Forgotten Victims of War: A Rapid Review of Counseling Needs and a Proposed Intervention Model for Civilian Survivors

Abstract

The counseling needs of civilian war victims, particularly those not classified as refugees, have been largely neglected in academic counseling research. This study addresses this gap by conducting a rapid literature review to evaluate the current state of counseling services available to these individuals. Using Google Scholar and Web of Science, we identified and reviewed studies on counseling services for war veterans, refugees, and civilians in conflict zones. This review revealed a significant lack of structured counseling support for non-refugee civilian war victims, despite their high vulnerability. Findings indicate that while substantial efforts have been made to support refugees and veterans, the mental health needs of civilians who remain in conflict areas are often unmet, with existing services being sparse and inadequately documented. To address this issue, we propose a preliminary model that includes culturally sensitive counseling programs, training for local counselors, and international collaboration to provide sustainable support. This study highlights the urgent need for focused research and practical interventions to develop comprehensive counseling programs for these overlooked victims of war, and encourages researchers to address this critical gap in mental health services.

1. Introduction

Counseling services have proven to be of great importance after war [1]. In the United States, significant efforts have been made to increase access to counseling veterans returning from war and their families (e.g., community Vet centers and inpatient residential or at-home care). War veterans are often diagnosed with post-traumatic stress disorder (PTSD), a serious condition that can sometimes lead to suicide. Consequently, suicide prevention services and PTSD treatment programs have been established in countries such as the US. In addition to the military community, refugees frequently result from wars. A refugee is defined as a person who has been forced to leave their country to escape war, persecution, or natural disasters. This definition can be extended to individuals who leave their homes while remaining in the same country but stay in refugee camps. In refugee camps, employment options are minimal and refugees have limited access to food, sanitation, medical services, and education. Another group of interest is the civilian population who was not displaced or was temporarily displaced, but also was exposed to different levels of war violence. Some may suffer severe consequences, such as loss of limbs or sight, or other medical challenges. This population, which includes vulnerable groups such as women and children, faces significant psychological challenges, including PTSD, trauma, anxiety, and depression [1,2,3,4,5,6].

The literature on counseling services for war-affected populations has predominantly focused on veterans and refugees. Studies have extensively documented the mental health needs of these groups, particularly in relation to PTSD. However, there remains a significant gap in research concerning non-refugee civilian war victims. This review highlights the scarcity of studies addressing the counseling needs of this population, emphasizing the urgent need for comprehensive research and tailored interventions. Research conducted on counseling psychotherapies for war-related conditions has primarily focused on post-traumatic stress disorder (PTSD) among war veterans [1,2,3,4,5,6,7]. Numerous papers demonstrate the considerable attention given to veterans’ mental health, including studies on PTSD counseling for Vietnam War veterans [2], the effectiveness of short-term specialized inpatient treatment for PTSD in veterans [3], and rehabilitation counseling in the context of brain injury and PTSD for Iraq War veterans [4]. Additionally, traumatic counseling has been explored for high school students to reduce PTSD symptoms [6]. These examples represent just a portion of the extensive body of work in this field.

Counseling has proven to be an effective treatment for individuals who have experienced trauma, whether due to war, natural disasters, or other traumatic events [7]. It is important that counseling services be available to persons affected by wars. However, civilians who are not designated as refugees receive little to no counseling support from national or international institutions. According to the United Nations (UN) Website, counseling services are funded by the United Nations Population Fund (UNFPA), the United Nations Educational, Scientific, and Cultural Organization (UNESCO), and other parts of the UN. Despite the UN’s best efforts, existing counseling-related programs do not match the number of civilian war victims [7]. Moreover, these programs are small and dispersed, thus failing to meet the challenges of counseling millions of civilians. Many existing programs are localized, with a limited reach, restricting their ability to scale up and provide sustainable support. Additionally, there is often a lack of coordination among various programs, leading to inefficiencies and gaps in coverage. Cultural and linguistic barriers may further reduce program effectiveness, while stigma and a lack of awareness about mental health issues often deter individuals from seeking help. Although significant resources have been allocated, most UN programs focus on refugees displaced internally or across borders, with fewer services available for civilians who remain in their homes within conflict zones [7]. Despite significant funding, most UN programs primarily target refugees who have been displaced either internally or to neighboring countries rather than civilians who remain in their homes within war-affected areas. This distinction results in a significant gap in services for non-refugee civilians who face the same psychological trauma but do not receive adequate support.

