Shervin Shahnavaz, Farzaneh Badinlou, Keyvan Bozorgmehr, Zohreh Khazraei-Manesh, Lars Lien, Karl Blanchet, and Bernadette Nirmal Kumar have written and published a commentary addressing a timely issue: the Iran–Israel–United States conflict has intensified political divisions, heightened tensions, and deepened ruptures, adding emotional pressure to a diaspora that was already under strain. Below is a translation of this commentary. The article was recently published in The Lancet Regional Health – Europe.

Armed conflict leaves psychological wounds that extend far beyond borders, as has been seen in the mental health burden of war on affected and forcibly displaced populations. Yet the burden carried by diasporas—those who watch the news of catastrophe, grieve, support from afar, and continue to care—remains insufficiently recognized.

Recent evidence shows that diasporas are continuously exposed to the suffering of others through family networks and digital media, placing them at risk of mental health difficulties. Broad trauma-related stressors produce geo-social psychiatric harm among diaspora individuals.

Common manifestations among Middle Eastern diasporas include sleep disturbances, somatic complaints, worsening of pre-existing depression, anxiety or trauma-related symptoms, moral disillusionment, moral distress and survivor exhaustion, as well as functional impairment caused by compulsive news consumption and round-the-clock monitoring of events.

For Iranians abroad, the Iran–Israel–United States conflict intersects with multiple pre-existing political and social conditions, including widespread transnational repression that extends through identity and kinship ties.

Parallel realities emerge: everyday life in the diaspora and war in Iran create a complex psychological landscape in which the outward appearance of normal life coexists with deep feelings of worry, grief, and anger, alongside hope and solidarity. The Iranian diaspora in many countries has mobilized, organizing large demonstrations that strengthen solidarity, shared identity, and emotional support. This helps transform feelings of helplessness into collective action and reinforces transnational bonds.

This powerful resilience, expressed through participation, increases a sense of agency, meaning, and control, and helps reduce psychological distress.

The Iran–Israel–United States conflict has intensified political divisions, heightened tensions, and deepened ruptures, adding emotional pressure to a diaspora already under strain. As a result, experiences of exclusion, increased fear, moral distress, and splitting between pro-war and anti-war positions have intensified.

Disruptions and unreliable digital communication are a major source of stress for the diaspora, as they depend on these connections to stay in touch with loved ones in Iran. Uncertainty about the safety of family members intensifies psychological pressure and anxiety about future news; it also increases emotional exhaustion and feelings of helplessness among Iranians living abroad. In addition, some members of the diaspora face fears of increased stress caused by restrictive immigration regulations in different countries. This combination of fears about the country of origin and uncertainty around residence status significantly increases their psychological strain and erosion.

In the short term, health and social services should include the mental health needs of diaspora communities in their overall response to ongoing conflicts. This includes assessing psychiatric and psychological impacts and ensuring that structured support is available both for patients and for clinicians, in order to reduce the risk of secondary or vicarious harm.

In the long term, sustained investment is needed to develop research and services that address the mental health needs of diaspora populations during periods of instability, with the aims of promotion, prevention, and treatment. Box 1 proposes short- and long-term actions.

Reducing psychological harm in the diaspora ultimately requires political solutions to ongoing conflicts. Without peace and de-escalation, the mental health burden of these conflicts may spread to diasporas and their networks, affecting even those who have no direct connection to conflict zones. In our interconnected world, migration is a lasting reality shaping our future. The effects of regional wars extend far beyond the areas directly affected and influence the mental health of people in distant places.

These indirect effects require greater attention from health professionals, researchers, and policymakers so that the global health consequences of armed conflict can be addressed effectively.

The commentary also provides guiding principles for clinicians, service providers, and communities.

1. Recognize the significance of indirect exposure and provide stepped, culturally responsive care that links primary care, mental health care, and social support.
2. Include self-care strategies and interventions that strengthen connection with friends and family.
3. Conduct sensitive and careful assessment at the point of care—especially in primary care settings—for direct and indirect exposure, psychiatric difficulties, acute stress, grief, sleep disorders, and suicidal thoughts. Also validate and recognize the effects of transnational repression and moral injury.
4. Implement the World Health Organization’s mhGAP Humanitarian Intervention Guide — mhGAP-HIG — and psychological first aid in primary care settings. Task-sharing is essential in low-resource settings, and peer support may in some contexts be more effective than professional support.
5. Provide evidence-based psychotherapeutic interventions, adapted to culture and language, for psychiatric diagnoses such as post-traumatic stress disorder and prolonged grief disorder.
6. Provide access to internet-based psychological interventions that can be scaled globally, with or without therapist support, including online self-care interventions.
7. Assess hope, social efficacy, and resilience alongside psychological distress; create low-risk, identity-affirming opportunities for social participation and connection in order to strengthen social resilience.
8. Support the well-being of service providers and manage secondary traumatic stress through supervision, peer support, and clear boundaries, while also recognizing shared exposure to trauma within the diaspora.
9. Recognize the practical effects on diaspora staff and students; provide visible organizational support, such as flexible policies and temporary adjustments to workload or deadlines.
10. Collaborate with non-governmental organizations and other institutions to create a channel for sending and receiving messages between the diaspora and family members and social networks in Iran. The Swedish Red Cross and the International Red Cross have established such a channel.
11. Immigration authorities should take current conditions in migrants’ countries of origin into account when making decisions about residence or permits, so that additional stress is not imposed on migrants during these difficult times.

Note: Zohreh Khazraei-Manesh, a collaborating consultant with eReliever based in Sweden, is one of the authors of this guiding commentary.