Experiences of displaced persons during and in the aftermath of the War in Nagorno-Karabakh: a qualitative research study

Abstract

Armed conflicts have resulted in the forcible displacement of almost 80 million population of the world by the end of 2019 recording the highest such number in history. Forcible displacement is defined as leaving homes due to a sudden crisis, including an armed conflict. Armed conflicts and forcible displacement are shown to be associated with multiple mental and physical health disorders among affected population. Also, overall social functioning of displaced people is disturbed. In 2020, a war broke out in Nagorno-Karabakh (NK), an area of conflict between Armenia and Azerbaijan, resulting in around 60,000 people forcibly leaving their homes. During this time, the Republic of Armenia (RA), as the host country was experiencing the second wave of coronavirus disease of 2019 (COVID-19) pandemic, which further restrained the country’s capacity to accommodate the displaced persons. Given this backdrop, this study aimed to explore the experiences of displaced persons during and in the aftermath of the war. Specifically, the study aimed to understand (1) how the displacement happened, (2) how displaced persons were currently living, (3) what were the experiences with psychosocial support are, and (4) what were the perceived needs for psychosocial support. Methods: This qualitative research was guided by the principles of phenomenology. The target population was adult individuals who were forcibly displaced due to the war of NK in 2020. The

data were collected in March 2021 through 12 semi-structured in-depth interviews, either face- to-face or online. The participants were purposefully selected through convenience, snowball,

and maximum variation sampling. The interview guide inquired about the participants’ demographics, displacement process, current living circumstances, psychosocial well-being, and experiences with psychosocial services. The data were analyzed through inductive and deductive thematic analysis, using the pre-defined themes of the Adaptation and Development after Persecution and Trauma (ADAPT) model for part of the data. Results: Seven participants were women and 5 were men, and the mean age of the sample was around 40 years. Most of the participants came from Shushi and the region of Hadrut, and half were currently residing in Yerevan. Three themes were identified: (1) displacement as an overlooked stage of war; (2) psychological support: projecting needs, rejecting services; and (3) adapting to the post-war situation. It was revealed that the participants were left alone as decision makers during the displacement finding themselves in extremely unsafe situations. However, the expectations were low for a system-based support during the process. When speaking about their needs for psychological support, all were skeptical towards the effectiveness of psychological services, as these services concerned themselves. In contrast, they thought that psychological services were useful in meeting the needs of others. Also, low propensity to seek or accept psychological support was identified. Finally, all the psychosocial domains of the ADAPT model were found to be disturbed. The ‘four walls’, a self-owned living place, regained social interaction, restoration of social roles and re-evaluation of existential meanings were reported to be important in the post-conflict adaptation. Conclusions: Displacement is an important war stage which requires proper coordination and communication by the government to ensure residents’ safety. Mental health care professionals and advocates should tailor the provided care integrating the revealed important patterns of perception of psychosocial support to diminish the resistance towards psychological services among the displaced persons. Also, further research on and advocacy for mental health care are recommended to thoroughly understand the reasons behind the skepticism and the resistance to psychological services and to enhance the overall mental health literacy in the population. Finally, a re-establishment of safe, predictable and comfortable environment, eliminating social stigma towards the displaced persons and promoting social engagement and integration, are needed as urgent measures to support recovery and adaptation.