Statistical data reveal staggering numbers of civilian victims affected by war. For instance, the United Nations High Commissioner for Refugees (UNHCR) reported that over 70 million people are displaced worldwide, with many more suffering within their own countries [8]. Meta-analyses from conflict-affected areas indicate a significant prevalence of PTSD and depressive symptoms, with estimates for PTSD ranging from 15.3% to 30.6% and those for depression from 10.8% to 30.8% [9,10]. These figures highlight the vast number of individuals who may not receive adequate counseling. Experts in trauma psychology emphasize the long-term psychological impacts of war on civilians, including chronic anxiety, depression, and PTSD, which underscore the necessity for comprehensive counseling services.

Exposure to war may result in severe psychological consequences due to complex mechanisms involving trauma, neurobiological changes, anxiety, depression, dissociation, and social disruption. Trauma, particularly post-traumatic stress disorder (PTSD), arises from life-threatening events and involves dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and brain alterations [3,4]. Chronic stress leads to changes in brain structures, such as the amygdala and hippocampus, affecting memory and emotional regulation [11]. Anxiety and depression, fueled by ongoing stress and neurochemical imbalances, are common, resulting in persistent fear, hopelessness, and sadness [12,13]. Dissociation serves as a coping mechanism, leading to detachment from reality but causing significant impairments in functioning [14]. Additionally, war disrupts social networks, leading to isolation and difficulties in social functioning, intensifying psychological symptoms, and hindering recovery [15]. Understanding these mechanisms is crucial for developing effective interventions for war-affected individuals. Counseling aims to address these psychological consequences by providing trauma-informed care, promoting emotional regulation, and restoring a sense of safety and normalcy in the lives of affected individuals. The goal is to enhance psychological resilience, improve mental health outcomes, and facilitate long-term recovery and social reintegration.

A comprehensive review of the psychological consequences of war [16] emphasized the severe impact on mental health among civilian populations. It highlighted that war significantly increases the incidence and prevalence of mental disorders such as PTSD, depression, and anxiety, particularly affecting vulnerable groups like women, children, the elderly, and the disabled [16]. The review underscored that these effects are exacerbated by the degree of trauma experienced and the availability of physical and emotional support. Furthermore, it discussed how cultural and religious coping strategies are frequently employed in war-stricken countries to manage these psychological impacts. It pointed out the critical role of the World Health Organization (WHO) and other international bodies in addressing these mental health issues and called for more comprehensive strategies to mitigate the psychological damage caused by war.

Few studies have examined counseling services for individuals affected by war other than veterans and refugees, leaving a significant gap in the literature. Some notable exceptions include studies on post-war counseling for specific groups. For example, counseling services for students in post-war colleges were explored [17], while problem-solving counseling for adults in war-affected areas of Indonesia was conducted using a controlled trial [18]. Research has also addressed the need for training school counselors as home-front responders [19] and the impact of war on the children of soldiers, along with their counseling needs [20]. Counseling interventions for families in war-affected Bosnia–Hercegovina were researched [21], as well as the psychosocial interventions for victims in Sierra Leone [22]. Of relevance to this study, it was argued that teachers should be prepared as counselors [23], a point that aligns with the model proposed in this paper. Additionally, a case study of trauma training for teachers and health professionals in Sri Lanka following the tsunami emphasizes the importance of culturally sensitive, long-term training for effective counseling in trauma settings [24].

While these studies address specific contexts, there remains a significant gap in research specifically targeting non-refugee civilian war victims, a group that faces unique psychological challenges yet often receives little attention. For example, the psychological effects of war on civilians highlighted the need for trauma counseling services [25], in addition to the perceptions of counselors and teachers regarding counseling support in war-affected Lebanon were presented [26]. These isolated studies prove the need for more comprehensive research on civilian war victims’ counseling needs.

