9 Feb 2022
Towards Psychosocial Peacebuilding: An Integrated Approach to Conflict Transformation in the Context of Nagorno-Karabakh
The seeds of tomorrow’s war grow in the soil of today’s unhealed traumas.
The seeds of tomorrow’s peace grow in the soil of today’s healing and reconciliation.
(Vaughn 2021, 186)
The article explores the linkages between Mental Health and Psycho-social Support (MHPSS) and peacebuilding (PB) within the context of the Nagorno Karabakh conflict after the second Karabakh war. The importance of studying trauma and tragic experiences of war and their impact on societies has been recognized as essential among peacebuilders working in the Nagorno-Karabakh conflict context. The article complements this deliberation and argues that the field of peacebuilding needs to consider the psychological effects that the conflict has on people and their mental health. Building on the existing literature that connects MHPSS with peacebuilding (PB), as well as on the empirical studies conducted both in Armenia and Azerbaijan, the paper suggests broadening the peacebuilding approaches by including MHPSS perspective. The authors argue that both fields can complement each other by providing tools and knowledge to adequately address the post-war wounds and grievances in the Nagorno-Karabakh conflict context and to pave the way towards sustainable peace. Finally, relying on the conceptual framework and findings from empirical studies, the article elaborates recommendations for the local and international organizations on how to further develop the framework for psycho-social peacebuilding, while also reflecting on the challenges and limitations for developing this approach in the context of the Nagorno-Karabakh conflict.
The human cost of the second Nagorno-Karabakh war of autumn 2020 has been very high. The fighting killed thousands of people from both sides and left thousands injured while tens of thousands have been displaced. Hundreds of local initiatives, volunteer groups, NGOs, and individuals have mobilized to help those affected by the war. This help has ranged from humanitarian assistance to various types of support provided to war veterans, injured soldiers, family members of those killed during the conflict, children, and other groups directly affected by the war. The efforts have been also made to address post-war trauma and stress. However, these efforts have been organized in a sporadic manner and have often lacked funding to support the activities. At the same time, there has been acknowledgment amongst peacebuilding professionals that previous peacebuilding interventions have not brought sufficient results and that new approaches and methods are needed to work with societies affected by the recent war (see, for instance, FriEnt 2021). Meanwhile, the political solution of the conflict, that is a precondition for successful peacebuilding activities and initiatives, has not been achieved yet. Resources that could have gone toward social and economic projects, education, or health care were diverted to an arms race serving particular political agendas. Opportunities and chances for democratization and regional integration have been squandered over the past thirty years (Gamaghelyan and Rumyantsev 2021).
The importance of studying trauma and the tragic experiences of war and their impact on societies has been recognized as essential among peacebuilders working in the context of the Nagorno-Karabakh conflict. Thus, through studying the impact of trauma and its role in the conflict context, Indie Peace (2021), a conflict transformation organization focused on the region, explores the impact of trauma on societies to find ways to heal both individuals and societies. Through personal and family stories of people from the Armenian and Azerbaijani sides, Indie Peace tries to understand how trauma develops and affects people both on the individual and societal levels. Mental health issues after the second Nagorno-Karabakh war have been also discussed at an online meeting organized in September 2021 by Bright Garden Voices, a project that aims to provide a platform for constructive dialogue between Armenians and Azerbaijanis. The discussions involved clinical psychologists from both Armenia and Azerbaijan concerning the status of mental health in their countries and the impact of the war and the conflict on local populations (Bright Garden Voices 2021).
Our article complements this line of thinking and argues that the field of peacebuilding needs to consider the psychological effects that the conflict has had on people and their mental health. Violent conflicts harm the relationships between people and their ability and willingness to participate in the social recovery processes. Violent conflicts weaken those traditional relations between people and communities that foster their coping mechanisms and resilience (Somasundaram and Sivayokan 2013). Therefore, efforts should be made to address mental health issues in order to reduce suffering, improve wellbeing, boost resilience, and empower conflict-affected populations to become agents of conflict transformation (ibid.).
Building on the existing research literature connecting Mental Health and Psycho-social Support (MHPSS) with peacebuilding (PB), as well as the original empirical studies conducted both in Armenia and Azerbaijan, we suggest broadening peacebuilding approaches by including the MHPSS perspective. We argue that the two fields can complement each other by providing tools and knowledge to adequately address the post-war wounds and grievances in the Nagorno-Karabakh conflict context and pave the way towards sustainable peace.
We conducted ten interviews with Armenian and Azerbaijani experts to identify whether there are any overlapping areas between MHPSS and peacebuilding interventions in their work and how they themselves consider those interlinkages. We interviewed two professionals in the MHPSS field from Armenia and one from Nagorno-Karabakh, as well as one professional in the field of education and two in the field of peacebuilding from Armenia. Research findings from the Azerbaijani side also rely on first-hand information gathered through in-depth interviews conducted with the people engaged in psycho-social support for war-affected people, including veterans. Two interviews have been conducted with mental health specialists—clinical psychologists—who are working with conflict-affected people, while two more have been conducted with social workers who live near the former contact line. Additionally, secondary information, consisting of news reports published by different local media outlets and official sources, has also been analyzed to create a clearer view of the situation. Although the data gathered was thoroughly analyzed, we acknowledge that the reader may notice imbalances in terms of the provided inputs between the Azerbaijani and Armenian sides. These imbalances inextricably result from structural-political differences in these societies.
