El Niño's impacts on health are widespread, but evidence of its psychosocial effects on historically affected communities is limited. We aimed to describe perceived mental health impacts, local barriers to psychological well-being, and challenges in accessing support post-El Niño in Tumbes, Peru.

Between May-June 2017, we conducted 27 semi-structured interviews and three focus groups in Spanish with 24 adult residents, including local authorities and residents from heavily and minimally El Niño affected areas. Data were analyzed thematically.

Initially, participants minimized El Niño's mental health impact, claiming to be "accustomed" to it. However, most described specific cases of suffering, including socioeconomic struggles, feelings of lack of support, unfairness, and helplessness. Local authorities acknowledged inadequate support availability. Psychosocial distress was exacerbated by poverty, scarce work opportunities, and disproportionate effects on vulnerable groups. Contextual factors like corruption, underfunding of prevention, and lack of reconstruction led to despair and distrust of authorities. Participants identified responsibility gaps at different levels but rarely acknowledged their responsibility or suggested alternatives. Psychosocial problems, therapy availability, or community support programs were seldom mentioned, though mutual collaboration was highlighted as useful but non-existent.

We found multiple interrelated issues in under-resourced post-disaster communities, highlighting the psychological burden of living "between disasters" and how socioeconomic distress and lack of support contribute to suffering. Beyond emergency aid, these communities require integrated care considering contextual and community-level distress, improving access to prevention and reconstruction activities, and addressing ongoing anxiety about future disasters to foster long-term resilience.