Evaluating the Real-World Effectiveness and Scalability of METRA for Adolescents in Conflict-Affected Contexts Across Syria, Iraq, and Afghanistan

Adolescents exposed to war, violence, and displacement in crisis-affected regions face high rates of psychological distress and trauma, yet have limited access to effective mental health care. To address this gap, our team developed METRA (Memory Training for Recovery-Adolescent); a brief, low-intensity scalable early intervention that can be delivered by trained local community health workers and educators. The program is culturally adaptable and designed for low-resource settings. We have conducted five clinical trials with adolescents aged 10–19 in Afghanistan, Iraq and Pakistan. Results show METRA is feasible, acceptable, and associated with improvements in PTSD, depression and anxiety symptoms. All sessions were delivered by trained non-specialists, demonstrating the intervention’s potential for scale. METRA was found to be cost-effective compared to individual trauma-informed interventions. We are now aiming to evaluate METRA in real-world conditions through the Wellcome Trust’s Impact Phase. Our objectives in the Foundation Phase are to further strengthen partnerships and pathways to implementation and scale for the Impact Phase. The Impact Phase will assess the effectiveness, scalability, and implementation of METRA in three diverse conflict-affected settings (Iraq, Afghanistan and Syria). The research will contribute robust evidence for early mental health interventions for adolescents affected by crises in LMICs.