Introduction
Armed conflict and protracted crises generate profound and long-lasting psychological consequences for affected populations. Recent estimates indicate that more than one in five people (22%) in conflict-affected populations experiences depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder or schizophrenia.Footnote 1 A systematic review and meta-analysis of studies from conflict settings found prevalence rates of 15.4% for PTSD and 17.3% for depression – considerably higher than global averages.Footnote 2 Moreover, rates of trauma-related distress remain high among populations affected by conflict.Footnote 3
Nearly everyone exposed to emergencies experiences psychological distress, manifesting in anxiety, sadness, fatigue and disrupted sleep. While many recover naturally with time and social support, a significant number of people develop mental disorders requiring professional intervention.Footnote 4 The consequences of untreated mental health conditions extend beyond individual suffering by undermining post-conflict recovery, perpetuating cycles of violence and imposing substantial economic costs on already fragile health systems.Footnote 5 The psychological consequences impact not only the affected populations but also health professionals and humanitarian workers themselves, who also operate in contexts of persistent danger and overwhelming need.Footnote 6
Recognizing the scale and significance of these impacts, the humanitarian sector to some extent views mental health and psychosocial support (MHPSS) as a core component of humanitarian response rather than a secondary concern. For example, the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings call for the integration of MHPSS across all sectors in emergencies, emphasizing that mental health is inseparable from overall well-being and that psychosocial considerations must inform protection, health, education and livelihood interventions.Footnote 7
The International Red Cross and Red Crescent Movement (the Movement), in its turn, has translated this recognition of the importance of addressing mental health and psychosocial needs into formal commitments. Resolution 2 of the 33rd International Conference of the Red Cross and Red Crescent (International Conference) called on States and Movement components to “scale up action on mental health and psychosocial support” and to “invest in sustainable mental health and psychosocial support systems”.Footnote 8 The subsequent Movement Policy on Addressing Mental Health and Psychosocial Needs (Movement MHPSS Policy) further articulates the commitment to providing layered MHPSS interventions, strengthening local capacities and ensuring that mental health is integrated throughout humanitarian action.Footnote 9 These commitments highlight that sustainable responses to mental health needs in conflict-affected contexts depend not only on direct service delivery but also on building the professional capacity of local actors who can deliver the care.
Yet translating these commitments into practice remains a challenge in the humanitarian sector. Despite growing policy recognition, MHPSS services in conflict-affected areas are often underfunded, fragmented and short-term interventions with limited continuity.Footnote 10 A persistent gap exists between the acknowledged need for local professional capacity and the reality of humanitarian programming, which often prioritizes rapid deployment of external expertise over the slower, more resource-intensive work of strengthening domestic health systems and supporting local professionals over time. This gap is particularly acute in protracted conflicts, where mental health needs are sustained and complex but the availability of trained professionals is severely limited and mechanisms for professional development and supervision are often absent.Footnote 11
This article examines the partnership between the International Committee of the Red Cross (ICRC) and the Swedish Red Cross (SRC), which began in 2014 and is currently ongoing, as a case study in MHPSS capacity-building in conflict settings, drawing on experience from Syria. Its central thesis is that strengthening professional capacity over time is essential to overcoming barriers to mental health care in conflict environments, where access to services is often limited and the psychological burden on both affected populations and care providers is significant. It illustrates how capacity-building of local MHPSS professionals on trauma interventions through tiered trainings and supervision can contribute to this goal. This approach moves the focus from service delivery toward system strengthening, from short-term interventions toward long-term capacity-building, and from reliance on external actors toward investment in local professionals embedded within their institutions and communities. The ICRC–SRC partnership showcases that such transformation becomes possible precisely when Movement components combine their complementary strengths, combining the ICRC’s operational presence and MHPSS work in conflict-affected areas with the SRC’s clinical expertise in trauma rehabilitation. It has been implemented in close collaboration with the Syrian Arab Red Crescent (SARC), the Syrian Ministry of Health (MoH) and the World Health Organization (WHO), whose local expertise and service delivery capacities are crucial.
The article aims to make three distinct contributions to humanitarian MHPSS policy and practice. First, it illustrates how a sustained, multidisciplinary capacity-building initiative operates in a protracted conflict setting, offering concrete insights into design, implementation, challenges and outcomes. Second, it articulates the clinical and conceptual rationale for multidisciplinary approaches to trauma rehabilitation, demonstrating why integrated interventions addressing physical and psychosocial dimensions alongside psychotherapeutic ones are essential for comprehensive care. Third, it showcases the added value of Movement cooperation in MHPSS system strengthening in an integrated manner, identifying how partnerships between Movement components can operationalize collective commitments and create models with relevance beyond specific contexts such as Syria.
Following the present introduction, the article proceeds in six substantive sections. The first section establishes the rationale for capacity-building in conflict-affected contexts, analyzing the gap between mental health needs and available services and arguing that investment in local professional capacity is central to increasing access to MHPSS services. The second section introduces the ICRC–SRC partnership, outlining how the cooperation emerged, the complementary strengths that each partner contributes and the framework guiding their collaboration. The third section presents the Syrian case study, documenting how the partnership has supported trauma-focused capacity-building for psychologists, physiotherapists and social counsellors through modular training and supervision in a context of protracted conflict and health system fragmentation. The fourth section examines why adopting a multidisciplinary approach to capacity-building – bringing together physiotherapy and psychosocial counselling alongside psychotherapy – contributes to more comprehensive responses and treatments. The fifth section discusses broader implications, analyzing the partnership’s added value, transferability to other contexts, challenges encountered, and future directions for more sustainable MHPSS capacity-building in humanitarian settings. Finally, the article concludes by summarizing key lessons and articulating strategic implications for Movement components, humanitarian actors and donors committed to translating MHPSS policy into sustained practice.
