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Background: Growing up in adversity can create enduring deficits in children’s cognitive and socio-behavioral skills that undermine later-life productivity, reduce human capital, and increase social costs. Early interventions that target caregiver mental health offer a promising pathway to strengthen the developmental environment of children exposed to severe stress. Yet, in low-resource humanitarian settings, evidence on scalable approaches that generate such intergenerational benefits remains limited. War-related displacement places mothers and young children at exceptional risk for psychological distress and impaired functioning, with potential long-term consequences for both generations. Self-Help Plus (SH+), a brief, low-intensity WHO group intervention based on Acceptance and Commitment Therapy, has shown promising short-term effects in reducing psychological distress among South Sudanese refugee women in Rhino Camp, Uganda. However, key questions remain regarding the durability of these effects and whether improvements in maternal mental health translate into measurable gains in children’s own well-being and early development.

Methods: This two-arm, parallel-group cluster-randomized controlled trial will enroll 720 mother-preschool-aged child (3–5 years) dyads from 24 villages in Rhino Refugee Settlement, Uganda. Villages are randomized 1:1 to receive either SH+ and Enhanced Usual Care (EUC), or EUC only. Assessments are conducted at baseline (T0), 3 months (T1), and 12 months (T2) post-intervention. The primary outcome is maternal psychological distress (Kessler-6) at 12 months (T2). The key secondary outcome is parent-reported child psychosocial wellbeing (Kiddy-KINDLR) at T2. Secondary outcomes include additional indicators of maternal wellbeing and mental health, parenting practices, and child outcomes assessed across study time points, including psychosocial difficulties and child self-reported well- being. Analyses will follow an intention-to-treat approach, adjusting for clustering and relevant covariates.

Discussion:This trial replicates and extends prior evidence on SH+ in a large refugee population. It will examine whether early mental health gains are sustained, and whether intergenerational benefits emerge for preschool-aged children. Findings will inform scalable intervention strategies to promote psychological resilience and child development in humanitarian contexts.

Trial registration: ClinicalTrials.gov NCT07062341. Prospectively registered on July 11, 2025.

BackgroundGrowing up in adversity can create enduring deficits in children's cognitive and socio-behavioral skills that undermine later-life productivity, reduce human capital, and increase social costs. Early interventions that target caregiver mental health offer a promising pathway to strengthen the developmental environment of children exposed to severe stress. Yet, in low-resource humanitarian settings, evidence on scalable approaches that generate such intergenerational benefits remains limited. War-related displacement places mothers and young children at exceptional risk for psychological distress and impaired functioning, with potential long-term consequences for both generations. Self-Help Plus (SH+), a brief, low-intensity WHO group intervention based on Acceptance and Commitment Therapy, has shown promising short-term effects in reducing psychological distress among South Sudanese refugee women in Rhino Camp, Uganda. However, key questions remain regarding the durability of these effects and whether improvements in maternal mental health translate into measurable gains in children's own wellbeing and early development.MethodsThis two-arm, parallel-group cluster-randomized controlled trial will enroll 720 mother-preschool-aged child (3-5 years) dyads from 24 villages in Rhino Refugee Settlement, Uganda. Villages are randomized 1:1 to receive either SH+ and Enhanced Usual Care (EUC), or EUC only. Assessments are conducted at baseline (T0), 3 months (T1), and 12 months (T2) post-intervention. The primary outcome is maternal psychological distress (Kessler-6) at 12 months (T2). The key secondary outcome is parent-reported child psychosocial wellbeing (Kiddy-KINDLR) at T2. Secondary outcomes include additional indicators of maternal wellbeing and mental health, parenting practices, and child outcomes assessed across study time points, including psychosocial difficulties and child self-reported wellbeing. Analyses will follow an intention-to-treat approach, adjusting for clustering and relevant covariates.DiscussionThis trial replicates and extends prior evidence on SH+ in a large refugee population. It will examine whether early mental health gains are sustained, and whether intergenerational benefits emerge for preschool-aged children. Findings will inform scalable intervention strategies to promote psychological resilience and child development in humanitarian contexts.Trial registrationClinicalTrials.gov NCT07062341. Prospectively registered on July 11, 2025.

