Monthly Archives: November 2015

Aid Worker Wellbeing: Reflections on the Guardian Survey and Steve Dennis case

This past week has seen a real shake-up in the aid sector. First last Monday the publication of the Guardian’s survey on aid worker wellbeing, which found that 79% of its 754 respondents claimed to suffer from mental health problems, including diagnosed depression, anxiety and post-traumatic stress disorder (PTSD). Then on Wednesday came the news that an Oslo court had found the humanitarian organisation Norwegian Refugee Council guilty of ‘gross negligence’ in the treatment of former employee Steve Dennis and others who were kidnapped by armed groups in Dadaab refugee camp in Kenya in 2012. Steve Dennis was awarded $500,000 in compensation plus costs.

Both pieces of news point to the same issue – that aid organisations are not giving nearly enough attention to the wellbeing of their staff, particularly those who are doing the frontline relief work in emergency areas, and that individuals are not getting the support they need when they experience serious stress and mental health conditions such as burnout and PTSD.

But before aid organisations quickly rush to demonstrate that they have all the right policies and structures in place to support their staff (I’m sure this is happening already, particularly given the legal implications of the Steve Dennis case) it’s worth reflecting on a few issues that are relevant but have not been so highly pronounced or exposed in these two pieces of news.

Which aid workers are being referred to in the Guardian’s survey? We are given little detail about who the 754 respondents are, except that most of them were female and expatriate. This in itself is hardly an accurate reflection of the broader aid sector, in which approximately 90% are nationals. I am also interested to know who these ‘aid workers’ were exactly. Only those working in disaster areas? Or development workers? They may not be exposed to the acute suffering that one witnesses in a disaster area, but are certainly likely to witness the human misery that arises from extreme poverty. Or human rights workers? They too are bearing witness to ongoing injustices. The survey did not make clear what jobs these 754 respondents were doing. For me this is of interest because the assumption is often that it is humanitarian workers who suffer the most from the work they do. And yet my own research is already demonstrating that you don’t have to be on the frontlines of war and disaster to suffer from burnout or post-traumatic stress disorder.

Can the causes of mental health problems be so easily defined? The main factors contributing to serious mental health conditions according to the Guardian survey were security incidents and the witnessing of human tragedy. Yet it is also becoming clear, in the Guardian’s own reports and elsewhere, that different people – women and nationals in particular – experience different challenges in this work. Given the Guardian’s own reporting on sexual assaults within the aid industry, a question we should be asking when addressing aid worker wellbeing is what specific challenges have women faced and what sort of support do they need? The same could be said about nationals. It is quite possible that some nationals are directly affected by the issues their organisations are working on; perhaps they are refugees themselves, or they or their family have been victims of domestic violence. These factors are important as mental health conditions cannot be fully understood unless we consider the individual’s background and identity and how these impact on their experiences in the workplace.

What are aid workers doing to address their challenges and difficulties? Both the Guardian survey and the Steve Dennis case may provide damning evidence that aid organisations need to be doing more to support their staff. And certainly the survey findings are pretty critical about the insufficient response given by aid organisations to staff who have suffered from mental health issues. But tightened security procedures, regular debriefings and staff counselling are not the only solutions aid organisations should be seeking. Staff themselves need to be considering what they must do to address the challenges they face in their work. As aid workers, we all like to moan about how our managers don’t have time for us and aren’t supporting us enough – and this may well be accurate a lot of the time – but are we also giving time and support to ourselves? In a culture that can often seem competitive and macho in its pressure to work the longest hours and be the most dedicated, what role can we play in caring for ourselves and stepping back, or seeking help, when we need to? With any big emotional challenges in our lives, it can be far easier to point fingers and blame situations or other people. It is harder, but just as important, to reflect on who we are and how we approach our work as possible factors in why we struggle in certain ways. As aid workers, our personal motivations, expectations and approach to work may say a lot about whether we eventually suffer disillusionment, guilt or burnout. And likewise reflecting on these and what needs to change within ourselves may help overcome some of our darkest moments.