As noted earlier, refugees’ counseling needs have received more attention. Studies have examined refugee counseling in a variety of contexts, such as the services offered to refugees from former Yugoslavia [27], coping mechanisms of refugees and immigrants [28], and practical methods for providing counseling to refugees [29]. Meta-analyses on trauma-focused therapy for refugees were conducted in [30], while [31] emphasized the importance of culturally sensitive counseling for migrants and refugees. Research on PTSD and intervention counseling among Syrian women refugees is also notable, as explored in [32].

Despite these efforts, the gap in addressing the counseling needs of non-refugee civilian war victims persists, highlighting the need for future research that develops and evaluates tailored interventions. Such research should consider the cultural and contextual factors of these populations, and the integration of community-based approaches, including the training of local counselors, could improve the sustainability and effectiveness of these services.

The present paper aims to locate and analyze studies on counseling services for veterans of war, refugees, focusing on civilians in conflict zones to bring this critical topic to the forefront of research in the counseling field. A second aim is to propose a model that may be considered for adoption by international bodies, relief organizations, and response workers to meet the mental health needs of civilians in the aftermath of war. This model addresses the challenges of providing enough counselors for war-affected populations while incorporating culturally sensitive approaches to ensure effectiveness in different world regions. Additionally, it is important to recognize that in some countries, the culture of counseling (i.e., seeking help for emotional distress from mental health professionals) does not exist, and the proposed model must include contingencies to address this issue.

2. Materials and Methods

2.1. Search Strategy

Consistent with the first objective of the paper, a rapid literature review was planned and documents retrieved from selected databases. This study followed the updated PRISMA guidelines in methods to select, identify, appraise, and synthesize studies [33]. The guidelines were followed in this study’s systematic search strategy, inclusion and exclusion criteria, and review of the literature relevant to the topic of this paper.

Two databases were selected for this study: Google Scholar and Web of Science. The criteria for choosing these two databases included their comprehensive coverage and the ability to access a wide range of international, high-quality, peer-reviewed literature. These databases collectively provided a broad and diverse collection of scholarly works necessary to conduct a thorough review of counseling needs for civilian war victims. The search strings, along with the resulting number of records, are shown in

Table 1. Datasets, search strings, and number of records.

Database	String	Number of Records
Web of Science	Counseling and War Or Counseling and Veterans Or Counseling and Refugees Or Counseling and Civilians	136 articles
	Counseling and War	45 articles
Google Scholar 1	Counseling and Veterans	71 articles
	Counseling and Refugees	29 articles
	Counseling and Civilians	0 articles

¹ Results for Google Scholar were generated using Publish or Perish software. Results may vary if accessing Google Scholar directly.

. This search was conducted between 21 May 2024 and 26 May 2024. The software “Publish or Perish version 8” [34] was used to facilitate the search in Google Scholar.

It should be noted that while the number of potential search strings is vast, we carefully selected specific strings designed to yield relevant results related to counseling in war-affected areas. Conducting a comprehensive search covering all possible strings is nearly impossible. For instance, we tested other string variations, such as “psychological first aid and war-affected”, which produced many results in Google Scholar, but analyzing the titles and abstracts retrieved with other search strings revealed that many papers were irrelevant for the purpose of this rapid review.

2.2. Inclusion and Exclusion Criteria

There was no date specified in the search, and the default setting for the date was used, which did not indicate the date, authors, affiliation, or publication name. Only keywords within the title were set as the search strings indicated in Table 1 to populate Table 2 and Table 3. To be included in the study, an article had to include counseling services pre- and post-war. Only English-language articles were included in this review, with the exception of one article written in Arabic but with an English abstract, due to the fact that one of the authors is also proficient in the Arabic language. Papers were analyzed based on the complete content of the paper and not only abstracts. Irrelevant papers and duplicates were excluded from the review. Six articles from the Web of Science were excluded and found to be either irrelevant or duplicates. Seventeen articles from Google Scholar were excluded for the same reasons noted before.

