 Thanks very much. I'm just a humble member of a larger study team, so it's my pleasure to present to you the outcome of our study that we conducted in Grozny in the Republic of Chechnya between 2014 and 2015 to evaluate the impact of an individual counseling intervention. The World Health Organization estimates that in an acute emergency between 15 to 20 percent of the population will develop a moderate mental health disorder. As you've heard today, there's a global focus on increasing mental health services in emergencies and for humanitarian agencies such as MSF to scale up our services. However, there's limited evidence on the impact of these interventions, particularly on the individuals that are participating in them. The Republic of Chechnya, for those of you that don't know, is located in the Caucasus region between Russia and Ingushetsia. It experienced greater than 20 years of conflict in the 1990s and early 2000s, and it continues to face an ongoing atmosphere of insecurity and instability. MSF conducted a survey in 2004 amongst internally displaced persons in Chechnya and determined that most of them were suffering from somatic complaints, anxiety and insomnia, depressive feelings and social dysfunction. Recently, Chechnya has undergone rapid reconstruction and development. MSF runs a mental health program in the Republic of Chechnya since 2001 in collaboration with the Ministry of Health. The program focuses on individual counseling, psychoeducation, group counseling and training of medics to recognize mental health problems. It does not focus on psychiatric problems. Our study hypothesis was that the intervention related to individual counseling improves the functioning of adult clients that attend our program in Chechnya. The location of the study and also the vast majority of our mental health program runs in three Ministry of Health Hospitals, which are located in Grozny. The target population of the mental health program and therefore of our study was persons who suffer from chronic stress and multiple traumas and who are self-referred to the mental health program. The individual counseling intervention has as the objective to improve functioning and symptoms of its clients. The counselors are a mix of lay and professionally trained counselors and they are constantly supervised by international mental health experts. The methods of individual counseling focus on theories that are derived from trauma focus therapy. Okay, so we conducted a randomized controlled trial using a step wedge design. The reason for the design to use a step wedge design was because it would account for time effects between the intervention and the control group. I will go through the process of inclusion and then the follow-up. So people that presented to the MSF mental health program were initially screened and they were screened to complete certain eligibility criteria. They needed to be over 18 years of age and they had to score greater than 1.75 on the Hopkins Symptoms Checklist 25. This is a validated scale internationally which measures symptoms of anxiety and depression. Clients who were not considered for inclusion in the study, if they are identified to have active suicidal ideation, a major psychiatric disorder that required medication, or if they'd been enrolled in the same MSF mental health program in the previous six months. Each of these exclusion criteria was established through a series of questions. Once they were considered eligible for inclusion in the study, they underwent informed consent and then they were randomized to two arms of our study. The randomization was done by a computer-generated randomization list which were located at each of our hospitals and the study counselors that were doing the enrollment were blinded to that process. Then we went to the intervention and the control group. The intervention group underwent a pre-counseling evaluation which I will explain in a moment and then they went immediately into the individual counseling component of the mental health program. Following the completion of that intervention, they underwent a post-counseling measurement. The control group also underwent a measurement at this point and then they entered a two-month wait-listed period. During that period, they were contacted once by our study team to ensure that their symptoms had not deteriorated. Then once they came back after the two-month wait-listed period, they underwent another evaluation and then they were immediately enrolled in the intervention of individual counseling. To measure functioning and symptoms, we used six different scales. For the functioning, we looked at the short Form 6, SF6, which measures aspects around general health, body pain, social supports and emotional functioning. We had also developed a Chechen functioning scale for males and females in a previous qualitative study. We also used the MSF functioning scale, which MSF OCA is using as a regular monitoring tool for our clients in mental health programs across our operations. We also looked at three scales for symptoms. So the Hopkins symptoms checklist, which I mentioned before, which looks at anxiety and depression, the HTQ 16, which looks at symptoms related to post-traumatic stress disorder, and the MSF scale looking at symptoms, which is similar to the MSF functioning one, which we use for regular monitoring and evaluation. In the analysis, we looked at a primary outcome to compare the scores and the difference in scores between the intervention and the control group at the post-counseling moment, so when the intervention group had completed counseling. The