It’s OK to not be OK: Digital mental health in Mahama Refugee Camp

In Mahama, Rwanda’s largest refugee camp, a silent mental health crisis is brewing. Mahama, in the far east of the country, is home to nearly 70,000 people forced to flee violent conflict, primarily from Burundi and the Democratic Republic of Congo. More than half of those surveyed have lived in the camp for seven years or longer. Over time, the initial trauma of displacement is compounded by everyday struggles and uncertainty.

Finding work in the camp is extremely difficult. Unemployment affects roughly two in every three people, and the inability to support oneself or plan for the future creates chronic stress that steadily erodes mental wellbeing. Three in every four camp residents experience anxiety, depression, or trouble sleeping. Yet, only a small minority seek out formal help, due to social stigma. For most, the burden is carried alone.

One young man describes this sense of isolation and helplessness:

“I used to think mental illnesses do not get better. I thought they were something that cannot be treated. I felt alone, with no one to tell about my grief and the situation I was going through.”

 

Recognizing that there is no health without mental health, UNHCR, the UN Refugee Agency, in partnership with Alight, set out to test whether accessible, digital-enabled mental health and psychosocial services (MHPSS) could dismantle barriers to seeking help.

‘I’m here, talk to me’

In Mahama, as in many contexts, fear of judgment from the wider community keeps many from speaking openly about mental health challenges. Rather than seeking support, many who are suffering turn to alcohol or withdraw socially — coping mechanisms that can make things worse rather than better. Dr Christophe Rushanika, Alight’s technical advisor on health and nutrition, explains:

“We needed a way to reach people and let them know it’s OK not to be OK — and that help is available at the clinics. In humanitarian contexts, primary healthcare often takes priority, while mental health support is underfunded. We knew that mobile phone adoption was high in Mahama, thanks to its use for cash transfer programmes. That gave us an opportunity to connect with more people using fewer resources.”

Based on prevailing social norms and mobile phone saturation, UNHCR, Alight, Viamo, and the Rwanda Biomedical Centre designed and piloted an offline-available interactive voice response (IVR) system to raise awareness and provide preliminary care. Through basic spoken audio on a mobile phone, the tool provides mental health information, guided self-help exercises, and personalized pathways to care — without requiring an internet connection. To access the service, users simply dial 845 and follow the voice prompts.

This system uses the Wanji Games platform: a “choose-your-own-adventure” IVR journey, designed to provide education via toll-free calling, with players charting their own course through the learning materials using their keypad. The model is particularly useful in contexts like Mahama, where connectivity can’t be taken for granted. In Luganda — a Bantu language spoken primarily in Uganda — “wanji” means “I’m here, talk to me.” For UNHCR and Alight, the intention was to offer a platform that listens — and then guides.

Quietly reaching thousands

The mental health scenarios developed during this pilot, supported through UNHCR’s Digital Innovation Fund, provide a variety of potential journeys based on what the user wants to know. After dialling 845 and selecting a topic, the caller is guided through a series of educational voice messages. Say, for instance, post-traumatic stress disorder (PTSD) is selected: The subsequent messages explain the symptoms, clarify that the condition is a response to trauma rather than a sign of personal weakness, outline prevention and treatment options available at community clinics, provide guidance on how to assist someone experiencing a flashback or distress, and, finally, conclude with a quiz to consolidate learning. Other messages share personal testimonies, walking listeners through what it’s like to take the first step toward care: how to prepare, what to expect at the clinic, and how treatment and recovery could unfold over time.

Beyond the content itself, the simple fact of an always available tool ready to listen and coach callers through taboo topics provided a sense of accompaniment. One young man in Mahama explained:

“This tool helped me feel not alone. Like coming from darkness to the light. Because there is a voice on the other end to guide you. It gives comfort. And you understand that other people face these problems too.”

