When Crisis Becomes Routine
When Crisis Becomes Routine
The Quiet Burden of Negotiating Dignity
The Quiet Burden of Negotiating Dignity
What it means to be Aging and Undocumented in the United States
What it means to be Aging and Undocumented in the United States
The Invisible Children of Crisis Response
The Invisible Children of Crisis
A Solitary Journey
A Solitary Journey
Refugee Healing Through Cultural Humility and Language Support
Refugee Healing Through Cultural Humility and Language Support
When Crisis Becomes Routine
Author: Ibnath Fariha
In many parts of Bangladesh, crises did not arrive once and pass. They returned again and again. In flood-affected regions, disaster was part of the calendar. Monsoon season brought rising water, damaged homes, and disrupted lives. When the water receded, routines resumed, and people waited for the next season.
As a child, I watched communities prepare for losses they already knew were coming. Relief arrived quickly and visibly: food rations, temporary shelters, brief attention. What followed received far less care. Rebuilding stretched on quietly, and no one asked how people were coping. No one spoke about mental health. But I sensed what was missing, and the repercussions of that silence settled mostly on women.
They managed households after displacement, cared for children while lives remained uncertain, and held families together through fear and exhaustion that had no name. Growing up as a woman in that environment meant learning early that your suffering was not the kind that got counted.
Those observations stayed with me. Years later, as a student of Epidemiology at Columbia University, I found language for what I had witnessed. I learned how humanitarian systems define crisis: as time-bound, measurable, and event-driven. Mental health support is typically tied to a flood, a conflict, a sudden displacement. But for communities where disruption never fully lifts, that boundary means nothing. The question I kept returning to was this: what happens to people when the emergency ends on paper, but not in their lives?
This is the thread connecting my childhood in Bangladesh to what I later encountered in Cox’s Bazar. Both populations live with crisis not as a single event but as a permanent condition. Today, Rohingya women there receive psychosocial support intended to address trauma, yet these services exist within camps where displacement has no timeline, legal status remains unclear, and futures are indefinitely suspended. I once heard a Rohingya woman say that the counseling sessions ended, but camp life did not. Healing was being encouraged while the structures sustaining harm, including statelessness, gendered power, and prolonged displacement, remained entirely intact. This is not a failure of individual caregivers. It is a failure of systems designed only for acute emergencies, not for lives shaped by chronic ones.
And yet women continued to care for one another. Informal networks in Bangladesh offered support through shared routines: cooking together, watching each other’s children, sitting with someone through difficulty. These practices were never labeled mental health care and received no funding or recognition, but they provided what formal services rarely could: continuity and the assurance that you were not invisible.
My interest in public health comes from what I witnessed growing up, and it shaped my sense of responsibility to address health inequities. At institutions like Columbia University, where research often influences global health policy, this commitment means advocating for funding that supports communities beyond the immediate emergency period and training the next generation of practitioners to recognize prolonged displacement as a serious mental health challenge. But universities alone cannot solve this problem. Organizations such as UNHCR and UNRWA, which work directly within these communities, have both the reach and the responsibility to do more. This includes compensating informal caregivers and integrating community-led support networks into official programs. Success should also be measured by whether people continue receiving care long after the initial aid is delivered.
The women I grew up watching were already doing the kind of care and support that many formal systems still fail to recognize. When the floodwaters recede and aid organizations leave, these women remain. They are the ones who hold communities together through what comes next. Mental health cannot be addressed only when a crisis is visible or when it fits within a project timeline. Recognizing their work is not just a moral obligation. It is the starting point for building systems that truly support communities over time.
The Quiet Burden of Negotiating Dignity: Prioritizing the link between menstrual and mental health in humanitarian response efforts
Author: Kendal Furman
Imagine planning your day around the fear of being seen.
You wake early to wash a reusable cloth in secret before others start their day, hiding it under a mattress to dry. You tuck the damp cloth into your clothing before walking to the latrine to avoid drawing unwanted attention. With nowhere to let the cloth dry out in the open, you worry about developing a rash or, worse, an infection. You fear constantly about sitting too long, standing too quickly, whether someone will notice a stain. You pretend not to feel any pain as you fulfill your daily responsibilities, too embarrassed to ask even your own family for help. You carry the constant, quiet anxiety of being exposed.
