– 6 months on, critical health needs continue
26 April 2024
Since September 2023, the World Health Organization, through the WHO Country Office in Armenia and the WHO Regional Office for Europe, has been supporting the Government of the Republic of Armenia, and working with national and international health partners, including the United Nations, to meet the acute and longer-term health needs of over 115 000 refugees who arrived from the Karabakh region in the fall of 2023.
WHO has strengthened the delivery of mental health and psychosocial support (MHPSS), provided trauma care and rehabilitation for burn patients, offered essential and critical health information to refugees, and supported vaccination campaigns to prevent disease outbreaks. Under the leadership of the Ministry of Health (MoH), along with the International Organization for Migration, WHO has co-chaired the health sector response, ensuring that emergency response activities are coordinated amongst health partners and, along with the United Nations High Commissioner for Refugees, co-chaired the Mental Health Task Force.
WHO stands ready to support the MoH to ensure that the health needs of refugee and host communities continue to be met in the years ahead. However, additional funding is required to sustain this effort.
WHO thanks the many countries working to address the health needs and gaps in the years ahead.
Samvel (right) and his sister Alla outside their home in a town outside Yerevan. Samvel was severely burned by an explosion at a fuel depot. With the support of the European Union (EU), along with the Romanian and Belgian governments, and with the help of the Belgian First Aid and Support Team, Samvel was evacuated to Belgium, where he received specialized treatment for his burns.
– supporting national medical teams on treating burns
WHO supported the immediate life-saving efforts of Armenian doctors caring for burn patients, by deploying and coordinating multiple international emergency medical teams (EMTs). These teams, specializing in burn management and medical evacuation, worked alongside Armenian medical staff from the early stages of treatment to rehabilitation.
In the first phase of their response, the EMTs carried out nearly 600 surgical procedures, changed dressings, and supported the early physical rehabilitation of burn patients. Several of them, together with their families, were medically evacuated for specialized treatment in the USA and European countries.
Six months since the Karabakh fuel depot explosion, with the steady support of Armenian doctors, burn patients continue their long road to recovery. Dr Karine Babayan, Deputy Director of the National Center for Burns and Dermatology in Armenia, has been overseeing the treatment and rehabilitation. In March 2024, she told WHO why she feels optimistic.
“There is one burn patient left in this hospital. The blast left him with burns over 80% of his body and with deep burn wounds to his face and limbs. Most patients in his condition unfortunately do not recover, but we know that he will. This gives us a sense of victory. Without the support of everyone involved, we wouldn’t have managed, and the number of casualties would have been much higher. Because of the support we received, we never felt alone.
Dr Karine Babayan, Deputy Director of the National Center for Burns and Dermatology in Armenia. WHO supported the immediate life-saving efforts of doctors like Dr Babayan by deploying and coordinating multiple EMTs to strengthen the national institutions and hospitals. EMTs provided surgical interventions and rehabilitation expertise for burn patients.
– rehabilitation of burn survivors
EMTs deployed to Armenia bolstered the capacity of national institutions and hospitals through life-saving surgical interventions for burn patients as well as training and sharing of expertise on rehabilitation.
WHO, together with the MoH of Armenia and the EMTs Samaritan’s Purse and UK-Med, organized Training of Trainers workshops for 26 specialists from 9 rehabilitation centres across Armenia, followed by a more comprehensive accredited training course for additional 30 rehabilitation staff offered in all provinces of Armenia. The training, made possible through a close collaboration between WHO, MoH, the EMTs and Samaritan’s Purse, engaged not only international trainers but also previous trainees as national experts.
Overall, these trainings enhanced the knowledge, skills and understanding of burn care and rehabilitation interventions, and strengthened the capacity of local trainers within the Armenian health system to transfer acquired knowledge and skills in burn care and rehabilitation.
As of April 2024, WHO’s training on rehabilitation has benefited over 56 specialists, including rehabilitation physicians, burn surgeons, nurses, and physical and occupational therapists in Armenia.
“We aim for continuous progress,” Marina Sergeeva, a rehabilitation therapist at the National Center for Burns and Dermatology in Armenia, told WHO. She then added, “Witnessing the sustained improvement brings us satisfaction.”
Marina Sergeeva is a rehabilitation therapist at the National Center for Burns and Dermatology in Armenia. She is also a refugee herself, having left the Karabakh region for Armenia in October 2023. Marina began working as a volunteer at the Burn Center, but now has a paid position and sees about 10 patients a day. Physical therapy skills are crucial for helping patients to regain their independence and mobility after severe damage to skin layers, muscle and connective tissue.
WHO continues to scale up MHPSS services for Armenian refugee and host populations, a critical need identified by refugees.
This includes the establishment of a mobile team that travels weekly to affected communities to provide immediate MHPSS support. To date, over 973 people have received MHPSS consultations, of whom 16% are children and 35% are older people.
WHO also continues to build the capacity of the MHPSS hotline. Operators work shifts, listening and providing referrals for callers who suffer from anxiety, depression or are experiencing suicidal thoughts. Over the past 6 months, 10 operators have received specialized trainings and responded to a total of 4546 calls.
