Refugees and displaced people are at a higher risk than other vulnerable groups of being exposed to mental health issues, with relatively high rates of depression, anxiety, and PTSD (Post-traumatic Stress Disorder) among them (Silove, Ventevogel, and Rees 2017). The hardships associated with irregular migration, intertwined with the local political realities, have created difficulties for the rights and well-being of migrants across the globe, including Southeast and Eastern Europe, Western Asia, and the South Caucasus. Mental health difficulties in particular are a critical issue facing migrants. In Bosnia and Herzegovina (BiH), irregular migration has become a heightened human security concern due to the country’s increasing role as a transit state through which many migrants seek entry to the European Union, posing significant implications for public health and mental well-being. In Azerbaijan, mental health outcomes are influenced by a markedly different geopolitical and governance context, in which central authority and a highly securitized migration agenda shape the range of interventions possible. 


Given the differences between these two examples, a comparative analysis with a focus on mental health provides a better understanding of how human security is managed in distinct contexts. Comparing BiH and Azerbaijan, both transit routes and securitized areas, clarifies how varying degrees of state centralization and geopolitically driven migration agendas create distinct vulnerabilities for migrant mental health. To this end, this analysis seeks to improve understanding of the specific social and policy-related factors that have driven mental health and well-being outcomes in migrant populations in BiH and Azerbaijan between 2018 and 2025. 

By comparing cases such as Azerbaijan and BiH, which are respectively viewed as highly securitized and transit contexts, we can clearly observe that the link between migration and mental health is not limited to clinical conditionalities but is closely related to social and political determinants. Thus, social determinants directly linked to political decision-making, such as the degree of social inclusion, presence of community networks, and quality of housing, form an ecosystem for mental health. Besides, the functional quality of this ecosystem, the circular nature of community-based Mental Health and Psychosocial Support (MHPSS), and its dependence on community responses turn it into a litmus test for addressing human security across various geopolitical realms and political structures. For this reason, the following analysis utilizes community-based MHPSS as a testing ground for the conditions under which community-based MHPSS can or cannot function.

The Community-Based MHPSS Framework

Community-based MHPSS is often described as a paradigmatic shift in psycho-social treatment and envisions “communities [as] drivers for their own care and change” (IASC 2019). In practice, it emphasizes context-specific, multidisciplinary psycho-social support systems grounded in the existing strengths of affected communities. It also endorses the idea that social reactions to individual challenges and social cohesion are conditional on individual and collective social well-being (Nersisian et al. 2021).

Recognizing the agency of individuals within the socio-ecological paradigm, community-based MHPSS anticipates the influence of psycho-social intervention as circular, rather than linear, where interactions among individuals, families, and social environments operate along a continuum (Bubenzer, van der Walt, and Tankink 2017). Consequently, the well-being of an individual is conditioned within the community context, which is itself embedded in larger socio-political, economic, and cultural developments (IASC 2019). This circular relationship suggests that socio-political, economic, and cultural structures impact an individual's psychological well-being, and that individual mental health outcomes are neither entirely subjective nor relative.


This model can be analytically helpful as it situates mental health within the cultural peculiarities of specific communities as well as socioeconomic and political realities, making it highly relevant for migration cases in BiH and Azerbaijan, where migrants originate from diverse cultural backgrounds and are regularly affected by political factors, such as border externalization and impacts of ethno-nationalist politization. Regarding cultural differences, it is also pertinent to mention that mental illnesses are perceived differently across various parts of the world, and the Western approach of dealing with psychological challenges individually may not apply across contexts (Hillel 2023). Available figures indicate that approximately 42% of individuals experiencing mental illnesses in Western societies are not receiving formal psychological treatment, with rates roughly doubling in non-Western societies (Hillel 2023).

Several key components distinguish the community-based MHPSS model, which are important for this comparative analysis (Nersisian et al. 2021):

1. Social reactions are seen as necessary to individual challenges and the role of social cohesion in conditioning individual and social well-being.

2. Context-specific, multidisciplinary support systems based on the existing strengths of affected communities must be utilized in all intervention responses.

