Unpacking the Personal in Aid Work

A six week break in the UK has meant the Life in Crisis blog site has been a bit neglected lately. Meanwhile, debates and discussions concerning aid worker wellbeing continue to grow and have become more widely recognised, thanks partly to the spotlight shone by the Guardian and by new blog sites such as Christopher Hensch’s Support for Humanitarian Aid Workers. Aid worker wellbeing is now so prevalent a topic within aid circles that it’s being satirised . It remains to be seen how far this growing recognition will translate into better policies and approaches by aid organisations, or contribute to a change in an organisational culture that continues to stigmatise the vulnerabilities and mental health needs of aid workers. Encouraging steps are meanwhile being taken by others such as International Location Safety and Interhealth to integrate this issue into the trainings and preparation of humanitarian workers entering the field.

Amidst this heightened interest in aid worker wellbeing I find myself still asking the same questions that I started out with three months ago when I began my field research in Kenya: why is it that some people suffer from the challenges of this work more than others? And what do we understand about the specific challenges and difficulties faced by national aid workers? It still feels that in many of the findings of recent surveys (such as the Guardian’s, which I commented on in my previous blog post) we are not getting the full, and complex, picture. Expatriate – and of these, mainly American or European – aid workers dominate the discussions. And although their concerns – about security risks, about living in unfamiliar and at times hostile environments, about the difficulties of articulating experiences to friends and families back home, to name a few – are legitimate and understandable, I’m still left wondering how national aid workers relate to these concerns.

Furthermore, I’m not fully convinced that it is the security incident, or the suffering one witnesses on a day to day basis as an aid worker, that is the direct cause of all the stress and anxiety within the sector. We have to understand what else is going on in a person’s life if we are to fully understand why they are struggling with their work. The degree of support provided by their employers, and to what extent they feel able to ask for it, are obviously important issues. But whether an aid worker is experiencing particular challenges may also be related to their gender, sexuality or nationality. We are seeing already that being a woman in the aid sector, for instance, has had unpleasant and discriminatory repercussions for many (if you can relate to this, you may wish to fill in this survey aimed at highlighting the extent of sexual abuse and discrimination in the sector). More generally, the aid worker’s personal landscape – how they understand their feelings, how they are able to communicate these feelings with others and express themselves – are factors which will make one person’s experience in the sector very different from another.

This has led me to wonder how stress – and more generally, the emotional impact of aid work – may be a relational issue; something that is determined by our relationship to others around us. How do aid workers articulate and talk about their emotions? What role do friends, family and loved ones play in helping or hindering one’s capacity or willingness to express difficult emotions associated with aid work, such as guilt, fear, anger or sadness? To what extent do aid workers feel able to reveal these emotions when in the company of those they feel are far worse off than them, or among their colleagues? And does the suppression of these emotions prompt the detachment and disillusionment that so often arises after years of working in difficult environments?

I find these questions interesting as my own experiences in the aid sector have shown me that it can be very easy to spend years concealing the most difficult emotions that arise, even from oneself. Likewise it can take years to realise that such emotions, if buried and unprocessed, can become your demons one day. In my case there was no ‘critical incident’, no specific traumatic event that prompted my emotional bloodletting. What happened was far more ambiguous and cannot simply be explained through the narrow focus of working conditions or challenging environments.

The questions I’m considering do not point directly to the external factors such as security and levels of institutional support which are so often referred to as indicators of stress in the sector. Instead they highlight how the challenges of aid work can be a deeply personal, and complex, experience requiring self-reflection and care as much as gentle, open-minded support from others. Emotions may ebb and flow according to specific social norms, interactions and memories. I wonder also what role cultural values and assumptions have to play in how one deals with difficult emotions. These issues are important to the aid sector as they highlight there is no easy, one-size-fits all answer to addressing aid worker health and wellbeing. Uncovering and untangling the complicated, emotional aspects of aid work isn’t easy, and I wonder myself what success I’ll have in the remainder of my field work in Kenya; but this work, and the questions I’ve raised, are an essential element in the ongoing efforts to highlight and respond to aid worker stress and burnout.

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.