Mental health interventions in crisis settings often concentrate on the immediate threats to safety that can cause trauma; overlooking the subtle, everyday stressors that accumulate to shape health outcomes just as powerfully. Menstrual health is one of these stressors. Often, menstruation is treated as a strictly biological issue—reduced to managing a bodily function with the right product or facility. In reality, the factors that contribute to inadequate menstrual health and hygiene (including limited access to menstrual products, menstrual-friendly toilets, clean water, soap, laundering facilities, proper waste disposal mechanisms, menstrual and pubertal education, as well as stigma-free environments) can have dramatic effects on an individual’s psychosocial and emotional well-being. As a result, menstruation sits at the intersection of systemic neglect and gendered social norms, causing both physical health threats and chronic psychological strain. For many, menstruation signifies a monthly battle to preserve dignity, safety, and belonging.
In humanitarian contexts, these risk factors become multiplied as structural barriers exacerbate menstrual inequities. Individuals may feel too embarrassed to walk to latrines with their products during the day, opting instead to make the trek at nighttime despite the added safety risks. Shame and social isolation are common, increasing the pressure to keep stains from becoming visible and to conceal any discomfort. Access to reproductive health education is scarce, with questions about what is and isn’t normal remaining unspoken and unanswered.
The impact extends beyond physical effects; leading to anxiety, hypervigilance, embarrassment, and the steady internalization of stigma. Over time, these experiences shape how confidently individuals see themselves and how comfortably they move throughout their communities.
While response efforts have made some meaningful progress to address the needs of menstruating individuals in crisis settings, they oftentimes focus on infrastructure and access improvements with little consideration of psychosocial factors. The inclusion of dignity kits, menstrual-friendly sanitation facilities, and growing recognition of menstrual health as a core component of sexual and reproductive health programming reflect years of hard-won advocacy. However, menstrual health and mental health continue to be treated as afterthoughts—separate logistics problems rather than interconnected, emotional experiences. When menstrual health is considered by humanitarian actors, it’s rarely connected to the routine social and emotional realities that shape how safe or accepted an individual feels.
Part of this neglect stems from how the humanitarian system defines what is considered “urgent.” Both menstrual and mental health are viewed as secondary to immediate, life-saving interventions like food, shelter, or acute medical care. Their importance gets washed away in the hierarchy of response priorities. Yet, for those living through crisis, the psychological burden of managing menstruation without privacy, safety, or support can feel both immediate and constant. What should be a manageable, acceptable reality becomes an omnipresent, debilitating force when the psychosocial impacts of improper menstrual health and hygiene go unaddressed by those in decision-making positions.
In light of the recent “Humanitarian Reset” seeking to improve inter-sectoral collaboration, I hope to see response efforts that push past oversimplified narratives which isolate menstrual and mental health. Greater collaboration between the WASH, Health, and Protection sectors could begin to bridge this gap. WASH and Health programming, for example, should move beyond product distribution to provide comprehensive menstrual health education that addresses stigma and encourages more positive attitudes toward menstruation to boost self-confidence and acceptability.
At the same time, mental health and psychosocial support initiatives could more directly engage with the fears and anxieties many menstruating individuals face around gender norms and puberty. Developing shared indicators and integrated programming that link menstrual health and psychosocial wellbeing would allow humanitarian actors to improve physical and emotional health outcomes; helping to build a humanitarian system that better reflects both the lived realities of vulnerable populations and the complex, intersectional nature of health.
If humanitarian response is meant to protect physical and emotional well-being, then menstrual dignity cannot remain an afterthought. The overlap between menstrual and mental health reminds us that the ability to move through daily life without shame, fear, or concealment is not a luxury—it’s foundational to the work being done in this sector.