These comments are not seeking to belittle individual experiences, nor undermine the serious mental health conditions that many are suffering in this work, including the staff of Norwegian Refugee Council who were kidnapped and those who responded to the Guardian survey. But I do believe we need a more nuanced approach to aid worker wellbeing that recognises that the challenges of this work are not simply related to security incidents and operating within conflict settings; I believe the experiences within the sector are far more complex. Nor are better security procedures or counselling services the only solutions. As the Guardian survey recognises, the culture within aid organisations must change. This not only means creating a space where it is safe and acceptable to admit you are struggling or not coping; it also means cultivating an environment in which people continue to feel valued and maintain a sense of purpose and meaning in what they do. This is the work of everybody – organisations and staff – who have an interest in reducing serious mental health and stress conditions and the resulting staff absenteeism and turnover; and who wish to encourage a spirit of humanity – not only in the field but also in the office.

 

 

The Role of Staff Welfare in Improving Humanitarian Practice

Yesterday saw the launch of three reports on humanitarian practice in Nairobi, and also saw me presenting on a panel for one of the reports. The panel was organised by the CHS (Core Humanitarian Standard) Alliance, a network of around 260 humanitarian organisations operating in 160 countries worldwide.   Its work focuses on ensuring the core humanitarian standards – nine commitments on quality and accountability – are mainstreamed throughout all humanitarian operations.

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A photo on display at the conference: MSF workers deliver food parcels to a remote mountain region in Nepal (Tatiana Kotova)

The CHS Alliance’s Humanitarian Accountability Report is entitled On the Road to Istanbul: How can the World Humanitarian Summit make humanitarian response more effective? In its 13 chapters, written by different experts from the humanitarian sector, 5 key themes are addressed, which the panel members, including myself, spoke to in our different capacities:

  • the role of principled humanitarian response in building trust and facilitating access
  • how standards can drive appropriate, effective and timely aid
  • strengthening national capacities in aid delivery
  • collective accountability and transparent decision making
  • good people management practices

This report launch coincided with two others – ALNAP’s State of the Humanitarian System report 2015 and Quality and Accountability Initiatives by the Inter-Agency Working Group on Disaster Preparedness in East and Central Africa. Whilst the content of these reports and the presentations given by the different speakers at yesterday’s event are all very relevant to the debates around improving humanitarian effectiveness, I will only touch here on the issue which concerns me most within my own area of interest – staff welfare. This was what I was discussing on the panel in the morning, and is an issue which was hotly debated on the margins of the global consultations for the World Humanitarian Summit happening in May 2016.

Sadly, I did not see these debates being addressed or given much attention in yesterday’s event, which was attended by around 80 regional and country directors and managers from various aid agencies, including UNOCHA, World Vision, Save the Children, Oxfam, Action Aid, Red Cross and Danish Refugee Council. The tendency of staff security, safety and welfare to be sidelined by what are seen as the bigger priorities of meeting the growing needs of populations living in crisis situations is nothing new. And certainly given the reality of today’s world crises and conflicts – creating higher numbers of refugees and populations in need of assistance – it is no surprise that humanitarian decision makers find it hard to consider their own health when having to make what often amount to life or death decisions affecting thousands of people.

Yet one issue highlighted in the ALNAP report on the State of the Humanitarian System  – the threefold increase in attacks on humanitarian workers since 2002 – demonstrate the huge risks, and the implications of these risks, for people working in emergency settings. In 2013, 151 humanitarian workers were killed, 171 wounded and 134 kidnapped. The majority of these were national aid workers, operating in their own countries. The increase in attacks are partly down to the changing nature of global conflict, with humanitarian workers now often being specifically targeted by non-state actors and armed groups. But as we’ve seen with the case of the MSF hospital blown up in Kunduz, Afghanistan, Western states are also responsible for flouting the laws governing armed conflict, directly affecting those engaged in humanitarian operations.

