Understanding the mental health impact of internally displaced persons (IDPs) and their support networks in southeastern Myanmar post-military coup: a qualitative study

Abstract

Armed conflicts and military offensives after the 2021 coup in Myanmar have resulted in the internal displacement of almost 3.5 million people as of 2024. The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships. As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal. This study aims to investigate the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. This qualitative study used a mix of purposive and snowball sampling approaches, conducting in-depth online and in-person interviews with 13 IDPs and 10 individuals from the IDP support network. Thematic analysis revealed that IDPs along with their support network described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children’s mental health and early warning systems for airstrikes emerged as practical coping strategies. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-025-00730-9.

Introduction

Following the military coup in 2021, Myanmar faced a profound humanitarian crisis resulted by widespread armed conflicts leading to human rights violations including killing of innocent civilians, burning of homes, and mass displacement of population. Armed conflicts and military offensives have resulted in the internal displacement of almost 3.2 million people as of 2024 [1]. Numerous internally displaced persons (IDPs) have had to repeatedly escape their homes, taking refuge in temporary camps, in the jungle, and in communities impacted by war, where they have little access to basic commodities, food, and medical treatment [2]. Due to the military junta’s severe travel restrictions and frequent assistance blockages, humanitarian groups have major obstacles while attempting to provide relief [3]. The protracted nature of the situation has placed IDPs in a condition of extended uncertainty, with serious consequences for their physical and emotional well-being, despite efforts by international community such as INGOs to provide mental health services.

Displacement has been linked globally to an increased risk of mental health conditions, such as anxiety, depression, and post-traumatic stress disorder (PTSD) [4]. Studies on IDPs from Syria, South Sudan, and Colombia indicate that prolonged displacement, exposure to violence, and lack of access to healthcare significantly contribute to psychological distress [5, 6]. Additionally, Ahmed et al. systemic review on mental health impact of IDPs in Iraq, reported that IDPs suffer from PTSD, depression, anxiety along with suicidal behaviors, particularly among Yazidi-enslaved girls and women who were subjected to enslavement [7]. IDPs frequently experience grief due to the loss of family members, social networks, and a sense of belonging, which exacerbates feelings of isolation and hopelessness [4]. Furthermore, humanitarian interventions often ignore the long-term consequences of displacement in favour of addressing urgent physical needs like food and shelter [8]. IDPs are further restricted from obtaining essential psychological assistance by the stigma surrounding mental illness and the lack of culturally appropriate mental health services [9].

Ethnic minorities in Myanmar who endured decades of conflict reported mental health impact due to displacement [10]. The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships [11]. As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal [12]. Furthermore, support networks, including community-based organizations, religious groups, and local NGOs, play a key role in providing informal psychological assistance. However, their activities are typically hindered by limited resources and security concerns [13]. Existing literature predominantly focuses on broad mental health trends and provides international-based mental health services without an in-depth exploration of local the experiences of both IDPs and their support networks in navigating the crisis.

Research objective

This study aims to fill this gap by investigating the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. Unlike previous research that primarily examines IDPs in isolation, this study takes a holistic approach by investigating the psychological toll on IDPs, civil society organizations, humanitarian program designers and policymakers who are directly involved in assisting displaced populations. By using qualitative research methods, this study seeks to capture the lived experiences, coping mechanisms, and mental health challenges faced by both groups. Understanding these dynamics is essential for designing more effective, sustainable mental health interventions that address the needs of both IDPs and their support networks. The findings will provide valuable insights for policymakers, humanitarian organizations, and mental health professionals working to improve psychological resilience and well-being in conflict-affected communities in Myanmar.

Research questions.

1. How has displacement affected your mental well-being?

2. How have internally displaced persons in Myanmar developed coping mechanisms and resilience approaches to navigate the challenges of displacement?