Fieldwork Challenges #1: Accessing Aid Workers

Any new doctoral researcher will arrive at their research site feeling nervous about the journey ahead. They may have spent the first year of their Phd learning research techniques, developing methodologies, mastering the art of investigative inquiry and active listening. But none of this really prepares the researcher for all the uncertainties that lie ahead during field research, particularly if it is in an unfamiliar environment.

I realised this pretty early on in my second year of my Phd, just days before I was due to leave for Nairobi. I had a year’s worth of study under my belt, which included a small research project in Brighton and several essays which examined various research methods – ethnography, life history, elite interviewing, research in conflict settings. And yet as I packed by suitcase and considered what I was about to embark on – at least 9 months of field research, on my own, in Kenya – I asked myself, ‘But what are you actually going to do there? How are you going to carry out your research? What is your starting point and where will you go from there?’

Six weeks in to my field research, and I’m still not sure I have the answers to these questions. And this comes as some surprise to me, as unlike many other doctoral researchers, I’ve returned to a place I’m relatively familiar with, to conduct research among a community whose profession I share – aid workers. My assumption had been that shortly after my arrival my research relationships would fall into my lap, much in the same way my previous relationships have with friends and colleagues when I lived and worked in Kenya, Uganda and Palestine.

But being a researcher in a foreign land is very different from being an aid worker, or anyone else in any other profession. For one thing, you are very much on your own. There is no organisation to cushion you and give you a safe landing into unfamiliar territory. No managers to guide you or structure your day with priorities and deadlines. And the only person who can really answer the sort of questions raised above is you, the researcher.

In addition, I’m realising that no matter how confident we feel in the community we are researching, we should never assume that access will be easy. Accessing research participants – identifying who exactly they may be and how we approach them – requires constant negotiation and self-reflection. As Hammersley and Atkinson note:

Not all parts of the [research] setting will be equally open to observation, and not everyone may be willing to talk…..If the data required are to be obtained, negotiation of access is therefore likely to be a recurrent preoccupation for the ethnographer.

Hammersley and Atkinson, 2007, Ethnography: Principles in Practice, 61

This may seem obvious but as so-called ‘insiders’ – those who feel ‘local’ to the community they are researching – we may often assume that we will gain immediate trust and interest from our research participants.

For me, I had gained some confidence about my research topic when talking to friends and colleagues in the aid sector. When I told them I would be investigating stress and burnout among aid workers, they were immediately enthusiastic and keen to tell me their own story or suggest others I could speak to. Yet the reality is that this topic is a sensitive one, for both individuals and organisations. Not all individuals want to recognise the personal challenges they face in doing this type of work, and not all organisations wish to address the thorny issue of why some members of staff appear to be struggling more than others. And even with those that do, I’m finding that this – perhaps understandably – is not a priority for them. We can enter our research site full of expectations around how willing people will be to talk to us about what we see as a vital and important issue affecting wider society, and find that although there may be interest, other ‘life’ situations get in the way. These may be work deadlines, family commitments, or in the case of aid workers perhaps a feeling that they should not spend too long seemingly navel-gazing when their mission is to help others. Any one of these circumstances are of course interesting research observations and findings in themselves – something we have to remember when we feel we’re not collecting the data we had wished for.

Having said that, some moving and relevant stories can come from the most unexpected of sources. Whilst I may spend some days still trying to figure out where I go next and what I ‘should’ be doing, on other occasions I’ve met with people on the pretext of simply finding out more about their work or getting to know them, and left feeling touched by some of the very personal stories they’ve revealed to me. This has taught me that we have to remain open to every new interaction, as we simply do not know where it may lead. And we must treat each relationship very much on its own terms – it may only be a fleeting exchange, but those few moments matter for connecting with people and trying to understand where they are coming from and how they feel about talking to you, as a researcher.

So whilst I try to navigate my way through the sea of humanitarian, development and human rights organisations in Nairobi – through their Directors, Human Resources Managers, programme staff and consultants – I’m doing my best to stick to what I feel are three important principles:

  1. Being open: to whatever opportunities arise, and to enter each situation and interaction without preconceptions or judgements
  2. Patience: to understand that making connections with people, particularly as a researcher, can take time. And that not every day will bring enriching data. There may be some days where little happens at all, except the opportunity to reflect on where I’m at so far and how I feel about it.
  3. Trust: despite the temptation to always question whether I’m doing enough or whether I’m doing things properly, I have to also see this entire process as one of learning – about myself as much as others. We have to feel our way into each day, each interaction, each space we occupy as researchers. Keeping this in mind encourages a sense of trust – that as a new researcher in the field I have to embrace the journey and be confident that each day brings with it a new lesson.