The article emphasizes throughout that mental health is integral to humanitarian action and not auxiliary to it. Likewise, investing in building local professional capacity is not a supplement to service delivery but rather is central to responding to the psychological consequences of armed conflict.
Rationale: Why capacity-building in MHPSS matters in conflict-affected contexts
Investment in local professional capacity is essential for effective and lasting MHPSS in contexts of armed conflict. Trauma-related needs remain high in conflict-affected contexts, while the availability of specialized trauma services is limited.Footnote 12 At the same time, the number of trained mental health professionals is critically low, and mechanisms for continuing education, supervision and peer support are frequently absent.Footnote 13 These structural constraints undermine both the quality and continuity of care, highlighting the need for sustained capacity-building initiatives that are adapted to local priorities and grounded in professional mentorship and supervision. In doing so, the ICRC–SRC partnership aims to contribute to the gradual building of sustainable national capacities that can increasingly meet the complex and enduring MHPSS needs of conflict-affected populations.
The global MHPSS gap in conflict settings
Despite the documented prevalence of mental health conditions in conflict-affected populations and the attempts to meet them, a substantial treatment gap remains. In Syria, for example, shortages of mental health professionals have been widely documented.Footnote 14 Similar shortages are observed in other conflict-affected contexts, where escalating mental health needs coincide with a shrinking capacity to respond.
There are several factors that contribute to this gap. Security constraints limit humanitarian access and impact consistent service delivery. Policy and legal frameworks in many conflict-affected States provide minimal recognition or support for mental health services, relegating MHPSS to low priority within already overstretched health budgets. The scarcity of trained mental health professionals remains one of the most critical barriers to service provision, and stigma surrounding mental health conditions, rooted in cultural beliefs and reinforced by fear of discrimination, further impedes help-seeking behaviour and community acceptance of services.Footnote 15 Infrastructure damage, population displacement and the breakdown of referral systems compound these challenges, fragmenting care pathways and leaving many without access to even basic psychosocial support.
Humanitarian funding mechanisms, which often operate on short annual cycles and incentivize quick and visible results rather than sustained investments such as capacity-building, also exacerbate the problem. MHPSS interventions often focus on time-limited psychosocial activities – awareness campaigns, brief psychological first-aid training – that provide immediate relief but leave limited institutional capacity once external support is withdrawn. These important and necessary interventions must be complemented by sustained investment in local professional capacity to ensure continuity of care.
Limitations of current humanitarian response models
The dominant model of humanitarian capacity-building has historically relied on short-term knowledge transfer, but while brief, one-off trainings may be cost-effective in the short term, they are insufficient for developing the clinical competence required for trauma-focused interventions. Mental health practice demands not only theoretical knowledge but also supervised application, reflective practice and ongoing peer learning. A three-day workshop on trauma treatment may raise awareness, but it cannot generate the sustained learning and clinical confidence necessary for effective and ethical service delivery. Without progressive learning opportunities, follow-up supervision and mentoring, newly acquired skills are quickly lost and the quality of care remains inconsistent or inadequate.
By investing in the capacity of professionals within SARC, the Syrian MoH and WHO, the ICRC–SRC partnership ensures that trauma-focused capacity-building is rooted in a nuanced understanding of local realities. This is a knowledge that cannot be quickly acquired by external actors but is embedded in the regular practice of national professionals. Building their capacity addresses the limitations of traditional models while generating several benefits:
• Sustainability and continuity: Local professionals provide care during acute crises, through transitions to post-conflict recovery, and into long-term development contexts. Investing in their capacity creates institutional memory and service continuity that external actors cannot replicate or substitute. Evidence from evaluations by the International Federation of Red Cross and Red Crescent Societies (IFRC) suggests that sustainable outcomes in MHPSS programming are linked to sustained training and capacity-building of national staff over time.Footnote 16
• Cultural appropriateness and accessibility: National professionals share language, cultural reference points and contextual understanding with affected populations. They can recognize and respond to specific expressions of distress, adapt therapeutic approaches to local beliefs and practices, and navigate community dynamics in ways that external actors cannot. This increases help-seeking, improves therapeutic alliance and enhances the relevance and acceptance of interventions.
• Integration with national health systems and cost-effectiveness: Building local professional capacity within SARC, the Syrian MoH and WHO, the ICRC–SRC partnership contributes directly to strengthening the Syrian health system. By ensuring that trauma-focused skills are embedded within existing health structures, the initiative aims to strengthen overall system resilience. This integration is essential for ensuring that MHPSS services continue beyond specific humanitarian projects. While capacity-building requires upfront investment in training, supervision and professional development support, it proves more cost-effective than long-term reliance on international expertise.Footnote 17 National professionals often deliver services at lower costs and remain accessible over longer time frames.
• Empowerment and dignity: Investing in local capacity acknowledges that affected communities possess not only needs but also resources, expertise and agency. It aligns with the humanitarian principles of dignity, participation and localization that are central to the ICRC–SRC partnership and the Movement’s approach to MHPSS.
• Movement commitment to sustainable MHPSS capacity: The Movement’s commitments to MHPSS explicitly prioritize capacity-building and sustainable systems. Resolution 2 of the 33rd International Conference calls on Movement components to “build and strengthen local and national capacities to provide quality, community-based mental health and psychosocial support services”.Footnote 18 The Movement MHPSS Policy, established at the 2019 Council of Delegates, specifically prioritizes creating and expanding professional development pathways and educational opportunities for MHPSS staff and volunteers, particularly in resource-poor settings.Footnote 19 The MHPSS Framework (2020–23) similarly emphasizes these commitments, which reflect a broader shift in the humanitarian sector towards localization, anticipatory action and resilience.Footnote 20
The ICRC–SRC partnership initiative in Syria constitutes a serious attempt to translate these Movement commitments into practice by prioritizing long-term capacity development of local MHPSS professionals. The following section examines how this partnership emerged and what complementary strengths each organization contributes to the shared goal of strengthening local MHPSS capacity.
