Refugee crises around the world have accelerated in the past few years. Globally, the number of those displaced in 2024 has surpassed over 120 million people, or about 1.2% of the global population, and continues to rise. Displacement can occur in response to many factors, including those related to weather cycles, such as prolonged drought that can precipitate famine conditions, political instability, and escalation of internal and regional conflict and violence. Many humanitarian crises that result in mass displacement occur in response to multiple concurrent events or protracted situations, such as in Sudan, which has experienced ongoing violence and tensions between political factions against a backdrop of the world’s most pronounced climate-change-driven agriculture failure and escalating food insecurity. This dire set of circumstances has displaced over 8 million people in Sudan, more than half of whom are children, and almost 2 million who are considered refugees.

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Because terms such as ‘displaced person’ and ‘migrant’ are often used interchangeably with ‘refugee’, it is crucial to underscore the distinction. ‘Refugee’ is an internationally protected legal designation assigned to people who have fled or been forcibly displaced from their home country because of persecution or who are at risk of violation of their human rights. For the more than 43 million current refugees estimated by the United Nations Refugee Agency, Syria, Ukraine and Afghanistan are the three most prominent origins. Despite presidential campaign rhetoric in the USA suggesting unmitigated surges of so-called ‘illegal immigration’, or attempts to curb ‘irregular migration’ by European Union leaders levying stricter laws for asylum seekers, there have in fact been sharp decreases in migration at the US–Mexico border reported by US Customs and Border Protection and by Frontex, the European Border and Coast Guard Agency. However, the vast majority (75%) of refugees are not migrating to high-income countries but instead are hosted by low- and middle-income countries. This has resulted in shifts such that migration between global south countries now accounts for nearly a third of all international migration. Migration patterns and the distribution of the world’s refugees are a therefore a decidedly different reality than is often described, compounded by the burden on resource-limited settings, and one that has stark implications for mental health and wellbeing.

By international law, refugees are afforded a number of rights and protections, including freedom of movement and housing, as well as medical screening and medical assistance. But beyond the provision of basic needs, such as food and shelter, the mental health needs of refugees and displaced people are often overlooked. This is not simply a function of budgetary commitments to migrant care, which vary substantially depending on the country context. People who have been displaced, and more specifically refugees, are not a monolithic group. Although a high percentage (over 70%) of displaced people have experienced trauma, whether through proximity to violence or natural disasters, many others will experience trauma in transit. People who are migrating are more likely to experience trauma associated with family separation, forced labor and human trafficking — with women and girls being especially vulnerable to gender-based violence. Approximately a third of trauma-exposed displaced people are more likely to report higher levels of depression, anxiety and post-traumatic stress disorder, but very few will be connected with treatment for mental health conditions. With such heterogeneous groups of people who also contend with discrimination and bias differently on the basis of their ethnicity, country of origin, or sex and gender, much more creative approaches and forms of mental health care are needed.

This has led to more systemic thinking about what kinds of outreach, interventions and infrastructure can be implemented to mitigate or prevent negative mental health outcomes associated with resettlement, for example. Researchers have highlighted resilience as one particularly salient factor that may characterize refugees who, despite exposure to potential trauma and adversity, are able to maintain positive mental health and wellbeing or who are more effectively able to recover from trauma exposure.

In this issue, we publish a systematic review by Nickerson et al. that investigates concepts that may be related to resilience by identifying protective and promotive factors in refugee mental health. The study classifies the following specific domains: sociodemographic characteristics, such as one’s sex or gender; environmental factors, including residency status or employment; sociocultural factors, including community support; and psychological factors, such as the use of cognitive coping strategies. In addition to providing a comprehensive review of the evidence-based protective and promotive factors for mental health, this review shapes a clear set of recommendations for policymakers, researchers, clinicians and mental health advocates. An overarching theme of these recommendations is to better refine research in global mental health by improving equity, measurement of factors, and integration of policy and practice.

Improving mental health outcomes for refugees and displaced people is not a simple path. It involves acknowledging the breadth of challenges faced by people who are the most vulnerable, from escalating climate crises to systemic inequity, bias and discrimination to violence and persecution. It is also a tremendous opportunity to infuse compassion and humanitarian activity with innovative, thoughtful and responsive research — an opportunity that allows mental health researchers and clinicians to apply their unique skills.