The paper is structured as follows: After introducing the conceptual framework of the article, we reflect on the findings from our empirical research. The sections and themes in the empirical section of the article have emerged from conversations with the aforementioned interviewees and represent the most salient topics highlighted by the practitioners in relation to MHPSS and its connection with other fields relevant for peacebuilding. We continue the article with the discussion section, in which we elaborate recommendations for local and international organizations on how to further develop the framework for psycho-social peacebuilding. We also reflect on the challenges and limitations to developing this approach in the context of the Nagorno-Karabakh conflict. The concluding section summarizes the main ideas of the article and relevant directions moving forward.
Interlinkages between MHPSS and peacebuilding
War and conflict weaken the social fabric and negatively affect societies by creating grave social problems including poverty, unemployment, social exclusion, housing issues, corruption, lack of security, gender-based violence, etc. As a result of war and conflict, emotional states such as trust, empathy, stress, and anger are negatively affected by violence-induced trauma (Kubai and Angi 2019). As Gutlove and Thompson (2004, 2) put it: “A process of social reconstruction is needed to rebuild the intangible but crucial fabric of human interactions that allow a society to function, while also meeting the immediate psychological and social needs of people who have been ravaged by violence.” The abilities of individuals and societies to overcome the painful experiences of war are limited and the coping strategies are often related to psychosocial trauma (Tankink, Bubenzer and Van der Walt 2017). When those issues are not addressed, they can result in negative cognitive, emotional, physical, and behavioral feedbacks (Gutlove and Thompson 2004). Supporting people in restoring their relationships with the community and strengthening mechanisms to cope with post-war trauma is vital for building sustainable peace (Tankink, Bubenzer and Van der Walt 2017).
Traditionally, mental health has not been considered an essential topic in the field of peacebuilding. On a practical level, little attention is given to MHPSS as a fundamental element of sustainable peace. Also lacking is an acknowledgment by healthcare professionals that “if they want to improve the well-being of people, attention needs to be paid to the broader society and context in which individuals exist” (Tankink, Bubenzer and Van der Walt 2017, 8). On the other hand, a study conducted by the Institute for Justice and Reconciliation (IJR) in 2017 showed that many professionals working in MHPSS and PB around the world think that connecting these two fields would be beneficial for interventions aiming at building sustainable peace (Tankink, Bubenzer and Van der Walt 2017).
Since the early 1990s, the interlinkages between mental health and peace began to be acknowledged by various multilateral organizations, such as the World Health Organization of the UN, which recognized that lasting health is essential to ensuring sustainable peace (WHO 2020). The UN Secretary-General’s Report on Sustaining Peace in 2020 recognizes the MHPSS as an integral part of Peacebuilding (UNSG 2020). As stated in the report (11): “The further development of the integration of mental health and psychosocial support into peacebuilding is envisaged with a view to increasing the resilience and agency of people and communities.” The UNDP’s Crisis Bureau/Conflict Prevention, Peacebuilding and Responsive Institutions (CPPRI) has commissioned research to develop a guidance note, which is expected to be published in 2022, on how to integrate MHPSS into peacebuilding. In addition, the psychological dimension was identified as one of the priority themes in the guidelines of the European External Action Service’s Peace Mediation (EEAS 2020).
Bubenzer and Tankink (2015) argue that because violent conflicts are complex and multi-layered, post-conflict reconstruction needs to be performed in an interdisciplinary manner that integrates the psychological, social, political, historical, cultural, and economic elements which constitute a society. Societal healing, in this case, becomes a process of social transformation that improves social relationships. Gutlove and Thompson (2004, 6) maintain that both MHPSS and PB have intertwined objectives related to “restoring healthy human relationships.” Both disciplines aim at empowering people to use their full potential in order to build peaceful societies (Bubenzer, Van der Walt and Tankink 2017). According to Bubenzer et al. (ibid.), healing can decrease the sense of loneliness, isolation, anger, and feelings of hatred towards others while simultaneously improving mood and inner peace. They contend that this happens in a group context and not in isolation (ibid.). The authors conclude: “Psychosocial and structural elements that are often interrelated and can provoke the continuation of violence and conflict are better addressed by combining MHPSS and PB” (Tankink, Bubenzer and Van der Walt 2017, 9).
Community-based psycho-social support within the socio-ecological paradigm
A literature review on theories connecting MHPSS and PB conducted by Tankink, Bubenzer and Van der Walt (2017) showed that these theories can be categorized under the holistic or socio-ecological paradigm, which places an individual in a social, cultural, historical context and a broader environment in which the person operates and interacts. This framework needs to be considered when addressing issues of sustainable peace and psycho-social wellbeing on individual and community levels. When interventions are performed on an individual level, they also affect the relations of the approached individuals with their families and communities, and can lead to the changing of norms on the societal level. Thus, “the influence is circular; and the interactions between individuals, families, communities and larger society is a continuum” (Tankink, Bubenzer and Van der Walt 2017, 12).