A photo on display at the conference: humanitarian workers on their way by helicopter to an IDP camp in South Sudan (Andrea Contenta)

A photo on display at the conference: humanitarian workers on their way to an IDP camp in South Sudan (Andrea Contenta)

As security risks to humanitarian workers are on the increase, so too is the likelihood of chronic forms of stress, such as post-traumatic stress disorder, for those working in the midst of crisis. My presentation at the CHS Alliance report launch highlighted two distinct issues arising from this reality, to be considered by humanitarian organisations. One was the need for organisations to understand the different cultural interpretations and ways of dealing with stress.   Staff welfare strategies, in terms of addressing problems such as stress, burnout or post-traumatic stress disorder, must acknowledge the diversity of the sector if they are to be effective. What is seen as stressful or traumatic for a white expat worker may be very different from what a Kenyan worker feels and experiences for instance. From the data I’ve collected so far in my research I’ve found that addressing the mental and physical health needs of national humanitarian staff is a major challenge. This is partly to do with inadequate support structures that privilege the expat staff, and partly to do with the very different cultural understandings of how personal emotional difficulties are talked about and dealt with. One important way of addressing this is to consider the right language to be used for addressing these difficulties. Trauma, for instance, or the more general term ‘mental health’ are still stigmatised words, not only in Kenya but in many other contexts.

Another issue I touched on in the panel discussion is related to the structures and culture of aid organisations. Some people, particularly national aid workers, have told me that there is a resistance to openly discussing vulnerabilities or difficulties in coping because people fear losing their job. This macho culture of working long hours, not really looking after yourself and not admitting that you’re not coping is so common in this sector and having the right support mechanisms in place is not enough to change this.

Instead, both managers and staff need to be asking themselves, how can they break down the stigmatisation around seeking help? How can they open up the space to allow for people to share their vulnerabilities and their personal insecurities? A major element that drives humanitarian work is compassion – compassion for the community in crisis. That same compassion can be lost when it comes to individual staff members looking after themselves or their colleagues. So a change in culture means cultivating an environment where staff can reflect on their emotional challenges and those of their colleagues, where they can realise they are not alone in the difficulties they face with this work, and where their personal problems are met with sensitivity and understanding.

These issues are of the utmost importance to people working in the humanitarian sector, as evidenced in various online discussions happening at the moment in the run-up to the World Humanitarian Summit next year. Yet so far there has been little recognition of the centrality of staff wellbeing to improving humanitarian practice; hence why it is not seen as a key theme to be addressed at the World Humanitarian Summit nor as an issue to be followed up in discussions such as those taking place in yesterday’s report launches in Nairobi. This is not to say that individuals, including those in the conference room yesterday, are not concerned about staff welfare. But addressing this part of humanitarian work remains far down the agenda of most aid organisations, and even more so for the donor agencies supporting those organisations. Humanitarian workers must continue to push the agenda of staff welfare within their organisations, and also at the World Humanitarian Summit in 2016. It should be an essential component in understanding how to make humanitarian action more effective and sustainable.

 

 

The Realities of a Life in Crisis

Watching Living in Emergency, a documentary film about doctors from the humanitarian agency Médicins Sans Frontières (MSF) operating in Congo and Liberia, reminded me of the profound emotional challenges and difficult decisions that are part of everyday life for many aid workers. The film tracks the lives of several doctors working in post-conflict Liberia and war-torn Congo, some of them located in remote areas with few resources to treat the hundreds of sick and wounded people who come to them for assistance. It addresses many of the issues I’m grappling with as I conduct my field research on stress and burnout among aid workers in Kenya, and which are important factors in remembering the human behind the humanitarian.