The ICRC–SRC partnership on MHPSS capacity-building: Complementarity in practice
The partnership between the ICRC and the SRC in mental health and psychosocial support, formalized in 2014, grew from a shared recognition of the importance of addressing the mental health and psychosocial consequences of armed conflict. Over time, this cooperation has evolved into a model for strengthening access to MHPSS systems in humanitarian settings by investing in local professional capacity on trauma-informed interventions. Grounded in the Movement’s humanitarian mandate, it combines the ICRC’s operational presence in conflict-affected contexts with the SRC’s clinical expertise in trauma rehabilitation.
Current cooperation and priorities (as defined in the Partnership Framework Agreement)
The current Partnership Framework Agreement (PFA) covering 2023–27 builds on this complementarity and articulates a common goal: to respond to the MHPSS needs arising from armed conflict and other situations of violence by working to ensure access to integrated MHPSS services and to strengthen cooperation in implementing the Movement MHPSS Policy and Resolution 2 adopted at the 33rd International Conference in 2019. This shared ambition is operationalized through a set of key priorities that structure the current phase of cooperation.
Amongst these priorities, two are particularly central to the partnership and most relevant to this article’s focus on capacity-building. The first is to enhance collaboration on addressing MHPSS needs and access to MHPSS services in jointly identified operational contexts, drawing on the SRC’s clinical experience from its Treatment Centres for Persons Affected by War and Torture and the ICRC’s operational presence in conflict settings. This priority emphasizes contextual adaptation, ensuring that interventions respond to the specific conflict dynamics, security constraints and MHPSS needs of each setting while remaining grounded in humanitarian principles and evidence-based practice. The second priority centres on building local professional capacity in a comprehensive and multidisciplinary manner. This involves ensuring complementarity between ICRC and SRC contributions through shared assessments, joint training design and delivery, and collaborative development of training materials and supervision frameworks. Current joint capacity-building initiatives in Syria, Armenia, Ukraine and Central Asia exemplify this priority, with each context requiring adaptation to specific conflict dynamics, health system capacities and local considerations while being aligned with trauma-focused, evidence-based approaches.
Beyond these two operational priorities, the partnership also encompasses other areas such as research, knowledge exchange and joint advocacy to advance the Movement’s MHPSS commitments. While these dimensions provide a relevant broader framework for collaboration, this article focuses specifically on enhancing collaboration on MHPSS services and building local capacity in conflict-affected settings. These priorities define the current phase of collaboration and provide the foundation for the case study that follows, which examines how the partnership model has been applied in Syria.
Complementarity of mandates and approaches
Realizing these priorities depends on the complementarity between the two institutions’ mandates and approaches, with each partner contributing their distinct yet mutually reinforcing strengths. For the ICRC, the partnership aligns with its operational mandate to protect and assist people affected by armed conflict and other situations of violence. In line with the ICRC Institutional Strategy and Health Strategy, the organization recognizes that exposure to violence, displacement, loss, and disruption of essential services generates not only physical harm but also significant psychological and psychosocial consequences.Footnote 21 As part of its holistic approach to preserving life and dignity, the ICRC integrates health and by extension MHPSS into its protection and assistance efforts, addressing the diverse needs of affected populations across multiple dimensions.
The ICRC’s health approach underscores the importance of ensuring access to essential health services – ranging from primary health care and hospital support to physical rehabilitation – and highlights the need to address the MHPSS consequences of conflict alongside physical health needs.Footnote 22 MHPSS is therefore positioned as a key component of the ICRC’s health response, contributing to the broader objectives of restoring functioning, reducing suffering and strengthening individual and community resilience.
The SRC, for its part, brings decades of clinical experience in rehabilitation for people affected by war, conflict and forced migration. This work is carried out through five Treatment Centres for Persons Affected by War and Torture, located across Sweden. Central to this expertise is the SRC Competence Centre for Rehabilitation of Torture and War Trauma, which coordinates research on trauma and rehabilitation across the Treatment Centres. It bridges clinical practice with scientific evidence, thus ensuring evidence-based methods and contributing insights from therapeutic practice to broader knowledge on trauma rehabilitation.
The SRC therefore has a solid foundation from which to contribute to the ongoing ICRC-led MHPSS capacity-building efforts. Through the partnership, the SRC and ICRC have jointly trained local mental health professionals, co-developed training materials and supervision frameworks, and carried out evaluations to document outcomes and refine approaches. By linking the ICRC’s field-based MHPSS implementation with the SRC’s trauma expertise, in close collaboration with local partners (such as SARC and the Syrian MoH), the partnership bridges two complementary levels of action and enhances both the technical quality and long-term sustainability of interventions.
SARC plays a central role in MHPSS provision and development in Syria. It operates across all levels of the MHPSS intervention pyramid, extending beyond specialized services. With support from the ICRC and the SRC, SARC provides focused non-specialized psychosocial support and case management through trained volunteers and specialized case managers. Services are primarily delivered through community centres and mobile teams, enabling access during both the emergency and recovery phases. Interventions are grounded in community-based approaches and increasingly integrated with the health sector, with particular attention to persons with disabilities and their caregivers, who receive tailored psychosocial support.
SARC is also a key actor within the ICRC–SRC partnership on MHPSS capacity-building. SARC psychologists, counsellors, social workers and physiotherapists form the core group of trainees, receiving modular training and ongoing supervision to strengthen trauma-focused competencies. Embedded within SARC health and rehabilitation facilities, these professionals ensure that enhanced capacities are translated into accessible services. SARC further contributes to the contextual adaptation of training materials, supporting cultural relevance and alignment with local needs.