Approaches that integrate MHPSS and the PB differ depending on various levels (individual, family, community, government, institutions, etc.) within the socio-ecological paradigm and have been used in different contexts. The common feature of these approaches is that they all look at the integration of the two fields from the intersectional and multi-disciplinary perspective, seeing local people as agents of social transformation and emphasizing local ownership and empowerment of conflict-affected populations in an inclusive way.
Within these different approaches, community-based psychosocial support (CBPSS) deserves special attention as one that links individual well-being and healing to community wellbeing and rehabilitation. (Figure 1) CBPSS has the potential to restore relationships while strengthening social bonds and mutual support, which increases the resilience of the community and allows it to become stronger in the long term (IASC 2007). According to Svenska Kyrkan (2021), “The CBPS approach focuses on involving affected populations in decisions and activities that concern their lives, as they themselves know best what needs exist and need to be addressed.”
The MHPSS intervention pyramid illustrates four different levels and types of intervention that, ideally, should be implemented simultaneously (see Figure 1). The first level addresses the basic services and security of the conflict-affected groups (this can include advocacy for basic services that secure and protect dignity) and which are delivered in a way that promotes mental health and psychosocial well-being. The second level involves community and family support to help the conflicted-affected adjust to new circumstances. This can include family tracing and reunification, mass communication on effective coping methods, livelihood activities, and activation of social networks. The third level is focused support for the groups that need some extra care and assistance (such as by creating spaces where various groups can meet and share experiences or get engaged in common activities to recover more quickly with the support from community workers, including social workers or primary health providers). This level can include story-telling, truth-telling, art-based forms of expression, and so on. The fourth level involves specialized services, such as psychological and therapeutical, for those who might have significant difficulties in basic daily functioning. Although specialized services are needed for only a small percentage of the population, in cases of large emergencies, they can involve thousands of individuals.
Hence, CBPSS includes interventions in various sectors that all contribute to the wellbeing of the community. Those interventions can range from addressing the humanitarian needs of the conflict-affected population to strengthening the capacity of aid organizations to effectively address the needs of the population by including the community members in their programs as key agents for social transformation (ibid.). Moreover, as noted by Svenska Kyrkan (2021), “Mainstreaming CBPS into different sectors is also a cost-effective way to increase the well-being of a community, as opposed to creating separate programmes”.
3. Findings from empirical research conducted in Armenia and Azerbaijan
The MHPSS field after the second Karabakh war: challenges, opportunities, and blind spots
Developments on the Armenian side
During and immediately after the second Nagorno-Karabakh war, different organizations and
individuals were mobilized in Armenia to provide primary psychological care to various groups affected by the war. There were about 190 specialists involved in the process who mainly worked on a volunteer basis (Khachatryan 2021). It is noteworthy that during the war and post-war period, state bodies such as the Ministry of Health, Ministry of Defense, Ministry of Emergency Situations, Ministry of Foreign Affairs as well as the Ministry of Labor and Social Affairs have been involved in the humanitarian aid and psychological assistance initiatives (ibid.).
In the early post-war period, several Armenian organizations in the MHPSS field, including Intra Mental Health Center, Psychosocial Recovery Center, Ambra Center for Mental Wellbeing, and others jointly elaborated a roadmap for the government on how to organize work in the field of mental health and psychosocial support. Later, the Ministry of Emergency Situations launched a call for organizations to provide psychological assistance to combatants and their families. Eight organizations won the tender in February 2021. They received funding as a consortium for a program of six months which started in June 2021. This is the first-ever state-funded program for psychological help in Armenia, which shows that the need for MHPSS has been recognized and prioritized on a state level. According to Armen Soghoyan, President of the Armenian Psychiatric Association and one of the coordinators of Psychological Support Consortium, the field of MHPSS is not well coordinated in Armenia and the consortium, which includes eight leading Armenian non-governmental organizations in the field of the MHPSS, aims to fill this gap: it currently involves more than 60 professionals who work with a wide range of target groups, directly or indirectly affected by the war, and covers the whole territory of the Republic of Armenia. In addition, the consortium is also operating a hotline to assist those who suffered from the war. There are different ways the consortium members provide psychological assistance, which include one-on-one meetings, group meetings, online meetings, as well as mobile groups deployed to remote areas. The specialists decide on the methods used based on specific cases and needs.
Besides the specialized MHPSS organizations, MHPSS needs in Armenia have been addressed by a variety of local and international humanitarian organizations, as well as Armenian communities abroad. These often short-term initiatives have aimed at providing support to various groups affected by the war, such as war veterans, displaced persons, children, and mothers and widows of fallen soldiers, etc. (Khachatryan 2021). The French humanitarian organization Première Urgence Internationale currently operating in Armenia seeks to bring a sectoral improvement to the field of MHPSS in the country.
