Those committed to a career in aid work are most often motivated by a desire to help others and make the world a better place.  This altruism is frequently life-long and rooted in core values instilled by family, community, or religious leaders at an early age.  Individuals entering aid work often intend to remain their entire career.  While this is an inspiring goal, many eventually leave before retirement age because of illness, fatigue or disillusionment, family crisis, growing unsuitability, or physical and/or emotional disability.  Even those who remain may find it hard to thrive and maintain their wellbeing for a variety of reasons, such as changes in personal mental health. 

The incidence of mental illness among humanitarian aid workers from developed countries is usually estimated to be 22-25%, although a few studies have found it to be > 40%.  This is higher than the general population, and diagnoses include those struggling with substance abuse, depression, Post-Traumatic Stress Disorder (PTSD), and anxiety.  Add to this group individuals recovering from a recent critical incident, local national staff living and working in the midst of a humanitarian emergency, and those chronically over-stressed but not yet experiencing pronounced symptoms, and the result is a fairly large number of aid workers facing emotional problems.  This makes an already complex job more difficult, less rewarding, and hard to sustain.

Why is this and what can be done?

Factors Contributing to Emotional Distress

There are a number of factors that increase the possibility of eventual emotional distress or disability.  Identifying them early helps everyone involved make informed choices and take corrective steps.  Here are the factors identified repeatedly in our research and field experience:

• Aid workers bring their own emotional vulnerabilities when they enter the field.  Genetic predisposition, personality styles, prior or present mental illness, history of personal traumatic events, and certain family dynamics may create blind spots or weaknesses that are exacerbated by the rigors of humanitarian aid work.  Although these factors need not disqualify people from pursuing this career, it is important to identify them, evaluate their potential impact, and take proactive steps to ensure wellbeing over time.

• All agree that aid work is difficult, and increasing security risks and growing context complexity have only made it worse.  Its many rewards don’t negate the impact of traumatic events, long separations from family and friends, and doubts regarding lasting effectiveness.  The work itself increases the possibility of emotional distress.  In an ideal world, no human should have to endure the disasters and atrocities or hear and see the suffering that aid workers witness during their careers.  A growing body of research suggests that, for many individuals, there is a cumulative impact that makes it harder for the brain to maintain optimal functioning over time.  Understanding how the brain absorbs and recovers from challenges inherent in aid work, and taking appropriate steps in response, may decrease aid work’s negative impact on emotional wellbeing.

• A weak social support network increases the likelihood of emotional distress, according to social science researchers.  Given the psychological rigors and vagabond nature of aid work, this is of special concern.  The emotional support, reality testing, and guidance provided by loved ones is invaluable, particularly at times of extreme stress or trauma.  Having no one to call in the middle of the night leaves a person too alone.  Recognizing the importance of close family and good friends is an important step in reducing the likelihood of emotional disability.

• Agency dysfunction, poor policies and practices, and ineffective communication are major organizational contributors to the staff stress leading to personal burnout and emotional impairment.  On a good day, typical institutional politics and red tape can be maddening.  In the midst of a humanitarian emergency or challenging development project, adding low personal frustration tolerance and fatigue make interfacing effectively with a larger organization nearly impossible.  The best informed organizations have moved from a reactive stance (offering support only after a critical incident) to a proactive one where the agency culture emphasizes personal resilience, pre-deployment orientation, post-deployment debriefing, and confidential access to mental health services or peer counseling support.  This corporate stance promotes thriving, personal resilience, and overall wellbeing.  The contrary simply adds to the problem.