Emergency Smile Research Project

Introduction

Forced migration due to conflict, persecution, or disaster displaces millions globally, creating urgent humanitarian needs and profound psychosocial challenges for those who are affected. Many refugees, especially children, face severe trauma and significant mental health challenges. At the same time, aid workers in these high-pressure environments face immense stress and burnout. This research project will assess the emotional and psycho-social impact of healthcare clowning activities for both unaccompanied minors and the aid workers supporting forced migrants in Lesvos, Greece. 

Scope 

The Aegean Islands in Greece is a primary entry point for migrants into Europe. Mental health challenges are common amongst many refugees, including children and youth. Studies indicate that up to 87% of young refugees suffer from anxiety, depression, and other related symptoms. These findings highlight the critical need for interventions that support emotional and physical wellbeing and foster resilience for youth living in refugee camps. Simultaneously, aid workers operating in these high-pressure environments are prone to high levels of stress and burnout, necessitating enhanced psychosocial support so that these vital workers can continue to support the refugee community. 

This research aims to address these challenges by building on RED NOSES International's Emergency Smile programme, which brings musical parades, interactive clown shows, and circus workshops—led by professional healthcare clowns—to children in crisis zones. These playful activities foster joy, emotional expression, and a sense of inclusion. In addition, aid workers participate in Humour Relief Workshops designed to reduce stress and build resilience. 

Using a mixed-method design, this research aims to provide valuable insights as to how humour and playfulness can improve wellbeing in crisis settings. It fills a significant gap in the literature on the impact of healthcare clowning and other artistic interventions in humanitarian contexts. Specifically, the research will evaluate the effectiveness of the clowns’ artistic activities on the wellbeing and social connectedness of unaccompanied minors, while also exploring how the Humour Relief Workshop for aid workers helps to reduce stress, strengthen team cohesion, and enhance coping mechanisms in high-pressure environments. 

Insights and Deliverables

The research team will submit an initial study protocol for ethical approval to an independent ethical committees. Upon receiving approval, fieldwork with children and aid workers in Lesvos will begin, supported by local partners in the field. 

Following data collection, the research team will analyze the impact of healthcare clowning activities on children’s and aid workers’ well-being, social connectedness, and stress levels. The results will be presented in one or more academic manuscripts, which will be submitted to peer-reviewed journals. 

These publications will support the advocacy, policymaking, and strategic planning by local and international stakeholders working with forcibly displaced populations. By centering the voices of children and the experiences of aid workers, the research will address a critical gap in the arts for health literature within humanitarian contexts. 

Project Team

The research is led by Eliala Alice Salvadori, PhD in Developmental Psychopathology at the Research Institute of Child Development and Education of the University of Amsterdam; Researcher at the Department of Pedagogy, Psychology, Philosophy of the University of Cagliari; and Visiting Research Scholar at the Department of Psychology of the University of Miami. The research team includes members from RED NOSES International, alongside experts from the National and Kapodistrian University of Athens, the University of Miami, Sapienza University of Rome, NYU Steinhardt, and WHO Europe. These collaborators bring expertise in clinical psychology, arts for health and wellbeing, and social and developmental psychology, contributing to a global and interdisciplinary approach to the project. 

Funding and Support

Support for this project was provided by Fondation Alta Mane.

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