According to Armen Soghoyan, the field of MHPSS, which has been traditionally under-prioritized in Armenia, is now in demand as more and more people seek psychological support. However, even if the number of people seeing mental health professionals is higher than before the war and the beneficiaries have been slowly overcoming their fears and mistrust towards psychological assistance, it is still challenging to encourage people in psychological need to ask for professional support. Lilit Mnatsakanyan, a member of the Armenian Association of Psychologists, noted that this problem is not merely a cultural norm specific to Armenian society but also reflects the depth of the trauma that people experienced during the war. As she puts it: “Trauma by itself is distorting interpersonal relations, and a person needs to be alone and is not willing to communicate with anyone; it is problematic to put the traumatized person[s] in contact with a specialist and to keep that contact with them. They [traumatized people] feel unwanted, useless, trying to overcome the problems by themselves. They have no strength to seek out specialists”.
Arpi Hovsepyan, a psychologist from Stepanakert, noted that sometimes people do not even realize that they need psychological help. They think that it is normal not to feel good emotionally and assume they have to deal with this issue without any support. Moreover, they do not prioritize psychological problems because they have too many other problems to deal with on a daily basis, such as financial struggles or conflict-related security concerns. One of the interviewees noted that people who lost their family members during the war are under permanent societal pressure, as the people around assume that they always need to mourn. For instance, it is expected that a widow always wear black clothing and whenever she wears any other color, she is criticized as someone who does not respect the memory of the deceased spouse. Therefore, there are many internal and external pressures that prevent people from seeking professional psychological help.
Psychologists use various means to reach the target groups, for example by awareness-raising through media, directly reaching out to potential beneficiaries, or finding beneficiaries through other social assistance programs. In some cases, psychologists decide themselves with which beneficiary group they want to work and reach out to those specific groups by, for instance, going to schools and working directly with teachers. However, this support cannot be imposed and can be applied only if the beneficiaries themselves are willing to engage with the psychologists.
Besides these challenges, all the interviewees believe that the work of psychologists is very much needed in Armenian society after the war and that this work should be done not only with war veterans, their families, and the family members of the fallen soldiers but society at large because, as Lilit Mnastsakanyan has highlighted, the war was by itself a very traumatic societal experience. She noted that everyone having experienced the war in one way or another, directly or indirectly, went through trauma and this trauma needs to be addressed and healed.
Developments on the Azerbaijani side
A few months after the end of the 44-day war, while almost all media channels in Azerbaijan were covering the celebrations of the results of the “Homeland War” (the official term used in Azerbaijan to refer to the recent war between the Azerbaijani and Armenian armed forces), the complaints of war veterans related to various bureaucratic hindrances and economic problems they face began to appear on social media. Meanwhile, videos of traumatized ex-combatants began to circulate through various social media channels, prompting the government to respond by launching psycho-social support under its own tight control, allowing only a few non-governmental agencies to participate in this work. As a result of the war, a great number of people were and are experiencing the repercussions of the conflict, leading to heated debates on various social media platforms. These developments have raised many questions and discussions regarding the capacity and readiness of the state to deal with the expected socio-economic problems that have erupted after the war.
The heated online discussions began to involve more people, especially when news about the suicides of veterans of the Second Karabakh war were spotlighted in the country’s mass media. On 24 February, the journalist Elshad Pashasoy publicized information about the suicide of a veteran living in Yardimli, a peripheral city in Azerbaijan. He noted that “if he could have gotten a few hours of psychological advice, it might have changed his mind” (Qafqazinfo 2021). The exact reason for the man’s suicide remains unknown, however Pashasoy said that the veteran was regularly recalling severe memories and talking about them. Subsequently, other similar reports appeared in various media outlets and produced a strong impetus for popular complaints about the state-organized psychosocial support available for conflict-affected people.
Nevertheless, the press release issued by the Ministry of Labor and Social Protection of the Republic of Azerbaijan on 27 September 2021 maintained a positive tone and reiterated that a “wide range of social support activities is taking place” to benefit war-affected people, including psycho-social assistance activities. According to the official information provided by the ministry, approximately 10,000 people from about 3,000 conflict-affected families have benefited from state-led psycho-social support. These are family members of fallen soldiers, family members of veterans, veterans, and other people affected by the war. Furthermore, the press release mentioned an approximate number of war veterans, about 1,500, who have benefitted from the rehabilitation services without clarifying the precise type.
Namaz Karimov, a social worker and youth worker from a conflict-affected community living nearby the former contact line, discussed the “aid culture” that international organizations established in the 1990s and which persists today. People are unwilling, he believes, to participate in activities such as psycho-social support or social development because they are accustomed to receiving direct (mostly material) assistance from the state. Referring to the specific local traits of the persisting conflict, the activist, youth worker, and social worker Ayaz Huseinov mentioned the inconsistency of the methodology of the social development programs presented by “the Western institutions” that cooperate with the government, which also includes psychological treatment.