2.3. Content Analysis

The methodology outlined in [35] was followed in the content analysis during the rapid review of the literature. The methodology is based on three stages of qualitative data analysis: open coding, which includes examining the articles and generating codes for description and categorization; axial coding, which analyzes the relationships between the generated codes; and selective coding, which includes refining and integrating the categories or themes identified during the open and axial coding stages to have a complete view. Codes were assigned during the open coding stage and were grouped by similarity. Similar codes were organized into categories to complete the analysis during the selective coding. Multiple reviews of the data were done to ensure the data were accurate. The flexibility of the approach allowed for a thorough examination of the literature. Throughout the process, careful attention was given to maintaining consistency in coding decisions, with periodic checks and re-evaluations to enhance the analysis. This approach strengthened the findings, providing a comprehensive understanding of the patterns related to counseling services for war-affected populations.

3. Results

The data retrieved from Google Scholar and Web of Science were carefully analyzed. Figure 1 and Table 2 show the outcome of the data retrieved from the Web of Science.

Table 2. Categories and number of articles in Web of Science.

Categories	Number of Articles
Refugees	46
Veterans	75
Youth	1
General	5
War Workers	2

Table 2. Categories and number of articles in Web of Science.

Categories	Number of Articles
Refugees	46
Veterans	75
Youth	1
General	5
War Workers	2

As shown in Figure 1, 35.7% of the retrieved articles from Web of Science were related to counseling refugees, 58.13% were related to counseling veterans of war, 0.78% were related to counseling youth, 1.6% related to counseling war workers, and 3.9% related to general subjects in counseling related to war. It is immediately apparent, as indicated in this paper, that veteran counseling is the most researched topic related to war and counseling, followed by refugee counseling. None of the papers retrieved here researched the counseling needs of civilians affected by war who were not classified as refugees.

Figure 2 and Table 3 show the outcome of the data retrieved from Google Scholar.

Table 3. Categories and number of articles in Google Scholar.

Categories	Number of Articles
Refugees	32
Veterans	87
Civilians	9

Table 3. Categories and number of articles in Google Scholar.

Categories	Number of Articles
Refugees	32
Veterans	87
Civilians	9

As shown in Figure 2, 25% of the articles retrieved from Google Scholar were related to refugee counseling, approximately 68% were related to counseling veterans of war, and around 7% were deemed relevant to counseling civilians affected by war. Again, the results indicate that veterans of war receive the highest amount of attention from researchers and counseling programs, followed by war refugees.

In viewing the results, it is immediately noticeable that the categories within the Web of Science and the Categories within Google Scholar are different, and this is due to the careful analysis and coding procedure outlined in [35]. The analysis and coding of the papers that resulted from the search gave different categories; for example, zero articles in the Web of Science addressed counseling for civilians. Both datasets also showed that counseling related to veterans had the highest number of articles, followed by those that addressed counseling for refugees. The nine articles coded as civilian did not comprehensively cover the counseling needs of civilians in war-torn countries; rather, they were very specific. References [36,37,38,39,40,41,42,43,44] are those coded as civilian. In [36], the authors study the impact of war and psychological symptoms and post-traumatic growth among Libyan citizens. In [37], the authors explore group counseling in Bukavu. In [38], counseling programs are explored in developing countries for civil war survivors and depressed mothers. In [39], trauma counseling in Sri Lanka after the war and tsunami is studied. In [40], the effectiveness of counseling programs in reducing nightmares and improving sleep quality among Gazan children with destroyed houses is also studied. In [41], low-cost trauma counseling on enhancing the social and economic resilience in war-affected communities in northern Uganda is the subject of this study. In [42], the authors recommend counseling programs for orphaned children in war-affected areas. In [43], gender, class, and counseling in post-war Rwanda are explored. As can be seen, these samples are specific studies to specific countries and still show the lack of research in post-war areas concentrating on civilians.

The civilians who stay in their country after a war ends are not categorized as refugees, and in big wars, the number of traumatized individuals within a country (civilians) far exceeds the number of people who choose to seek refuge in safer places, whether within the country or in neighboring countries. In war-affected countries, more than half the population is diagnosed with mental disorders, including depression, PST, and anxiety, with only 10% of this population receiving the required therapy [44].