 

 

 

 

How to be Vulnerable in Research and Aid Work

I’ve been thinking a lot about vulnerability lately, as I spend the first days in Nairobi figuring out what I’m really doing here and how I should spend my time.

Whilst I’m here with a purpose – to conduct field research on stress and burnout in the aid sector – the actual reality of what this entails for me as a doctoral researcher, with no person or organisation here to guide me, is hard to grasp. I’ve come here alone and it is only I who can make my time here successful. When a doctoral researcher arrives to conduct their field research, there is no great fanfare or welcoming party, nor a fixed agenda with specific deadlines. We simply have to get on with it, whatever ‘it’ may be.

For me this has meant setting up several meetings and networking with aid workers. This side of things is in itself a bit nerve-wracking; working out when it is I’m being a researcher and when it is I’m just being ‘me’ – a new arrival to Nairobi (although I have the advantage of having lived here before), who is genuinely wanting to meet people and make friends.

The challenge I’m describing will be familiar to anyone doing ‘insider research’ – in other words, researching one’s own social or professional community. Putting aside the debate as to whether any researcher, given their status, can ever truly be an insider, I do think having experience in the community one is researching brings its own dilemmas and difficulties. We do not want to appear a fraud in our relationships with research participants, and the chances are as an insider we are sympathetic towards their cause. Yet at the same time we are aware of the ulterior motives that often lie behind each interaction with individuals who may be both friends or colleagues and potential informants. This becomes even more problematic if informants who we have a relationship with outside the research open up emotionally in an interview in a way they haven’t done in normal friendship conversations. How do we respond? As a researcher or as a friend or confidant?

This potential challenge in my research highlights how vulnerability is at the heart of the interaction between researcher and informant, and none more so than in my chosen study topic. I do suspect that for some aid workers, who operate in an organisational culture that discourages the display of too much raw emotion, speaking to a researcher about their feelings may be easier than revealing them to their friends or colleagues. Many aid workers avoid showing their emotional discomfort when assisting poor or war-affected populations or documenting human rights abuses. To do so seems inappropriate in the face of far greater human suffering. And in this way vulnerability is repeatedly pushed aside and denied. This denial becomes so commonplace that it can at times seep into friendship interactions as well, so that when asked how you feel about the work you are doing it is difficult to articulate in a genuine, emotional way.

Being vulnerable is difficult for everybody, not just aid workers. As Brené Brown, vulnerability ‘expert’ says,

The difficult thing is that vulnerability is the first thing I look for in you and the last thing I’m willing to show you. In you, it’s courage and daring. In me, it’s weakness.

And it’s difficult for researchers too. Like aid workers, researchers feel they must maintain a level of professionalism that hides vulnerabilities such as self-doubt and guilt over not ever doing ‘enough’, over not meeting our own expectations or those of our informants.

I have a growing belief that recognising and working with these vulnerabilities rather than pushing them aside has value both for aid work and the Phd research process. Staying with our emotions as they arise can help us gain insight into the emotional behaviour of others. Mindfulness, which I discussed in more detail in another blog post, is one tool with which to practise this emotional presence and awareness. Through mindfulness we can observe without judgement our emotions as they come and go in the present moment. By recognising our own suffering, we become more in tune with and compassionate about the suffering of others – whether these are friends, colleagues, research informants or populations being assisted by aid workers. At the same time, acknowledging emotions as they arise through the practice of mindfulness may be an important way of developing resilience in the field, as an aid worker or as a researcher.

Being emotionally engaged – and vulnerable – can deepen researchers’ understanding of themselves, including their status and position in relation to those they are researching. For researchers of development and aid, this level of emotional awareness may enrich their insights into the hopes, passions and desire for justice that underscore much aid practice. It is these same emotional states that are often the drivers for academic research and which should be integral to understanding how data is collected, generated and ultimately used for constructive ends.