3. What role do social networks and community support play in this process?

Methodology

Study design and participants

This qualitative study employed in-depth online and in-person interviews with internally displaced persons (IDPs) and their support networks including local Civil Society Organizations (CSOs), donor organization and local authority in Kayin, Karenni, and Eastern Bago between December 2024 and March 2025. Our study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist to ensure transparency, rigor, and completeness in reporting qualitative research [14]. Key stakeholders were selected using a purposive sampling approach, while snowball sampling facilitated recruitment due to access challenges. Civil Society Organizations (CSOs) assisted in referrals to ensure diverse representation. Participants were briefed on the study’s objectives, procedures, and their right to withdraw at any time. Eligibility criteria included being at least 18 years old and residing in an IDP camp or working with IDPs for at least one month. Only those who provided voluntary consent were interviewed. Each session, conducted in Burmese and Kayin, lasted 20–35 min and was audio-recorded with detailed field notes. The pilot test for interview questions was conducted with one participant from each stakeholder groups and discussed within the research team together with Civil Society Organization members who facilitated field interviews, to finalize the most appropriate questionnaire.

Data collection and analysis

A stakeholder analysis was conducted to identify relevant level participants that study need to include in the study, mentioned in supplementary Table 1. Recruitment involved targeted outreach with study details and informed consent procedures. Online interviews were led by the research team, while local CSOs facilitated in-person sessions by nominating trained interviewers. Qualitative interview facilitation training was provided to selected civil society organization participants by the research teams to equip them with skills to conduct qualitative interviews with IDPs in the field, ensuring consistency and reliability across all interviews. Interviews were conducted in the Burmese and Kayin language and this study was focused on question number 4 of the qualitative interview.

Data analysis

Thematic analysis followed Braun and Clarke’s framework [15], with researchers familiarizing themselves with the data through repeated listening and note review before transcription. Transcripts were translated into English, cross-checked for accuracy, and systematically coded. The mixed method approach of inductive or deductive reasoning was used to identify 8 initial codes including (1) acceptance and coping, (2) airstrikes impact, (3) Depression,4) Guilt of not being present or not able to support,5) mental health impact of women and children, 6) Mental health support, 7) social support network. The coded data were then analyzed thematically by identifying patterns and merging similar responses into overarching themes. The coded data were then analyzed to identify recurring themes. We utilized an open-source qualitative data analysis tool, Taguette software, to upload transcripts, highlight relevant text segments, organize codes, retrieve coded excerpts, and export reports, ensuring consistency and transparency in our analysis, in accordance with the New York University data services guide [16].

Ethical considerations

Ethical approval was obtained from the Community Ethics Advisory Board (CEAB), Mae Tao Clinic, with reference number CEAB-2024-016 on 9th December 2024. Participants provided oral consent and were assured of confidentiality. To protect anonymity, identifying details such as names, locations, and participant ages were omitted. Pseudonyms were assigned for transcription, coding, and analysis.

Results

Demographic characteristics of participants

The study included 23 participants, comprising internally displaced persons (IDPs), civil society organisation (CSO) representatives, local governance officials, and donor organisation members from Kayah, Kayin, and East Bago, as shown in Table 1. Of these, 14 were male and 9 were female. All donor representatives were male, among IDPs, 9 were male and 5 were female. CSO participants included 3 females and 1 male, whereas local governance representatives consisted of 2 males and 1 female. Regarding age distribution, most participants (8) were between 31 and 40 years old, followed by 7 participants aged 21–30,5 participants above 50 age groups, and 3 participants aged 41–50. To ensure anonymity, participants were assigned coded identifiers based on their roles and gender: donor representatives as “Donor_M1, M2”; local governance officials as “Governance_M1, M2” or “Governance_F1, F2”; CSO representatives as “CSO_M1, M2” or “CSO_F1, F2”; and IDP participants as “IDP_M1, M2” or “IDP_F1, F2.”

Table 1.

