leszno declaration

Leszno Declaration

in support of individuals affected by war and military conflicts, and their mental health professionals - psychiatrists, psychotherapists, therapists, and allied personnel

In response to the devastating impact and trauma of war and military conflict this declaration recognizes the undeniable urgency of the needs of the people affected – children, adolescents, and adults. The challenges they face necessitate dedicated and tailored support, for individuals and intact or remnant families striving to rebuild their lives.

As well, central to this initiative is support requested for psychiatrists, psychotherapists, therapists,  and allied mental health professionals working in war-affected regions, whose expertise in addressing the effects of physical, emotional, and economic traumas, sexual violence, and neglect, is vital to peoples’ recoveries and fostering their emotional resilience.

This statement does not ignore the crucial  care rendered by other medical professionals, comprising various specialties, who render highly needed and required aid and treatments. However, this declaration deliberately focuses on the mental health needs of those affected directly by war and military conflicts and the unique challenges encountered by their providers.

Objectives:

  1. Significance: Psychiatrists, psychotherapists, therapists, and allied mental health professionals working in war-affected and related areas are continously exposed to the sequelae of violence. From both human and moral perspectives, these painful impacts deserve the attention of the international community.
  2. Supporting Specialists: Psychiatrists, psychotherapists, therapists and allied mental health professionals working in these challenging war-related conditions will often experience significant emotional and ethical burdens consequent to their work. This declaration expresses support for these professionals who dedicate themselves to helping people suffering from war-related traumas.
  3. Ensuring Standards of Care: This declaration commits mental health professionals to the maintenance of the highest standards of care as stipulated by United Nations conventions and protocols, World Health Organization guidelines, and professional disciplines’ codes of ethics. It is essential to adhere to such standards in order to ensure the quality and effectiveness of the provided assistance.
  4. Collaboration and Training: Collaboration among mental health specialists and their professional organizations is crucial to the provision of comprehensive quality care. Such collaboration, and the organization of training and workshops to develop competencies in the delivery of psychological and related support, is strongly encouraged and urged.
  5. Facilitating Access: It is important to ensure access for mental health workers, who are caring for victims and survivors suffering from war-related traumas and their psychosocial consequences, including psychiatric disorders, and traumas, to mental health care for themselves. The unique therapeutic work they provide can be enormously demanding, draining, and the provision of such needed mental health aid to providers ultimately benefits the war-traumatized individuals and families receiving care.
  6. International Cooperation: This declaration calls on the international community to collaborate in the provision of substantive and financial support for initiatives designed and organized by mental health professionals for victims and survivors of war-related violence. As well, this declaration is intended for the provision of professional psychosocial support to all individuals affected by war and military conflict, independent of geographic location.

War-related Traumas include:

Individuals who:

  1. Have experienced direct war activities, eg., military personnel and civilians, are imprisoned in war and military conflict zones, and victims of related attacks.
  2. Are refugees, repatriated and/or displaced persons, ie., individuals forced to leave their homes and countries of origin who experience trauma related to these losses.
  3. Are direct witnesses to the suffering of others including psychiatrists, psychotherapists, allied mental health specialists, humanitarian aid workers, journalists, and others present during war conflicts, who develop (secondary traumas, vicarious traumas, or retraumatization) due to observing significant suffering.
  4. Are indirect witnesses to war and military conflict activities via viewing of media.


Experiences of War Violence:

  1. Physical – violation of physical integrity, inclusive of imprisonment, abuse, and/or torture.
  2. Psychological – resulting from, eg., constant exposure to life-threatening situations, witnessing violence against others, social isolation, and/or lacks of emotional support.
  3. Sexual – violations inclusive of rape, sexual exploitation by authority figures, forced marriages, sexual harassment, and/or intimidation.
  4. Economic – violations of property rights, inclusive of destruction of property, burglaries, thefts, extralegal dispositions of property, forced labor without compensation, loss of income sources, destruction of means of production and livelihood.
  5. Neglect – violations of the ordinarily expected duty of care by caretakers resulting from forced deprivations of food, shelter, and other basic needs, lack of access to education, particularly for children and youth; lack of access to healthcare; inability to ensure safety and stability impacting the most vulnerable, ie., children and the elderly.


Psychosocial Consequences

The development of mental disorders, particularly post-traumatic stress disorder (PTSD) of varying intensity and duration, which may emerge from either direct or indirect exposure to war-related violence.


