East Africa and the Horn of Africa host millions of refugees, migrants, and internally displaced people who face serious humanitarian crises driven by civil wars, political instability, environmental disasters, and economic hardship. Armed conflicts in Sudan, South Sudan, the Democratic Republic of the Congo, and Somalia have significantly increased the risk of mental health disorders such as depression, anxiety, and PTSD, particularly among the region’s most vulnerable populations. This chapter examines the mental health challenges faced by refugees and internally displaced people (IDPs) in East Africa, with a specific focus on the ongoing war in Sudan, where individuals experience violence and have limited access to mental health services. Despite the grim realities of war, East Africans are marked by extreme resilience deeply rooted in their culture and belief systems. This chapter aims to identify the multifaceted migration journey, including its hardships and the resilience acquired through adversity. The aim is to enrich the current body of literature, which predominantly focuses on African refugees in Western countries, by introducing a paradigm shift in humanitarian aid work and culturally appropriate mental health services that rely on community mobilization. The WHO’s notion that “there is no health without mental health” is examined to assess the current state of mental health services in refugee and IDP camps, as well as host communities in East Africa. Displaced persons often face intensified mental health challenges due to trauma from events before migration, compounded by the stresses of resettlement in poorly serviced refugee camps. The chapter explores the nature of mental health services and policies in some East African countries, introduces theoretical frameworks for better designing mental health interventions, and sets the stage for future chapters to explore needs, propose interventions, and document case studies highlighting profound resilience among some of the world’s most vulnerable groups.