Stress in the Aid Sector: Who Suffers Most and Why?

Something in my heart snaps. My hands tremble and my eyes burn. For the first time since arriving here I cry. I cry for the dead boy buried in the cornfield. I cry for the hungry man beaten by the police. I cry for the little boy whose hopes of living with family have been shattered. I cry for the woman who will never recover from the wounds inflicted by her husband…

Miranda Gaanderse, relief worker in Rwamanja refugee camp, south-western Uganda (from Chasing Misery, ed. Kelsey Hoppe, 2014).

Why do some aid workers suffer from stress more than others? How do they cope with their emotional difficulties and what does this tell us about who they are and why they are doing this work? These are some of the questions I will be considering as I conduct field research in Kenya for my doctorate.

My research is inspired by my own experiences and those of my colleagues in the aid sector. Having worked in many different roles and in a variety of contexts – from villages at risk of demolition by Israeli authorities in the West Bank, to communities recovering from conflict and the tsunami in Sri Lanka – I’ve realised that stress and burnout is more complicated in this sector than one may originally assume. It is not merely the consequence of working in emergency or crisis situations, nor is it solely related to insufficient institutional support or the difficulties of working in unfamiliar settings, far away from family and friends. As mentioned in a previous blog piece there is a wealth of literature addressing the possible causes and symptoms of stress and burnout. However, whether it be in academic literature or in NGO/aid agency policy papers, we are told little about who it is specifically that suffers from stress and why. In particular I have found that there is an emphasis on the experiences of people operating in emergency settings – primarily relief workers – and on expats; with little attention paid to the reality that stress and burnout are also problems for other types of aid workers – such as development professionals or human rights activists, and nationals operating in their own countries.

The fact that there are so few studies about national aid workers is of particular concern, given that they make up approximately 90 per cent of the workforce.  They are often at the most risk from the work they do, due to their social proximity to the victims and perpetrators of human rights abuses and the state authorities responsible for addressing such abuses. They are also usually on lower salaries, with less benefits than their expatriate counterparts. They cannot simply leave the country when times get tough, nor do they have the same luxuries as many of their expat colleagues in terms of living arrangements and housing allowances.

Recent, and now increasing, reports of female aid workers being sexually harassed whilst on the job also highlights that women are at times faced with specific challenges and risks that are not fully recognised and no doubt are a serious source of stress.

Although these issues are receiving growing attention, this is not yet being translated into providing better advice and support that acknowledges the complexity of aid workers’ experiences. My research is thus aimed at highlighting that stress among aid workers can only be fully addressed by examining the diversity of personalities and identities within the sector and the influence of these elements on behaviour and experiences.

Motivations are particularly important here; I believe a deeper understanding of these may shine some light on why some people suffer from stress more than others. It is common for aid workers to be perceived as purely altruistic (particularly in the media and indeed by our own family and friends), or the complete opposite; in other words, motivated by what they may gain in terms of personal or professional development and status. Aid workers increasingly try to debunk the image of the altruistic hero by emphasising their primarily selfish motivations. My feeling is motivations are more complicated than this, and may be influenced by one’s background, upbringing and political beliefs. I’m interested to find out what role these motivations play in how aid workers approach and deal with the pressures of their job.

I also hope to reveal how one’s identity – whether this be class, gender, race, sexual orientation, culture or religion – influences the aid worker’s experiences. Whilst aid workers themselves share their experiences of the specific challenges of being, for instance a woman, or gay, far more analysis is needed to understand how these challenges contribute to stress and burnout in the sector.

It is my belief that understanding these issues is vital if organisations are to provide better staff care, and if aid workers are to make sense of the emotional upheavals associated with their jobs. I hope that my research, as well as this blog site, will provide opportunities to share experiences and reflect on how as aid workers we can understand ourselves and each other better.

