A guest blog by Zoe Thomaidou, former intern at Humanitarian Advisory Group 

Every year on August 19, we pay tribute to aid workers who have risked and lost their lives in humanitarian service. The World Humanitarian Day serves as an opportunity to “advocate for survival, well-being, and dignity of people affected by crises, and for the safety and security of aid workers”.

Indeed, being in the frontline of humanitarian response is not exactly what you would call a regular day at the office. Over the past two decades, more than 4,300 aid workers – the overwhelming majority being local staff –  have been killed, injured or kidnapped. Yet again, the risks associated with humanitarian work do not necessarily have to result in fatal attacks or physical harm before they are considered serious.

Beyond casualty statistics, the numbers we don’t talk about enough

Guardian research conducted in 2015 shined a light on alarming findings regarding mental health in the aid sector. The survey found that 79% of respondents had experienced mental health issues, with 93% attributing these to their work in the industry. Anxiety and depression featured high on the list, while many reported incidents of panic attacks and post-traumatic stress disorder (PTSD) diagnosis.

But this is not the first time in the recent years that high incidence of psychological injury among aid workers has been brought to the sector’s attention. In a widely cited report published in 2012, the Antares Foundation reveals that approximately 30% of expatriate staff surveyed in development and aid agencies reported PTSD symptoms on return from assignments. As part of the same series of studies in collaboration with the Centre for Disease, Control & Prevention (CDC), the researchers explored the emotional status of 1,032 national workers across three countries. Between half and two-thirds of those showed clinically significant levels of depression and approximately half of them signs of anxiety.

As hinted in the introduction, in-country personnel are those who endure the greatest risks of humanitarian work, not exactly a surprise given that about 90% of aid staff in the field are local aid workers. Mental health deterioration is not an exception. While systematic research on the mental health of national humanitarian staff has been rare to date, available literature still overwhelmingly points to the prevalence of prolonged stress and trauma-related issues.

Where the human and business cost intersect

Of course, it is not breaking news that aid workers are exposed to high levels of pressure. Workload appears to be a top stressor for UNHCR staff, and work stress is a commonly cited experience for humanitarian personnel across the globe.

For one, working in crisis situations is dangerous and emotionally demanding. Both for those directly and indirectly affected, witnessing the human impact of conflict and disaster can understandably be corrosive to mental health. Add to these long working hours and office politics that may arise, as in any workplace, and you already have a powerful mix of stressors. While people know what they sign up for when they choose to become aid workers, does this mean that burnout and PTSD are part of the job description?

Not really. In fact, humanitarian agencies have long recognised that poor staff welfare compromises both individual performance and effectiveness of responses. In the words of an advocate for including aid worker wellness in the 2016 World Humanitarian Summit agenda: “The last thing someone running from war needs is a neurotic aid worker”.

Preventing and addressing psychosocial implications for aid workers goes beyond the legal liability and moral duty of the employer. It is also a matter of accountability the humanitarian community, as a whole, has towards affected people, in using as efficiently as possible every aid dollar to their benefit. For those interested to read more on this line of argumentation, a senior UN OCHA worker makes a compelling business case for investing in aid workers.

A brief reflection on the sector’s early response

Emphasizing the need for adequate human resource management, a research report, published by the Overseas Development Institute, over 20 years ago, is often credited for catalysing a shift in our awareness of staff care in the development and humanitarian sector. Indeed, a number of initiatives followed to improve organisational effectiveness in people management. Among the most prominent developments was the creation of People in Aid (now merged under the CHS Alliance network) and the launch of its Code of Best Practice in the Management and Support of Aid Personnel[1], which became a guiding tool for agencies concerned with getting staff care right.

In the following decade, with the humanitarian sector facing new pressures to ensure aid effectiveness, and witnessing increasing professionalisation as an industry, the demand for psychosocial support of its staff, if anything, grew bigger.  As a result, more elaborate efforts to respond emerged, such as this seminal publication by Antares Foundation – for developing and implementing stress programs for humanitarian workers or the IASC (Inter-Agency Standing Committee) Guidelines on Mental Health and Psychosocial support (MHPSS) in Emergency settings. Perhaps the most recent consolidated effort to recognise aid worker wellbeing as key organisational responsibility and an essential element of high-quality humanitarian action is the Core Humanitarian Standard. Launched in 2014 by CHS Alliance, it calls for staff[2] to be supported to do their job effectively, and treated fairly and equitably, thus paving the way to standardized policies and procedures on psychosocial care.

The aim here is not to provide an exhaustive timeline or bore you with a shopping list of acronyms some readers will probably be more familiar with, than me. The point I’m trying to make is that, given the sector has succeeded in building awareness of these issues at such an extent, the expectation would be for aid workers to receive adequate support. Yet, the statistics cited above – and many others I encountered during my brief online investigation on the issue – paint a different picture. So do the personal stories that lie behind the figures, like this former UNHCR employee who resigned after her request for mental health support during deployment remained unanswered or the testimonials of UN and NGO aid workers featured in this short documentary highlighting the disconnect between the support they needed and what was provided. Even when aid agencies and organisations establish wellness mechanisms “many aid workers find the care inadequate”. There are multiple reasons the response has often fallen short, but instead of entering this debate it makes more sense to ask ‘where to next’?

Exploring the way forward

As a word of caution to all of us concerned with the issue of aid worker wellbeing, it is important not to get caught up in the circle of criticism, but instead focus on working towards giving it the attention it deserves. Notwithstanding positive initiatives so far, sector-wide standards have been difficult to implement, and the focus has tended to be on treatment-based strategies.

A promising initiative suggesting a more proactive approach to mental health within aid organisations coupled with an improved treatment side comes from the Start Network, a global consortium of aid agencies committed to improve effectiveness of humanitarian action. As part of their Transforming Surge Capacity project, they are currently piloting a three-year mindfulness and wellbeing program, exploring ways to increase resilience to stress and support self-awareness both at the individual and organisational level. A range of activities have been undertaken in collaboration with CHS Alliance, such as developing HR guidelines for safer recruitment and holistic support of staff, creating an online platform and organising conferences for sharing good practice, as well as rolling out mindfulness-based approaches coupled with traditional psychological support.

Reversing what appears to be a long-standing crisis is not going to happen from one day to the other and there is certainly no magic-bullet, but there are steps that can be taken towards that direction. The most crucial one is the support by the humanitarian community as a whole. Peers can prove indispensable in combating the culture of silence that usually surrounds mental health issues, while donor support  has been recognised as crucial for prioritising staff wellbeing on the agenda for effective humanitarian action. Ultimately, compliance with duty of care lies in the hands of the organisations, which points to the need for strong leadership involvement to drive a positive change. After all, failing to give aid worker wellbeing the attention it deserves, does not only jeopardise the health of those who have made fulfilling the humanitarian mandate their profession. It also compromises the effectiveness of humanitarian response and eventually takes its toll on the people aid agencies aspire to serve.

[1] A revised version of the People in Aid Best Practice in the Management and Support of Aid Personnel Code can be found here.

[2] including national, international, permanent or short-term employees, as well as volunteers and consultants.