Karimov has stressed the importance of changing the models of the psycho-social support services being conducted in Azerbaijan, stating that “vulnerabilities are not similar to what appears to be a vulnerability in Western societies” and that there should be a different “theory of change” for Azerbaijani conflict-affected people that takes into account the local reality in which people are living. Huseinov also mentioned that “Western approaches” are becoming increasingly inapplicable for and unclear to the vulnerable groups that emerged after the war, as particular programs do not take into consideration the local reality and the exact needs of the beneficiaries. He proposed a comprehensive needs assessment for a better application of the interdisciplinary approach and said social development programs should be adjusted to the concrete needs of the beneficiaries besides the mere need for increasing the number of the professionals (clinical psychologists and social workers) who are engaged in the psycho-social treatment.
Another important and relevant issue concerns gender sensitivities and patriarchal norms. Namaz Karimov, a youth worker, and Rovshan Suleymanov, a clinical psychologist, mentioned the difficulties in reaching conflict-affected women due to barriers emerging from cultural norms. Suleymanov emphasized that clinical psychologists working with families sometimes insistently try to reach particularly women, although they are more reluctant to receive psycho-social treatment than men due to prevalent social norms. Due to this issue, Karimov, for example, brings his sister along for increased gender balance in the focus group discussions conducted as a part of psychosocial support activities.
Suleymanov has also raised concerns about the difficulties caused by COVID-19 regulations. These regulations made it difficult, if not impossible, for conflict-affected rural communities to hold grief ceremonies and this situation has had a devastating impact on people’s mental health. As a result, there has been no opportunity to mourn for nearly a year. He strongly emphasized the need for psycho-social support for Azerbaijani conflict-affected communities, highlighting that at least during such consultations beneficiaries get the feeling that they are not forgotten. Maintaining this spirit can form solid ground for further steps towards trauma healing.
It is worth noting that both in Azerbaijan and Armenia there is a lack of MHPSS specialists as well as limited funding for the field (Ghazaryan and Isayev 2021). Although there is currently a state-funded consortium in the MHPSS field in Armenia, as well as other private national and international initiatives to support work in this field, all the Armenian interviewees agreed that there is a need for better coordination and more long-term engagement in the field, which would include the preparation of specialists, supervision, specialized trainings for professionals, coordination of the network of high-quality psychological services in the whole territory of the Republic of Armenia—that is, for a coordinating body that would make those services more efficient and provide regular psychological support also for psychologists themselves. Azerbaijan is also in need of such well-organized and coordinated psycho-social support for conflict-affected people. To this end, all the Azerbaijani interviewees mentioned that there should be more room for other stakeholders than governmental agencies to engage in the provision of psycho-social support in the country.
The interdisciplinary approach and community-based support as keys to societal healing
As the aim of the present article is to identify the interlinkages between the field of MHPSS and peacebuilding, we asked both MHPSS and peacebuilding professionals, as well as professionals from other fields, whether and how they see their work as contributing to peace processes and what the interlinkages they notice between the two fields when it comes to addressing the healing process of Armenian and Azerbaijani societies.
The Armenian perspective
For all the Armenian interviewees from the field of MHPSS, peace primarily means peace of mind, which can be achieved through psychological support. One of the interviewees noted that he and his colleagues clearly see improvements in the beneficiaries’ mental health; their minds become more peaceful, their aggression is swept away, and they are ready to restore relations with people around them. As Armen Soghoyan noted:
“It is clear that if there are more peaceful people in the society, the society itself becomes more peaceful. Similarly, if there are more tensions and negative feelings in the society, the society looks like a boiling kettle, ready to explode at any moment. When people’s minds are not settled and calm, it is easy for them to be influenced and any little spark can turn into a huge fire.”
He added that it is very important to think about the peace “in our own society,” as there is currently a lot of radicalization and polarization in Armenian society in general.
Arpi Hovsepyan noted that positive results from psychological treatment are clearly visible from people’s faces, their gestures, and the increasing sense of calm in their communication. She is convinced that the psychological assistance can contribute to peace, because when people are healthy, calm, and in a harmony with themselves—when their mind is peaceful and they feel comfortable in their own space—they are willing to have good relations with the immediate social environment, including family and neighbors, and do not seek revenge, which would destroy this environment; instead, they direct their energy towards creating new and useful activities for themselves and the people around them.
At the same time, the MHPSS professionals noted that the psychological support by itself is probably insufficient when it comes to having a wider impact to positively transform a society. They noted that their efforts as specialists in the field should be complemented by other ways of reintegrating people affected by the war into society and, in general, of restoring social connections. These additional approaches do not necessarily rely on professional psychological support alone but also other types of assistance, such as public policies aiming at providing employment opportunities to different war-affected groups or at creating a safe space where people can address their grievances with other members of their communities. As noted by Lilit Mnatsakanyan, many soldiers with whom she has worked appreciated merely the opportunity to have someone with whom to converse. They often said that they prefer to talk to someone outside their family circle, so as not to cause additional suffering to their loved ones. She also said that the feeling of empathy from friends, compassion, or feelings of being understood are very important and are probably the most effective in re-establishing relationships with the wider society.
