These are the words of Armand Tchoffouo, the Democratic Republic of Congo (DRC) National Director of SOS Children’s Villages. His words are especially troubling given that children without parental care have unique needs, especially support for their mental health.

Over 200 million school-aged children and young people worldwide are affected by humanitarian emergencies. Because of these crises, they are at severe risk of developing mental health conditions such as depression, anxiety and post-traumatic stress disorder. Up to 142 million children live in conflict zones, with an estimated 24 million experiencing high levels of distress and needing mental health support.

Greater risk of exploitation

Not only do these children require immediate access to essential services such as healthcare, education, and psychosocial support, but children separated from parents are at greater risk of abuse, exploitation, and violence, including abduction, forced recruitment and trafficking. They may also face arrest or detention due to perceived association with armed groups and experience ostracization or victimization by authorities.

The world's eyes are currently on Gaza, and it is no surprise that Gaza's children have been deeply traumatized. As Zoya Thalgieh, an SOS Children's Villages psychologist in the West Bank who works with children evacuated from Gaza, says: "In our setting, trauma shows itself most clearly through behaviour. Many children act out with aggression, either verbally or physically. Some harm themselves, while others sink into deep hopelessness or anxiety. For many, anger becomes the only way they know how to hide their fear and grief."

Her words are echoed by Baker Awad, an SOS Children's Villages psychologist working in the Gaza Strip, who says: "The most serious issues are the psychological effects of worsening hunger and famine, which directly impact the most vulnerable groups—children, women, and the elderly. Among displaced children, the lack of basic necessities inside camps has resulted in both health and psychological problems".

But extraordinary as it may sound, there is little evidence that any extra or special support is generally granted to children. According to a 2019 report, Mental Health and Psychosocial Support (MHPSS) received only 0.14% of Overseas Development Assistance funding between 2015–2017, indicating limited resources for children's mental health in emergencies.

A paper in 2023 suggested that a shortfall of nearly $650 million in child protection funding is leaving nearly 18 million vulnerable children and caregivers living in the world's worst humanitarian crises at risk of violence, exploitation and abuse. The same report suggested that the shortfall would reach $1billion if the trend remains in place.

As Orso Muneghina, SOS Children's Villages International Mental Health and Psychosocial Support Lead makes clear, "Children in humanitarian crises already face collapsing protection and very fragile mental health systems, and a billion-dollar funding gap would mean stripping away the very last safety nets, leaving millions exposed to violence, exploitation and trauma."

Children retraumatized by everyday events

This absence of support has numerous implications. Firstly, children can be retraumatized by everyday events. Huge anxiety can be triggered by loud noises because it reminds children of violence they have witnessed. The loss of stability and repeated displacement causes daily stress and trauma, with children repeatedly asking themselves how long the trauma will continue. It is particularly challenging when children have witnessed their parents killed in front of them.

There is now evidence that this trauma has become intergenerational. According to a recent report by Rwanda's Ministry of Health, at least one in two Rwandans have experienced trauma, which means that young people are currently living with transgenerational trauma. And as Jean Bosco Kwizera, national director of SOS Children’s Villages in Rwanda points out, “If you are not mentally well taken care of, it has an impact on your decision making, your education, your concentration on tasks, and how you grow up responsibly."

'Inside their minds is chaos'

Above all, though, children without parental care need emotional support. As Gina Nqabakazi South Africa’s SOS Children's Villages National Director says, "Children may have shelter, food, clothing — but inside their minds there is chaos. They still have a lot of healing to do, and the environment does not provide a platform to lay out their turmoil, confusion, and anxiety."

These children are crying out for support. SOS Children's Villages has been at the forefront of the response, often deploying innovative techniques in crisis, or former crisis zones across the world, providing sustained mental health and psychosocial services to children in long-term crises.

As Anastasiia Karandashova, psychologist and MHPSS Advisor in SOS Children's Villages Ukraine says: "It is very important for such a child to have a “witness” to their experiences — an adult who can notice, listen, acknowledge the pain, offer support, and show that life also has another side. That while difficult events affect life, they do not define the person. This helps restore a sense of stability and control — that there is still something they can influence, even when war is all around."

At SOS Children’s Villages, mental health support is one of the key pillars of its humanitarian response. Through the work of the Global Programme Expert Group on MHPSS, since 2020, SOS Children’s Villages has collaborated with organizations and partners from 58 countries, enhancing the capacity building of 1,200 staff members. In just 2024 alone, more than 3,101 children and young people were supported through the TeamUp intervention – which aims to strengthen the emotional resilience of children – in 19 countries.

Keeping children at the centre of the system

Models like TeamUp meet the needs of children at risk of family separation or children who have lost parental care. Keeping children at the centre of the system, the approach focuses also on families, communities and society at large to build an enabling environment to increase access to mental health and psychosocial support services.

The challenge, as Orso Muneghina explains, is, "how can we provide mental psychosocial support to children and families in low-resource settings." The solution, he says, is the introduction of the 'step-care model'. The team starts with, "the intervention that requires less specialisation and less cost, both for the people that have to access it and the people delivering it. You create a system where the few specialists you have available are actually providing training."

In this way, more intensive care is scaled up only when preventative and universal interventions cannot meet the increased needs for treatment. One method – 'ReachNow' – is a 'case detection tool', consisting of a series of vignettes and images describing prototypical examples of a child that suffers from either the internalization or externalization of problems.

Part of the new process is to train those who are not mental health experts to use the tool to proactively detect children in need and then refer them for further care to specialized resources.

Working with parents in crisis

In Haiti, SOS Children's Villages is piloting programs focused on parents. 'Problem Management Plus' trains staff to work with parents in crisis, helping them manage stress so they can support their children. Schools were identified as spaces to act as protective environments. For parents, the school is no longer just a school but a safe place where they know their children can be cared for.

This emphasis on parents is replicated in South Africa. As Gina Nqabakazi points out, “In parenting networks, parents realize, ‘I’m not alone.’ They share experiences and see that their situation is normal. That is empowering and helps them overcome challenges.”

In Gaza, SOS Children’s Villages contributes to community integration of displaced families by providing specialized psychosocial support programs and activities that help integrate children and adolescents through recreational days, individual and group counseling sessions, awareness activities, and psychological first aid, all of which significantly support participants’ integration into their surrounding community.

What unites all these approaches, however, is that children's own views are central to all approaches. This point is made by Gina Nqabakazi “They [children] don’t understand love — how to receive love and give love. We had to start afresh, working with caregivers to meet them where they are. When children had a voice in shaping their space, everything started to change.”

And when their voices are heard, their true selves are reawakened. As Zoya Thalgieh of SOS Children’s Villages Palestine says: "When a child begins to open to someone they trust, forming a new friendship, or expressing themselves through art or school, it reminds me that recovery is always possible. I also find hope in the commitment of our staff and the kindness of the community. Everyone works with such heart to give the children the care they deserve. Most of all, it’s the children themselves who inspire me."

But despite this, the world cannot be allowed to forget that urgent mental health support is still required for countless children. As Bilal Naem in Gaza says, "Mental health support must be integrated consistently into humanitarian responses, with careful consideration of available resources and priorities, so that it is not treated as a secondary activity but as an essential component of interventions to reduce trauma and strengthen children’s psychosocial resilience."