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Health, psychological and social aspects

Support materials for trainers linked to this module.

1. Methodology 2. Summary 3. Presentation 4. Video 5. Questionnaire 6. Additional resources

Methodology

Duration: 2 hours

In this case, we propose the flipped classroom methodology, seeking to stimulate student proactivity in learning the course contents. To this end, at the end of module 2, students will be provided with the necessary material (a document in pdf format, either printed or accessible on the platform, with the contents of module 3 summarized).

After a careful reading, they will be able to access the usual format of the module; but before the exposition of the contents (both in classroom and online format), the teacher will ask two or three questions of certain complexity that the students will be able to answer in writing on the screen or on paper. They will be of development, but brief in the request of contents.

Then, the more theoretical part will begin with the usual format. Finally, there will be 10 multiple-choice questions of three options of less difficulty (to assess whether to do it on paper or through the platform for the face-to-face format).

The time distribution will be as follows.

The pdf would count as half an hour, the contents with the difficult questions one hour and fifteen minutes, and the test fifteen minutes for both formats (online and face-to-face).

Summary

This module examines the health, psychological, and social dimensions of forced displacement, taking the war in Ukraine as a reference. The massive arrival of people in situations of extreme vulnerability presents not only an organizational challenge for host countries but also an ethical responsibility. Therefore, frontline professionals—educators, healthcare workers, social workers, and volunteers—need tools that allow them to intervene from an integrated, sensitive, and coordinated approach.

Physical Dimension: Health and Access to Care

The health of refugees is shaped by accumulated risks: long journeys, exposure to harsh weather conditions, overcrowding, poor nutrition, and lack of continuous medical care. In many cases, for example, staying in improvised shelters during bombings exacerbated respiratory infections, skin problems, and pre-existing conditions.

The most common health issues upon arrival include respiratory and gastrointestinal infections, musculoskeletal pain, and decompensation of chronic diseases such as diabetes or hypertension. Prioritizing the identification of serious conditions through proper triage is essential, even when there are no obvious emergency symptoms.

Some groups require particularly careful attention, including pregnant or breastfeeding women, children with incomplete vaccination schedules, older adults with chronic illnesses, and people with disabilities. Their personal and medical circumstances involve additional risks and specific needs, making it essential to apply a differential approach that tailors health and social interventions to each individual, ensuring adequate, accessible, and equitable care.

Although the European Union activated Directive 2001/55/EC to guarantee temporary protection and access to basic services, linguistic, administrative, and cultural barriers continue to hinder actual access to healthcare. Lack of knowledge about rights, fear, or missing documentation may prevent people from seeking help.

In this context, educational and community staff act as cultural mediators: providing understandable information, accompanying people to medical appointments, and promoting basic health education (hygiene, rest, nutrition, vaccination). They must also be alert to warning signs such as malnutrition, persistent fatigue, or behavioral changes, interpreting them with cultural sensitivity.

Psychological Dimension: Trauma and Resilience

Forced displacement is a potentially traumatic experience. Exposure to violence, loss of loved ones, family separation, and the destruction of homes can generate reactions such as anxiety, hypervigilance, deep sadness, irritability, or difficulties with concentration. In children, trauma may manifest as regressions, social withdrawal, or repetitive play related to war.

These responses are normal human reactions to extreme situations. However, when they persist over time, intensify, or significantly interfere with daily life, they can develop into disorders such as post-traumatic stress, depression, or severe anxiety, requiring specialized care. In this context, the appearance of self-harming behavior or suicidal ideation should be considered a priority warning sign, requiring immediate intervention and urgent referral to mental health services.

Psychosocial intervention should focus on validating distress without pathologizing it, providing safe spaces for expression, and rebuilding routines that bring stability, as these actions form the foundation upon which resilience can develop. Resilience is strengthened through predictable environments, the presence of available adults, and participation in meaningful activities that restore a sense of control and belonging.

Within this framework, Psychological First Aid (PFA) offers an accessible tool for non-specialized professionals, aligned with these intervention principles. PFAs are based on listening without judgment, validating emotions, conveying calm, and offering practical guidance, while also facilitating access to support networks. In this way, PFAs contribute both to immediate emotional containment and to the gradual strengthening of resilience.

Social Dimension: Integration and Reconstruction of the Community Fabric

Forced displacement involves the loss not only of territory but also of social networks, professional identity, family roles, and cultural references. This disruption can lead to isolation, reduced self-esteem, and difficulty in redefining one’s social role, affecting how people participate and perceive themselves in the host community. For example, qualified professionals unable to practice their profession, parents feeling unable to adequately protect their children, or young people disoriented by new educational systems are common situations that illustrate this complexity.