Syria case study: Building local MHPSS competence in protracted crisis
The Syrian case illustrates how the ICRC–SRC partnership model translates into practice within a context of protracted crisis and health system fragmentation. This section documents the design, implementation and outcomes of a multi-year capacity-building initiative that has trained approximately 100 MHPSS professionals across complementary disciplines while establishing supervision structures to sustain quality and professional development over time.
MHPSS needs and health system gaps in Syria
The prolonged armed conflict in Syria has significantly increased the number of individuals who are sick, wounded, missing, or living with permanent or long-term physical disabilities. The violent nature of injuries sustained during hostilities – combined with reduced access to health services, delayed treatment, and deterioration of chronic conditions – has intensified both physical and psychological vulnerability among affected populations, leading to high levels of mental health and psychosocial needs.
Disability prevalence in Syria is considerably higher than global estimates. Nearly one third (30%) of Syrians aged 12 and above live with disabilities – twice the global average of approximately 15%. Among internally displaced persons, the rates are even higher, with 37% of individuals aged 12+ and 40% of heads of households living with disabilities.Footnote 23 Coping with life-altering injuries or chronic conditions often involves significant emotional distress, including fear, anger, sadness, grief, and difficulties adjusting to new realities. These psychological consequences highlight the need for sustained, high-quality MHPSS provision.
The conflict has also resulted in large numbers of missing persons. Thousands of Syrians have lost contact with family members, including civilians fleeing hostilities, children separated from caregivers, combatants missing in action, and individuals who were arrested, abducted or killed without their remains being recovered. The uncertainty surrounding the fate of missing relatives creates profound and enduring psychological suffering, characterized by ambiguous loss, prolonged grief, and significant social and economic burdens for families.
These extensive MHPSS needs unfold within a health system that has been severely weakened by over a decade of conflict, facing significant structural and operational challenges. Many public health facilities are only partially functional and experience chronic shortages of medical supplies and equipment.Footnote 24 Displacement, economic decline, the loss of qualified staff, and continued insecurity have placed additional pressure on the health system and have affected access to care, particularly in rural and hard-to-reach areas.Footnote 25
Mental health services are among the most affected. The number of trained professionals remains very low, and specialized facilities are scarce and unevenly distributed. Rates of trauma-related distress remain high among populations affected by conflict, while the availability of specialized trauma services is severely limited.Footnote 26 The absence of structured mechanisms for continuous professional development, supervision and quality assurance exacerbate service delivery to affected populations.Footnote 27 These combined capacity constraints occur within a broader context of funding unpredictability, shifting national and international priorities, and the ongoing challenge of maintaining service continuity amid security incidents and population movements.
ICRC MHPSS services and response
In response to these diverse and extensive needs, the ICRC implements MHPSS programmes targeting populations affected by the conflict, including families of missing persons, individuals with weapons-related disabilities, survivors of sexual violence, children and families associated with armed groups, and people recently released from detention. Given the range of mental health conditions observed (from mild distress to severe disorders such as anxiety, depression, PTSD and psychosis), the programme provides interventions across all layers of the MHPSS pyramid, from basic psychosocial support to specialized mental health care. Early identification of psychological distress and timely referral for moderate to severe conditions are key priorities.
Services are primarily delivered by graduate psychologists, with psychiatric support available when needed. Providers receive essential training in common mental health conditions and counselling principles, complemented by protocol-based interventions such as narrative exposure therapy (NET) and cognitive behavioural therapy (CBT) for PTSD. Regular clinical supervision helps ensure quality, ethical standards and trauma-informed practice.
The ICRC–SRC capacity-building initiative: Design and scope
Building on these efforts, the ICRC and SRC launched a long-term capacity-building initiative in 2023, aiming at strengthening trauma-focused competencies among mental health professionals in Syria. Operating within the ICRC–SRC PFA, the initiative is implemented in close collaboration with several relevant stakeholders. Its main partner is SARC, whose institutional infrastructure and professional staff provide the essential foundation for sustainable local capacity. The partnership also trains a number of the Syrian MoH’s psychologists, as well as psychologists from WHO. This tripartite cooperation exemplifies the localized, system-strengthening approach that is central to the partnership model.
The initiative seeks to contribute to building trauma-focused competencies among mental health professionals and establishing supervision structures that provide ongoing professional support and quality assurance. These objectives align with the Movement’s broader commitment to integrating MHPSS into its humanitarian operations while prioritizing local ownership and sustainability.
The capacity-building initiative has engaged professionals from different regions of Syria and across multiple disciplines, reflecting the deliberate emphasis on multidisciplinary system strengthening. The core cohort comprises approximately forty psychologists, predominantly from SARC mental health clinics, with additional participants from the MoH, WHO, and the ICRC’s supported health-care facilities. These psychologists have participated in four consecutive training modules delivered between November 2023 and October 2025, creating continuity that enables progressive skill development, peer network formation, and gradual integration of trauma-informed approaches into their clinical practice.
Beyond psychologists, the initiative has trained twenty SARC counsellors and social workers in psychosocial support methods, and forty-two physiotherapists from SARC and the ICRC in trauma-informed physiotherapy. This multidisciplinary reach – spanning psychotherapy, psychosocial counselling and physiotherapy – operationalizes the understanding that trauma’s impacts extend across the psychological, social and somatic domains, requiring coordinated professional competencies.
Most participants work in primary health-care centres, mental health clinics, hospitals and physical rehabilitation facilities, ensuring that strengthened capacity directly enhances services accessible to affected populations in Syria.