The need for an interdisciplinary approach to address psychological wounds was also stressed in the interviews conducted with representatives of other fields. Lusine Kharatyan—a researcher, social anthropologist, and peacebuilding practitioner—is currently leading a media project that aims at collecting and highlighting human stories and people’s experiences of the war. The aim of this project is to circulate the narratives about the war from the human perspective. The stories are made public by following the “do no harm” principle of cultural anthropology. While sharing their stories with a wider audience, the project participants feel understood and their self-assurance increases when someone else shares their concerns, worries, and pain. This initiative has not been designed as a healing intervention, but it certainly appeases the pain of those who share their stories and war experiences.
In addition, Lusine Kharatyan is currently working on an initiative to develop art therapy in Armenia, especially focusing on writing therapy and bibliotherapy as trauma healing methods. She also seeks to bring international experience in this field to Armenia. This program plans to involve researchers and psychologists so as to combine the theory and the practice of trauma healing. Kharatyan noted that currently, the government makes efforts to support the trauma healing programs mostly aimed at the people who have been directly affected by the war, but there is a need for approaches and initiatives that involve other groups, as well, because war trauma has affected the whole society. In her opinion, there is a need for a more general healing process in which different disciplines can complement each other.
Gayane Abrahamyan, the founder of an NGO called For Equal Rights which leads various educational projects across Armenia, shared her experience of working with different war-affected groups before, during, and after the second Nagorno-Karabakh war. Although those interventions were not initially designed as a combination of peacebuilding and psycho-social support, elements from both fields have been strongly intertwined in her work. For example, after the war, the NGO designed art therapy classes for displaced children together with psychologists. The main objective of the classes was to overcome post-war stress and trauma through developing pottery art skills. Thanks to the collaboration with psychologists, it has been possible to better address children’s emotions and help them overcome fears and grievances caused by the recent war. Another example of the interdisciplinary approach to address war trauma is a solo performance by an artist from Nagorno-Karabakh whose family suffered from the first war and who has shared her experience through this theatrical artistic expression. This event took place in Syuniq region of Armenia and was also organized by For Equal Rights. According to Abrahamyan, although the performed story itself was sad, it was also full of love, hope, humor, and positivity, and therefore this performance eventually had a healing effect on the audience.
For Equal Rights also supports different war-affected groups by connecting individuals with employers that provide training and job opportunities to war veterans and women who lost their husbands in the war. Here again, this type of support helps people overcome the psychological trauma caused by the war. For instance, the widowed women who now are concerned with the material needs of their families underwent enormous psychological trauma as they were not ready to assume this role. Thanks to the above-mentioned programs, they can overcome the trauma and start to believe in themselves and in their ability to acquire and use new skills to earn money and take care of their families. Similarly, veterans who participated in the project trainings and then received jobs in an IT company were able to re-establish their connections with society in a way that positively contributed to their mental health. As Abrahamyan mentioned the young generation, in particular, has a lot of negative feelings for revenge after the war. The educational programs provided by the NGO has helped to appease those negative feelings, which was actually an unintended outcome of its interventions.
According to Anush Petrossian, a practitioner in youth work and peacebuilding, the importance of having MHPSS professionals in peacebuilding activities is undeniable. It is essential that participants have the required tools to address deeply situated mental health and psychological issues and reflect on memories of conflict constructively so as to not leave peacebuilding sites with perplexity or confusion. MHPSS professionals can provide the tools to cope with psychological issues during peacebuilding activities. Therefore, MHPSS can be considered not only as a framework of addressing the past through empathy and mutual acceptance, transforming the understanding of conflict within the societies affected by it, but also can ensure the sustainability of now fragile dialogue and peace processes in many post-conflict settings, even where some form of an agreement has been signed by previously conflicting sides. Petrossian also stressed the importance of engaging MHPSS professionals in supporting practitioners in the peacebuilding field, who can themselves internalize and become affected by the stories and experiences of conflict. According to Petrossian, giving proper attention to the mental health and psychology of practitioners will help strengthen the field of peacebuilding.
In the post-war period, numerous grassroots, community-based initiatives have also emerged to address the needs of various war-affected groups on the Armenian side. These initiatives have contributed to societal recovery because of the active participation of community members. As one example of such initiatives in Armenia, the mothers of fallen soldiers established a movement called Eternal to support, help each other, and share the grief and pain of their loss (CivilNet 2021). This contributes to their joint healing process. Armen Soghoyan noted that this group has been regularly provided with professional counseling and guidance from psychologists. Another example of grassroot community-based initiatives is the refugees from the Hadrout region who have created their own support group trying to assess their needs, make their voices heard, and support each other. According to Gayane Abrahamyan, in all of the previous examples, the communities have organized themselves and the mechanism of helping and supporting each other have contributed greatly to the healing process.
Moreover, various war-affected groups (e.g., widows, injured soldiers, youth) are in permanent contact with each other, and therefore the success of one person is motivating to others. Thus, this ‘snowball effect’ is a very important factor of community-based psycho-social support. For instance, people who were initially uninterested in support programs become attracted and engaged after hearing about the positive effects that those initiatives have had on their community members. According to Gayane Abrahamyan, rehabilitation takes time but people find coping mechanisms to overcome their traumas with the help of their community members. She noted that for some war-affected groups, the recovery process is a question of time but with necessary support from their community members, they are overcoming their stress. For other groups, such as veterans, especially those who have injuries, overcoming the trauma is more problematic and the need for professional psychological assistance is more apparent.
