Addressing Mental Health and Substance Misuse in Climate-Displaced Ethiopian Communities

Pastoralism in Ethiopia represents both a cultural heritage and essential livelihood system that spans vast rangelands across the country (Beyene et al, 2024). Pastoral communities occupy 61% of Ethiopia's total land mass, with 97% of Ethiopian pastoralists concentrated in lowland areas of Afar, Somali, Oromiya, and SNNPR regions (Mohamed, 2019). About 10 million pastoralists depend on livestock based livelihoods as their primary source of wealth and subsistence (Ayele et al. 2020).

This traditional lifestyle faces significant challenges that threaten its sustainability. Ethiopian pastoralists now operate over increasingly degraded rangelands suffering from bush encroachment, with shrinking grazing areas due to population growth, agricultural expansion, land degradation, blocked migration routes, and resource-based conflicts (Ayele et al. 2020). These communities face frequent droughts with high livestock mortality that often threatens the viability of pastoral livelihoods and leads to famine (Ayele et al. 2020). Additional pressures include competition for water and pasture, underrepresentation in socio-economic and political activities, ethnic conflicts, and poverty (Mohamed, 2019).

The scale of climate-induced displacement among Ethiopian pastoralists has become severe, with communities experiencing catastrophic losses that force large-scale migration. Migration patterns have fundamentally changed as climate pressures intensify. The increase in frequency and length of drought cycles in Ethiopia have forced herders to move more frequently, often to new destinations for extended periods (Chinasho et al, 2017). However, pastoralist migration faces unique challenges in terms of recognition and protection. Unlike certain categories of migrants, pastoralist migration has not been formally recognised or protected, and administration borders are being drawn without considering pastoralist mobility needs, leading to inter-communal tensions, insecurity and conflict (Chinasho et al, 2017).

Ethiopia had 4.4m internally displaced people as of March 2024 (UN OCHA, 2024).

Ethiopia faces a severe displacement crisis, with over three million internally displaced persons (IDPs) due to political conflicts (often relating to climate change), making it the third largest internal displacement situation globally (Yitbarek et al, 2021).

In Ethiopia, it is estimated that 15% of people are affected by major mental illness or substance abuse disorders (World Health Organization, 2016). The mental health burden is particularly acute in the Oromia region, due to displacement (Yitbarek et al, 2021). Displaced individuals living in settlement camps experience the highest burden of mental health problems, often stemming from the initial trauma of conflict (with many having witnessed the killing of relatives or lost family members entirely) or the ongoing stressful living conditions in displacement settings (Yitbarek et al, 2021). The most prevalent mental health conditions among displaced populations include post-traumatic stress disorder, anxiety, depression, and psychosis; with cases concentrated in camps around Sululta and Bishan Guracha (Yitbarek et al, 2021).

Substance use presents as an additional challenge, with notable research showing that approximately 62% of Ethiopian university students use at least one substance, most commonly alcohol (Yitbarek et al, 2021) (Tesfaye et al, 2014). Khat chewing affected roughly 23% of Ethiopian university students, with the highest use in Oromia region at 32% (Yitbarek et al, 2021) (Gebrie et al, 2018). Depression significantly increases the likelihood of substance use by approximately three times (Yitbarek et al, 2021) (Tesfaye et al, 2014).

Cultural responses to mental health problems among displacement populations often involve traditional and religious approaches, with many associating mental illness with evil spirit possession or divine punishment for sins (Yitbarek et al, 2021).

Research supports several key approaches for addressing mental health and substance misuse in displaced populations. Some examples include:

1. Ethiopia's Productive Safety Net Programme provides cash transfers to reduce food insecurity from droughts and supported community relocation to safer areas where their lives and health are not threatened by climate disasters (Pega et al, 2015). These safety net programs address fundamental stressors that contribute to mental health deterioration in displaced populations. Such programs can help prevent the acute psychological trauma associated with sudden displacement while ensuring basic needs are met during transition.
2. Screening, Brief Intervention and Referral to Treatment (SBIRT) systems provide an evidence-based framework that can effectively reduce unhealthy alcohol and drug use while addressing co-occurring mental health problems (Kane et al, 2023). These approaches should be integrated into routine clinical practice alongside brief motivational conversations, psychosocial support, and medication-assisted therapies for substance use dependence and withdrawal (Horyniak et al, 2016) (Dua et al, 2011).
3. Community-Based Care represents a critical approach for narrowing mental health and substance use treatment gaps in African contexts, with models classified into psychotherapeutic, social, lifestyle/physical health, economic, and psychopharmacological approaches (Raeber et al, 2024). These interventions must address context-specific needs while adopting adaptable, scalable, and holistic approaches, with common recommendations including partnering with local organisations, implementing regular suicide prevention efforts, and customising digital tools to community needs (Luberenga et al, 2025).

Implementing mental health and substance misuse interventions in displaced populations requires multi-dimensional approaches that address the complex nature of these interconnected problems. Ethiopia's experience demonstrates that successful implementation depends on committed leadership by policymakers, stakeholder buy-in from critical partners, and calibrated integration that enables task sharing across different levels of healthcare providers (Gebremedhin et al, 2021).

Essential implementation factors include provision of adequate supervision and mentorship to ensure proper skills acquisition, program monitoring systems, and mobilisation of adequate financial and human resources to ensure quality and sustainability of interventions (Gebremedhin et al, 2021).

Context-specific adaptation represents a critical implementation challenge, requiring interventions that are feasible, relevant, and acceptable in local settings. Structural and systemic barriers pose significant implementation challenges that require coordinated responses across multiple sectors. Programs must address underlying causes including psychological trauma, exposure to potentially traumatic events, and difficulties meeting basic needs, which requires interdisciplinary coordination between humanitarian aid sectors (Haddad et al, 2023).

Incorporating livelihood and recreational programming into substance use services necessitates collaboration between health sectors and economic development programs. Implementation strategies must ensure security and confidentiality for both implementers and participants while integrating local community leaders and traditional healing practices (Haddad et al, 2023).

Service integration offers both opportunities and challenges for implementation, with potential to reduce structural stigma and increase service scope when substance misuse treatment is integrated into existing health systems like primary care or mental health services (Greene et al, 2018).

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