3. Communities must be engaged participatorily to tackle the communal and individual challenges.

4. Broadscale support of collective structures and systems is essential to the daily life and well-being of communities.

This methodology reflects the principles of community empowerment and participatory health by positioning agents as active collaborators of support systems, thereby redistributing the responsibility for care (Im 2025). This shift from the institutional approach to “task sharing” enhances cultural relevance, bridges systemic gaps, and fosters sustainability rooted in community involvement (Im 2025). Given this, the level of materialization of community-based MHPSS principles and their practicability on the ground may be considered a key determinant of how human security is fulfilled. By mentioning human security, I refer to the underlying rationale for the measures taken against anthropogenic, naturogenic, and emerging technological and artificial intelligence threats, beyond traditional military and espionage threats, that target the effective functioning, healthy development, freedom, and existence of human society on a specific or general scale, whether that be a specific migrant community or the general inhabitant population of a given area.

Migration-related human security challenges and MHPSS in BiH

The migrant population in BiH has experienced grave mental health challenges over the past seven years, as people using the “Balkan Route”* often come from conflict-affected, unstable areas with a history of trauma. Having fled their countries due to abrupt conflict-related and harsh economic reasons, migrants often endure severe psychological distress. Hardships experienced during migration could extremely affect their mental well-being, leaving them vulnerable to being re-traumatized. Irregular migrants traveling through BiH are likely exposed to severe threat-laden scenarios, such as exploitation, smuggling, and violence at the EU border.

Statistics provided by “Doctors of the World,” an international NGO focused on health and human rights, estimate that approximately 25,000 violent pushbacks** took place at the Bosnia-Croatia border from 2020 to 2023 (Reliefweb.int 2024). 90% of these cases involved harsh and open violence, including punches, strip searches, beatings with sticks, threats with guns, rubber bullet shots, exposure to cold and water, and destruction and confiscation of personal belongings (Reliefweb.int 2024). The resulting damages are both physical and psychological, leading to devastating, long-term mental traumas. Among people interviewed by “Doctors of the World” who experienced pushbacks at the Croatia-Bosnia border, 32% were diagnosed with anxiety disorders, 21% with depression symptoms, 20% with severe sleep problems, and 7% reported excessive use of medication or drugs or suffered from suicidal thoughts (Reliefweb.int 2024).


While conditions are harsh for the entire migrant population, some vulnerable groups, such as women and minors, may experience additional mental risks. Migrant children and unaccompanied minors are subject to adversities during their formative years, sometimes separated from their families, in unfamiliar cultural surroundings, and out of formal education (Médecins du Monde 2021). These stress factors can cause long-lasting emotional and developmental disorders. Research indicates that family separation can result in high levels of PTSD, anxiety, and depression among unaccompanied minors (Médecins du Monde 2021). Migrant women are another high-risk group; their heightened vulnerability is conditioned by factors such as experiencing unique stress in a male-dominated environment, undermined reproductive health needs, and often neglected gender-based violence along the route. Mental health issues among migrants are thus ubiquitous and systemic, requiring a wide range of treatment that considers the precariousness of being a migrant, along with gender, social status, and individual identity.


Given the severity of the human crisis and its potential to grow, utilizing MHPSS is irreplaceably important in the case of BiH. A close examination reveals that infrastructural conditions are crucial for comprehensive MHPSS in BiH, as placing the burden mainly on non-state actors undermines the potential of both MHPSS and human security. As several positive developments, mainly by non-state actors, supporting community-based MHPSS have been recorded, the main problem for BiH consists of the unresponsiveness of state institutions. In 2018, there were only two migrant shelters available: the Delijaš Asylum Center and the Salakovac Refugee Reception Center. This capacity grew with the assistance of the IOM, resulting in new Temporary Residence Centers (TRCs) in Sarajevo Canton (Ušivak and Blažuj) and Una-Sana Canton (Bira, Borići, Sedra, Lipa, Mira, and Blažuj) (Otsuka 2024). However, despite the potential for substantial progress in sheltering, the primary issue remains poor living conditions characterized by inadequate heating systems, a lack of privacy, and limited access to healthcare (Otsuka 2024). Characterized by political fragmentation, as well as radically different views between constituent entities, and a hardline position of Republika Srpska, on the agency of migrants—especially those of 'Muslim origin'—BiH remains bureaucratic regarding migration policies. BiH’s integration policies require migrants seeking refuge to wait nine months after applying for asylum, receiving basic sustenance during this period (Human Rights Watch 2025). Human Rights Watch criticized this procedure, stating that asylum seekers in BiH are “essentially without rights” during the wait (Human Rights Watch 2025). In 2023, 4 individuals acquired refugee status and 63 received subsidiary protection (Human Rights Watch 2025). This number grew significantly in 2024, when cumulatively 45 people acquired formal refugee status, and 429 people were registered under subsidiary protection (UNHCR 2024a).

