Results Recommendations• NGOs should provide MHPSS services with a focus on empowerment and self-reliance • Introduce interventions focusing on pain mechanisms, coping strategies and physical resilience • Implement livelihood programmes • Increase service accessibility and outreach activities • Provide support groups for people who have lost a close family member • Highlight the importance of supervision and training • Ensure high quality service provisions by applying relevant outcome measures and to further contribute to the evidence base for MHPSS • Diversify MHPSS activities to different target groups, including men and women, and address the needs of elderly and individuals with disabilities This study provides evidence of a large gap between the need of MHPSS among Syrian refugees and provided services. Of the 1082 respondents in this study, 62% expressed that they needed assistance to deal with physical pain and distress. Almost 80% reported being in pain, of which 27% were in severe or very severe pain. Additionally, 55% suffer from distress and 56% rate their own health as fair or poor. Even among the 18-25-yearolds, the prevalence of reporting their overall health as fair was 30.7%. For functionality levels, 28.5% felt severely or extremely emotionally affected by their health problems, and more than 20% had serious difficulties in doing day-to-day work. On the other hand, the majority (72-74%) had no problems in maintaining friendships and participating in community activities