Tuesday, January 13, 2015

Disaster Management: The Health and Safety of Aid Workers

Every job, paid or not, in every city in every country in the world, involves a certain level of risk (Henry 2004; CDC 2013).  Unfortunately for aid workers, the level of risk involved in providing assistance to populations affected by disaster is fairly high, particularly in conflict scenarios.  The many potential dangers to which aid workers might be exposed include:
  • Illness or disease (contracting a communicable disease, food poisoning, or complications that arise from pre-existing or developing chronic conditions).
  • Injury or trauma (accidental or intentional as the result of a transportation accident).
    • May result in infection or gangrene if an injury or laceration that goes unnoticed and/or untreated.
  • Emotional or psychological distress (as a result of witnessing or being the victim of trauma, an attack, a kidnapping or a disaster).
    • May have secondary consequences and/or physical manifestations such as burnout or addictions.
(CDC 2013; Henry 2004)

Aid workers are also at risk of misrepresenting the organisation that they are working under, which could compromise the public's trust in that group or even aid workers in general and therefore negatively impact future initiatives in the area (Henry 2004; The Sphere Project n.d.).

The majority of the countries that require assistance are developing nations and many of these have high rates of infectious disease.  The rates of transmission could potentially increase as a result of the disaster or even as a result of a surge in aid workers in the area.  For example, in the aftermath of the earthquake in Haiti, an aid worker providing assistance unknowingly infected the water with cholera bacteria resulting in an outbreak of the disease that had previously not been present in the island nation.  Because of the earthquake damage and the lack of infrastructure, many were consuming water from stagnate surface or compromised ground supplies which became contaminated when the infected individuals defecated in open areas or poorly constructed latrines. 

Foreign aid workers are particularly vulnerable to infectious diseases because they have not acquired the same level of immunity as the local population and may not be entirely familiar with the illnesses or methods of transmission in the area.  They may also become nonchalant about prevention measures over time, for example, skipping their malaria prophylaxis because it makes them feel nauseated or not checking the inside of their bed nets for mosquitoes before going to sleep because they are too tired.  

Transportation has become essential in our world and lives as human beings.  Aid workers rely on transportation to move them to the areas and facilities in which they will be working, but unfortunately while it is necessary, it is also inherently dangerous.  In fact, a research study by King in 2001 determined that of 249 humanitarian aid workers killed over a four-year period starting in 1997, 28% died as a result of traffic accidents (Henry 2004).  Road traffic injuries are a major cause of death and disability in many developing countries, due in large part to poor transportation infrastructure (i.e. roads that are properly maintained, etc) in addition to the lack of road safety laws and the enforcement of those laws.  In many cases, aid workers end up using local methods of transport such as motorcycles because they are easier to access and cheaper than taxis or buses, even though they are more dangerous.  They may ride without proper protection (i.e. not wearing helmets or long pants to protect their legs, etc) and fit several people onto the back of a motorbike to save time and money.

With the recent terror attack on Paris still in the headlines, the fact that conflicts are still raging around the world is never far from people's thoughts (well, not mine anyway).   At this exact moment, the U.S. Center for Preventive Action’s Global Conflict Tracker has identified 34 situations of dangerous political instability, conflict, widespread violence and/or incidences of ongoing terrorist attacks around the world (Council of Foreign Relations 2015).  While the very concept of armed conflict and widespread violence clearly denotes a high level of danger, aid workers are still sent into those situations to mitigate the impacts of that and other disasters that may occur in the area simultaneously.  Unfortunately, aid workers are increasingly becoming the victims of violence, rape, kidnapping, torture and murder in conflict zones (Henry 2004).  Some groups have decided to take aid workers hostage to make money by ransoming their families or the organisations that they work for, while other groups have decided to make a public display of their murders to further their own agendas.

Despite the level of danger, many aid organisations have policies prohibiting the carrying and use of weapons to protect their workers.  The carrying and use of weapons could damage the organisation's reputation as a humanitarian agency that is there to help and not there to fight.  As a result, they could be mistaken for insurgents or viewed as providing tactical support to one side of the conflict and attacked on those grounds.  The weapons could also be stolen and used by insurgents, in which case the resulting casualties could be considered the fault of the organisation who brought the weapons into the area.  On the other hand, not having a method to protect the workers means that they must rely on the public's appreciation of their efforts and the relationship that they have built with the conflicting sides.

Finally, aid workers in disaster settings are working in highly stressful environments where their actions have serious consequences, where they work very long hours and in very rough conditions (CDC 2013; Dunham 2014; Henry 2004).  They are also witnesses to (and sometimes even victims of) very distressing circumstances such as large loss of life and limb, kidnappings, rapes, murders, assaults and widespread devastation (Dunham 2014; Henry 2004).  The physical and psychological stresses can lead to burnout and even drive some individuals to use drugs and alcohol to try and cope, which can result in addiction (Dunham 2014; Henry 2004).  Other risk factors of burnout include unrealistic expectations, lack of support and the feeling of having no control over the situation (Dunham 2014).  The long-term emotional and psychological impacts of being an aid worker can be extensive and very destructive if not dealt with appropriately.