effect size and the difference of gain scores is calculated as something that's called Cohen's D, and the important point to remember here is that a large effect size is if you get a Cohen's D that is greater than 0.75. We also constructed a multivariate regression model to compare differences in mean gain scores, and the adjustments included hospital recruitment, age, sex, marital status and employment status upon enrollment, the number of counseling sessions that the intervention group had undergone, and coping mechanisms. All analysis was done using an intention to treat model. So these are our results. Out of 203 persons that presented to the mental health program, 168 were eventually enrolled, and 191 of those had actually been eligible, but obviously a proportion declined to participate. We randomized 84 persons to the intervention group and 84 to the control group, and as you see, the vast majority of the clients that were in the study were female. The differences between the two groups was not significant. In the intervention group, there was a six-person dropout between enrollment and post-counseling, and in the control group, there was only a four-person dropout between enrollment and once they completed their wait-listed period. The intervention group underwent a mean of 3.8 sessions, and those 3.8 sessions lasted for approximately 32 days. So these are two examples of the scales that we used to measure functioning. So on the left-hand side, you see the SF6 related to general health. In purple is the intervention group, and in green is the control group. What you see on the left-hand side is the scores that they had prior to counseling, and then the second part of that graph is what the scores they had after counseling in the intervention group and for the control group once they completed their wait-listed period. So you see that intervention and control group are quite similar prior to counseling and that there's a significant increase in the intervention group and even a slight increase and thus improvement in the control group. Cohen's D for this scale had a medium effect size. Then on the right-hand side, you see the thing that we use for the MSF functioning scale is the scale from 1 to 10. Again, intervention and control group are very similar pre-counseling with a significant improvement in functioning measured post-counseling for the intervention group compared to the control group. These are all the scales that I mentioned before, and I'll just draw your attention to the top three. So the ones in the red box all had Cohen's D, so large effect sizes, and all were highly significant. So the intervention group compared to the control group did substantially better on these three scales. Social support, Chechen functioning for females, and the SF6 around general health had a medium effect size. And the SF6 for body pain had a small effect size, and we kind of attribute that to the fact that the majority of our clients were actually enrolled in a hospital-based environment, so possibly that their health problem had not resolved. This is a similar analysis that was conducted for the scales that we used to measure symptoms. If I draw your attention to the column D, so that's the effect size, you can see that for all the scales that we used to measure symptoms, there was a large effect size between the intervention group and the control group, so a dramatic and significant increase in improvement in symptoms in the intervention group compared to the control group. This very busy table shows the adjusted analysis using the regression model that I mentioned before. If you look at the unadjusted column compared to the adjusted column, you see that the scores actually didn't change so much once we accounted for the covariates, and that almost all of them are highly significant. The only one that was not significant is the scale related to the Chechen functioning in males, and we attribute that probably due to the fact that we didn't have as many males enrolled in our sample. Obviously, this is an important study and I think it's the first time that MSF has tried to measure the impact of mental health programming using this type of approach, but there were limitations. So as I mentioned before, we did a hospital-based recruitment, so obviously the results are not necessarily represented for the rest of Grozny or the rest of Chechnya. We did our very best to ensure the blinding and definitely upon enrollment, we are quite confident of the fact that our study counselors were completely blinded to the allocation of groups, but we can't exclude that during follow-up visits and follow-up measurements that that status was possibly revealed in the conversation. At the moment, we can't extrapolate the findings to emergencies and acute trauma or even to persons that are experiencing more severe mental health distress. So in conclusion, we think that the counseling intervention that's included in the MSF mental health program in Grozny is significantly improving functioning and significantly reducing symptoms of our clients, but we really encourage everybody in this room working in similar contexts and particularly in acute emergencies to confirm that the same approach for the mental health program also is working here. There's a lot of people to acknowledge from MSF, also Johns Hopkins University, but our thanks really goes out to the clients that were enrolled in the study. You saw the dropout rate was pretty amazing, so they really committed to it once they enrolled, and then finally the study team across three locations. So thank you very much.