Typically, wars involve two opposing sides, often including leading global powers and other countries. While the dominant powers generally emerge victorious, there comes a point when they must withdraw their troops and exit the defeated country. Given that these global powers tend to be more advanced in terms of education, infrastructure, and financial resources, they are often well-equipped with counseling programs and organizations. Consequently, it is not surprising that comprehensive counseling services are regularly provided to their veterans. Therefore, the number of articles for counseling veterans is the highest. After the second world war, the leading global powers also initiated the United Nations (UN), and several organizations under the UN have extensive services for refugees. Counselors funded by the UN offer services to these refugees. Thus, we see that the second highest number of articles for war-related counseling focus on counseling services for refugees. However, neither the leading global powers nor the UN offer services to the countries that were defeated in the war. These countries are not as academically advanced and might not even have enough counseling degree-granting programs, if any. In the aftermath of war, the defeated countries are economically devastated and cannot offer their population services such as counseling [45]. They are more concerned with offering basic services such as food support, basic medical health services, and other important services (restoring power plants, transportation infrastructure, etc.). It is essential to recognize that even the existing counselors within war-affected countries are part of the population that has been directly impacted by the conflict. As a result, they, too, may suffer from the psychological effects of war. The frequency of conflicts over the past 30 years has been considerable, and future wars are likely.

Given these challenges, international support for war-affected nations must extend beyond traditional humanitarian aid, such as food supplies and medical care. A structured, comprehensive framework is required to provide essential psychological support services, ensuring that populations can address the profound effects of trauma, ensure resilience, and work toward long-term recovery and stability.

4. Proposed Model

The proposed counseling model is designed to provide comprehensive, culturally sensitive mental health support for civilian war victims. Its key objectives include addressing the immediate psychological needs of civilians, building local capacity for sustainable support, and ensuring that interventions are tailored to the unique cultural challenges in war-affected regions. This model encompasses several key strategies: (1) establishing a dedicated United Nations organization, (2) creating degree-granting counseling programs, (3) providing culturally adapted training to local counselors and leaders, and (4) implementing community-based interventions to ensure long-term sustainability.

Currently, several UN agencies provide services to refugees of war. These agencies work together to offer various services, including protection, food, shelter, healthcare, education, and legal assistance. These agencies include the United Nations High Commissioner for Refugees (UNHCR), United Nations Children’s Fund (UNICEF), World Food Programme (WFP), World Health Organization (WHO), United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), International organization for Migration (IOM), United Nations Population Fund (UNFPA), and United Nations Educational, Scientific, and Cultural Organization (UNESCO). A rapid review of available sources suggests that several organizations claim to offer services to civilians in war-affected regions, including mental health support. However, research indicates that these services are either minimal or, if they are more widespread, lack sufficient documentation. For example, in war-torn Syria, while the United Nations website lists various services, counseling support is notably absent [46]. If mental health services were being provided on a large scale, one would expect to find comprehensive documentation in the literature, along with corresponding research published in academic journals and conference proceedings. The absence of such records raises concerns about the actual provision and scope of these services.

The model presented in Figure 3 outlines a proposed framework to address the needs of civilians in war-affected regions. Similar to the establishment of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), this model proposes the creation of a specialized organization under the United Nations, referred to as the UN War-Affected Civilian Support Organization (UN-WACSO). This organization would be tasked with delivering essential services to civilians in war-torn countries, including protection, food, shelter, healthcare, education, and legal assistance—services typically provided to refugees. Within the healthcare sector, a dedicated unit would focus specifically on offering psychological counseling to civilians. The proposed model articulates the process this counseling unit would follow in addressing the mental health needs of the war-affected civilian population. UN-WACSO will work alongside other UN agencies (UNHCR, WHO, and UNICEF) to ensure an integrated approach to supporting war-affected populations.

In order to be proactive, UN-WACSO will divide its work in mental health into two main timelines: pre-war and post-war. In the pre-war era, the agency will identify regions at high risk of conflict, allowing for proactive planning to meet the increased demand for counseling services. Once these regions are identified, the organization will focus on establishing or expanding degree-granting counseling programs within these countries. This can be facilitated by offering scholarships, grants, and other incentives to encourage the training of more certified counselors. Similar efforts should also be initiated in neighboring countries. The number of counselors graduating from degree-granting programs should be substantial enough to meet the demands during and after conflict. To ensure these counselors are employed in the pre-war era, an awareness program should be launched to educate the general population on the benefits of counseling and to reduce the stigma surrounding mental health services. Additionally, collaboration with governments will be essential to expand the employability of counselors in other professions, such as education, healthcare, and community services, during peacetime.

