question: Background: ‘Digital Mental Health services,’ or mental health care delivered via internet, computers, mobile phones, tablets, or text messaging services, are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its mental health (MH) activities to digitally supported remote services in 2020 across humanitarian and resource-constrained settings. Methods: From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of digital MH services provided during the COVID-19 crisis. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews (IDI) occurred. Results: Respondents in 44 countries (6 world regions), mostly from Sub-Saharan Africa (39.5%), the Middle East (18.5%) and Asia (13.6%) participated. Most digital MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using digital interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using digital platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought digital MH services had some degree of utility, most commonly citing improved access to care (37.7%) and greater time efficiency (32.8%) as reasons for its continued use. Conclusion: Digital MH activities were seen as an acceptable alternative to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the humanitarian contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering digital MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.