Tag Archives: staff welfare

What do Stress and Wellbeing mean to Aid Workers?

In the last few weeks I’ve been engaging in discussions that have put the question of how aid workers interpret stress and wellbeing at centre stage. In August I ran a stress management workshop with an Italian NGO in Kenya which was attended by Kenyan, Somali and European staff. Aside from that, I’ve been talking to various people who have an interest in or are working on providing stress relief for aid workers and social change makers.

The question of how stress and wellbeing is understood by different people is important because in a world that is flooded with information about ‘alternative therapies’ such as yoga and meditation, as well as the western psychotherapy models, we can forget the hundreds of cultural traditions around the world that have handled emotional difficulties and mental health problems in their own, localised way. We can also forget that what works for one culture or society may not work for another. And in the aid sector, where the majority of staff are nationals from the southern hemisphere, we perhaps therefore still have a lot to learn about what interventions (if any) are appropriate for dealing with work-related stress.

The tendency is to assume that standard psycho-social models are a sufficient mechanism for addressing staff mental health. But there is a counter-argument that suggests that Western models of trauma healing are not always appropriate, nor healing, for some individuals from post-conflict countries. This has been argued in various literature (for instance, here) and was a point made by an Italian doctor I met recently who was conducting a training for humanitarian workers in body, mind and spirit practices for stress, trauma and compassion fatigue. During the training she related how in previous trainings in Rwanda and Burundi, some of the participants had commented how traumatising they had found the counselling given by Western psychotherapists.

’Stress’ and ’counselling’ are pretty familiar terms in European and American societies. Whilst there is still stigma around issues of mental health – people don’t talk openly about their depression, for instance –  there is an assumption that stress is part of everyday life, and that chronic forms of stress affect some of us and require clinical intervention in the form of one-to-one counselling.

The personal perception of stress and the way one deals with it is, in many ways, culturally and socially rooted. Whilst many NGOs provide some form of counselling for their staff, it would seem that ‘talking therapies’ are not necessarily the answer for a lot of aid workers.

Here are a couple of quotes from my data:

“There are those of us like me who come from nomadic background which thinks that talking about it is…is being a bit of a sissy. But, there are those of us that come from that culture of expressing yourself and you can see that people do grieve with each other, with different cultures.”

Somali UN worker (male)

“They pay for our counselling…but since it’s not so African to go for such things, most people don’t go for…debriefing. You can go during your R and R but nobody seems to ever get to it […] We as Africans we handle our stress differently – everyone has their own issues so why do you think yours is bigger? […] I think people just learn to handle their stress on their own, in case it’s there. Because for one we don’t open up that much, and especially here in Kakuma who would you open up to, especially if stress is work-related [….] basically you have to learn to handle your stress by yourself.”

Kenyan humanitarian NGO worker (male) (Kakuma)

Stress is not only culturally rooted; it is a gendered concept too. In the stress management workshop I recently ran, the Kenyan women remarked that stress in their society is largely seen as a women’s issue and associated with marital pressures, and with being of the ‘weaker sex’. This not only denigrates stress to the female experience, it also sends out the message that men do not suffer from stress, and therefore should certainly not talk about it.

I have been wondering about self-care practices too. ‘Self-care’ is in itself a dirty word for some aid workers. If it’s not seen as a bit ’new age’ or ‘hippy’, it’s seen as self-indulgent and completely at odds with a sector supposedly focused solely on helping others, not oneself.

There is a growing interest in yoga, meditation and similar self-care practices as a means to relieve stress, build resilience and encourage deeper self-awareness and compassion among aid workers and other social change makers. Regular yoga and mindfulness practices have certainly helped me in the last few years; the way I approach my work as a human rights defender has been transformed by following a daily practice that cultivates presence and a more mindful response to my own emotions and to the challenges around me.  And I continue to explore these further as a means to engage more fully in the world as well as to bring inner wellbeing.

But can these sorts of practices be adapted, and adopted, in African cultures? Are there traditions within African cultures which in fact use some of these practices already but give them a different name? I’m conscious that here in Kenya, for instance, trying to impose yoga or mindfulness as a stress relief tool may be seen as an effort to convert people to Hindu or Buddhist religions. Yet some of the techniques used in both these practices can probably be found in many other ancient cultures, including in Africa.

There are examples where the use of yoga and mindfulness have been introduced in different cultures, among aid workers and the communities they serve, with positive results – as this video from a woman who worked in Afghanistan suggests. Capacitar training also uses yoga, tai chi and other practices for trauma healing in communities that may be otherwise unaware of these traditions.

Self-care needn’t require a commitment to these increasingly popular practices however. As this blog by an Afrofeminist writer eloquently describes, there are many ways of practising self-care without having to devote oneself to yoga, and without necessarily having to completely change one’s lifestyle. Spending more time with family and loved ones is  important for aid workers and any other social change makers; because one of the big symptoms of stress and burnout is social detachment and disengagement, triggered by repeated exposure to the brutality and injustice that represent the darkest elements of human behaviour.  After such exposure, it is vital to seek out community and friendship. This can restore one’s faith in humanity and help cultivate compassion in a working environment that can be susceptible to ‘compassion fatigue.’ This video by the Headington Institute provides some advice to aid workers on how to maintain relationships with loved ones as a means of self-care.

Stress and how one responds to it is in some ways a complex matter. In the aid sector, both the individual and the organisation need to listen more – to themselves, to their staff, and what forms of support and healing are appropriate. It could take some time before aid agencies  go beyond a ‘one size fits all’ approach to staff care, but in the meantime there is a lot aid workers can do to help themselves. The starting point is that old adage, ‘Know Thyself’. What is your body trying to tell you and are you willing to stop and listen?

 

 

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.

 

 

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.