To counter exclusion and discrimination, it is essential to promote the active participation of refugees, recognize their skills, and avoid paternalistic approaches that limit autonomy. In this regard, schools and other educational spaces play a key role as safe, structured, and socializing environments. An inclusive, predictable, and culturally sensitive climate supports integration, strengthens identity, and prevents bullying and marginalization.

Social inclusion ultimately depends not only on individual actions but on a community-wide process that requires collaboration among institutions, local associations, and citizens. Creating intercultural meeting spaces, promoting mutual aid initiatives, and recognizing the skills and resources that refugees bring helps restore dignity, strengthen autonomy, and rebuild the community fabric.

Conclusion

In summary, this module presents a comprehensive approach that integrates physical health, psychological well-being, and social inclusion. Only through coordinated, empathetic, and intercultural action can the response to emergencies be transformed into an opportunity to rebuild life projects under conditions of dignity and hope.

Video

Video for this module and language.

Resource available for this module.

Questionnaire

HTML link to the module questionnaire.

Resource available for this module.

Additional resources

Self-assessment questions

What is a common condition in refugees after prolonged forced displacement? a) Controlled hypertension without the need for medication b) Respiratory and gastrointestinal infections c) Improvement in dermatological health

Correct answer: b) Respiratory and gastrointestinal infections Comment: Respiratory and gastrointestinal infections are common due to the precarious conditions during displacement, lack of hygiene, and limited access to healthcare.

What barrier might hinder refugees' access to the healthcare system? a) Language and understanding of medical instructions b) Overabundance of information about their rights c) Ease of obtaining medical appointments

Correct answer: a) Language and understanding of medical instructions Comment: Language is a key barrier that impedes effective communication and may limit access to and the quality of care received.

Which of the following is a health warning sign that should be addressed in refugees? a) Good nutritional status b) Chronic fatigue and constant somatic complaints c) High energy and constant physical activity

Correct answer: b) Chronic fatigue and constant somatic complaints Comment: These symptoms may indicate untreated physical or emotional health problems that require attention.

What is a common emotional reaction in people who have experienced forced displacement? a) Anxiety and frequent startle reactions b) Excessive joy and overconfidence c) Total indifference to their surroundings

Correct answer: a) Anxiety and frequent startle reactions Comment: Exposure to traumatic situations generates anxiety, hypervigilance, and post-traumatic stress.

In refugee children with psychosocial trauma, which of the following behaviors might be observed? a) Repetitive play with a war-related theme b) Active and constant participation in classes c) Fluent verbal expression of emotions

Correct answer: a) Repetitive play with a war-related theme Comment: This type of play is a way for children to process their traumatic experiences, showing signs of stress or fear.

What is an important protective factor for enhancing resilience in refugees? a) Lack of routines and clear norms b) Presence of affectionate and consistent adults c) Avoiding discussion of emotions

Correct answer: b) Presence of affectionate and consistent adults Comment: Stable and consistent emotional support is crucial for strengthening resilience and recovery after trauma.

What is a key principle of psychological first aid (PFA)? a) Forcing the person to tell their traumatic experience b) Listening without judgment and validating emotions c) Ignoring emotions to avoid reliving the trauma

Correct answer: b) Listening without judgment and validating emotions Comment: PFA aims to provide containment and security without pressuring the person to recount traumatic details.

In social integration, what impact does the breakdown of the social fabric have on refugees? a) Increased immediate support network b) Feelings of loneliness and isolation c) Better adaptation to the new community

Correct answer: b) Feelings of loneliness and isolation Comment: The loss of social bonds leads to isolation and makes it difficult to feel a sense of belonging.

What is a good practice in educational settings to promote the inclusion of refugee children? a) Segregating groups by language or nationality b) Adapting materials to linguistic and cultural diversity c) Applying the same rigid rules to everyone without adaptation

Correct answer: b) Adapting materials to linguistic and cultural diversity Comment: Adapting resources makes it easier to understand and fosters a sense of inclusion in the classroom

What strategy helps strengthen the community support network for refugees? a) Creating intercultural meeting spaces b) Limiting refugees' participation in community activities c) Promoting isolation to avoid cultural conflicts

Correct answer: a) Creating intercultural meeting spaces Comment: Meeting spaces facilitate integration, cultural exchange, and the building of support networks.

Recommended readings

WHO (2013/2014). Psychological First Aid: Facilitator’s Manual for Orienting Field Workers.

IASC (2007). Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

WHO (2021). Mapping health systems’ responsiveness to refugee and migrant health needs.

WHO. Refugee and migrant health (fact sheet y página temática actualizada).

UNICEF Innocenti (2023). Mental Health in Displaced Child and Youth Populations.

Suggested videos

Psychological First Aid Mobile Team Reaches Ukrainian Refugees

UNICEF and partners help ensure every child's right to mental health