MHPSS professionals also highlight that through psychological treatment, especially group therapy, beneficiaries feel more empowered to serve their social circles because they understand and realize how they can be useful for their family members, their pupils (in the case of the teachers), etc. They overcome the feeling of hopelessness that they had previously and clearly realize both their capabilities to help others as well as their limits. Importantly, these positive results empower the psychologists themselves, who are a part of the overall social environment affected by the war; helping others is also a coping mechanism for them to overcome their own war trauma. Such community-based psycho-social support initiatives have been boosting trust, empathy, and cooperation among community members who have been heavily affected by the war.
The Azerbaijani perspective
The psycho-social support for veterans and other people affected by the conflict in Azerbaijan during the post-war period was primarily provided by ministries and other state-led institutions. Nevertheless, the Azerbaijani interviewees emphasized the need for more professionals in providing psycho-social assistance due to the abundance of cases; additionally, it is becoming clear that in order to integrate psycho-social support with peacebuilding, the participation of international and local peacebuilding-oriented organizations is needed. Overall, the Ministry of Health of the Republic of Azerbaijan, a state-led health institution, named the Coordinator Union of the Health Area Departments (in Azerbaijani: TƏBİB) and the International Committee of the Red Cross (ICRC) as be sole organizations providing such support continuously and systematically alongside sporadic and unstructured support provided by various civil society groups. Comparing the quality and interdisciplinarity of the provided support, the interviewees have mentioned that TƏBİB is more open to new approaches, encompasses all regions of Azerbaijan, attempts to engage with other professional fields in psychological treatment, and carries out its work in a less bureaucratic manner.
However, clinical psychologist Rovshan Suleymanov remarks that social and psychological treatment is almost absent in post-war Azerbaijan while there is a huge need for both. Compensating this, ICRC benefits from the work of its other departments, such as the General Health Department and the Economic Security Department, apart from providing direct psychological support. Thus, to some extent, it substitutes for the necessary social work on the ground.
Nonetheless, the demands are more complex than the assistance offered. According to Suleymanov, “personally facing the trouble or trauma” is the best technique for dealing with post-traumatic stress disorder, which is widespread among persons who have been directly touched by the war. However, the issue is complicated by the fact that diverse services and an interdisciplinary approach are required to reach the point where beneficiaries are ready to “directly confront the reality.” Furthermore, because diagnoses and cases are so dissimilar, there is a necessity for diverse methodological approaches. For instance, as he said, if the beneficiary experiences the “complicated grief” diagnosis one cannot address such a particular diagnosis with the measures used for treating depression. Overall, it is becoming evident from this perspective that an interdisciplinary approach and the use of multiple approaches are in great demand for dealing with the implications of the aftermath of war on personal lives. Thus, based on his experience working with conflict-affected communities, Suleymanov also wishes to see a more holistic and interdisciplinary approach to healing, as contributions from various directions are required to address beneficiaries’ trauma-based resistance to psychosocial support. According to the clinical psychologist, this could open up new opportunities and change people’s attitudes toward psychological treatment.
Another clinical psychologist, Rafael Mammadov has highlighted the lack of time for having in-person therapy sessions with beneficiaries while mentioning that these sessions are indeed important as they provide a safe space for expressing suppressed emotions and in this sense, as a next step, are extremely fruitful for nourishing welcoming approaches to peace on the side of beneficiaries. At the same time, he would like to see a more conflict-sensitive approach by psychologists and other practitioners, as the healing process requires approaches from different perspectives and well-organized social work is also lacking. In addition, Mammadov mentioned that the evaluating pre-sessions should be conducted for developing a meaningful interdisciplinary approach (in a form of synergy between social work, economic, and psychological assistance) as “sometimes needs can stay unseen.”
Based on these examples, it is possible to observe that psychological wounds can be addressed and healed not only through therapeutic interventions but also through various interdisciplinary approaches of psycho-social support, and subsequently may pave the way for the peacebuilding initiatives, as discussed in the conceptual part of this article.
Discussion and recommendations
The aim of our research is to identify linkages between the fields of MHPSS and peacebuilding in the context of post-war interventions in the Nagorno-Karabakh conflict context. We first elaborated on a conceptual framework based on the already existing research, arguing that the integration of MHPSS and peacebuilding fields can maximize the impact of interventions aimed at efficiently addressing post-war traumas and grievances and pave the way towards sustainable peace, first in Armenia and in Azerbaijan and then between the two societies. Our empirical research suggests that the current interventions addressing various post-war social needs in Armenia and Azerbaijan include numerous overlaps between both the MHPSS and the peacebuilding fields without them being necessarily designed as such. Such overlaps naturally stem from local needs. Our findings have also shown that although MHPSS itself is currently very much needed to address the psychological wounds of those who suffered from the Karabakh war, MHPSS interventions alone are not enough to respond to the post-war needs of conflict-affected groups. Some concrete examples have shown that combining the MHPSS with peacebuilding, education, and art helps increase the efficiency of help addressing post-war grievances and allows people to restore social bonds and reintegrate into society. Our findings speak for the importance of community-based interventions and an interdisciplinary approach to societal healing and conflict transformation. Although the scope of our research is limited, it provides some food for thought on how to move towards psychosocial peacebuilding.