Vahan Simonyan, a psychiatrist on the mobile team, tells WHO that mental health needs are still acute: “Six months on, we are diagnosing long-term and more chronic conditions like depression. Refugees came with their own history of mental health, and severe signs are now manifesting themselves.”
Providing MHPSS for burn patients, their families and medical staff has also been a major feature of WHO’s response.
Over 1262 individual sessions have been provided to 149 people, including 96 burn patients, 32 family members and 21 medical staff. WHO has also provided trainings and capacity building on basic psychosocial skills, self-care and stress management to more than 360 nurses.
As of March 2024, 6 months after the influx of refugees from the Karabakh region, the number of people approaching and requesting psychological support is growing, requiring additional funds to integrate MHPSS services into primary health care and to continue building community resilience.
WHO and its partners have scaled up MHPSS activities for refugee and host populations in Armenia. The WHO-supported mobile team, consisting of a social worker from the Karabakh region, a psychiatrist, and psychologists, provides immediate MHPSS support in underserved and remote areas.
Preventing, identifying and controlling disease outbreaks in host and refugee populations through public health measures, including immunization activities, has been a core aspect of WHO’s refugee health response.
WHO, together with MoH and national health partners, has participated in activities focusing on immunization against infectious diseases. Paediatricians and immunization coordinators from 370 primary health-care centres around Armenia were trained on WHO guidance on delivery of immunization services for refugees. They then supported national medical teams in the nationwide catch-up immunization campaign by raising awareness on the importance of vaccination among the public and groups that are at particular risk. With co-funding from the EU, informational materials on measles, poliomyelitis, and human papillomavirus, as well as on the updated schedule for catch-up vaccinations were developed, and 20 000 copies were disseminated throughout primary health-care centres in Armenia.
Between November 2023 and February 2024, WHO supported an outreach immunization campaign that focused on raising awareness, providing medical consultations and influenza vaccination to older people and those suffering from chronic conditions living in refugee shelters, care centres and assisted-living facilities. Teams of health-care workers, including cardiologists and infectious disease specialists, along with 50 trained student-volunteers from the Youth for Health WHO-EU initiative, reached around 500 beneficiaries.
Nella Movsisyan, 75, is among more than 90 refugees from the Karabakh region living in a former kindergarten repurposed into a refugee shelter. Alongside her family, Ms Movsisyan received her flu shot from a mobile vaccination team.
“Back home, I kept up with all of my vaccinations, including those against COVID-19, so I took the opportunity to get vaccinated against the flu, too.
Nella Movsisyan, 75, is among more than 90 refugees from the Karabakh region living in a former kindergarten repurposed into a refugee shelter. Alongside her family, Ms Movsisyan received her flu shot from a mobile vaccination team.
WHO has placed refugees and host communities at the forefront of this response, ensuring that their needs are reflected and addressed. Crucial public health advice, for example, on how to register for health services, is being delivered with and for affected communities. To date, 72 500 refugees have registered and now have access to health-care services.
Under the umbrella of risk communication, community engagement and infodemic management, WHO key activities have included establishing social listening systems and tailored risk communication packages, consisting of animation, infographics and factsheets. WHO has also trained over 30 social workers and 50 youth volunteers from the Youth for Health WHO-EU initiative on how to deliver timely health advice.
The training of the youth volunteers bolstered their capacity to support health sector responses. Working with doctors, they conducted visits to various primary health-care centres, disseminating crucial health information in communities to promote healthy behaviours, including the importance of vaccinations.
Zara Petrosyan is a social worker trained by WHO on risk communication, community engagement and infodemic management. She is one of 30 social workers providing daily support to refugees. Social workers are a vital component of WHO’s response. As trusted community members, they provide a range of advice, including guidance on how to register for health services.
“Many displaced people facing health issues do not know what services are available, and rely on social workers for guidance. We aim to understand their challenges, identify their primary concerns, and work collaboratively to find solutions.” Zara explains. “I am available 24/7 for the families I serve, to provide information on how to access free health services.”
Zara Petrosyan, a social worker from the Karabakh region, meets with a refugee family. Zara currently provides resources and support to 50 refugee families in the town of Masis, a short distance from the capital Yerevan. “I am available 24/7 for the families I serve, to provide information on how to access free health services in Armenia.”
While the acute needs of refugees have been met in the past 6 months, key gaps in health services persist.
As of March 2024, approximately 30% of the refugee population, or around 30 000 people, still had not registered in the national e-Health system (ArMed) and therefore do not have access to State-provided health care. Further analysis is required to understand why, and should be followed by outreach efforts to encourage registration.
MPHSS interventions are becoming more urgent and need to be sustained. In the months ahead, psychological first aid for nonspecialized health personnel will be a key priority.
Rehabilitation services for burn survivors are required for years to come, as some face permanent disabilities and a long road to recovery. Rehabilitation needs to continue, with technical support provided to health-care workers.
Refugee populations will have ongoing health needs. The fact that specialized health services are largely concentrated in the capital Yerevan poses accessibility challenges for refugees spread across the country, which will need to be addressed by longer-term efforts focusing on strengthening rural services.
The refugee crisis may not be a headline anymore, but that does not mean it is over.