Training approach: Modular, tiered and competency-based
The design of the training approach is informed by a needs and capacity assessment drawing on surveys, consultations and group discussions during programme visits, as well as ongoing input from ICRC staff and the SARC mental health coordinator. This ensures responsiveness to locally identified needs and evolving clinical priorities. The assessment findings also inform the selection and adaptation of the therapeutic approaches included in the training, such as NET and CBT for PTSD, both well established in conflict-affected and displaced populations.
The training approach is modular, tiered and competency-based, designed to build trauma-focused intervention competencies and clinical skills progressively rather than through isolated workshops. Each training module combines theoretical input with case-based learning and supervised practice, ensuring that knowledge translates into clinical practice. Regular follow-up and supervision – provided by ICRC field-based supervisors and complemented by remote sessions with SRC psychologists – reinforces learning and addresses implementation challenges over time.
All training modules are designed and delivered by SRC trainers specializing in trauma rehabilitation, working in close coordination with the ICRC and SARC to ensure contextual relevance and operational feasibility. Core training components include:
• Trauma-informed care: An approach to service delivery that recognizes the impact of trauma by prioritizing creating safety, fostering social connection and improving individuals’ ability to manage difficult emotions and bodily reactions.
• NET: A treatment for PTSD that helps integrate traumatic memories into a coherent life narrative, reducing emotional, cognitive and behavioural symptoms.
• CBT: A psychological treatment that helps individuals to identify and modify unhelpful thoughts, emotions and behaviours. It uses structured techniques such as cognitive restructuring and behavioural activation to reduce distress and improve daily functioning.
• CBT for PTSD: A psychological treatment with several focus areas, aimed at reducing the impact of PTSD symptoms and addressing maintenance mechanisms like avoidance. This is achieved using various CBT interventions, including in vivo and imaginal exposure, as well as cognitive restructuring and behavioural experiments, among others.
• Trauma-informed physiotherapy: A physiotherapy approach specifically adapted to address the complex physical and psychological consequences of trauma. It combines body awareness techniques with targeted physical activity to restore regulation and functioning.
• Life management system: A trauma-informed psychosocial approach that helps individuals strengthen their ability to manage daily life while identifying both protective factors and areas where support is needed.
Learning occurs in progressive stages, with each cohort advancing through successive modules that deepen competence, each followed by structured supervision to consolidate skills and support clinical application. In 2023, psychologists participated in joint training on trauma-informed care, traumatology and NET, establishing a common foundation. In 2024, this was followed by training in CBT for psychologists, focusing on the basic principles of CBT and evidence-based practices for treating depression, insomnia and panic syndrome.
In 2025, a four-day training on CBT for PTSD was conducted to specifically address PTSD, while physiotherapists received training in trauma-informed approaches within the broader MHPSS Framework. Later in 2025, additional modules on child-focused interventions took place, to strengthen responses to trauma among children. These efforts will be complemented with follow-up trainings in 2026 to consolidate and refine skills in both CBT for PTSD and trauma-informed physiotherapy.
This progressive and tiered approach offers several advantages. It provides continuity, allowing the same professionals to build on core skills before progressing to more specialized methods. Sustained engagement with the same cohort reinforces learning over time and fosters peer networks that extend beyond formal training sessions, promoting ongoing exchange and mutual support.
Contextual validity of NET and CBT for PTSD
NET and CBT for PTSD are included in the training as they are supported by extensive evidence across diverse conflict-affected and displaced populations. In particular, NET has a strong record of feasibility and effectiveness in settings characterized by cumulative trauma and cultural diversity. Evidence demonstrates positive outcomes among Syrian refugees in Jordan, Sudanese refugees in Cairo, internally displaced women in Ethiopia, conflict-affected populations in Nigeria, and refugee and migrant children and youth.Footnote 28
Similarly, systematic reviews show that trauma-focused CBT produces significant reductions in PTSD, depression and anxiety across different cultures, age groups and types of adversities, including war-related violence, forced displacement and sexual violence.Footnote 29 Studies from low- and middle-income settings likewise demonstrate its effectiveness for adults and children affected by conflict, with outcomes comparable to those in more stable settings and emphasizing that only modest contextual adaptations – such as adjusting metaphors, examples or idioms of distress – are typically required.Footnote 30
Together, these studies show that both CBT- and NET-based interventions address core psychological processes that are widely observed after exposure to adversity, making them relevant in contexts of ongoing conflict.
Within the ICRC–SRC training, these therapeutic models are not applied rigidly but are used as flexible, principle-based frameworks that practitioners refine collaboratively to ensure cultural and contextual fit. Training and supervision are delivered by SRC clinical psychologists with experience working with conflict-affected displaced patients living with PTSD in Sweden, many of whom are from Syria. This expertise informs adaptation and delivery across all stages of the training process:
• Prior to delivery: ICRC local psychologists adapt and translate training materials to ensure that language, cultural references and case examples are locally meaningful. This process is carried out in close dialogue with representatives from SARC.
• During training delivery: Methods are further refined in dialogue with training participants, adjusting language, pacing, narrative structure and cultural references to reflect local clinical contexts and practitioner’s experiences.
• In post-training supervision: Supervision provides a space to continue refining signs of distress, case examples, family involvement and other relevant elements so that interventions align with clinicians’ everyday practice and the needs of their patients. It also allows participants to work together with SRC supervisors to assess remaining capacity needs that require further consolidation in following trainings.
These adaptations preserve the empirically supported components of each method while ensuring that interventions are meaningful within local patterns of meaning-making and help-seeking, as well as being coherent with the clinicians’ own established clinical practice. In this way, the training process strengthens clinical competence not by imposing external models but by supporting practitioners in integrating well-established and evidence-based trauma-focused techniques with their own expertise, cultural knowledge and experience of working within Syrian communities. The result is an approach that is both scientifically grounded and locally meaningful, consistent with a needs-based and contextually responsive capacity-building model.