  • MotivationsThese are complex and not always what may be assumed. Whilst it’s easy to think that aid workers have purely altruistic motives – the wish to help others – sometimes they are fighting their own personal demons or pursuing a form of happiness they never achieved back home. In the film, one MSF veteran of 9 years mentions that some people do this work to run away from something, as was the case with him and his escape from life back home in Australia. A doctor who gave up his comfortable life in the United States to work in a hospital in Liberia claims, ‘It ends up being a selfish thing. Somehow fixing other people fixes yourself’.
  • Disconnection with home. The longer that aid workers are working in foreign lands, far away from the comforts of home, and the more they are exposed to immense and at times relentless suffering, the harder it becomes to relate to friends and family thousands of miles away. The Australian doctor in Congo claims he is essentially ‘homeless’ after moving around for so many years. The American doctor in the only free emergency hospital in Liberia’s capital Monrovia at the time, says, ‘If you’re going to talk to some of your friends about some of the stuff you saw, and you can’t describe the smells, the feeling of the heat on your body, the sweat running down your back, the smell of the pus that hits your nose and the unwashed bodies in a closed room…the smell of your own panic when you’re not sure what to do…you can’t share that stuff.’
  • Tensions between expatriate and national aid workers. Expat aid workers can often forget the privileges associated with their position, particularly in relation to their national counterparts. In the aid sector, the term ‘expat’ is often assumed to refer to a white person from the global north. Furthermore, the term ‘expat’ is conflated with ‘expert’ in the language of the aid industry. These assumptions are problematic for the aid worker from the global south, who is left on the sidelines of dominant white expat approaches to aid. In Living in Emergency, these roles are played out between the expat staff and national staff at MSF. In one scene there is an altercation between a Liberian doctor who is accused of being arrogant by his Italian colleague after disputing treatment being recommended by one of the expat doctors. In front of the camera he tells his Italian colleague, ‘Tell your doctors to talk to me like a doctor and not like a small boy. And don’t tell me I’m arrogant because I disagree with the diagnosis’. The different experiences of national and expat aid workers are highlighted again when some of the expat staff prepare to leave the country. A national staff member comments to his colleagues, ‘don’t get used to any expatriates. As they go, other people come’.
  • Inability to meet expectations of populations in need. As an aid worker, you can at times feel that people are depending on you massively to save their lives. Indeed sometimes this is the case – you are their only hope. What you decide may affect whether that person survives. And sometimes you have to say no, because you can’t meet everyone’s expectations – perhaps because of lack of resources, or because of the limitations of your organisation’s mandate. In my own experience, people have sought my help and I have not been in a position to give them the assistance they need. In one case, the person died as a result of not accessing the required treatment. Doctors at MSF have to accept this reality all the time. As the American doctor says, ‘you have to be able to live with wrong decisions. That’s really hard to do.’ An Italian woman working for MSF in Liberia comments, ‘I think we all have the same question and that is, what is our limit?’ A young Australian doctor on his first MSF mission and working in a remote village in Congo says, ‘I compare myself to others and I wonder whether another doctor in the same setting would have had the energy….to spend longer with that patient, sleep less that night, and got more work done the following day than I got done.’
  • Loss of idealism. Many aid workers start off their career with a determination to put an end to some of the injustices that they have seen on the news or read about during their studies. When they travel to the field they face realities that challenge the noble intentions to simply do good and help others. In the face of war or extreme poverty, and limited by lack of resources, the sort of help they had envisaged giving may not be possible. As an Italian woman working for MSF in Liberia says, there is a loss of innocence: ‘At the beginning I was feeling good about everything I was doing. Now I’m not feeling good anymore’.

These are some of the realities of a ‘life in crisis’, whether working for MSF or another humanitarian agency. They are also the experiences at times of development and human rights workers, who aren’t necessarily operating in emergency settings but who on a daily basis are faced with immense suffering and expectations that they are unable to meet. The guilt associated with these realities is felt by many and may linger for a long time.

And while for expats there are undoubtedly significant challenges to working far away from one’s home country, and at times it can feel like living in two very different and disconnected worlds, the national aid worker has their own unique struggles. They have no choice to leave the country after a year. The suffering they witness is part of their own society, perhaps their own family and friends, and will not end when the expat finishes their mission.

These realities have emotional consequences. How do aid workers maintain a sense of hope in the face of the struggles they encounter as they carry out their work? What is important and gives meaning in their lives when confronted on a daily basis with so much suffering and so many challenges? Searching for the answers to these questions is a part of my research and should also be considered by aid organisations and staff alike in the quest to address stress and burnout in the aid sector more effectively.