The rationale for increasing the number of certified counselors in neighboring countries is based on cultural and linguistic similarities shared with the affected regions. This need for certified counselors in war-affected regions is supported in the extant literature [47,48]. These counselors can provide culturally sensitive care and act as first responders in addressing the trauma experienced by civilians. In addition, these countries are often more stable and can provide support for neighboring regions in conflict. UN-WACSO will focus on training programs that build long-term local capacity, ensuring that mental health services are sustainable even after international organizations have scaled back their operations.

In the post-war era, the agency will initiate a large-scale deployment of counseling services by mobilizing counselors trained both in the war-affected country and in neighboring countries. Additionally, mobile counseling units will be dispatched to reach populations in rural areas. However, despite the increased number of counselors from both the affected country and neighboring regions, the scale of trauma, potentially involving hundreds of thousands or even millions of individuals, may exceed the available resources. Therefore, immediate, specialized training programs should be implemented for key members of the population, such as teachers and community leaders. Given that these trainees are often part of the same traumatized population, the training must be tailored to address their unique circumstances.

By implementing this initial model, the counseling needs of civilians in war-affected countries may be effectively addressed. There are likely numerous indirect benefits, which warrant further research. For instance, civilians in war-torn countries who do not receive adequate counseling support may be at higher risk of developing mental health issues, potentially escalating ongoing violence or contributing to other negative outcomes. Addressing their counseling needs is crucial to breaking this cycle and fostering long-term stability [44,49,50]. The theoretical basis for the proposed model for counseling civilian war victims is grounded in several established psychological and counseling theories and the existing frameworks of United Nations (UN) organizations that offer services to war-affected nations. These theories and frameworks provide a robust foundation for understanding the mental health needs of the civilian population and developing effective interventions.

Trauma theory explains how individuals respond to and recover from traumatic events, emphasizing the importance of addressing both immediate and long-term psychological impacts. Trauma-informed care principles are integrated into the proposed model, ensuring that interventions are designed to recognize and respond to the effects of trauma. This includes creating safe environments after wars, promoting empowerment, and facilitating trauma recovery [51,52]. Research on war survivors indicates the prevalence of PTSD and other mental health issues, which necessitates trauma-informed care principles to promote recovery [44,51].

Culturally sensitive counseling emphasizes the need for counseling interventions to be tailored to the cultural contexts of the individuals being served, which is crucial in war-torn regions with diverse populations [53]. By training local counselors and leveraging culturally similar neighboring countries, the model ensures that counseling services are culturally sensitive and relevant to the affected populations. This approach not only fosters a sense of trust and comfort among survivors but also enhances the effectiveness of interventions, as individuals are more likely to engage in therapy when it aligns with their cultural values and communication styles. Furthermore, culturally sensitive counseling helps prevent misunderstandings that may arise from differing cultural norms, ultimately promoting better mental health outcomes and long-term recovery. It also encourages community engagement, as local leaders and counselors play a significant role in building resilience within the population.

Community-based intervention models focus on leveraging local resources and training community members to provide support, which is essential in areas with limited access to professional mental health services [54,55,56]. The World Health Organization has stressed the importance of training local healthcare workers and utilizing community resources to address mental health needs in conflict zones. Community-based interventions will be implemented by training key figures within communities—such as teachers, religious leaders, and local health workers—to provide psychological first aid and basic trauma counseling. The UN-WACSO will work with local NGOs and community groups to develop training programs that equip these individuals with the necessary skills to identify trauma and provide immediate support. By empowering communities, the model ensures that mental health services are accessible and culturally relevant. Success will be measured through community feedback, monitoring mental health outcomes, and evaluating the long-term impact of the training on community resilience.

