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In war-affected countries, over half the population experiences mental health conditions such as depression, PTSD, and anxiety, yet only 10% receive the necessary therapeutic support (Alghazo & Premuda-Conti, 2024, p. 607). While the psychological toll on soldiers is extensively documented, non-refugee civilians who remain in conflict zones also face these mental health challenges, often lacking adequate support and resources. As Alghazo and Premuda-Conti (p. 602) highlight, “meta-analyses from conflict-affected areas indicate a significant prevalence of PTSD and depressive symptoms, with estimates for PTSD ranging from 15.3% to 30.6% and those for depression from 10.8% to 30.8%.” Vulnerable groups, such as women, children, the elderly, and individuals with disabilities, often face heightened exposure to trauma and are disproportionately affected.
Such statistics illustrate the overwhelming need for mental health practitioners in war-affected environments. However, these regions often face a severe shortage of professionals due to the devastating consequences of war, including displacement, destruction of infrastructure, and considerable safety risks. In recent years, especially after the COVID-19 pandemic, the telemedicine consultations have been recognized as a practical solution in challenging environments. Under such circumstances, telemedicine, which provides remote healthcare solutions including mental health support, proves crucial in overcoming challenges like geographical barriers while ensuring access to professionals.
Mental Health Challenges and Telemedicine
The long-term consequences of exposure to war are profound, including trauma that disrupts brain function, dissociation that impairs daily life, and social disruption that isolates individuals from support systems. If unaddressed, not only do these effects impact survivors, but also extend to future generations through the intergenerational transmission of trauma. By addressing the root causes of trauma and fostering resilience, the intergenerational transmission of trauma can be reduced, decreasing the likelihood of recurring conflicts and promoting long-term peace and stability in war-affected areas (Alghazo & Premuda-Conti, p. 603). For these reasons, tele-mental health support plays an integral role in providing counseling aimed at delivering trauma-informed care.
Where psychological support is urgently needed but difficult to access, telemedicine provides an effective solution, offering significant benefits in delivering mental health interventions. With just a phone call, email, or text message, individuals can connect with healthcare professionals. Haimi (2024, p. 3) reports, “the experience in Ukraine shows that, of the 62,000 telemedicine consultations conducted by Health Tech Without Borders and Telehelp Ukraine, 98% of them consisted solely of text communication between the doctor and patient on a secure telehealth platform.” This example illustrates telemedicine’s transformative potential in resource-limited and war-affected regions.
Moreover, in regions impacted by conflict, telemedicine offers a creative, cost-effective, and reliable solution for healthcare, yet its success is often hindered by limited local expertise and inadequate infrastructure, with connectivity issues further impeding its implementation (Haimi, 2024, p. 3). Despite these challenges, the platform offers opportunities for overcoming traditional barriers to healthcare delivery. For instance, these platforms enable coordination among healthcare providers across locations, ensuring the exchange of medical records, treatment plans, and follow-ups, which is essential for managing chronic illnesses, rehabilitation, and psychological support to improve individuals’ well-being (CureSelect Healthcare). By bridging these gaps, telemedicine equips healthcare providers to address both the immediate and long-term needs of patients in conflict-affected areas.
Furthermore, telemedicine can, in certain cases, provide a secure environment where patients feel safe to seek care. According to Shoib et al. (2022, p. 2), another clear advantage of telemedicine is that it offers a safe space for patients to openly address sensitive topics, particularly for those in conservative sociocultural environments who might hesitate to address them in person.
Limitations and Challenges of Telemedicine
One study demonstrated that tele-mental health services are not suitable for all patient groups, with audio-only technologies posing significant challenges due to the absence of non-verbal cues, which hindered effective risk assessment and care delivery (Ibragimov et al., 2022, p. 8). While technology-specific obstacles present immediate challenges, addressing systemic barriers remains crucial for the successful implementation of telemedicine in low-resource settings. Additionally, the implementation of telemedicine in low- and middle-income countries or conflict areas faces multiple challenges, including resource constraints such as limited funding, insufficient human resources, inadequate equipment, unstable power supplies, and poor connectivity, as well as systemic issues like poor implementation, limited evaluation of effectiveness, and insufficient research data, especially in conflict-driven environments (Haimi, 2024, p. 2).
Talhouk (2024, p. 313) argues that “the inequalities engendered by the coloniality/modernity of humanitarian technologies are further compounded by the inequalities inherent to digital divides.” This becomes particularly evident in regions with limited or unstable access to digital tools and internet connectivity. Moreover, Talhouk (p. 313) addresses critical questions that underscore the limitations of telemedicine in humanitarian and crisis settings: “Who has access to digital technology and connectivity? What digital capabilities are available to those most marginalized?” Roth and Luczak-Roesch (2020) explore how such disparities in digital literacy, access, and control influence how humanitarian technologies are critiqued and configured. This unequal distribution of resources is particularly relevant for telemedicine in crisis settings, as it directly impacts its effectiveness and shapes whether such technologies can be deployed in conflict regions.
Such systemic disparities contribute to a broader dynamic of technocolonialism, reinforcing existing power asymmetries between refugees and humanitarian organizations, and perpetuating colonial legacies (Talhouk, 2024, p. 319). It is important that telemedicine providers, often designed in the Global North, consider the local and cultural contexts of the populations in crisis-affected regions worldwide. A substantial challenge lies in failing to incorporate local languages and culturally appropriate mental health approaches into these platforms, which can consequently impact their effectiveness.