Background

Climate extremes in Africa threaten the food security of war-affected refugees, who often experience mental health challenges that hinder their capacity for agricultural adaptation. Cost-effective, climate-smart farming interventions are crucial for addressing food insecurity in humanitarian contexts, yet evidence on their effectiveness is limited, and the potential benefits of integrating them with mental health interventions remain unexplored. We hypothesize that the success of agricultural interventions, especially under adversity, is influenced by mental health and psychological functioning.

Methods

This study employs a three-arm, parallel-group, cluster-randomized controlled trial (cRCT) in the Nakivale refugee settlement, Uganda. Thirty villages within the settlement will be randomized in a 1:1:1 allocation ratio to one of three conditions: Enhanced Usual Care, a Home Gardening Intervention (HGI) or HGI combined with the peer-delivered psychosocial intervention Self-Help Plus (SH + HGI). A total of 900 refugee mothers and their children (aged 3–4 years) will be enrolled, with 30 dyads per village. The primary outcome is food insecurity at 12 months post-intervention, assessed using the Food Insecurity Experience Scale (FIES). Secondary outcomes include dietary diversity, child malnutrition and mothers’ psychological distress. Data will be collected at baseline, 3-month and 12-month follow-ups. Primary analyses will use an intention-to-treat (ITT) approach.

Discussion

This study will shed light on the role of mental health in agricultural adaptation for food security, evaluating the efficacy of scalable, cost-effective interventions in a refugee setting. The findings will have implications for the design and implementation of integrated food security and mental health programs in humanitarian and other resource-constrained settings.

Trial registration

ClinicalTrials.gov NCT06425523. Registered on 24 May 2024.

The detrimental impacts of wars on human development are well documented across research domains, from public health to micro-economics. However, these impacts are studied in compartmentalized silos, which limits a comprehensive understanding of the consequences of conflicts, hampering our ability to effectively sustain human development. This article takes a first step in addressing this gap by reviewing the literature on conflict impacts through the lens of an inter-disciplinary theoretical framework. We review the literature on the consequences of conflicts across 9 dimensions of human development: health, schooling, livelihood and income, growth and investments, political institutions, migration and displacement, socio-psychological wellbeing and capital, water access, and food security. The study focuses on both direct and indirect impacts of violence, reviews the existing evidence on how impacts on different dimensions of societal wellbeing and development may intertwine, and suggests plausible mechanisms to explain how these connections materialize. This exercise leads to the identification of critical research gaps and reveals that systematic empirical testing of how the impacts of war spread across sectors is severely lacking. By streamlining the literature on the impacts of war across multiple domains, this review represents a first step to build a common language that can overcome disciplinary silos and achieve a deeper understanding of how the effects of war reverberate across society. This multidisciplinary understanding of conflict impacts may eventually help to reconcile divergent estimates and enable forward-looking policies that minimize the costs of war.

The Battle of Mosul (2016–2017) was one of the most grueling urban warfare campaigns in recent memory. The fighting quickly concentrated in West Mosul, where civilians prevented by the Islamic State from leaving their homes experienced airstrikes and indiscriminate shelling by government forces. Utilizing the as-if-randomness of severe damage or destruction of people’s homes, this paper examines the impact of war exposure on the endorsement of moral foundations among a large and diverse sample of Mosul residents (N = 1027). Home damage increased binding morality but had a larger impact on individualizing morality, heightening concerns about fairness and protection from harm. A survey experiment in which the sectarian identity of the target was randomly assigned further revealed a strong association between individualizing morality and parochial altruism. Challenging conventional wisdom, both individualizing and binding morality reinforce group cohesion in ways that are functionally adaptive and responsive to the damage wrought by war.