In addition to the above psychological and counseling theories, it is imperative to find existing bodies that offer services, including counseling services in war-affected areas. Several UN agencies provide services to refugees and war-affected populations which can serve as a foundation for expanding counseling services to civilian war victims. These agencies include the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). These organizations offer various services, including protection, food, shelter, healthcare, education, and legal assistance. However, counseling services are often minimal or not well-documented, highlighting the need for a dedicated organization to provide comprehensive mental health support [45,56,57].

The integration of these theoretical perspectives and existing UN frameworks creates a comprehensive approach to counseling civilian war victims. The model incorporates trauma-informed care principles, ensuring interventions recognize and respond to trauma’s effects, create safe environments, promote empowerment, and facilitate recovery. By training local counselors and utilizing culturally similar neighboring countries, the model ensures culturally sensitive and relevant counseling services. Emphasizing community-based interventions and training local teachers and community leaders enhances the sustainability and reach of counseling services. Additionally, leveraging existing UN agencies or services ensures that the proposed model aligns with international efforts to support war-affected populations.

The theoretical underpinning of the proposed model considers well-established theoretical frameworks and existing UN frameworks, making it more robust and credible. Another advantage is that this model can be practically implemented from within the UN, building upon the already established UN organization, their services, and experience. The proposed model not only addresses the immediate mental health needs of civilian war victims but also promotes long-term resilience and recovery within affected communities. It may provide a comprehensive and sustainable solution to the counseling needs of civilian war victims.

In summary, the proposed model for addressing the counseling needs of non-refugee civilian war victims involves several key components: (1) Establishing a dedicated UN organization to coordinate services for civilians in war-affected areas; (2) Developing degree-granting counseling programs in affected countries and neighboring regions; (3) Training local counselors and first responders to ensure culturally sensitive care; (4) Implementing community-based interventions to provide immediate and sustainable counseling support; and (5) Conducting ongoing research to refine and improve the effectiveness of interventions based on the model.

By implementing this model, war-affected civilian populations will gain access to much-needed psychological support. The model’s focus on building local capacity, providing culturally sensitive care, and engaging communities ensures long-term sustainability. This comprehensive approach addresses current gaps in mental health services for civilians in conflict zones, fostering resilience and aiding in the recovery of war-torn communities.

5. Discussion

The research literature on counseling services for war-affected populations has predominantly focused on veterans and refugees. Studies have extensively documented the mental health needs of these groups, particularly in relation to PTSD. However, we have documented a gap in the research literature concerning counseling services for non-refugee civilian war victims. This review highlighted the scarcity of studies addressing the needs of this population, emphasizing the urgent need for comprehensive research and culturally-adapted intervention. For example, in the Syrian civil war, millions of civilians were reported to be affected [46,48], and any cursory exploration using Google Academic would not reveal much in the way of counseling support services for this population, whether from the UN or the Syrian government. The same search can be concluded for the Ukraine war and, most recently, for the Gaza war. The objective of this paper is not to focus on increasing research regarding the counseling of civilians affected by war, but to emphasize the need for the development of appropriate counseling programs for this population. Research and subsequent publications will naturally follow once these programs and services are established. Similar to the existing body of research on trauma counseling for veterans—reflecting the availability of extensive counseling services for this group—there is a need for similar attention to civilians to address the current gaps in service provision.

