These two letters to the Editor, published in the Lancet Journal, provide an overview of the situation in Lebanon amidst the Syrian crisis and the resilience of the health system against all odds. They particularly shed light on the establishment of a national mental health programme and the launching of a mental health system reform in Lebanon, as an example of turning adversity into positive change. The factors that have led to this growth are highlighted. The authors nevertheless warn about the importance of bearing in mind the major impact that social determinants have on mental health and stress that effective action for mental health will be hindered unless these determinants, such as ongoing conflict, displacement and socio-political injustices, are addressed.