Scenario planning

Supporting Afghan Londoners’ mental health needs (Oct 2023)

Updated 10 October 2023

Introduction

As part of Thrive LDN’s research and insight’s function, we routinely carry out public mental health scenario planning exercises to synthesise available intelligence, anticipate what might be on the horizon and plan actions to strengthen and maintain capabilities to support partners to step up public mental health responses to crises.

To discuss any of the detail included in this briefing or the ideas for next steps, please contact the Thrive LDN Evidence and Insights team via info@thriveldn.co.uk.

Overview

Earthquakes in Afghanistan – Overview

On Saturday, 7 October 2023, a series of powerful earthquakes and strong aftershocks struck western Afghanistan, measuring at worst 6.3 in magnitude on the Moment Magnitude Scale. The epicentre was 40km northwest of regional capital Herat.

Afghan authorities have confirmed that at least 2,400 people have been killed, with more than 10,000 people injured. The death toll is expected to rise as rescuers struggle to support the mountainous, earthquake prone areas impacted. Many of those injured have been unable to get the treatment they need due to a lack of infrastructure and restrictions in place. The lack of food, shelter and clean water are increasing health risks among communities.

The disaster comes just a year after an earthquake struck eastern Afghanistan in June 2022 and killed at least 1,000 people, which was only a matter of months since the emerging humanitarian crisis in the region following the withdrawal of the International Security Assistance Force (ISAF) at the end of 2021.

The full extent of the earthquake’s impacts is yet to be known, but in light of these distressing events it is important to consider the mental health impacts on Londoners in relation to this natural disaster, in particular London’s Afghan community, many of whom were displaced and more broadly effected by the withdrawal of foreign aid in 2021.

This is the third major international earthquake in just 8 months, following on from the devastation of the Turkish-Syrian earthquakes in February and more recently the Morocco in September, so likely to also be a challenging time for London’s significant Turkish, Kurdish and Syrian communities, many of which are experiencing loss and bereavement and will be triggered by the events unfolding in Afghanistan.

Future needs

Anticipating future needs and impact for public mental health in London

Humanitarian crises require international awareness and compassion as populations flee and recover from threats to safety, livelihood, and life, all of which have the potential impact on public health in and surrounding countries.

The earthquake will be accompanied by a rising death toll over the coming days, weeks and months, with rescue efforts obstructed by the remoteness of the areas worst effected and difficulties accessing communities. The full impact of the disaster on local, regional, and broader populations is yet to be realised. Loss and bereavement will be experienced by thousands of people, many of which have suffered through adversity in the form of economic downturn, and the impacts of the COVID-19 pandemic, increasing the risk for compounding trauma which is felt not only by those immediately affected but equally those across the diaspora for months and years to come.

The following factors have been identified when considering how best to support partners to step up an appropriate public mental health response to these events.

Diaspora populations in London

London is home to the UK’s largest community of Afghans, known to largely concentrated in North-west boroughs Ealing, Hounslow, Brent, Harrow, Hillingdon and Barnet. 7 in every 10 Afghan citizens in the UK reside in the Greater London area.

A total of 24,600 arrivals from Afghanistan were recorded in the UK as of 30 June 2023[1].

Considering the scale of this natural disaster and the enduring humanitarian crises in Afghanistan, the mental health and wellbeing of this community is of significant concern. Afghan people living in London are likely to feel concerned about families and friends left in their countries of origin and feel ‘helpless and shocked’ about the current situation. There may be heightened feelings of anxiety and stress, as well as thoughts of ‘survivors’ guilt as the death toll rises into the tens of thousands and issues of displacement materialise to an increasingly significant extent.

There is the need for an appropriate public mental health response targeted towards these communities in a way that is trauma-informed and culturally competent. Learning from previous humanitarian crises, including the withdrawal of foreign aid in Afghanistan, we know that many migrant communities in London have already faced experiences of trauma, isolation, and discrimination, and may access support through their own communities as opposed to more formal routes. Therefore, their mental health needs will be potentially urgent but equally will require specialised, tailored support that addresses their life experiences, culture, and behaviours in an appropriate manner. As per the London response to the displacement of Afghan people in 2021, support must be rooted in community action, utilising routes and pathways that may be preferred to more traditional routes of mental health support already in place.