What it means to be Aging and Undocumented in the United States
Author: Karla Gures
Among immigrant communities in the United States, mental health is often deprioritized and becomes invisible in the broader struggle for economic stability and legal security. A forgotten subgroup within immigrant populations in the U.S. are older undocumented immigrants. Though former President Ronald Reagan granted legal amnesty to all undocumented immigrants in the 1980s, multiple generations of undocumented immigrants have continued to live with no applicable pathways to legalization. This leaves thousands of older undocumented immigrants aging into decades of vulnerability including limited access to healthcare, exclusion from public benefits, and persistent economic instability along with exploitative work conditions. The consequences of these structural barriers create a constant state of living in precarity, which has transpired into a silent suffering for decades. This prolonged insecurity manifests into a chronic state of stress that is both physiological and psychological.
Living in the United States as an undocumented immigrant means having an ingrained daily fear of deportation, which impacts more specifically the older adults who have been here for the majority of their adult life. Many of these older undocumented immigrants are facing undiagnosed and/or untreated depression on top of this due to social isolation, language barriers, and the lack of community due to leaving their countries of origin. This is compounded by limited mobility and inability to work as they age since this population is not able to qualify for the usual public benefits that support aging populations. A lot of older undocumented immigrants are also the ones who fled civil war and political crises within their countries decades before. Yet without access to affordable or culturally competent care, this trauma will continue to remain unprocessed and compound with the already present stress of being in the United States without papers. Care that addresses this includes expanding reduced-cost and free clinics and care through state and private grants since the federal government is currently in the process of defunding what was available through their funds.
As a daughter of immigrants who were undocumented for 25 years, I have seen and felt the impact regarding legality and mental health in the United States. I have seen my parents and loved ones normalize the idea of deeply struggling and accepting it because society has equated struggle in the United States to what one must do to accomplish the elusive idea of the American Dream. When my father was undocumented, he only took 3 days off in those 25 years while simultaneously working 16-hour days every day. With a smile on his face, he would always remind me this is the way to live when pursuing a life in this country. This common idea within immigrant communities reinforces the concept of emotional distress being continuously internalized. Older undocumented adults are more likely to interpret symptoms of depression and other mental health disorders as a sign of personal weakness rather than a product of an environment that is against them. This not only impacts the older adult, but also reverberates through entire families by creating a cycle of stress and trauma that younger generations often absorb and carry into their own lives.
The only way to address this is policy change. Undocumented immigrants are set up in the United States to remain low-income while not being able to qualify for any public benefits. Concrete reforms are truly needed, and this can include expanded access to healthcare, public benefits, and more importantly, legal pathways. While non-profit and other assistance work benefit immigrants tremendously, this is not sufficient when targeting older adult undocumented mental health. We live in a reactive system that focuses on the impacts of being undocumented in the United States rather than focusing on the root of the issue which is a complete reform in immigration policy. Immigrant-support networks and mutual aid groups are valuable in their own ways when building social and support networks, but the reason for these groups is due to the structural barriers that the United States has perpetuated. Generations of families are impacted by this policy failure and will continue to be as their family members and themselves have to endure the every-day fear of deportation.
The Invisible Children of Crisis Response
Author: Meraf Ketema
Children with disabilities have been close to my heart ever since my brother was diagnosed with Autism at three years old. As I grew older and helped in raising him, I often thought, “Thank God my parents emigrated to the US, because how could we have handled this in Ethiopia.” And as I grew interested in conflict zones, especially as my own homeland became one, I thought of children like my brother who weren’t broadcasted on the news. Where were they?
In the summer of 2017, I saw a child that could’ve been my brother. I taught English at a small school in Addis Ababa. There, I met a boy who was born without a hand and couldn’t speak. I was seventeen and ill equipped to teach fifty children, let alone provide support to a child in an underfunded school.
In 2023, I worked in Turkey after an earthquake devastated the region. I administered community surveys and facilitated weekly gatherings for women and children intended to provide psychosocial support, play, and a moment of normalcy after the disaster. For that hour, despite the language barrier, we created joy. But the children I knew to be disabled, whether physically or mentally, were never in the spaces designed for healing.
If roughly 1 in 33 children have an intellectual disability, then statistically there were children like my brother in every town I worked in. But they were not in our reports, and that absence isn’t random. Humanitarian work moves fast. Donors want impact within months. Disability does not fit neatly into emergency timelines. It requires long term care and adaptation, and data many, actors don’t collect. And so, these children disappear not because they do not exist, but because the systems built to serve “the most vulnerable” were not designed with them in mind.