Demographic characteristics of study Participants. (n = 21)

Stakeholders Level	Age	Gender	Geographic location
Donor_01	38	Male	Working Across Myanmar
Donor_02	44	Male	Working Across Myanmar
Donor_03	39	Male	Working Across Myanmar
Governance_01	60	Male	Eastern Bago
Governance_02	42	Female	Karenni
Governance_03	70	Male	Eastern Bago
CSO_01	34	Female	East Bago
CSO_02	29	Female	Kayin
CSO_03	33	Female	Karenni
CSO_04	48	Male	Kayin
IDP_01	29	Female	Karenni
IDP_02	23	Male	Karenni
IDP_03	34	Female	Karenni
IDP_04	21	Female	Karenni
IDP_05	24	Female	Karenni
IDP_06	25	Male	Karenni
IDP_07	30	Male	Karenni
IDP_08	64	Male	Karenni
IDP_09	35	Female	Kayin
IDP_10	39	Male	Kayin
IDP_11	34	Male	Kayin
IDP_12	58	Male	Kayin
IDP_13	62	Male	Kayin

*IDP – Internally Displaced Population, CSO – Civil Society Organizations

Mental health impact

Anxiety and lack of psychological safety

A consistent theme across interviews including IDPs, civil society representatives, and local governance actors was the pervasive sense of anxiety and psychological insecurity. This was particularly driven by the constant fear of airstrikes and bombardments by the Myanmar Military. These fears are especially acute among women and children living on the ground. While donor-level participants did not directly reference the psychological impact of airstrikes, it emerged as a central concern for those more directly exposed to the conflict.

….In my entire life, I haven’t had any real airstrike or missile strike experience before. I still remember when we had to rush to escape with strangers that we never knew to survive. This is still in my memories that I can’t forget. Ah…how the sound of the airstrike and missile fired have impacted me mentally is when I heard someone walking or running upstairs or even a car door slam or children playing football, I wonder whether these sounds are missile fired. Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes. One of the IDP women has severe mental impact by the sound of airstrikes, whenever she hears the sound, she becomes so much more uncontrollable herself, she stands and becomes stuck like a child, and she cannot move reimaging the experience from the previous airstrike.

IDP_F5

…Most of IDP including me are not mentally fit. When we live in our home, we are happy mentally safe and strong. But when we become IDPs who live in camps and other villages, is not the same. Before the coup, we could stay in our homes but now we have to feel unsafe of the airstrikes and large weapons. We felt very sad about the loss of the soldiers who defended our home when the military attacked. Everyone wants to live in their home, we felt unsafe to stay in war. We worry about when things will happen next, but we have a strong will to survive.

IDP_M6

…. Another major issue is the fear caused by airstrikes. When an airstrike occurs, children and women experience intense fear—they scream, cry, and panic. These experiences create a lasting sense of insecurity, making them feel unsafe no matter where they are.

Governance_M3.

Depression and guilt

Depression was another recurring concern. IDPs frequently reported emotional fatigue, helplessness, and trauma. Stakeholders involved in humanitarian support also reported emotional distress and guilt over being unable to provide adequate aid.

“…Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes.”

IDP_F5

…. When people work, they carry fear in their minds, but they must work to survive. When we talk about depression, some people feel depressed, wondering how they will survive under the constant threat of airstrikes. This situation is not only happening in our village but probably in the entire country.

IDP_M11

…Despite knowing how much support is needed, we are often constrained by limited resources. This gap between what we want to achieve and what we can realistically provide leads to feelings of frustration, self-doubt, and emotional exhaustion. I sometimes feel unappreciated or question whether my efforts are truly making a difference.

Governance_F2

…Since the coup, I’ve been receiving daily news about airstrikes in townships and how many children have died from this, medics who have lost their lives while supporting communities in the field, and hospitals that have been bombed. Every morning, in the early stages of the crisis, I would wake up to this heartbreaking news. It was depressing and made me feel devastated for my country and the suffering of my society.

Donor_M1.

Mental health coping strategies

Formal mental health services

Stakeholders at the governance, civil society organization (CSO), and donor levels discussed efforts to address mental health through Mental Health and Psychosocial Support (MHPSS) training. These included basic psychological first aid provided to healthcare workers which was limited to one-time interventions. However, the overall impact remains minimal due to resource constraints and the lack of sustained support. Most IDP interviewees do not report receiving or benefiting directly from these formal services.

