Armed conflicts create deep psychological harm that reaches far beyond the battlefield. The mental health consequences of modern wars affect not only those who directly experience violence but also those who encounter it indirectly. According to the United Nations High Commissioner for Refugees Global Trends Report 2024, 123.2 million people had been forcibly displaced worldwide by the end of 2024, representing 1 in every 67 people on Earth, with Sudan, Syria, Afghanistan and Ukraine accounting for more than a third of all displaced persons. ¹ Psychiatrists, aid workers and diaspora populations often experience vicarious trauma, a condition that emerges from empathetic engagement with others’ suffering. This exposure alters emotions, cognition and worldview, producing long-term distress among those responsible for providing care. ^{Reference Amsalem, Haim-Nachum, Lazarov, Levi-Belz, Markowitz and Bergman2}

Vicarious trauma occurs when clinicians or caregivers repeatedly listen to or witness traumatic experiences. Over time, these encounters reshape their beliefs about safety, justice and humanity. Symptoms frequently resemble post-traumatic stress disorder (PTSD), including intrusive memories, avoidance and emotional numbing. For psychiatrists, who often treat victims of war and displacement, sustained exposure to patients’ trauma narratives can lead to moral exhaustion and a loss of empathy. The psychological toll is intensified in war-affected settings where psychiatrists confront resource shortages, ongoing violence and ethical dilemmas while attempting to remain objective and compassionate. ^{Reference Kalaitzaki, Goodwin, Kurapov, Vintila, Lazarescu and Lytvyn3}

Indirect trauma is also prevalent among individuals outside of conflict zones. Members of the diaspora and those exposed to graphic war content through news or social media exhibit symptoms of anxiety and depression. In a study of the Tigrayan diaspora in Australia, more than 80% of participants reported PTSD-related symptoms despite living far from the conflict. ^{Reference Gesesew, Tesfamicael, Mwanri, Atey, Gebremedhin and Gebremariam4} Such findings reveal how digital networks can transmit emotional contagion, transforming collective witnessing into a sustained psychological burden. Psychiatrists must therefore broaden their understanding of trauma to include indirect exposure mediated through technology and shared identity.

For mental health professionals working in humanitarian crises, the boundaries between healer and sufferer often blur. Clinicians treating war survivors frequently share the same environment of fear and instability, resulting in what has been described as a shared traumatic reality. In such settings, psychiatrists risk developing secondary traumatic stress, which can impair judgement, empathy and self-efficacy. Without appropriate supervision and institutional support, repeated exposure to patients’ trauma can evolve into compassion fatigue and emotional withdrawal, reducing treatment effectiveness.

Women consistently show higher prevalence rates of PTSD, depression and anxiety following exposure to war and disaster compared with men, a pattern robustly confirmed across disaster settings by recent meta-analytic evidence. ^{Reference Nolting, Morina, Hoppen, Tam and Kip5} Independent of gender, early exposure to armed violence during childhood and adolescence further amplifies long-term psychiatric vulnerability, as demonstrated by longitudinal studies in Palestine and Ukraine. ^{Reference Goto, Pinchuk, Kolodezhny, Pimenova, Kano and Skokauskas6} Psychiatrists treating these groups must incorporate developmental and trauma-informed perspectives that consider the influence of disrupted caregiving and prolonged insecurity. Trauma also affects caregivers themselves, particularly parents and teachers, creating intergenerational cycles of psychological distress that complicate recovery efforts.

Protective factors can mitigate the effects of vicarious and direct trauma. Social support, reflective supervision and religious or cultural coping mechanisms enhance resilience among both clinicians and survivors. ^{Reference Hoppen, Priebe, Vetter and Morina7} Psychiatrists who receive structured peer discussions and emotional debriefing display fewer symptoms of secondary stress and maintain stronger professional boundaries. However, these supports are often absent in conflict-affected regions where healthcare systems are fragmented and underfunded. Limited access to supervision or peer consultation leaves psychiatrists isolated, increasing their vulnerability to burnout and self-doubt.

Cultural context significantly shapes trauma expression and treatment. In many war-torn societies, stigma surrounding mental illness, rigid gender roles and collective notions of endurance influence how individuals interpret distress and whether they seek care. For psychiatrists, cultural competence is essential to effective intervention. The incorporation of culturally familiar practices, spiritual beliefs and community structures into therapy enhances trust and compliance. In diaspora populations, culturally adapted trauma therapies can address identity conflicts and foster psychological integration following displacement.

At the system level, psychiatrists face institutional and ethical challenges in responding to war-related mental health crises. Inadequate funding, unstable governance and legal uncertainty restrict the continuity of care. Research from post-conflict regions shows that early trauma-focused interventions can reduce acute distress but have limited long-term effects when follow-up services are unavailable. ^{Reference Miller and Rasmussen8} To improve outcomes, mental health strategies must be embedded within public health and humanitarian systems, ensuring sustained access to care and protection for practitioners. Beyond individual-level recovery, evidence from post-war Syria demonstrates that collective healing through peace-building, restoration of social trust and community-based psychosocial reconstruction is central to sustainable mental health recovery in war-affected societies. ^{Reference Churbaji, Bryant and Morina9}

Despite progress, significant research gaps persist. Most studies on vicarious trauma are cross-sectional and rely on self-reported data. Longitudinal research is needed to understand how chronic exposure affects clinicians over time, and to identify biological or neurological correlates of stress. ^{Reference Kalaitzaki, Goodwin, Kurapov, Vintila, Lazarescu and Lytvyn3} Few randomised controlled trials have evaluated the effectiveness of professional support interventions, and culturally specific programmes remain underdeveloped. Future research should explore how personal trauma histories, professional contexts and institutional environments interact to predict vulnerability or resilience among psychiatrists.

In conclusion, the invisible wounds of war reach both victims and healers. For practising psychiatrists, vicarious trauma represents an occupational risk that demands systematic recognition and response. Trauma-informed supervision, cultural sensitivity and organisational support are essential to sustaining clinician well-being and maintaining quality of care. Addressing these challenges requires collaboration among psychiatric institutions, humanitarian organisations and policy-makers to establish safeguards that protect those who care for others. The future of psychiatry in war and post-war contexts must prioritise not only the healing of survivors but also the mental health of those who serve them.