The Role of Mindfulness in Aidwork

Using the terms mindfulness or meditation in the work setting of a humanitarian or human rights NGO can often feel inappropriate or irrelevant. In a sector that focuses primarily on caring for others, this method of self-care may seem at best of secondary importance, at worst in contradiction to the principles of selflessness that are associated with aid work. In the wider Western world, these terms also have negative connotations – of being hippie or ‘New Agey,’  therefore only understood and respected by people who have chosen a spiritual path. And a common accusation is that meditation is a navel-gazing exercise, which allows us to be detached from, or to escape, the realities of the world we live in but has no value in bringing any sort of change to those realities. This accusation can be found in, for instance, an article by Guardian columnist Suzanne Moore, which claims that mindfulness is all about self-help, but does nothing to change an unjust world. I would like to take issue with some of these assumptions about mindfulness and meditation, whilst also highlighting and attempting to address the uneasiness that exists towards the practice, both in the humanitarian and human rights sector and the wider world.

But first, what is mindfulness and how can it be distinguished from meditation? I see mindfulness as a practice, or exercise, that can be applied at any point in any day, no matter what we are doing. Meditation is one tool in which to practise mindfulness – a way of stepping out of what one is doing in the day, and dedicating 5, 15, 20 or 50 minutes to simply sitting and being present. Focusing on the breath is a common way of anchoring ourselves in that present moment. Mindfulness, whether through quiet, solitary meditation or otherwise, is an opportunity to transcend the endless chatter in our heads – the grievances about the past, the anxieties about the future – and simply focus on experiences as they happen, in the present. We can practise mindfulness without needing to meditate. The moment may be something as mundane as doing the ironing or as challenging as physical or emotional pain. Or the enjoyment of eating chocolate or walking in the woods. How often do we actually taste the food we are eating, when most of the time we are eating whilst working, or reading, or talking to others? How often do we actually feel our physical pain, when our instinct is to distract ourselves from it or be so consumed in worries about the possible future implications of the pain? Mindfulness puts us in touch with the immediate sensory experience, so that we are able to really feel what is happening, and acknowledge what that feeling is. It helps to deepen our awareness of all the thoughts, feelings and emotions that make up who we are, not only as individuals but as part of the human race.

Relating this back to humanitarian and human rights work, being mindful is a way of ensuring that we are not continuously led by our emotional responses. This is not to say that emotional responses to injustice, or human suffering, are not important. I think the problem that Suzanne Moore and others – including myself at times – have with ‘spiritual’ practice is the notion that it is too inward-looking, and makes robots out of human beings; real, raw emotions may in fact be lost in the search for authentic and transcendental enlightenment.

But mindfulness is as much about connecting with the outer world as it is with navigating our inner world. Both of these are important – we cannot help or show understanding to others if we are unable to help or understand ourselves. This is why compassion plays such an important role in Buddhist teachings of meditation. By exploring what is happening within, we can connect with deeper truths about human existence, consciousness and suffering that we so often overlook, ignore or avoid in everday life. Mindfulness also enables us to take a moment to watch the emotional reactions we have and guage whether they are helpful for us and for others. Anger and rage may be common experiences when working on issues related to oppression and injustice, but they are not always helpful. I have worked in settings where these emotions, displayed bombastically, provocatively and argumentatively serve to alienate the sympathisers to our cause as much as our opponents. Is that what we really want to achieve each time we disagree with something or someone we don’t like? Breathing in to and observing those emotions, instead of always getting lost in them, helps us to gain some clarity over how it is we really wish to respond, and what it is we really wish to convey when we react to human suffering. We are mindful not only in observing our thoughts and emotions, but also in putting those thoughts and emotions into action, for a particular effect or outcome. This is why it is an essential tool to bring into all that we do.

The debate over the relevance of mindfulness in aid work and activism is far from over, and in fact has only just begun, as more and more people take up the practice as a means to relieving stress and burnout. Whilst I try to practise various forms of mindfulness in my everyday life, I also continue to ask myself certain questions about its scope and use in the sector I work in. How can it help aid workers interact more effectively and compassionately with people around them? What role can it play in the quest for social justice? Is it merely a practice for the privileged or can it have meaning for the communities served by aid workers? Perhaps some readers have experiences to share that can help answer these questions.