…Unfortunately, all our support is focused on immediate needs. Although we provide some mental health support, it’s just one time. There was no long-term support specifically for mental health. There should be someone trained in the camp to support the IDPs.

CSO_F1

…Currently, some MHPSS training is being provided to basic healthcare providers, like nurses, teaching them psychological first aid. This has increased awareness, and people are beginning to recognize mental health as an important issue. In the past, mental health struggles carried a stigma, unlike physical illnesses. Now, with education, attitudes are slowly changing. However, the number of trained professionals is still extremely low, and the gap between basic skills and the actual level of care needed is very large.

Donor_M3.

Field-level coping strategies

At the community level, IDPs primarily rely on informal mechanisms for mental health coping. These include strong peer and family support systems, religious practices, hope for political change, and psychological adaptation to ongoing threats. Access to education was highlighted as essential for the emotional well-being of children. Additionally, early warning systems for airstrikes emerged as a practical coping tool that reduces fear and anxiety during emergencies.

…Mentally, most of us have problems. Some of us feel like dying when we see or experience something bad. When we hear the sound of missiles, my parents become terrified and don’t know where to run or how to survive. I try to calm them.

IDP_M7

…I want to share how I overcame this. I listen to music, read books, and try to meditate—even for just one minute. Then I pray. Whatever religion you follow, reading religious texts can help. Singing loudly, praying, and living far from the airstrikes has healed me mentally.

IDP_F5

…For children, providing educational opportunities makes a big difference. The school offers them some sense of normalcy. Since IDPs have diverse experiences, it’s difficult to address everyone’s needs with a single program. People suffer in different ways, so tailored support is important.

CSO_F2

…We have one program—an early warning system. Not all IDP camps have it, but those that do benefit from reduced anxiety. Waiting in fear doesn’t help. We’re also planning recreation spaces in villages for IDPs to gather. These areas will serve as both community hubs and emergency shelters during airstrikes.

CSO_M4

…Another important factor is accepting the reality of the situation. I’ve come to terms with the fact that death could come at any time, and I must face that fear. We’ve created early warning systems and civilian protection teams to prepare and reduce panic when threats arise.

Governance_M3.

Discussion

This study highlighted the significant psychological toll of conflict on internally displaced persons (IDPs) and stakeholders involved in humanitarian efforts in the Kayin, Karenni and East Bago regions of Myanmar. All study participants described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized Mental Health and Psychosocial Support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children’s mental health and early warning systems for airstrikes emerged as practical coping strategies.

The mental health impact experienced by participants can be interpreted through the lens of the Kübler-Ross model on stages of grief, commonly referred to as the five stages of grief: denial, anger, bargaining, depression, and acceptance [17–19], shown in Fig. 1. Many IDPs and their support network appeared to shift between these emotional stages. Many IDPs expressed disbelief and shock at the events they experienced, reflecting the denial stage. In the anger stage, several participants especially IDPs voiced deep resentment toward the military for triggering the armed conflict, while support workers expressed frustration at their inability to provide adequate assistance due to limited resources.

Fig. 1.

Alignment of IDPs and Support Networks’ Experiences with the Kübler-Ross Model of Grief along with recommended mental health interventions in Southeastern Myanmar

Feelings of guilt and despair over the loss of loved ones and communities were commonly reported by both IDPs and support actors, which aligns with the bargaining stage of grief. Nearly all participants also described emotional exhaustion, helplessness, and fear of airstrikes, along with intrusive thoughts of death hallmarks of the depression stage. Notably, some IDPs and support actors spoke of their proactive efforts to establish early warning systems and their acceptance of the constant threat of mortality, signalling movement toward the acceptance stage. While previous research emphasizes that grief is rarely linear and often complex, recognizing the mental and emotional stages individuals occupy during prolonged crises can help design more responsive and effective mental health interventions for displaced populations [20, 21]. The findings reveal significant gaps in the accessibility and effectiveness of Myanmar’s current Mental Health and Psychosocial Support (MHPSS) services [22].