Given the significant gap in the research and the lack of structured counseling support for non-refugee civilian war victims, it is crucial to establish a coordinated global effort to address these needs. International organizations, such as the United Nations and non-governmental organizations, must collaborate to develop comprehensive counseling programs tailored to these civilians’ unique experiences and cultural contexts. This effort should include training for local mental health professionals, creating easily accessible counseling resources, and implementing community-based support systems. This effort should include several key activities to ensure comprehensive support for civilian war victims. Training local mental health professionals involves establishing or expanding degree programs in psychology and counseling at local universities, offering scholarships to encourage enrollment, and providing specialized training workshops and seminars. These programs should focus on trauma-informed care, crisis intervention, and culturally sensitive counseling practices. Creating easily accessible counseling resources includes setting up community-based counseling centers and mobile units to reach remote and underserved areas, developing online platforms and telehealth services to provide remote counseling and self-help resources, and launching public awareness campaigns to educate the public about available services and reduce the stigma associated with seeking mental health support. Implementing community-based support systems involves training community leaders, teachers, and volunteers to provide essential psychological support and integrating mental health services with existing community services such as schools and healthcare facilities. Additionally, there should be an emphasis on developing evidence-based interventions specifically designed for war-affected civilians, ensuring that the mental health services provided are both effective and sustainable. By prioritizing the mental health needs of these often-overlooked populations, we can begin to mitigate the long-term psychological impacts of war and support the healing and recovery of entire communities. This proactive approach will not only improve the quality of life for civilian war victims but also contribute to global peace and stability by addressing the root causes of trauma and fostering resilience in conflict-affected regions. By providing comprehensive mental health support, civilian war victims can experience significant improvements in mental health outcomes, including reductions in PTSD, depression, and anxiety symptoms. Access to counseling helps individuals regain balance, enhance their daily functioning, and improve their overall well-being. Implementing community-based support systems restores social cohesion, rebuilds trust within communities, and empowers individuals with coping strategies and social support networks. Additionally, training local mental health professionals ensures the sustainability and cultural relevance of the services, further improving the quality of life for affected individuals. By addressing the root causes of trauma and fostering resilience, this approach also prevents the intergenerational transmission of trauma, reducing the likelihood of future conflicts and contributing to long-term peace and stability in conflict-affected regions.

6. Conclusions

It is concluded from this rapid literature review that an important population in war-affected countries is largely disregarded in terms of their counseling needs and counseling services. This population requires a large number of counselors because the number of civilians affected by war is usually in the millions. They also require multiplying counseling services. The counseling services alone would require financial resources that war-torn countries cannot provide, especially since they have to offer other services to their population, including nutritional aid, medical services, rebuilding infrastructure, etc. Thus, the international community should provide the financial resources required for counseling services under the umbrella of the United Nations. This paper proposes an initial model to ensure that the counseling needs of the forgotten population of civilians are met. The model ensures that the international community under the umbrella of the United Nations meets their commitment to war-affected countries and provides both the economic and logistical requirements to offer all services to civilians post-war in countries that need them. This model is directly linked to the results of our study, which highlighted significant gaps in the availability and effectiveness of counseling services for non-refugee civilians. By establishing or expanding degree programs in psychology and counseling at local universities and offering scholarships, the model addresses the shortage of trained mental health professionals identified in the results. Furthermore, creating community-based counseling centers and mobile units ensures that services are accessible even in remote areas, directly responding to the identified need for improved coverage and accessibility. The integration of online platforms and telehealth services further extends the reach of mental health support, particularly in regions with limited infrastructure. Public awareness campaigns and community training initiatives aim to reduce stigma and increase the uptake of counseling services, addressing the cultural barriers highlighted in our findings. By ensuring that these components are in place, the model not only improves the immediate mental health outcomes for civilian war victims but also contributes to long-term resilience and stability, ultimately supporting the recovery and rebuilding of conflict-affected communities.

Implementing such a comprehensive model necessitates a multi-faceted approach that includes not only financial and logistical support but also a commitment to ongoing research and development in the field of trauma counseling for war-affected civilians. Future studies should focus on the efficacy of various counseling interventions, culturally adapted approaches, and the long-term impacts of these services on civilian populations. Furthermore, establishing a global network of mental health professionals dedicated to crisis intervention and post-war recovery can facilitate knowledge exchange and the development of best practices. By utilizing the expertise of international bodies, local governments, and academic institutions, we can create a robust framework for addressing the mental health needs in war-torn regions. This concerted effort will help bridge the current gap in services, ensuring that all civilian victims of war receive the psychological support they desperately need, fostering resilience, and aiding in the reconstruction of their communities.

This study emphasizes the crucial need for a coordinated global effort to address the counseling needs of non-refugee civilian war victims. The proposed model provides a comprehensive framework for delivering culturally sensitive and sustainable mental health support. By prioritizing these often-overlooked populations, we can begin to mitigate the long-term psychological impacts of war and contribute to the healing and recovery of affected communities. Future research could focus on the implementation of this model or parts of it, and its effectiveness in different cultural contexts [58].