Adapting programming: Responding to emerging needs
The programme has remained flexible in order to address and adapt to new needs arising from a shifting context. Following the release of thousands of prisoners from Syrian prisons in early 2025, the SRC and ICRC organized four online workshops to support professionals meeting released detainees and their families. The sessions covered trauma-informed care, ambiguous loss, the psychological consequences of torture for adults and children, and life management systems for survivors and families. The workshops, delivered jointly by SRC and ICRC specialists to SARC and ICRC MHPSS staff, drew on the SRC’s long-standing experience in providing rehabilitation to torture and trauma survivors in Sweden. They reinforced trauma-informed principles for work with torture and trauma survivors and strengthened referral pathways between the organizations.
This experience illustrates that while pre-planned training modules are central for progressive skill development, supplementary online workshops ensure that professional support remains responsive to evolving needs. Training and supervision are delivered through a hybrid model conducted in person by ICRC colleagues in Syria and remotely by SRC specialists in Sweden, allowing for continuous support despite access constraints and security challenges.
Supervision as a core component of the capacity-building model
Supervision has proven a critical component of the ICRC–SRC capacity-building model, providing ongoing support and guidance to psychologists applying trauma-focused interventions such as NET and CBT for PTSD. It focuses on the clinical application of these interventions, fostering a collaborative and supportive learning environment where practitioners can present cases, discuss dilemmas and receive guidance from more experienced colleagues. Regular follow-up is conducted by ICRC field officers and delegates, complemented by online sessions with SRC supervisors, which provide a structured space for case discussions, strengthen practitioners’ skills and reinforce reflective clinical practice.
The provision of ongoing supervision distinguishes this model from other humanitarian capacity-building approaches. While workshops transmit theoretical knowledge, supervision enables its integration into practice, helping practitioners to navigate implementation challenges and maintain quality standards over time. The experience from this partnership shows that without reinforcement, technical knowledge quickly erodes, particularly in crisis environments where competing demands and limited peer support strain professional practice.
The role of multidisciplinary care in trauma rehabilitation
This section examines why the ICRC–SRC partnership has deliberately adopted a multidisciplinary approach – building the capacity of physiotherapists and social counsellors alongside psychologists – rather than concentrating resources within a single profession. This mirrors practice, where psychotherapy constitutes the core treatment modality, complemented by physiotherapy and psychosocial counselling within an integrated framework.
Why multidisciplinary approaches matter
Research consistently demonstrates that trauma rarely confines itself to a single dimension of human experience, simultaneously disrupting emotional stability, bodily regulation and social connectedness.Footnote 31 Psychological trauma breaks connections within the brain and between mind and body, also commonly affecting the ability to form and maintain social relationships.21 Recovery therefore depends on interventions that address mind, body and social functioning in parallel – a principle supported by extensive evidence demonstrating that multidisciplinary rehabilitation improves outcomes across diverse traumatized populations.Footnote 32 While psychotherapy provides the foundation for processing traumatic memories and restoring psychological coherence, physiotherapy addresses bodily dimensions of trauma, and psychosocial counselling supports reintegration into daily life and community.
Psychotherapy: Core treatment for trauma
Psychotherapy constitutes the core of trauma treatment, enabling survivors to process overwhelming experiences and integrate them into coherent life narratives. Through training in NET and CBT for PTSD, Syrian psychologists gained evidence-based tools for conceptualizing the impact of trauma, developing individualized treatment plans and implementing relevant evidence-based trauma treatment interventions.
Post-training evaluations documented marked increases in participants’ confidence when formulating trauma cases and applying therapeutic methods, particularly Socratic dialogue, imaginal exposure and relapse-prevention planning. The combination of structured training and ongoing supervision proved essential, not only enhancing technical competence but also fostering reflective clinical practice. In humanitarian contexts like Syria, where psychologists often work in isolation, continuing supervision by ICRC field officers and SRC experts provides critical professional support, creating space for case consultation, troubleshooting, and maintaining trauma-informed principles in practice.
Physiotherapy: Addressing somatic dimensions
Physical manifestations of trauma – chronic pain, muscular tension, hyper-arousal, dissociation – are common among people affected by violence and torture yet have historically received insufficient attention in humanitarian MHPSS programming. Body-oriented approaches provide complementary “bottom-up” interventions that enhance body awareness and address somatic dysregulation alongside psychological treatment.Footnote 33
Recognizing this evidence, the Syria initiative has trained forty-two physiotherapists from SARC and the ICRC in trauma-focused physiotherapeutical approaches, including basic body awareness therapy methods. Participants learn to identify links between psychological trauma and somatic dysfunction, apply grounding techniques, and recognize when referral to mental health specialists is needed. Post-training evaluation data from this single cohort of physiotherapists suggests increased awareness of mind-body connection, with some participants noting the perceived usefulness of body-based methods as a complement to psychotherapy, particularly in cases characterized by anxiety or avoidance.Footnote 34 This integration has strengthened coordination between MHPSS and physical rehabilitation programme units, recognizing that physical rehabilitation facilities represent crucial entry points for identifying psychosocial distress – many trauma survivors first present with somatic complaints rather than psychological symptoms.
Psychosocial counselling: Supporting reintegration
While stabilization and symptom reduction are essential, trauma recovery ultimately requires restoration of social functioning and meaningful participation in daily life. Psychosocial interventions focus on restoring agency, rebuilding relationships and reconnecting with education, employment and community activities – dimensions critical for sustained recovery.