In countries facing repeated conflict, mental health systems are often fragile and among the first to collapse. Trauma informed care assumes participation and short-term intervention, but children with intellectual disabilities face a different vulnerability. Their needs do not align neatly with standardized programming. They are at significantly higher risk of violence and exploitation in crisis settings, yet even that heightened vulnerability rarely translates into targeted protective measures. The spaces designed for healing rarely accommodate children who cannot communicate in conventional ways, who need routine, or who become overwhelmed by loud environments. Someone like my brother would need one-on-one attention, sensory support, and therapies tailored to him, yet most humanitarian programming is built to be broad, standardized, and easy to scale. When interventions do not adapt, they fall through the gap that gets constructed.
If humanitarian work truly believes in protecting the most vulnerable, it must consider those who cannot speak for themselves from the very beginning. From the moment of my brother’s diagnosis, he was put into speech and physical therapies, music and sports activities tailored to children like him, and different approaches were explored to understand how he functioned best. While humanitarian organizations must also consider what happens when they eventually leave, elements of this kind of support can still be incorporated into emergency response, with a training component added to ensure continuity of care. Even a basic version of this support in humanitarian settings could involve staff trained to recognize developmental disabilities, quieter activity spaces for children who struggle with sensory overload, and simple therapy exercises taught to caregivers so support continues beyond the program. If we are willing to design with these children in mind, then maybe next time I walk into a tent or a classroom, I will not be left wondering whether there is a child like my brother sitting just beyond my vision.
When humanitarian actors speak of reaching “the most vulnerable,” I think of my brother. I think of the boy in Addis and the children in Turkey whose names I never learned. Their absence is not proof they don’t exist; it is evidence that we haven’t asked the right questions. If we are serious about protecting the most vulnerable, then the children we never see should be the first ones we look for.
A Solitary Journey: Life after Loss for the Children of the Rohingya
Author: Sarah Shams
True powerlessness forces one to view nature as a more merciful oppressor than man.
It is that powerlessness which compels a father to put his children on rickety boats crossing oceans, so bleak are their prospects on land. This is the reality that faces the Rohingya people of Myanmar, who, confronted by the brutal violence of the Tatmadaw regime, find the savage waters of the Andaman Sea safer than their native soil.
I first came to understand at fifteen, during my time as a volunteer teacher at Madrasah Hashimiah, a small community school serving Rohingya refugee children who had arrived in Malaysia via this route, many of whom had been orphaned along the way. They had escaped the fate that had befallen their parents, who had, perhaps, slipped through the cracks of the transnational trafficking network, or sent their children ahead alone, hoping to soon follow.
For most, this reunion would never come.
The UN calls the Rohingya one of the most persecuted minorities in the world. When I came to know them in 2015, their grief was a physical, palpable force. The violence they had witnessed had descended inwards, leaving them quiet and withdrawn even during the play-based activities we’d organized. There seemed little hope for rehabilitation within the white-washed walls of their accommodations, devoid of the familial warmth the children needed.
How does one begin to heal such wounds?
We must first concede that healing cannot occur in vacuum. Currently, mental health resources for refugees, where they exist, centre on trauma-focused therapies; effective, but often unfamiliar to the collectivistic communities they serve. The question remains: how do we rebuild community for those that have lost it? I find an answer in my recollections.
While we’d been tasked with teaching the children a makeshift education of writing and arithmetic, the lessons were improvised, with children of vastly different ages sharing worn notebooks, their schooling interrupted by years of displacement. It was in this fractured environment that the older students began to assume a role no curriculum could impart: the role of surrogate parents. They translated instructions for the younger children, coaxed them into games when they retreated into silence, and guided them through the small rituals of the school day. In doing so, they formed the first semblance of family they had experienced since the violent dissolution of their own.
I do not wish to romanticize the parentification of these children, which carries its own implications. Yet what I witnessed imparts an important lesson on humanitarian responses: that the first individuals capable of reaching these children are not outside professionals, but peers who share their language and loss.