Between June and August 2025, the platform served 12,333 callers who listened to 74,844 key messages. It proved especially popular among young listeners: 55% were under 25 years old and the vast majority were under 35, with women consistently outnumbering men among users. The anonymity and flexibility the platform offered meant callers could learn about mental health from the comfort of their homes, on their own schedule, and without fear of judgment.

Learning together

At the conclusion of the pilot, mental health literacy had measurably improved across the community. According to surveys, more people were able to define ‘mental health’, recognize the symptoms of certain mental disorders, and understand that conditions such as epilepsy and depression are treatable. Belief in biomedical explanations for mental health disorders increased, while reliance on supernatural explanations declined. People reported feeling more comfortable discussing mental health and their own struggles.

Overall, stigma and discrimination around mental health decreased by 10%. Ndagijimana Beatrice, a woman in the camp, says:

“Understanding our own mental health helps us understand and support others. When we see someone struggling with mental health, we don’t judge them. We say: Go and see a doctor, they can help. Our lives are better when we don’t keep this for ourselves.”

Indeed, the project resulted in significantly more people seeking help. Clinics reported a 5% increase in individuals coming forward for psychosocial support. Community coping mechanisms also began to shift. Instead of withdrawing or turning to alcohol, people increasingly adopted healthier strategies for managing mental health challenges, such as attending individual counseling sessions, participating in MHPSS support groups, and reaching out to community health workers and peer supporters. Reflecting this wider shift, one young man says:

“Listening to the messages brought hope. It helped me understand that mental health illnesses are normal — and that there is a path forward to cure them. That tomorrow will be better. It encouraged me to seek help at the health centers and to trust health practitioners to help me.”

No panacea

In addition to promising results, this pilot delivered important lessons to incorporate into the design and delivery of digital MHPSS interventions. One is the importance of addressing economic opportunity alongside mental wellbeing. This is illustrated by the experience of Jacqueline, a 16-year-old who became pregnant after rape. Ostracized by her family, she attempted suicide. Through the project, Jacqueline accessed youth-focused group therapy sessions. This psychosocial support was accompanied by economic empowerment, through a savings group established by a different Alight initiative. The impact of this dual support was transformative. Jacqueline started a small business and became an advocate, encouraging her peers to seek mental health support.

However, awareness didn’t always lead to action. While stigma around mental health reportedly dropped by 10%, clinic visits rose by just 5%. This gap suggests that awareness alone is not enough. Future interventions must consider how to address other social, psychological, and structural barriers people face at the moment they consider seeking care. This means tailoring communication and services to different demographics and making it easier for people to move from intention to action through measures like clear referral pathways and community-based, decentralized care points.

Building trust with religious leaders and traditional healers was key to the pilot’s success. Many camp residents have historically turned to them, rather than to clinics, to address mental health issues. Through community outreach and dialogue, the pilot created lines of communication and established trust with these actors. Over time, they began referring people to clinics. Community health workers play a similarly essential role in linking people to care, but they require ongoing training and support to confidently handle complex mental health cases.

Finally, while digital tools are particularly effective for reaching young people, they must be combined with non-digital approaches to ensure those without phones or digital skills are not left behind.

Looking to scale

This pilot demonstrates that digital solutions can help guide people toward care and reduce stigma, but they cannot solve the root causes of distress or provide holistic care on their own. Poverty, limited opportunity, and prolonged uncertainty continue to weigh heavily on mental wellbeing. To achieve long-lasting impact, mental health interventions must go hand in hand with pathways for education, vocational training, and income generation.

Nevertheless, the IVR system’s impact on stigma, awareness, and service access was clear. And Mahama is not unique; similar challenges exist in other camps across Rwanda and beyond. Given the strong uptake and positive behavioral outcomes, there is a clear rationale to expand the platform to additional refugee camps in Rwanda and potentially to neighboring countries. The project team is actively seeking partnerships and funding opportunities to support this next phase, with the goal of scaling a cost-effective, accessible model for delivering MHPSS to populations with limited internet connectivity.

Learn more about the Digital Innovation Fund.