Burnout in the Aid Sector: Debates and Emerging Issues

Burnout is a term that has become increasingly popular among the helping professions. Described by its key researchers as the emotional exhaustion and development of negative attitudes towards oneself and others that occurs among individuals doing ‘people work’  it is now increasingly recognised as a widespread problem within the aid sector. Within this sector, burnout is equated with mental and physical exhaustion, emotional detachment and insomnia arising from operating in challenging environments, heavy workload and insufficient social or organisational support. Concern has also been raised over its impact in terms of high staff turnover and absenteeism.

However the causes of burnout among aid workers are not clear or straightforward. There is a misguided assumption in much of the academic literature and public debates on this issue that chronic forms of stress such as burnout and post-traumatic stress disorder are associated with working in insecure or dangerous environments. This assumption fails to capture who exactly the aid worker is and how their unique circumstances – the personal values, choices or expectations that influence their work – may have an effect on their experience of stress. In addition, the humanitarian workers featured in most of the studies of stress and burnout in the sector are expatriates, whose emotional challenges are often associated with the specific pressures of living away from home in unfamiliar settings. Only a limited number of studies examine stress among national aid workers operating in their own countries (for some exceptional examples read Ager et al, 2012, and Cardozo et al, 2005).

A recent online consultation by PHAP (Professionals in Humanitarian Assistance and Protection) was a promising step towards putting the issue of stress and burnout and improving staff welfare in the aid sector firmly on the agenda of the UN at the World Humanitarian Summit next year, alongside a petition calling for the same. Among the rich and impassioned debate among approximately 170 aid professionals who joined the consultation online, a couple of issues emerged that reinforce the concerns I’ve outlined above. One is that we need to recognise that the emotional difficulties of this work do not only affect those doing the frontline interventions. Aid work means many things to many people; within my own professional experience this has included being a programme officer, human rights defender, researcher and campaigner. None of these roles fit traditionally within the humanitarian worker mold, but the emotions they provoke are not dissimilar due to the implications of repeatedly bearing witness to immense suffering and the horrors of mankind.

Not only is the call for better staff welfare too often focused purely on those working in emergency settings, it is also focused too often on expatriate aid workers. Yet, as acknowledged at the PHAP consultation and by others, national aid workers make up approximately 90 per cent of people operating within the aid sector.  They are often the ones exposed to more danger and risk due to their social proximity to communities their organisations are assisting and the fact they receive less security benefits and privileges – such as R&R packages and evacuations – than their expatriate counterparts.

Another important issue to emerge from the PHAP consultation is the aid sector’s organisational culture, which prevents the issue of staff welfare being widely discussed. In a sector that is constantly battling to get funds for its programmes, and where the public image is so focused on helping others, staff care costs are seen as a luxury. The fact that many organisations are not providing enough support or services for people suffering from chronic stress or burnout is obviously a major concern. However, so too is the fact that staff themselves are not admitting they are having difficulties. It’s quite possible that as aid workers, we all know someone who has suffered from chronic stress. But the signs are not always obvious. Aid workers and others within the helping professions are quite good at their emotional labour – a term described by Arlie Hochschild, the person who coined it, as ‘the management of feeling to create a publicly observable facial and bodily display’. In the case of aidworkers, amidst witnessing and responding to human rights violations and humanitarian catastrophes, showing one’s own vulnerability at times feels self-indulgent, or a sign of weakness amongst one’s far tougher colleagues and managers. Marianne Elliott provides some good examples of this in her account of her experiences working for the UN in Afghanistan. As does Kathleen Rodgers in her research into staff at Amnesty International.

Where there is a culture of suppressing difficult emotions it’s hard to know what the best response or form of support can be. Self-organisation among aid workers – seeking out support groups (please refer to my Resources page) – and opening up the discussion among colleagues, is in my view as important as putting pressure on  managers to take more responsibility in duty of care. As another humanitarian blogger has noted, we need to bring our burnout and our breakdowns out of the closet. Staff support and welfare interventions should certainly become more of a priority for aid organisations wishing to address staff burnout and turnover. But we as aid workers should also be willing to engage more directly with our own emotional needs and those of our colleagues. After all, this is part of the compassion that lies at the heart of all humanitarian work.

World Humanitarian Day: Remember the Human Behind the Humanitarian

Welcome to my blog site, Life in Crisis, which I’m launching on the 19 August to mark World Humanitarian Day.