The Path Forward
Looking ahead, a key focus for research and development should be improving communication infrastructure in war zones. This includes creating innovative telehealth technologies designed to meet the specific needs of conflict-affected populations, enhancing the training and capacity of healthcare providers, and advocating for policies that support telemedicine’s ethical and responsible use in such settings (Haimi, 2024, p. 6). Training local counselors and collaborating with culturally similar neighboring countries can help provide counseling services that are both relevant and sensitive to the needs of affected communities (Alghazo & Premuda-Conti, 2024, p. 609). Ultimately, overcoming systemic obstacles and implementing advanced telemedicine solutions are key steps toward providing equitable and effective healthcare in regions affected by conflict.
REFERENCES
Alghazo, R., & Premuda-Conti, P. (2024). Forgotten victims of war: A rapid review of counseling needs and a proposed intervention model for civilian survivors. Psychiatry International, 5(4), 601–615.
CureSelect Healthcare. (n.d.). Telemedicine in warfare and conflict zones: Enhancing healthcare amidst adversity. CureSelect Healthcare. Retrieved November 25, 2024, from https://cureselecthealthcare.com/blog/telemedicine-in-warfare-and-conflict-zones-enhancing-healthcare-amidst-adversity.
Haimi, M. (2024). Telemedicine in war zones: Prospects, barriers, and meeting the needs of special populations. Frontiers in Medicine, 11, Article 1417025. https://doi.org/10.3389/fmed.2024.1417025.
Ibragimov, K., Palma, M., Keane, G., & Médecins Sans Frontières. (2022). Shifting to tele-mental health in humanitarian and crisis settings: An evaluation of Médecins Sans Frontières’ experience during the COVID-19 pandemic. Conflict and Health, 16(6). https://doi.org/10.1186/s13031-022-00437-1.
Roth, S., & Luczak-Roesch, M. (2020). Deconstructing the data life-cycle in digital humanitarianism. Information, Communication & Society, 23(4), 555–571. https://doi.org/10.1080/1369118X.2018.1521457.
Shoib, S., Armiya’u, A. Y., Roza, T. H., Saeed, F., Swed, S., Arif, N., Park, C., & Chandradasa, M. (2022). Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers, and prospects. Asian Journal of Psychiatry, 75, Article 103203. https://doi.org/10.1016/j.ajp.2022.103203.
Talhouk, R. (2024). Humanitarian technologies. In S. Roth, B. Purkayastha, & T. Denskus (Eds.), Handbook on Humanitarianism and Inequality (pp. 308–319). Edward Elgar Publishing. https://doi.org/10.4337/9781802206555.00032.
Hi Eni!
I found your post on remote mental health support in conflict-affected areas very surprising and insightful. I had never considered telemedicine being used in such challenging environments, as I always associated it with post-pandemic governmental implementations. Personally, I’ve used telemedicine a lot, but your post opened my eyes to its broader applications.
I particularly appreciated how your post felt like an introduction to an academic article. I don’t think we see many of those kinds of in-depth articles on social media. nowadays. The section on limitations and challenges was especially valuable, as these aspects are not always obvious for someone who has used telemedicine in different circumstances, like getting a sick leave. Additionally, I learned a new term thanks to this post: “technocolonialism.”
Your post also adds a new perspective for me. In my corporate-journalistic environment, we talk a lot about the mental health of journalists who are constantly exposed to news, including those returning from war zones. However, we often tend to forget about the mental health of people who actually live in the war zones. Corporate journalists are offered many mental health programs, extra days off, and medical support on a daily basis—things that are so obvious for some are not that obvious for others.
Good job!
All the best, Julia from Group 2
Hey Julia! Thank you so much for your thoughtful response! I’m glad to hear that the mental health of journalists is a topic of discussion in your work environment. It’s such an important conversation to have and Lan Chi even addressed this in her post here: https://wpmu.mau.se/msm24group1/2024/11/05/journalists-under-fire-the-urgent-need-for-mental-health-support/. And you’re right, the mental health needs of those living in war zones often don’t receive the attention they deserve, if they receive any at all.
Hi Eni,
Thank you for the comprehensive write-up on leveraging ‘Telemedicine’ for mental health support in Conflict -affected areas. I would like to share my perspective on this. The complexity of mental health is wide-ranging and while telemedicine is an innovative solution to support mental health, its effectiveness as a virtual solution in war/conflict zones remains questionable.In these areas, people are often preoccupied with meeting their basic needs,which may limit the utility and accessibility of such services for those facing real-time crises.Do you think the affected individuals can build the same level of trust in a telemedicine-based support system as they would with in-person support?
Best regards,
Pree(MSM GROUP-5)
Hey Preetha, thank you for sharing your perspective and adding to the discussion. That’s a great question. My perspective is that it depends. Remote mental health services can be particularly useful in situations like hotlines or immediate support when no in-person help is available. However, it is a sensitive matter, and the potential for misuse cannot be ignored.
So, to answer your question, I think that remote mental health services are not universally ideal but can be effective in certain circumstances. Regarding trust, I believe remote support cannot fully replace the genuine connection and experience of in-person support. However, what I consider particularly important and the authors seem to emphasize this as well is the role of language and cultural familiarity. These factors are crucial in building trust. So I would say cultural sensitivity is probably the most important aspect of building trust, in my opinion.