To provide more effective intervention, we recommended integrating the Inter-Agency Standing Committee’s (IASC) layered intervention pyramid for mental health and psychosocial support in emergencies integrated with the identified stages of grief, shown in Fig. 1 [21–23]. In the context of the IDPs and their support networks, denial is often addressed by ensuring basic humanitarian services and security. The anger stage resulting from frustration can be addressed by facilitating space for peer, family community networks for emotional expression and collective healing. In the bargaining stage, marked by feelings of guilt and despair, training local facilitators and community health workers will offer culturally sensitive psychosocial support and basic counselling. Additionally, providing educational opportunities for children can strengthen their mental health resilience while fostering a greater sense of purpose and personal agency in life [24]. During the depression stage, where emotional exhaustion and helplessness dominate, there will be a need for access to professional mental health services.

While this approach may have limitations, training local staff and establishing innovative referral pathways such as through telepsychiatry can significantly improve access to essential mental health services within the community. During the stage of acceptance, there is an opportunity to reinforce existing community-based coping mechanisms such as early warning systems and educational programs for children to help address ongoing fears related to airstrikes. Future programs should align the IASC’s MHPSS intervention pyramid into a horizontal approach with the stages of grief and offer a more targeted, contextualized, and realistic framework for supporting IDPs and their support networks.

This study has several limitations. First, the participants were primarily from the Kayin, Karenni and East Bago States, of Myanmar, limiting the generalizability of the findings to IDPs in other regions with different socio-political and conflict dynamics. The experiences of IDPs in other states may vary due to differences in conflict intensity, access to aid, and local support structures. Second, while in-depth interviews provided valuable insights into the psychological impact of displacement, the study relied on translations from Burmese to English, which may have introduced translation bias. Certain cultural or emotional nuances may not have been fully captured in the transcriptions, potentially affecting the interpretation of findings. Finally, the study focused on qualitative methods, which, while useful for exploring lived experiences, do not provide quantifiable measures of mental health conditions. Despite these limitations, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time.

Conclusions

This study’s findings revealed the profound psychological impact of ongoing conflict on internally displaced persons (IDPs) and their support networks in Southeastern Myanmar, revealing a spectrum of emotions anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children’s mental health and early warning systems for airstrikes emerged as practical coping strategies. Futhermore the study aligns with the stages of grief outlined in the Kübler-Ross model and IASC’s MHPSS intervention pyramid revealing critical gaps in existing mental health services and proposing a more practical, horizontal, and culturally responsive approach. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time.

Author contributions

All authors were involved in conceptualising and investigating the articles. HMT is involved in data curation, formal analysis, methodology, software, and writing the original and final manuscript. NZW, HNH, and NNNL are involved in data curation, formal analysis, review, and supervision of the final manuscript. HAR and LN are involved review and supervision of the final manuscript.

Funding

No funding was received for this study.

Data availability

​​All data generated or analysed during this study are included in this published article. The datasets generated and/or analysed during the current study are not publicly available to preserve the anonymity of study participants; however, they are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The paper received ethical approval from the Community Ethics Advisory Board (CEAB), Mae Tao Clinic, with reference number CEAB-2024-016 on 9th December 2024. All the participants were informed that their participation was voluntary. Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, in alignment with research ethics. All the participants’ names were assigned pseudonyms. All methods were performed according to relevant guidelines and regulations. All participants were informed that their involvement in the study was entirely voluntary. Both oral and written informed consent were obtained prior to each interview and audio recording, in accordance with ethical research standards. To ensure confidentiality, all participants were assigned pseudonyms. All methods and procedures were conducted in compliance with relevant institutional guidelines and ethical regulations.

Consent for publication

All authors agree on consent for publication.

Competing interests

The authors declare no competing interests.