Through life management system training in 2024 and 2025, SARC counsellors and social workers enhanced their ability to help individuals set achievable goals, manage family relations and reconnect with livelihood opportunities. These interventions address ongoing daily stressors – displacement, stigma, economic precarity – that often represent as significant barriers to recovery as traumatic memories themselves. Psychosocial counselling complements psychotherapy and physiotherapy by translating clinical gains into sustainable life changes embedded in social contexts, linking personal recovery with community-level resilience.
Operationalizing Movement MHPSS principles
Within the Movement’s MHPSS Framework, care extends across a continuum from community-based psychosocial activities to specialized clinical services. The ICRC–SRC cooperation in Syria positions its capacity-building within this continuum, ensuring that strengthening one layer reinforces others. In practice, psychotherapy serves as the core treatment modality, with physiotherapy and psychosocial counselling as essential complements. The approach draws on experience from SRC Treatment Centres for Persons Affected by War and Torture, where multidisciplinary teams work in close coordination to address trauma’s interconnected dimensions.
The multidisciplinary capacity-building model operationalizes key principles of the Movement’s MHPSS Framework. First, it provides a layered support approach by connecting specialized services with broader focused and community-based trauma-informed interventions to ensure integration across the MHPSS pyramid. The approach rests on the premise that no single layer suffices and that effective systems depend on integration and the ability to move individuals between layers as needs evolve. Second, it ensures continuity through supervision by embedding learning within ongoing professional accompaniment rather than one-off workshops; evidence shows that supervision prevents professional isolation, maintains quality standards and sustains trauma-informed practice over time. Third, it advances localization by training national professionals within their own institutions while fostering cross-institutional collaboration. When professionals understand one another’s roles and establish referral protocols, they create coordinated care pathways that enhance service delivery across organizational boundaries.
The ICRC–SRC partnership in Syria demonstrates that effective trauma rehabilitation in conflict settings requires investment beyond single-discipline capacity-building. However, translating training into sustained practice change requires more than technical competence; it also demands organizational commitment and resource allocation.
Outcomes and lessons learned
Post-training evaluations from Syria initiatives provide evidence of several positive developments.Footnote 35 Quantitative evaluation data show high satisfaction rates, and participants marked increases in confidence when formulating trauma cases and applying trauma-related treatment methods, highlighting specific learning gains in the use of Socratic dialogue, imaginal exposure and relapse-prevention planning. Several participants emphasized the motivational value of group case discussions and role-play in consolidating learning, confirming that experiential learning methods enhance skill acquisition beyond that provided by didactic instruction.
Qualitative feedback from participants consistently identified several valued aspects of the training approach. The continuity of working with the same cohort over multiple training modules fostered peer support networks and opportunities for mutual learning. Participants noted the benefit of multidisciplinary exchange, with psychologists reporting value in “networking with physiotherapists”, while physiotherapists described how understanding mental health dynamics improved their patient interactions. The modular structure that builds progressively on foundational knowledge was viewed as more effective than isolated workshops, and participants consistently requested more time devoted to practice and role-play, underscoring the importance of hands-on learning for consolidating clinical skills.
These evaluations provide important indications of training outcomes and demonstrate the value of the initiative’s approach, but they need to be complemented with more systematic evidence on changes in clinical practice, service delivery quality and patient outcomes. The initiative incorporates ongoing supervision to support the translation of training into practice, but longer-term follow-up will be necessary to assess its ultimate impact on MHPSS service quality.
Lessons for capacity-building in conflict settings
Beyond specific training outcomes, the Syrian experience has generated several cross-cutting lessons relevant to capacity-building in similar contexts:
• Needs-based training design: Training content is most effective when grounded in a clear assessment of existing capacities and identified needs. Aligning training content with participants’ prior knowledge, competencies and roles helps ensure that modules are neither too advanced nor too basic, and that they directly address operational gaps. This increases relevance, enhances learning outcomes and supports the transfer of skills into practice.
• Contextual adaptation: Across all training modules, the SRC and ICRC emphasize contextual adaptation as a core component of competency development. Throughout workshops and supervision, Syrian practitioners actively shape the application of the methods to ensure cultural and contextual relevance. Evidence-based methods are therefore treated as flexible frameworks that are co-adapted with participants to respond to the needs identified in their clinical practice.
• Supervision as an essential component: Regular follow-up through supervision has proven indispensable for translating knowledge into sustained practice change. Technical knowledge degrades over time without follow-up and reinforcement, particularly in stress environments where competing demands and limited resources challenge sustainability.
• Peer learning and professional identity: Working with the same cohorts over multiple years enables prolonged learning and retention as well as fostering the establishment of professional networks and mutual support. Participants valued not only the formal content of the training but also the relationships formed with peers facing similar challenges, creating communities of practice that extend beyond structured training sessions.
• Flexibility within structure: The partnership’s ability to rapidly organize supplementary workshops responding to emerging needs (such as prisoner releases) demonstrates the value of adaptive programming. It illustrates that while pre-planned training modules remain central for progressive skill development, supplementary workshops ensure responsiveness to evolving capacity needs without compromising the structured learning pathway.
• Multidisciplinary integration: A key lesson is the importance of expanding the reach of trauma-focused capacity-building initiatives beyond mental health specialists to physiotherapists and social counsellors. This multidisciplinary approach allows for the establishment of intra- and cross-organizational referral pathways, facilitating earlier identification of psychological distress and broadening access to trauma-informed care across multiple entry points.
Challenges and contextual constraints
There are several factors that have influenced the pace and scope of implementation. The volatile security situation in Syria has at times delayed training activities, while remote delivery modalities – necessitated by access restrictions and resource limitations – have limited the possibility of interactive learning through components such as role-play and skill demonstration.
