Mental Health and Psychosocial Support in Hebron
Background
Médecins Sans Frontières (MSF) has a longstanding history providing medical and humanitarian assistance in Palestine. The Mental Health and Psychosocial Support (MHPSS) program operated by MSF has been in Hebron for nearly three decades (since 1996). The period between 2018 and 2024, was marked by significant contextual factors such as increased violence in Palestine, recurrent external restrictions on MHPSS operations, the COVID-19 pandemic, and a fragile public health infrastructure in Hebron. In this context of environmental uncertainty, complex care needs, and initiation of new practices MSF iteratively adapted the MHPSS program to address the community’s needs.
Context for Review
Due to the numerous shifts and adaptations required to make the program responsive and operational during the 2018-2024 period (e.g., increase in the number of mobile clinics, use of telehealth, nationalization of some staff roles), MSF initiated this review to assess how MHPSS adapted to prolonged political instability, recurrent violence, public health emergencies, and structural constraints within the Palestinian health system. Specifically, the review explored:
- What new MHPSS programs or initiatives were implemented and/or what existing MHPSS programs were adapted in Hebron from 2018-2024?
- What contextual factors may be affecting the success of these programs and initiatives in the context of Hebron from 2018-2024?
- What potential impacts have these programs and initiatives had on patient attendance and/or outcomes for the Hebron context from 2018-2024?
Summary of Methodological Approach
This review was not designed as a formal performance evaluation but as a reflective analysis of program evolution and adaptation during a period of sustained instability. The current review followed methodological principles consistent with Developmental and Formative Evaluation. A Developmental Formative Evaluation is used to enhance the success of a program(s) or intervention(s) by exploring their fit and feasibility for beneficiaries, MSF staff, and the context while these program(s) or intervention(s) are in use. The reviewers used the Health Equity Implementation Framework (HEIF) to analyze qualitative data from MSF documents (e.g., annual plans and reports) with the goal of identifying potential barriers and facilitators to successful MHPSS programming in Hebron. The HEIF was used to develop an interview protocol. Semistructured interviews were conducted with 14 staff. The sample consisted of 9 international and 5 national staff, whose tenure with MSF ranged from 2 months to 7 years and spanned 2018 to present. Interviews included therapists, supervisors, mental health activities managers (MHAM), medical coordinators, and mental health advisors, and technicians. Please see Annex V for interview participants’ demographics. The reviewers used findings from the qualitative analysis of documents and staff interviews to develop plausible interpretations (i.e., triangulation) of previously analyzed beneficiary attendance and outcome data. Preliminary analysis was shared with the review commissioners and MSF VEU team for validation. Their feedback was incorporated into the final analysis presented in this document.
