Three years of war in Sudan. One of the largest humanitarian and displacement crises in the world. More than 1.3 million Sudanese refugees have arrived in Chad since the beginning of the war, around 47,000 of whom are currently living in Metche camp, on the eastern border with Sudan. Literally in the middle of nowhere. At the Médecins Sans Frontières (MSF) hospital in Metche, there is a specialized mental health department providing support to both children and adults. The mental health team conducts individual and group sessions, offers psychiatric services, crisis interventions, support for survivors of sexual and gender-based violence, psychomotor support (psychostimulation) for malnourished infants and their mothers, activities for children, as well as rehabilitation activities for people living with severe chronic mental health conditions. Katia Koumantou, clinical psychologist and MSF mental health activities manager, explains in more detail what these activities involves.
Focusing on the most serious cases, what do you encounter most often in Metche in terms of mental health?
All cases are serious. But if we were to define the most severe ones, they would be cases where there is an increased risk either for the person suffering or for the people around them. Very often, we see deep and chronic trauma expressing itself in complex ways, from severe psychological exhaustion to other more serious mental health symptoms that can lead to difficulty thinking clearly, staying organized or losing touch with reality. What we see, however, is that most of the people we follow began developing symptoms after the war, after witnessing extreme violence and inhumane conditions.
At the same time, we have observed a very significant increase in substance use, particularly among young adults, as a way of coping with trauma and emotional pain. In many cases, this eventually becomes linked to severe psychotic symptoms and a major deterioration in mental health.
We also see children with neurodevelopmental difficulties, either congenital or following severe illnesses that affected the brain, often due to limited access to appropriate care and treatment in the past. Many of these children still do not have access to the specialized rehabilitation they need, which frequently leads to a further worsening of their condition.
How is the MSF mental health team trying to respond to these complex needs within the context of Metche?
MSF responds through specialized and evidence-based mental health approaches, including psychological and psychiatric support, clinical protocols, and continuous supervision of mental health staff. But the reality we are facing is so complex that, many times, we need to return to the most basic human needs. Safety, expression, and connection!
This is how we created a rehabilitation group for adults living with severe mental health conditions, where we adapted techniques and tools often used in child support interventions, such as parallel play, creative activities, and expression through art. Almost like a small return to childhood. A safe space where people can share stories, play, create, and simply exist together with others. People of different ages, stories, and difficulties, all sharing the same need of human connection, acceptance, and a small sense of normality within the chaos.
In these photos that you took, we see people from this rehabilitation group trying to form a heart, each in their own way. What did this activity represent, and what did you observe through it?
This activity took place during one of our group sessions, where we discussed emotions and how, in the end, people often feel the same things, but express them differently, because each person has different experiences and a different story. Just like these hearts, none of them were the same. Each person created their own way, according to their own abilities, and yet every single one of them was beautiful. For us, this represented the idea that every heart carries a story, and every story deserves to be heard. It was about expression, but also about accepting differences. Especially for people who, for a very long time, felt seen only through the lens of illness and stigma, rather than as whole human beings.
What have these activities shown you about the needs of people, behind the symptoms and the trauma?
People lost their dreams coming here. The need for connection, creativity, and the need to continue dreaming became central in these group sessions. Trauma is not only a memory; it changes the way a person experiences the world and the sense of safety around them. When someone has lived for a long time in fear and survival mode, the body and the brain remain in a constant state of alert and dysregulation, as if the danger is still present.
This is what these group sessions try to do. To help people feel present again, even if only for a moment. To reconnect with themselves and with others. To feel safety, expression, and human presence again. Because every human being deserves the right to dream. And in those smiles, we can see pieces of safety, connection, and hope slowly returning.
Through your experience in Metche, what has impacted you the most regarding mental health and the people there?
Three things impacted me the most.
- The first is how much mental health has gradually become de-stigmatized within the community. Through the team’s daily presence in the field, we see more people speaking openly about their mental health condition and asking for help. And many times, the way mental health is collectively understood and accepted here feels far more advanced than in societies that consider themselves more “developed.”
- The second was the team, “my” team. The people working every day to provide psychosocial support to Sudanese refugees are Sudanese refugees themselves, living inside the camp. And many times, I find myself wondering how much strength this process requires. What emotional endurance does it take to support people who carry the same pain as you?
- The third thing I will always carry with me is the preservation of dignity through small everyday acts. In Metche, temperatures can exceed 40 degrees during the dry season, dust everywhere, and limited access to water. And yet, the women in MH team always wear beautiful dresses perfectly matched with their headscarves, while the men arrive in clean and carefully ironed clothes. They arrive every day with perfume, cleanliness, and dignity while running between the hospital and community activities under the heat and dust.