Over the past 25 years, humanitarian programming has increasingly included attention to the psychological and social impacts of conflict. Over this time, a wide variety of approaches have been developed to address these ‘psychosocial’ issues. The authors argue that labelling these approaches, as a distinct and separate sector of activity is not helpful, either conceptually or programmatically. They further believe close operational co-ordination is essential among the various kinds of intervention required to help any particular population affected by armed conflict to improve its psychosocial, biological and material well-being. The article includes a graphic framework that reflects the integration of safety, participation, and development within the various elements of well-being. An integrated perspective and approach is proposed that calls for inclusion of psychosocial issues within humanitarian programming, across all sectors of intervention. The significant question is not, therefore, what constitutes a ‘psychosocial intervention,’ but rather how do humanitarian interventions together promote over-all well-being. Throughout the article, points are illustrated with examples from field practice.

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For the past 25 years, Afghans have accounted for the greatest number of displaced persons in the world. A large proportion of this population has sought refuge in neighbouring Pakistan. Many Afghan refugees have experienced unimaginable suffering due to war and its consequences. Mental health is an essential aspect of the care of refugees, yet the mental health and well-being of Afghan refugees has not been well studied. This qualitative field survey endeavours to gain some understanding of collective factors influencing mental health in a refugee camp in Karachi, Pakistan. We present ways of expressing distress, various sources of stress, and some of the coping mechanisms utilised by the refugees in this camp. On basis of these results, some recommendations are given.

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In situations of protracted armed conflict such as in sub-Saharan Africa, there exists a strong tendency to describe rebel violence as a senseless war of ‘all-against-all’. This ‘Hobbesian’ violence (a theory that people have the fundamental right to pursue selfish aims but will relinquish those rights in the interest of the common good) is often illustrated by the sight of drugged and gun-toting youths engaged in the harassment of innocent civilians. Their sole motivation appears to lay in the benefit of organized plunder. However ‘senseless’ it may appear, the violence still has its functions. It is used to foster strategies of political control, and has an important identity and social dimension. This article explores both the political and socio-psychological functions of violence in the rural areas of the Democratic Republic of Congo (DRC). The analysis focuses on the provinces of North and South Kivu and on Ituri, where the authors have carried out extensive field research. Their analysis will be developed in particular regard to the current demobilisation and reintegration efforts that are carried out within the scope of the ‘transition’ process in the DRC, but which so far have seen limited results. Finally, the authors will explore some alternative methods to rethink war trauma and the rehabilitation of ex-combatants in (former) conflict areas such as the DRC.

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This field report describes the support and reconciliation work in a weekly multicultural and multilingual therapeutic group of African refugee women in a shelter in Johannesburg, South Africa. The problems of the participants, the therapeutic approach (which includes team building exercises, guided imaginations, story telling, drawing, modelling and discussion) as well as the impact on the participants, are all discussed.

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Three days after the Tsunami hit the war-torn Jaffna district in northern Sri Lanka, a mental health task force was formed. The approach of this task force, comprising a cooperative initiative between 18 humanitarian agencies, is described in this field report.

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This article presents a community approach to supporting people affected by organised violence and torture in post-conflict Guatemala. Through an observation of a reflection group session and focus group interviews conducted with participants in a community reflection group for women, it is shown how the practical work carried out through the ODHAG - RCT (Human Rights Office of the Archbishop of Guatemala (ODHAG) and the Rehabilitation and Research Centre for Torture Victims (RCT) of Denmark) programme focuses on actively building trustful social support systems and re-establish inter-personal relationships. Furthermore, it is argued that although the community approach uses health as the entry strategy, its aim is not confined to decreasing health related symptoms; in particular, the aim is the creation of social structures within the community capable of fostering social and political transformation.

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