Rather than leaving this dynamic to chance, humanitarian programs should cultivate it intentionally by vesting older youth and young adults as peer mentors trained in basic psychosocial support. With modest stipends and supervision from educators and health workers, these mentors could serve as classroom aides, translators, and trusted caregivers for younger children without the exploitation of their labour. For host countries like Malaysia and Bangladesh, where clinical mental health resources are scarce, such programs would expand care without imposing unsustainable burdens on local systems. More importantly, they would root this care within the displaced communities themselves, among people who share the children’s culture and their memories of home.
We cannot undo the forces of structural violence that set these children on their solitary journey across the sea, but we can ensure that the communities receiving them are strong enough to help them come of age in a world far removed from the one into which they were born. Only then can we fulfil a father’s hope of delivering his children to a refuge that offers more than mere safety and subsistence, but the possibility of a life beyond irreparable loss.
Refugee Healing Through Cultural Humility and Language Support
Author: Anaya Sheikh
When I sat in a circle for gender-based violence group therapy in Jordan, the silence wasn’t empty; it carried the burden of displacement with an added layer of stigma and discrimination. My visit to a local refugee camp was no different. I sat with a family in their well-decorated tent, which they called home. As they narrated their experiences of losing loved ones or of living in the camp, they smiled and poured us hot shai, their hospitality was boundless. Unlike my peers, with the little Arabic I knew, I could converse with them, understand their faith, values, and culture, and ease our foreignness. My several years of psychology coursework didn’t prepare me to understand mental health from a context outside the U.S., where militarized aggression severely diminishes basic needs and causes constant chronic stress. As a psychosocial support intern, I saw firsthand that for refugees, escape from conflict zones is only the first step toward survival. The struggle for mental health well-being persists long after borders are crossed, but local communities, especially in the West, are frequently ill-equipped to support these needs.
Our ignorance and neglect in tailoring mental health needs during crises reflect how host communities engage with refugees. Although support is well-intentioned, deep-seated sociocultural barriers to healing are often overlooked. People feel powerless when protective systems ignore their identity or values. Notably, 22% of conflict-affected people experience depression, anxiety, or PTSD, yet the care in resettlement typically follows a “one-size-fits-all” model, which does not connect to their lived experiences (“Mental Health in Emergencies”).
Resettlement programs and mental health clinics usually emphasize symptom reduction rather than a holistic approach that accounts for the multiple determinants of health. Each person’s diverse upbringing and experiences should be considered in treatment plans. Thus, host communities should advance beyond a purely medical approach and adopt a social model that recognizes the barriers we subconsciously impose.
One of the most common concerns about accommodation and access to care is the lack of interpreters and language services. This barrier affects marginalized groups, as shown in a study of European mental health services: only 53% had interpreters for refugees and asylum seekers (Satinsky et al.). I saw a similar gap in Ohio when I accompanied my mom (who had volunteered through the local mosque) to interpret for an Afghan refugee family at a hospital with insufficient language services. She translated post-natal care and birth certificate information for the Afghan couple after the wife gave birth. I immediately witnessed the family’s relief, gratitude, and comfort at being understood, highlighting how access to interpreters eases marginalized patients’ stress.
Engaging with Palestinian and Syrian refugees, I learned about mental, maternal, and child health through a uniquely Middle Eastern and Islamic lens, shaped by additional trauma from war and displacement, where faith and community are vital for recovery. I had the incredible opportunity to provide interactive psychosocial programs in Jordanian schools and refugee communities, using culturally specific socioemotional learning to help adolescents process their trauma with integrity and dignity. Effective support means delivering education and services in refugees’ native languages, building trust among providers, systems, and patients. Advocacy should focus on equipping local providers with psychological first aid and cultural humility.
Western host countries must build communities that address mental health as much as physical needs, creating networks and integration services to prevent isolation. Through these acts of service, we do more than offer shelter; we offer a future where mental well-being is recognized as a fundamental human right.
References
“Mental Health in Emergencies.” World Health Organization, World Health Organization, 16 Mar. 2022, www.who.int/news-room/fact-sheets/detail/mental-health-in-emergencies.
Satinsky, Emily, et al. “Mental health care utilisation and access among refugees and aslyum seekers in Europe: A systematic review” Health Policy, Sep. 2019, https://www.sciencedirect.com/science/article/pii/S0168851019300399#sec0035