In order to highlight the overlapping points between MHPSS and peacebuilding and provoke further thinking on psychosocial peacebuilding in Armenia and Azerbaijan, we have elaborated a set of recommendations for local and international organizations to further develop this thinking and framework.
– Encouraging regular dialogue among the professionals and organizations in the MHPSS and peacebuilding fields to create efficient ways of addressing the needs of war-affected groups and society at large aiming at societal healing and conflict transformation. This could be done by engaging MHPSS professionals in peacebuilding activities, such as dialogue sessions between conflicting parties. The psychological needs of the peacebuilding professionals could be also addressed through regular interactions between the professionals and organizations in the fields of MHPSS and peacebuilding.
– Our findings show that points of correlation already exist between the MHPSS and peacebuilding fields, but, according to our interviewees, they require further mapping and coordination in a more systematic way combining elements from both fields.
– Moreover, comprehensive research should be carried out in order to determine the exact needs of the beneficiaries as well as their attitudes toward psychosocial support. This may improve the efficacy of the activities and attract more people to the offered services of psychosocial support and peacebuilding initiatives.
– Engaging donors by raising their awareness about the benefits of the integrated approach, encouraging them to look at peacebuilding through the MHPSS perspective and vice versa. For this, it is important to demonstrate the interconnection between the two fields by collecting success stories, as well as the stories that need further improvements and by making the local voices of those who advocate for such an approach heard on different levels.
– Following the debate on psychosocial peacebuilding as an emerging approach of leading international peacebuilding organizations and accommodating its latest developments into the Nagorno-Karabakh conflict context.
– Giving sufficient space for creative partnerships among local organizations in the fields of MHPSS and peacebuilding to support the integration of their activities. In other words, a co-creation process between local peacebuilders and MHPSS professionals on how to integrate psychosocial support into the dialogue/peace/reconciliation process(es) needs to be initiated.
– Initiating and conducting the in-country awareness-raising campaigns for MHPSS professionals and practitioners of conflict transformation and peacebuilding for further joint actions.
Indeed, we have noticed various obstacles to the integration of MHPSS and peacebuilding in the context of the Nagorno-Karabakh conflict. The conflict obviously polarizes the Armenian and Azerbaijani societies and this polarization, in turn, reduces the space for reconciliation and creates resilient grounds for dehumanizing the other side. Thus, the persisting polarized environment makes the space for peacebuilding interventions rather limited, which makes it difficult to explore the linkages between peacebuilding and other fields and, more specifically, MHPSS across the conflict divides.
Moreover, taking into consideration that the combination of MHPSS and peacebuilding is still a novel and rare occurrence in the regional context, we observe little to no advocacy and activism for developing the integrated approach, while the lack of understanding about peacebuilding and conflict transformation among many MHPSS professionals is also a real obstacle that needs to be tackled. At the same time, the knowledge of MHPSS is deficient on the side of peacebuilders, as well. Therefore, as an initial step, in-country awareness-raising initiatives on peacebuilding should be promoted and implemented for mental health specialists and psycho-social support practitioners and vice versa. Subsequently, it would be pertinent to stimulate the joint actions of these professionals and practitioners from Armenia and Azerbaijan as part of cross-border peacebuilding processes.
Although the findings of our research clearly depict the need for the integrated approach to psychosocial support in the context of the Nagorno-Karabakh conflict, as all interviewees highlighted the increased demand for it, our article opens up prospects for further discussions rather than giving precise answers and providing an exact action plan. Overall, we believe, this research article can be a good starting point for more investigations on interlinkages and complementarity between MHPSS and peacebuilding. The 44-day war resulted in personal and collective traumas among the affected communities on both the Azerbaijani and Armenian sides. Therefore, the potential of well-organized and need-based psychosocial support that would include community-based psychosocial support elements should be explored for the purposes of peacebuilding.
Such measures as organization and strengthening of holistic interdisciplinary cooperation to address the psychological, social, and economic needs of conflict-affected people and enhancing the awareness and capacities of MHPSS professionals and practitioners should be taken prior to the cross-border activities aimed at integrating MHPSS and peacebuilding. The application of the integrated approach requires comprehensive assessment of the needs of affected groups, more material and organizational support from stakeholders (IOs, NGOs, and donors), as well as bringing more expertise and experienced people to the field, as the demand for psycho-social support is of high urgency in the post-war context. All in all, based on the results of our research and the perspectives provided by the interviewed experts, we recognize the great need for uniting psychosocial support and peacebuilding efforts and expect positive outputs from this combination to a peaceful transformation of the Nagorno-Karabakh conflict context.
*The cover image of the article is taken by Neil Thomas on Unsplash. “A Helping Hand To Hold Tree Up” sculpted by John Butler, located in Bideford, Devon UK.
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