventive approaches. The same year, the German Ministry for Eco­nomic Cooperation and Development (BMZ) and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) published a Guiding Framework for MHPSS in Development Cooperation, which established links to social cohesion and peacebuilding but did not make them the focus of the framework.

In 2019, the IASC MHPSS Reference Group reconvened its Thematic Working Group on MHPSS and Peacebuilding to reinforce the conceptual link between the two issues. The following year, the MHPSS agenda was raised in the Review of the UN Peacebuilding Architecture, which highlighted the significant role of MHPSS in achieving and sustaining peace. A task force coordinated by the Dutch Ministry of Foreign Affairs drew up core recommendations for strengthening this interface. The same year, the UN secretary-general emphasised the need to integrate MHPSS more closely into peacebuilding in his report titled Peacebuilding and Sustaining Peace. And the European External Action Service (EEAS) recognised the importance of psychosocial expertise for peace processes in its 2020 Concept for EU Peace Mediation.

Other important milestones followed. In 2022, the IASC presented a revised version of the Mental Health and Psychosocial Support Minimum Service Package – a standardised range of services that also focuses on longer-term aftercare in displacement contexts. The same year, the United Nations Devel­opment Programme (UNDP) published comprehensive guidelines on integrating MHPSS into peacebuilding. That publication was supplemented by a practice-ori­ented manual from the International Orga­nization for Migration (IOM) for commu­nity-based MHPSS work in displacement contexts.

From the above, it is clear that a paradigm shift has taken place over the past couple of decades – away from purely humanitarian psychological emergency care towards a strategic understanding of psychosocial support as an integral part of sustainable peacebuilding, especially in contexts of displacement, fragile statehood and violent conflict.

The peace dimension in the HDP nexus: “Small p” and “big P”

Although MHPSS and peacebuilding are already regarded as linked (and are also connected in practice), there is no explicit conceptual embedding of MHPSS in the nexus. However, such a step is warranted, as a differentiated analysis of the peace dimension of the nexus – referred to in the specialist literature as the “P” (for “peace”) pillar – shows.

The “P” pillar is usually divided into “small p” and “big P”. “Small p” refers to the promotion of peace at the local and societal level. It covers everyday social coexistence, trust, social cohesion and non-violent conflict management.

“Big P”, on the other hand, refers to struc­tural and political peace processes that focus on the causes of violence and aim to create sustainable stability and positive peace. They include not only high-level political dialogue, diplomacy, peace mis­sions and stabilisation operations but also reconciliation, transitional justice, insti­tutional reconstruction and the restoration of trust in state structures.

Psychosocial support can focus simultaneously on promoting individual and com­munity resilience (“small p”) and on facili­tating social healing and the creation of struc­tural peace (“big P”).

Conclusion: Synergy between MHPSS and the HDP nexus in refugee contexts

For lasting solutions in displacement con­texts, psychosocial support is essential at both the “small P” and “big P“ level: posi­tive peace requires not only peaceful co­existence at the local level but also political peace that addresses the structural causes of violence. MHPSS can make an important contribution here: psychosocial support always has an impact on several levels at the same time. It alleviates acute distress, strengthens social and economic participation and creates the conditions for trust and cohesion. Alongside the Netherlands, Ger­many has been one of the most important donors in the field of MHPSS for many years – both in humanitarian aid and in development cooperation.

Germany should make strategic use of its leading role in the field of MHPSS to strengthen the peace dimension of the HDP nexus in displacement situations. The goal should be to systematically integrate MHPSS expertise into peace processes, stabilisation missions and transitional justice formats – for example, by seconding psychosocially trained professionals to mediation and ob­servation missions and by taking psychologi­cal factors into account in conflict analyses and peace agreements. At the same time, MHPSS should be firmly anchored as an in­tegral part of programmes for (re)integra­tion, return assistance and increased social cohesion. Local structures and partner orga­nisations must be more closely involved in this process.

Especially in times of global funding cuts – Germany is no exception – and dwindling commitment to the HDP nexus on the part of traditional partners such as the United States, the German government has a strategic role to play. Continuing to publicly prioritise the MHPSS concept as a resource for peace – and working to remove the taboo surrounding mental health issues – in multilateral forums, at the United Nations and in the EU will not only strengthen Europe’s capacity to act in fragile contexts. It will also send a signal that Germany is committed to a resilience-oriented peace policy and is positioning itself as a driver of holistic, people-centred peacebuilding.