There is substantial evidence that armed conflict increases the prevalence of mental health conditions that can have long-lasting consequences for individuals, families and communities, and while recognition of the importance of mental health and psychosocial support (MHPSS) in armed conflict settings has taken decades to gain momentum, such recognition is now increasingly reflected in the interpretation and implementation of different fields of international law. In light of this, several articles in the present issue of the Review examine the implications for MHPSS under international humanitarian law (IHL) and international human rights law.

A related trend is the growing number of resolutions adopted on the subject in multilateral fora such as the International Conference of the Red Cross and Red Crescent, the World Health Assembly and various United Nations bodies. These frameworks provide critical foundations for protecting dignity, recognizing mental health as an integral component of the right to health, ensuring access to essential services, and helping people to cope and recover amid the complex realities of armed conflict. Upholding IHL and those commitments remains essential, as violations can further increase risks to the mental health and psychosocial well-being of individuals and populations affected by armed conflict, in addition to humanitarian staff and volunteers working in these environments.

While awareness of the importance of MHPSS has significantly increased, challenges remain in ensuring that MHPSS considerations are integrated from the outset of humanitarian responses, including in emergencies. Some of these challenges are operational, relating to access to affected populations, maintaining services in contexts where systems are under strain, and responding to needs amid limited resources. Some are technical, requiring appropriate approaches to support people with pre-existing and conflict-related mental health and psychosocial needs, while ensuring that interventions are adapted to the realities of armed conflict and emergency contexts. In many settings, the challenge is not only identifying effective interventions but also determining who can provide them, given the limited availability of specialized mental health professionals and the constrained humanitarian environment. Ensuring access to a continuum of care – from basic psychosocial support to psychological interventions and psychiatric care – remains a key challenge, particularly where skilled and trusted service providers are scarce.

These difficulties are particularly evident when supporting groups whose mental health and psychosocial needs may not always be captured within conventional humanitarian responses. Certain groups affected by armed conflict – including weapon-wounded persons, families of missing persons, people deprived of their liberty (including prisoners of war), and survivors of torture, sexual violence and other forms of abuse – may have specific and complex mental health and psychosocial needs requiring tailored approaches. Ensuring that these experiences and needs are recognized and addressed should remain an important priority for humanitarian organizations.

MHPSS in emergency contexts continues to be an evolving area requiring further understanding, investment, research and adaptation. In many situations, responding to MHPSS needs means navigating what is possible within highly constrained environments, with the objective of reducing suffering, preventing further harm and supporting people’s ability to cope and recover.

The duty of care owed to humanitarian workers who operate in highly demanding environments and may experience considerable emotional and psychological burdens is particularly important. Many humanitarian workers, particularly national staff and volunteers, can face a “triple burden”: being part of the affected community themselves, working in contexts affected by armed conflict and violence, and providing support that requires sustained emotional engagement, including listening to experiences of suffering, supporting survivors of violence and accompanying people through grief and loss. Ensuring adequate supervision, staff well-being measures and “help the helpers” approaches is essential to supporting those providing care and to reducing risks related to secondary traumatic stress, burn-out and moral injury.

In response to these challenges, the MHPSS sector has continued to develop guidelines, frameworks, tools and policies that have strengthened the capacities of workforces and systems, promoted quality and accountability, helped identify and address harmful practices, and supported greater alignment across different professional disciplines, including mental health, protection, rehabilitation and social services. Given the diverse needs of affected populations, a coordinated and complementary approach among different actors remains essential to ensuring appropriate support across the continuum of care.

Gaps remain in the evidence base, particularly regarding which MHPSS interventions are most effective in complex conflict environments, for whom, under what conditions, and through which delivery models. These gaps are especially relevant for populations facing severe exposure to violence and living in contexts where humanitarian access is limited, including survivors of sexual violence, torture survivors, families of missing persons, people with weapon-related injuries, released prisoners of war, and individuals with severe or acute mental health needs.

This issue of the Review seeks to contribute to the continuing discussion on mental health and psychosocial needs in situations of armed conflict, the consequences of violence on individuals and communities, and the approaches that can support affected populations in these challenging environments. It aims to connect the importance of mental health and psychosocial services with existing legal and humanitarian frameworks, highlight the need for stronger protection of humanitarian and health-care workers, promote the integration of MHPSS across humanitarian action, and showcase practical experiences that illustrate what can be achieved when responding to mental health and psychosocial needs in armed conflict settings.