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Alternatively, with regard to non-state actors, it is noteworthy that Catholic Relief Service (CRS), working with UNHCR, established “bespoke inclusion plans” tailored to family needs, focusing on housing assistance, language classes, job training, and school enrollment for children (UNHCR 2024b). This capacity building promotes social inclusion, enhances migrants’ mental and physical well-being, and strengthens their psycho-social resilience. Employment, in particular, reinforces migrants’ integration into BiH’s communities and triggers the feeling of being “at home” (UNHCR 2024b).


Community-based MHPSS is intertwined with social cohesion, as its effectiveness is conditioned by structural factors (public prejudices against refugees) and subjective factors (capacity building for migrants). Past endeavors by the International Organization for Migration (IOM) should be positively assessed, as they conducted exemplary projects targeting regions with low social cohesion to support social inclusion and prevent the scapegoating of migrants (IOM 2021). State measures include the BiH Council of Ministers issuing an Action Plan for Integration of Refugees, which focused on coordination among state, entity, and local authorities to ensure communication between irregular migrants and state institutions (European Commission 2022). Also, a bylaw on integration introduced in 2021 enforced several rights, including access to the labor market, education, health insurance, and social welfare, for refugees and those with subsidiary protection (UNHCR 2024c).

However, the fact that integration efforts are more frequently launched and supported by international organizations, rather than local public institutions, weakens their societal legitimacy and acceptance. Furthermore, BiH’s shrinking civil society space due to funding cuts puts the sustainability of civic initiatives in question, as both the government and donors may view MHPSS for migrants as secondary and unnecessary. For instance, “Doctors Without Borders,” a crucial initiative dealing with health and human rights, ceased its operations in BiH due to a lack of resources (Reliefweb.int 2024). This climate leads to serious uncertainties for community-based MHPSS for migrants in BiH, affecting the fates of thousands.

Migration-related human security challenges and MHPSS in Azerbaijan 

Azerbaijan, situated at the crossroads of various migration routes, adopts a contrasting stance to BiH due to its distinct geopolitics and tight internal control, unlike BiH’s EU-oriented policies. Azerbaijan pursues highly restrictive policies in both the migration and mental health sectors, generally excluding third-party interventions. 

Despite the government’s reserved approach, immigration exhibits a slightly positive trend from 2018 to 2025. Data on administrative decisions made by the State Migration Service (SMS) related to irregular migration [referred to in the source as 'illegal migration'] shows an overall increase throughout the six years, reaching 22,345 in 2024 (State Migration Service of the Republic of Azerbaijan 2025). Azerbaijani authorities are more prone to issue entry bans (future-oriented restrictions) than to order formal deportations (which require immediate removal).


A notable issue highlighted by UNHCR data concerns registered stateless people in Azerbaijan. The number of registered stateless people declined significantly from 3,585 in 2023 to 513, and then to 271 in 2024 (UNHCR 2025). This sharp decline signals a potential issue related to the rights of stateless people during the regularization process.

Azerbaijan’s current migration policies are characterized by border deterrence and heightened administrative regularization. Border deterrence helps maintain an easy-to-control migration landscape. Heightened administrative regularization, systematic in its approach and evident in the stateless persons case, implies tight control over demographic trends.

Despite restrictive policies, the country’s refugee stock and number of asylum applications have grown. The refugee stock showed a positive trend from 2018 to 2024. By 2024, the total number of registered refugees was 6,431, with the majority from Ukraine (4,906), Afghanistan (1,080), the Russian Federation (274), Iran (60), and Pakistan (45) (UNHCR 2025). This spike was likely due to the Russia-Ukraine war in 2022 (UNHCR 2025). For comparison, the overall number of accepted refugee cases was 1,815 in 2018 and 1,109 in 2019 (UNHCR 2025). 