Although I would not strictly call myself a humanitarian worker, I have operated within the humanitarian sphere for many years, in Palestine, Kenya and Uganda among other places. As someone who has worked for human rights and development organisations, and with local communities living in or recovering from conflict, I am fully aware of the challenges of this sort of work. These challenges relate both to our external environment and our internal emotional landscape.

On the one hand, living in unfamiliar terrains, often isolated from close friends and family and exposed to untold suffering on a daily basis takes its toll on even the most hardened aid worker. On the other, we’re often fighting our own inner battles of guilt, anxiety and self-doubt; constantly asking why we’re doing this job, whether we’re making any difference, whether our egos are getting the better of us, whether in fact our presence in the countries we’re operating in is doing more harm than good. We may have our own expectations of what this job was meant to be, or may be frantically trying to meet the expectations of our managers and colleagues. And so often it can feel like we’re failing on both counts, because we simply cannot respond to all the demands that the work places on us. And we cannot solve all the world’s problems, or the problems of the country we’re working in, or even the problems of one person asking for our help.

World Humanitarian Day is important as it forces us to remember the complexities of the challenges faced by aid workers. What do I mean by this? Firstly, that who we call the humanitarian worker encompasses hundreds of thousands of different people, of all ages, nationalities and backgrounds. They may currently be working on the Ebola response in West Africa or assisting refugees from Syria, but they were also the first responders during Hurricane Katrina in 2005, and are providing food and shelter to people fleeing the ongoing violence in Ukraine. Many are volunteers who have given up their day job to respond to something they feel deeply concerned about; many others are doing this work as a career, within the UN or international NGO sector.

And they are not all white and from the Western world, as one might assume from portrayals in the media. The popular image of the caring and nurturing twenty-something – often female – holding a sick African child, is one snapshot of a far more diverse and complicated sector. An estimated 90 per cent of humanitarian workers are nationals who operate in their own country. In other words, nationals from countries undergoing natural or man-made disasters and conflicts such as Syria, Nepal or Afghanistan are all playing a crucial role in humanitarian interventions, and the chances are they are putting their lives at far greater risk than their expatriate counterparts in doing so.

This is because of the high risks they face of being targeted or attacked in their own environments, and the unfortunate reality that they are unlikely to receive the same sort of support from their employers as would their expatriate colleagues. 

So today is an opportunity to remember the human face of the humanitarian worker, whether they be from the US, Europe or the developing world. It is a chance to recognise the complexity of each and every personality in the sector, and their associated morals, values and motivations.

There are two dominant narratives that describe the humanitarian worker. One is of the selfless hero – the popular image promoted by aid agencies themselves and by the media. The other is the selfish and privileged careerist – portrayed often by aid workers themselves who wish to debunk the selfless hero myth. But neither narrative gives a fair representation of the many thoughts, beliefs, feelings and emotions behind every humanitarian intervention. Aid workers are not always heroes, but they are not villains either. They are often walking a fragile tightrope between responding to the suffering of the communities they are assisting and to their own personal and emotional needs. All too often the latter plays second fiddle to the former and the desire to maintain the facade of the humanitarian hero. And it is this neglect of ‘the self’ – of understanding and working with complicated personal interests, motivations and feelings – that can lead to far greater emotional difficulties such as chronic stress and burnout.

This blog site will be examining and reflecting on these issues in more detail over the coming months. But for now, suffice to say, if we are to really ‘reshape aid’ we need to consider the personal as well as the professional aspects of aid work. We need to remember that feelings and emotions matter for the humanitarian as much as they do for any other human being. They shape their choices and their actions, and therefore have a huge role to play in how humanitarian work is done. This is why the current petition calling for staff welfare to be included on the agenda of the World Humanitarian Summit in 2016 is so important. It highlights that aid interventions – as flawed as they may be at times – cannot be efficiently administered or improved unless we address the emotional suffering of aid workers and the impact this has on what they do. World Humanitarian Day may seem an uncomfortable way of recognising the existence of this suffering alongside the suffering of the populations receiving aid.  But it’s also an opportunity to keep pushing the issue of staff welfare and self-care onto the agendas of all aid workers – managers and field officers alike; it is a collective responsibility and one that we can start addressing today.