Despite improvements in referral mechanisms, institutional barriers to intra- and cross-organizational cooperation remain, limiting continuity of care and coordination between actors. A critical challenge is that embedding multidisciplinary, trauma-informed approaches within organizations requires sustained organizational engagement beyond individual capacity-building. Technical competence among professionals is not sufficient without managerial commitment and resource allocation that enables trained staff to apply their skills in practice. Addressing these systemic dimensions remains an ongoing priority as the initiative develops, but the Syrian experience makes a strong case that sustained, multidisciplinary capacity-building can strengthen national MHPSS systems amid protracted crises marked by insecurity, resource scarcity and health system fragmentation
The following section draws on the evidence base and clinical experience to highlight the need for integrated professional competencies and coordinated care pathways in response to trauma’s effects on mind, body and social functioning.
Discussion and conclusion: Implications for sustainable MHPSS capacity-building
This article illustrates how the ICRC–SRC partnership’s capacity-building approach represents a tangible effort to transform Movement MHPSS Policy commitments into practical outcomes in humanitarian settings. Drawing from the experiences in Syria and other contexts, the model shows that investing in local professional competence strengthens both the quality and continuity of care, moving beyond short-term project logic to build a professional practice that can persist within fragile health systems and evolve as needs change.
Added value of partnership and complementarity
The partnership showcases the potential of complementarity within the Movement. By linking the ICRC’s operational presence and contextual understanding with the SRC’s trauma expertise, it demonstrates how Movement components can align their comparative advantages to reach common goals. The collaboration operationalizes the intent of the Movement’s MHPSS Policy commitments, which call for integrated, mutually reinforcing efforts to strengthen MHPSS systems.
In Syria, this alignment proved particularly valuable. The ICRC’s established relationships with SARC and the MoH ensured contextual adaptation and access, while the SRC contributed expertise and trauma-focused methodologies drawn from decades of rehabilitation work. Together, these strengths created a capacity-building initiative that was both technically sound and locally owned.
Sustainability through progressive learning, supervision and localization
Sustainability in humanitarian MHPSS capacity-building depends less on the number of trainings than on learning depth and continuity of support. The ICRC–SRC model illustrates how supervision and mentoring extend learning outcomes by embedding professional development within national institutions. Sustained engagement with the same cohorts of professionals over several years has enabled progressive skills development and gradual integration of trauma-informed interventions into their practice, as well as fostering peer networking.
Localization is equally central. By training professionals across Syria, working in SARC clinics, MoH facilities, hospitals, and rehabilitation centres, the initiative promotes national ownership of MHPSS services while embedding multidisciplinary approaches within existing systems. Effective trauma care requires collaboration across professions and institutions ensuring continuity of care. This approach recognizes local professionals as co-producers of practice and positions them as the key guarantors of quality and sustainability within national MHPSS systems.
Challenges and enabling factors
Implementation has faced predictable challenges. Insecurity, resource constraints and limited access have required adaptive strategies such as hybrid training formats and remote supervision, and while these have ensured continuity, they have also sometimes reduced opportunities for experiential learning through observation and practice. Institutional barriers and funding gaps continue to limit progress in referral coordination and the sustainability of supervision structures.
These challenges highlight that sustainable capacity-building in conflict and post-conflict settings requires investment not only in individual competences but also in strengthening the actual systems that support practice, including supervision structures, referral networks and institutional development. Addressing these constraints requires organizational commitment and funding. Embedding supervision and multidisciplinary collaboration within institutional systems depends on leadership support, resource allocation and adequate systems being in place; technical competence alone is insufficient without managerial backing and mechanisms that allow staff to apply skills in practice.
Several factors have nevertheless enabled progress. The hybrid model – combining in-person sessions by ICRC staff in Syria with remote supervision from SRC specialists in Sweden – has proven particularly effective in maintaining support during periods of restricted movement, and the long-term continuity and local anchoring of the partnership has fostered trust and a common foundation for collaboration. These lessons suggest that sustainable capacity-building requires both structure and flexibility.
Transferability and future directions
Beyond Syria, the ICRC–SRC cooperation offers lessons for strengthening MHPSS systems in other protracted contexts. Its key components – tiered training, structured supervision, multidisciplinary integration and institutional partnership – are adaptable across settings and align with WHO and IASC guidance on community-based, stepped-care approaches.
Looking ahead, further standardizing of supervision frameworks across professional groups would improve coherence and scalability. Strengthening links with academic institutions and professional associations could enhance recognition and sustainability, while documenting outcomes through systematic evaluation would help demonstrate effectiveness and guide future policy and investment in MHPSS capacity-building.
Concluding reflections
Reflecting the Movement’s layered approach to MHPSS, sustainable MHPSS capacity-building rests on three pillars: continuity, supervision and integrated care. Training alone does not create sustainable systems; it is the combination of structured learning, supervision, and organizational commitment that transforms individual competence into institutional capacity.
The ICRC–SRC partnership demonstrates that investing in local professionals and establishing supervision structures can bridge immediate humanitarian response and long-term recovery. Supervision consolidates learning, maintains ethical standards and fosters professional well-being. By embedding training and supervision within national institutions and across professional disciplines, the initiative has strengthened ownership and continuity of MHPSS services, operationalizing the Movement’s commitments to localization, accountability and sustainability.
The partnership further illustrates how complementary Movement capacities and cooperation can strengthen health systems The ICRC’s operational presence in conflict-affected contexts and established cooperation with local partners – including SARC and the Syrian MoH – provide contextual understanding and access. The SRC contributes clinical expertise and trauma-focused methodologies developed through decades of rehabilitation work. By aligning their comparative strengths, Movement components, in cooperation with other actors, can collectively advance the quality and sustainability of MHPSS interventions.
Ultimately, the ICRC–SRC partnership illustrates an approach for translating MHPSS policy into action. It shows that strengthening professional capacity is both a technical investment and a humanitarian imperative for building resilient MHPSS systems in conflict-affected settings.
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