In Azerbaijan, the mental health and migration sectors are mostly—if not absolutely—dependent on centralized government decision-making, as both spheres are considered highly strategic.

The government has always emphasized security concerns. Commenting on the continuous closure of Azerbaijani land borders following the COVID-19 pandemic, MP Azer Badamov reiterated the government’s security concerns (Milli.Az 2025). Although the formal explanation for the closed borders for several years was the pandemic, starting in 2024, Azerbaijan began highlighting security issues, emphasizing regional instability (Talibzade and Geybullayeva 2024).

MHPSS is strictly controlled by the government. Three public bodies—the Ministry of Health, the Ministry of Labor and Social Protection, and the State Agency on Mandatory Health Insurance—work hand-in-hand to conduct activities at psychiatric hospitals, out-patient facilities, residential facilities, rehabilitation centers, and psychiatrists’ offices at district polyclinics (Ismayilov 2022). While community-based MHPSS activities have appeared in reports from Azerbaijan since 2011, the strong government presence paired with limited room for civic engagement raises concerns about implementation. The head of the National Mental Health Center, Dr. Fuad Ismayilov (2022), describes “community-based Mental Health” as a de-institutionalized form of psychological treatment involving group activities conducted by mental health teams, notably without touching upon the civic engagement aspect (Ismayilov 2022).

The current official migration measures and the observed rise in various statistical data raise concerns about social harm and human security for migrants. An upward trend has been observed despite the restrictive measures over the years, suggesting that an increase in migration flows is expected due to conflicts and climate change-induced repercussions. It is not readily apparent whether administrative cases, entry bans, and related measures are associated with pushbacks without individual assessment and/or mental health impact. Since community-based MHPSS is tightly institutionalized and security issues are prioritized over migration, mental health conditions are highly dependent on government decisions, leaving no room for civic intervention.

Conclusion

The essay analyzed migration-related human security in BiH and Azerbaijan comparatively, using the practicability of the community-based MHPSS on the ground as an indicator of success. Findings demonstrate that while BiH has given more space to non-state actors, guaranteeing more grassroots representation, the lack of centralism in decision-making and inter-institutional coherence leads to an environment where migrants’ well-being is precarious. In contrast, Azerbaijan maintains high centralization through a security-first agenda, but this inherently erases “community” from “community-based MHPSS.” Community-based MHPSS, the indicator of human security in the context of this essay, remains unsustainable due to the lack of effective state involvement and scarcity of resources in BiH, and de-contextualized, therefore non-existent, lacking the participatory elements that define the model in Azerbaijan. 

Once more highlighting that mental health is more than clinicality, and encompasses the outcomes of social and political determinants, which impact it, the essay concludes that transit areas in the face of BiH may produce overt physical and mental health repercussions, while the securitized areas, such as Azerbaijan, may impose vulnerabilities through administrative invisibility and restricted agency. 

In both cases, the circular model of community-based MHPSS is damaged, respectively, due to a lack of basic human security and the absence of community agency and participatory engagement. This exposes human security to vulnerabilities. Despite deterrence policies towards migration being on the rise, migration flows are increasing due to humanitarian crises, and a simple counter-force against migration will continue to lose its viability as a “solution”. 

The fact that community-based MHPSS was already applied in BiH’s context should be appreciated, despite this method being innovative and potentially challenging. Further research should be conducted to investigate the institutional shortcomings, while acknowledging the willingness and positive examples of actions implemented by the BiH authorities. On the other hand, Azerbaijan’s security concerns should be taken into consideration and assessed, as the country is indeed situated along trade routes and energy corridors. However, security concerns must be effectively counterbalanced with addressing migrants’ well-being, mental health needs, and non-refoulement rights deriving from international norms and standards.

Endnotes

* The term “Balkan Route” refers to the geographical pathway through countries situated in the Balkan peninsula and used by migrants, asylum seekers, and refugees traveling from the different parts of Asia and Africa to seek asylum or better economic conditions in the European Union (EU). 

** The term “pushback” refers to the practice by state authorities of forcing migrants, refugees, or asylum seekers back across a border, either land or sea, shortly after they have crossed it, without an individual assessment of each case based on their legal rights. 

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