Paola de Leo, Head of Philanthropy, Henley & Partners
Every day, we are bombarded by media reports and photographs showing the horrific impact of the wars raging in various countries throughout the world. We see footage of distraught parents seeking help for their injured children; people buried alive beneath the rubble of bomb-blasted buildings; desperate refugees crawling to the shore of their hoped-for safe harbors.
It is important that we are called to bear witness to such atrocities, but what we rarely speak about is the high level of personal risk that aid workers globally face when operating in those situations.
Each year hundreds of ‘Humanitarian Heroes’ join the ranks of international aid organizations, committing themselves to supporting and defending the rights of entire populations displaced by war and conflict. In doing so, they accept the risks of being threatened, wounded, kidnapped and killed.
The statistics speak for themselves. Between 2005 and 2015, 1,079 aid workers were killed and 2,208 injured in a total of 1,679 incidents. A further 902 aid workers were kidnapped1.
“Every time I hear of an attack on aid workers, I say to myself: ‘There but for the Grace of God go I,’” said Dr. Sergio Arena, former Director of Health & Wellness Division at the UN Refugee Agency and today holding the same position at the World Food Programme. “After 15 years of aid work, it is no longer remarkable that I know friends and colleagues that have been killed or wounded. Sadly, it is unavoidable … and there will be more.”
For Sergio, who has participated in numerous field missions during his career, the cost of such risks has not just been learned through the narrations of the personnel he takes care of. He himself has been a target of kidnappers in Somalia, was held at gunpoint by child soldiers, was caught in a frightening stampede during a food distribution session in Haiti, and has lived through many threatening and overwhelming situations.
The Hidden Risks and Lifetime Effects of Stress
Apart from personal physical safety, there are other risks that nobody ever talks about — the mental stress that humanitarian workers are forced to endure and the toll that this can take on their psychological well-being. The Antares Foundation works towards improving the quality of humanitarian assistance, and its research demonstrates that around 30% of aid workers report significant symptoms of post-traumatic stress disorder (PTSD) upon returning from assignments.
“Even when not directly exposed to the trauma of conflict, the experiences of the victims are transferred onto us,” Sergio explains. “In order to cope, we then build emotional walls and suppress our feelings. Studies conducted over 50 years on the experiences of soldiers, show that post-traumatic stress can be cumulative and manifest many years later. Aid workers can experience similar levels of stress but without the benefits of training networks or support. Unlike most military and emergency services personnel around the world, there is rarely — if ever — psychological testing of aid workers before they are deployed to humanitarian emergencies or when they return.”
UNHCR’s Global Staff Well-being Survey, conducted in 2014, is the first research to link psychosocial hazards in a global humanitarian organization to mental health outcomes. This study reveals that high percentages of UNHCR employees are at risk for different mental health/behavioral outcomes. Secondary Traumatic Stress (STS) was identified in 38% of respondents.
The survey illustrates how working with refugees involves witnessing constant human suffering. The degree of exposure depends on the type of work: someone working on refugee status determination (RSD), for instance, is highly likely to spend most of their working time interviewing asylum seekers to determine whether or not they meet the criteria to be recognized as refugees (i.e. persecuted in their country of origin), and such interviews typically contain detailed descriptions of horrors and human rights abuses.
The Commitment of Organizations
The emergence of specialist NGOs, such as the Antares Foundation and People In Aid, is a proxy indicator of the need for more resources to manage mental health. The seventh principle of People In Aid’s Code states: “We have a duty of care to ensure the physical and emotional well-being of staff before, during, and on completion of their period of work.”
However, since the Code was first developed, only 10 organizations have been verified to effectively apply the Code while a further 40 have expressed a “desire to continuously improve their HR and people management skills”.
“Given the number of aid agencies across the world, which must number in the thousands, the low level of commitment to the Code is a shocking indictment of the system-wide [lack of] commitment to the welfare of aid workers,” said Sergio.
In 2016, the World Humanitarian Summit, an initiative of the UN Secretary-General, Ban Ki-moon, sought to build awareness and find solutions. The Summit received a petition — signed by almost 1,500 people representing national and international aid workers across the sector — urging the inclusion of aid worker health and safety measures.
A report was subsequently issued under the title Restoring Humanity: Synthesis of the Consultation Process for the World Humanitarian Summit. An excerpt states: “Improving the safety and security of aid workers is a priority concern.”
“What the report has to say is encouraging,” Sergio comments, “but it’s not enough by itself. Humanitarian organizations need to invest systematically in the physical, mental and psychological well-being of their staff including psychosocial assessments; proactive engagement and wellness services; destigmatizing psychosocial care and counseling; and [providing] continued access to psychosocial healthcare after employment, which is when post-traumatic stress symptoms often appear.”
“We must raise awareness and understanding of the importance of mental health aid for workers. Bring post-traumatic stress, depression, burnout and breakdowns out of the closet,” he urges.
Sergio also suggests the establishment of a Global Trust Fund for aid workers to “ensure that no matter what the contractual status, if there is a worker casualty, there must be a safety net for them and their families”.
He calls for more support for the People in Aid Code and goes as far as to propose that donors should only support those organizations that are committed to the Code. “Donors have a vicarious liability to ensure the agencies they fund do the right thing when it comes to staff welfare and safety,” he declares.
In March this year, the Special Envoy for the UN Refugee Agency, Angelina Jolie, delivered her lecture, “In Defense of Internationalism”, to honor the memory and work of UNHCR staff member and diplomat Sergio Vieira de Mello, who was killed in Iraq in 2003 when the UN office in Baghdad was bombed by terrorists. “We remember them for the power of the example they set,” she said, “brave individuals from 11 different countries, working to help Iraqi people, at the direction of the United Nations Security Council, and on behalf of us all. This is sometimes forgotten: that in serving under the UN flag, they died in our names, as our representatives.”