Given the close proximity in time, since the earthquakes in Turkey, Syria and Morocco, it is likely this is a particularly sensitive and upsetting situation for Turkish, Kurdish, Syrian and Moroccan diaspora communities, with a potential risk of re-traumatisation for those recovering from the impact that disaster.

[1] Afghan Resettlement Programme: operational data.

Londoners’ resilience

Londoners’ resilience

At this point in time, nothing is certain regarding the full impact of this disaster which has emerged in Afghanistan, which took place almost concurrently with conflict in Irael and Gaza. As always with emerging issues, it is important to consider the impact across the general population and determine how best to strengthen resilience and ensure all Londoners have the tools and resources to manage uncertainty and cope with distressing information around this humanitarian crisis. Natural disasters have a proven link to both direct and indirect trauma and distress, as people across the world are exposed to feelings of powerlessness and insecurity that often occur in the wake of a mass tragedy such as the one currently unfolding in Afghanistan.

For many Londoners, being confronted with the realities of this situation could be a source of stress and anxiety. This is particularly significant for London’s multitude of migrant communities from areas which have been prone to natural disasters and/or experienced displacement alongside the loss of their homes and livelihoods.

More generally, Londoners are living in a post-COVID era, experiencing a period of significant economic adversity, and a variety of challenges. Collective memory of the trauma experienced during the pandemic and widespread ongoing concerns related to the cost-of-living combined with distress of this crisis has the potential to erode resilience and negatively impact population mental health indicators such as depression, anxiety, happiness, and life satisfaction.

Current Thrive LDN actions

Trauma-informed training

Thrive LDN has partnered with Nicola Lester Psychological Trauma Consultancy to offer free, pre-recorded Trauma-Informed Practice training to support individuals and organisations.

Offered at three levels, this training series is designed to help professionals and volunteers gain an understanding of the impact of trauma and to integrate a trauma informed approach to practice. In responding to this current crisis, a trauma informed approach utilised by those who will be interacting with diaspora communities, as well as any Londoner impacted, could not be more important.

A bitesize approach to the trauma-informed practice training is now also available. Individuals who sign up will receive a weekly email to complete the training one chapter at a time, enabling people to spend 20–30 minutes across eight weeks to progress through the bronze level training ‘becoming trauma aware’, silver level training ‘developing trauma informed practice’ and gold level training ‘committed to trauma informed practice’.

Resources for London's Afghan refugee community

In 2021, Thrive LDN coordinated a programme of work to support the mental health and wellbeing of displaced Afghan’s in London and support community partners working directly with Afghan refugees such as Paiwand, Afghan Association of London (AAL), Refugee Council, and Refugees in Effective and Active Partnership (REAP). The following resources were co-produced which are also useful for the current situation:

Help with your concerns or worries guide – available in English, Dari and Pashto.

Guidance for supporting the mental health and wellbeing of refugees – directed towards professionals or volunteers that will come into contact with the Afghan refugee population and is intended to help you support the mental health and wellbeing of those refugees

Good Thinking Coping with Trauma workbook – London’s digital wellbeing service, Good Thinking, has produced several resources designed to help individuals cope with trauma, including the ‘Coping with Trauma’ workbook, available in English, Dari and Pashto, and accompanying short film series in English.

Resources for displaced people and crisis situations

Help Yourself and Others is Thrive LDN’s interactive platform to build Londoners resilience and improve and protect wellbeing.

A suite of targeted resources have been co-developed for crisis situations and displaced groups.

Other available resources

Wellbeing guidance in 36 languages – including English, Dari and Pashto

Five ways to good mental wellbeing & Islam – including English, Dari and Pashto

Bereavement guides and resources on Good Thinking – including an Islam and Bereavement guide.

Thrive LDN support after sudden bereavement resource (currently framed around COVID but may useful)

Thrive LDN mental health conversation starter tool (SIGNSS)

Good Thinking’s tools and advice to support with anxiety, stress, low mood and trouble sleeping

Further mental health workbooks developed by Good Thinking and expert advisors include sleep, and panic

Urgent mental health support

For those supporting communities – free Trauma-Informed Practice training and suicide prevention training

Principles of psychosocial approaches and general guidance for supporting individuals and communities adversely affected by events (currently framed around COVID but still useful)

Moments for Mindfulness. A self-help guide to managing stress and uncertainty by the Refugee Council.

Resources to support refugees and asylum seekers in accessing and understanding the NHS.