Transgenerational Consequences

Children and grandchildren of individuals who have experienced war traumas may incorporate the traumas of their ancestors and suffer accordingly.

Declaration

    1. We express deep concern and compassion for individuals and families challenged by harrowing wartime experiences and acknowledge the need to provide them with care, support, and assistance. We also emphasize the diversity of needs of adults, adolescents, and children affected by war and military conflict, recognizing that specialized care is required by these different age groups.
    2. We emphasize the importance of ensuring access to expert psychiatric, psychotherapeutic, therapeutic, and allied mental health-related assistance for individuals and families affected by war trauma and related experiences.
    3. The provision of assistance to all individuals suffering from the consequences of  war-related traumatic experiences requires high standards of care and professionalism.
    4. War-related traumatic experiences require the provision of unique understanding, sensitivity, and dedicated actions from mental health professionals.
    5. We commit to support the professionals providing care for those affected by war-related violence by providing them with the tools necessary for their work.
    6. We emphasize the need to provide emotional and psychological support for psychiatrists, psychotherapists, therapists, and allied mental health professionals who work in challenging war-related settings and may consequently experience secondary trauma, vicarious trauma, and/or retraumatization.
    7. Fostering collaboration among specialists and organizations, and organizing training and workshops to enhance competencies in assisting individuals affected by war-related traumas, is a necessity.
    8. We commit to openly communicate, share experiences and knowledge, and improve efforts designed to better the lives of all those directly and indirectly impacted by war-related violence.
    9. We call upon the international community to provide support for initiatives targeting care for individuals directly and indirectly affected by war-related trauma.
    10. We appeal to international humanitarian aid groups, health provider organizations, national governments, European Union and United Nations agencies devoted to global engagement and mobilization to work toward the goals of providing aid and support for individuals and families affected by war-related trauma and violence, and likewise to the aforementioned mental health workers providing support to the people affected by war-related violence.


On November 24, 2023, the document was for the first time signed in Leszno (Poland) and read out.

 

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Sign the declaration

References

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  6. Johnson, R.J., Antonaccio, O., Botchkovar, E. et al. War trauma and PTSD in Ukraine’s civilian population: comparing urban-dwelling to internally displaced persons. Soc Psychiatry Psychiatr Epidemiol 57, 1807–1816 (2022). DOI:10.1007/s00127-021-02176-9
  7. Killian, K. D. Helping Till It Hurts? A Multimethod Study of Compassion Fatigue, Burnout, and Self-Care in Clinicians Working With Trauma Survivors. Traumatology, 14(2), 32-44. (2008). DOI:10.1177/1534765608319083
  8. Musisi, S. & Kinyanda. E. Long-Term Impact of War, Civil War, and Persecution in Civilian Populations—Conflict and Post-Traumatic Stress in African Communities. Front. Psychiatry 11:20 (2020). DOI: 10.3389/fpsyt.2020.00020
  9. Sangalang, C. C. & Vang, C. Intergenerational trauma in refugee families: A systematic review. J. Immigr. Minor. Health 19(3), 745–754 (2017). DOI:10.1007/s10903-016-0499-7

  10. American Psychological Association: Ethical Principles of Psychologists and Code of Conduct. https://www.apa.org/ethics/code [access: 05.11.2023]

  11. United Nations High Commissioner for Refugees: MHPSS Annex of Public Health Strategy 2021-2025. https://www.unhcr.org/media/mhpss-annex-public-health-strategy-2021-2025?fbclid=IwAR1DlXsIrZ9KnjSelKP4Kpuc7UjkZvjCqYOUkQ_8akyzYxQ5p91CHhesPAQ [access: 10.11.23023]

  12. World Health Organization: World mental health report: Transforming mental health.  16 JUNE 2022. https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.who.int%2Fteams%2Fmental-health-and-substance-use%2Fworld-mental-health-report%3Ffbclid%3DIwAR3YKqhrMbLOud70qh8TXbJYo0RhS8sSqi8yvpUBOyoR9SjORk2v9HDraLY&h=AT3YsNPaY1rwZq2IHdNDetXLxYTN4ghQaQIsetoVFCto9IKQeyzms0ASxNhcY6TS5t_HJWahExSruXVHt3SuwgbRqFIrN6O8-X4-dUODy8AshZkGzw8szu96ax3oZxedt15ptg [access: 05.11.2023]

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