Thursday, December 30, 2004

Forgotten Victims of Humanitarian Disasters

Just came across a recent interview Reuters did with a friend who heads the Red Cross in south Africa. It’s a relief to know she’s still alive. We've recently had our doubts about that. From the photos, she has aged considerably since we last met. Humanitarian relief work does that to you. Very quickly. But that is only a pale reflection of the enormous personal trauma you experience on the job.

In humanitarian disasters like the tsunami tragedy, most media attention (and hence, public sympathy) is focused on the direct victims: those killed, injured and maimed; those who survived death and injury miraculously by the skin of their teeth or because of the sacrifice of someone else; and the family members of the dead, injured or missing... But the behind-the-scenes toll on international humanitarian aid workers (HAWs) is also enormous yet unacknowledged.

Loss of Life
There has been a documented rise in mortality rates of HAWs over the past decade. This has mainly been due to a rise in intentional violence related to the use of weaponry, infectious disease and accidents: Warlords protecting their own turf or interrupted looters or hungry disgruntled people trying to steal aid food or money have contributed to the deaths of many HAWs who were standing in the way of these people and the things they desired; dieases experienced by humanitarian staff can have serious consequences in countries where the availability of health services may be limited. Medically preventable infectious diseases and accidents have been reported as the main medical problems and account for much of the fatalities amongst HAWs; and accidents have occurred more frequently as foreign HAWs are flown in from abroad and sent directly out into the field without knowledge of the territory. One wrong turn, one underestimation of the terrain has frequently ended the life of many a HAW. One study suggests that most HAW deaths occur among HAWs who are 3-months young in the job.

Psychological Disorders
HAWs are at risk of developing significant mental health problems. Returned HAWs have developed post-traumatic stress disorder (PTSD) after three years at home, a rate comparable to levels of distress amongst humanitarian peacekeepers. There are reported to be high levels of depression, anxiety and alcohol abuse in HAWs and multiple sources have repeatedly documented the related distress, culture shock and burnout that HAWs experience.

Violence and the perceived threats to one's life constitute the important risk factors in the psychological wellbeing of HAWs. Threats of violence are reflected in the general state of the host society and its phase of conflict and development, threats of violence targeted at particular groups (i.e. foreigners, women, ethnic groups) and threats of violence targeted at particular individuals. They include bombings, shootings, assaults, kidnappings, rape and accidents. In humanitarian work, ongoing concerns about personal safety to oneself, colleagues, family and friends are common. It has been found that the severity of exposure and high frequency of these occurrences were associated with higher levels of distress upon return home. Civilian interpersonal violence, the kind that HAWs commonly experience, is also more likely to carry greater risk for PTSD than other traumatic events.

Additionally, social, cultural and geographical isolation are often an inherent part of the HAW overseas experience. Expatriates are likely to be socially isolated from other foreigners, distanced from cultural familiarities and, if living in remote or inaccessible regions, geographically isolated. A combination of social, cultural and geographical isolation can evoke griping feelings of abandonment, despair and fear.

HAWs often experience ongoing conflicts between their professional goals and those of external players such as beneficiaries, local and international governments and other associated bodies. The work HAWs do can be perceived as an antithesis to the goals of governments who are corrupt, factional or dictatorial. HAWs experience frustration, despair and anger at the difficulty of conducting effective work within these contexts.

The interpersonal relationships of HAWs can experience change and disruption when they work overseas, increasing the potential for stress. Relations with significant others at home and living abroad are affected by the change to overseas work. Furthermore, HAWs may leave others at home (spouse, children, elderly parents) that create worry because of the distance and difficulties or impossibility of attending to their concerns. Those at home may have difficulties understanding what the HAW is going through and do not care for them socially upon their return.

Daily exposure to decomposing bodies, having to comforting and confronting the pain of the dying, the continuing stress of extreme grief, despair and helplessness desensitises HAWs to the subtleties of the normal range of human emotions and local social convention upon their return home. The resultant social isolation further contributes to the risk of PTSD.

I was reminded that I should remember the HAWs in my prayers as well, and to take care of their special needs when they return. They certainly need all the help they can get.

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