There are several steps that organisations providing and supporting aid operations can take to protect their workers and minimise the risks to their health, well-being and security.  The first set of steps involves appropriate recruitment.

1.  Recruitment

Recruiting the appropriate people with the right experience for the work involved is absolutely essential to providing optimum care to the populations being served in addition to building and preserving the organisation's reputation.  Ensuring that the workers have the right credentials, education and aptitudes for the tasks they will be undertaking can also help to avert psychological trauma that may result from them being unprepared and therefore unsuccessful.  This is especially true in cases when being unsuccessful could result in loss of life or other devastating consequences.

Things to consider include the applicant's:
  • Age - younger people take more risks, especially men but older people might become more complacent (Henry 2004).
  • Gender - there should be a balance between men and women (Henry 2004).
  • Experience - whenever possible, it is very beneficial to recruit people who have experience working with the organisation or ones like it (Henry 2004).
  • Nationality, heritage and/or place of residence - recruiting locals can be very helpful because they are familiar with the area, language(s) and customs and are more likely to stay and carry on activities (Henry 2004).  Having individuals who are more permanent fixtures can help maintain continuity throughout the programs.  While organisations have been previously criticised for the lack of opportunities and promotions afforded to local staff, some of the more proactive agencies have actively begun to improve on this front (Henry 2004).  However, in conflict situations, they may also be affiliated or seen to be associated with a particular side, which could put them, their coworkers and the effectiveness of the organisation's efforts in danger (Henry 2004).
  • Health status - applicants should be found to be in relatively good health before deployment, otherwise the efficiency of their work could be compromised and instead of providing assistance, they may be more likely to require assistance (Henry 2004).
  • Other personal factors that could be unveiled in the recruitment/interview process (i.e. criminal history, personal ethics, etc). 
Recruitment should also include a thorough explanation of what will be expected of the candidates should they be accepted so that they can make an informed decision about whether or not they want to continue with the process.  

2.  Induction and Training

Before being sent anywhere, it is of the upmost importance that workers receive the appropriate training, whether they are part of the initial wave of responders or taking over for individuals who are leaving.  The training for aid work should be thorough and should include the organisation's aims, policies and methods of operations in addition to teaching new employees or volunteers any additional skills they will be expected to perform as part of their role with the agency.

3.  Briefing

In addition to training, briefing workers on specific situations that require consideration or changes to protocol prior to deployment and/or throughout their assignment is also important.  This may include briefing them on recent security breaches, a developing conflict in the area, cultural contexts of which they must be aware, etc.  Briefing is a crucial part of preparing staff for aid work.

4.  Reasonable Working Conditions

While the work will come with risks that cannot be completely avoided, it is important that the work standards be as good as possible to minimise the frequency and severity of complications.  Organisations should always be looking for ways to actively protect their workers.  This may involve re-locating them to safer environments, providing security staff (if it is not against the agency's code of conduct and agreement with the host government), setting strict curfews, educating workers on the appropriate evacuation procedures, etc (Sphere, n.d.).  

Despite the overwhelming demand and probable shortage of professionals, it is vital that organisations provide their workers with adequate down time, even while on duty, instead of pushing them to the point where they are overworked and susceptible to burn out (Henry 2004; Sphere n.d.).  Not taking care to provide employees and volunteers with good working conditions can compromise the quality of their work and lead to stress, depression and erratic behaviour (Henry 2004).  As a result, it may also result in them exiting the program early or being reluctant to return and work for the agency, which could make it even more difficult to staff initiatives down the track (Henry 2004).

There should also be systems in place for workers to submit complaints, concerns or ideas for improving procedures (Henry 2004).  Workers should also have access to training that can further their personal development and skill-set (Henry 2004).

5.  Debriefing

After an incident or the completion of an assignment, workers (both local and international) should go through a debriefing process (Henry 2004).  This process involves examining what went on over the course of the staff member's assignment and/or the incident they witnessed if one occurred and their feelings about the experience (Henry 2004).   The debriefing offers an opportunity to inform human resources and management of any issues that need to be dealt in order to improve the success of the agency's efforts, their overall procedures as well as the experiences and safety of their employees in the future (Henry 2004).  It also gives human resources a chance to identify staff members who are in need of counselling or other additional services (Henry 2004).

There are four typical kinds of debriefs:
  • Operational debriefing - operation or work specific.
  • Personal debriefing - focuses more on the individual.
  • Critical incident debriefing (CID) - very structured personal debrief after traumatic ordeal.
  • Exit interview - operational and personal debrief at the end of a professional contract.
(Henry 2004)

6.  Counselling

Counselling services should always be provided to aid workers to help them deal with traumatic events, the stresses associated with their work or distressing situations that they have witnessed (Henry 2004).  This will help them to work through their feelings of sadness, anger, fear, anxiety and/or guilt and move on (Henry 2004).  It is the best way to help avoid burn out and post-traumatic stress disorder so that they can return to their normal lives in a healthy mental state and continue to be productive individuals (Henry 2004). 

7.  Rest and Relaxation

It is critical that staff have a break away from working in the field to rest and recuperate so that they can return refreshed (Henry 2004).  This includes adequate rest periods both during and between field assignments (Henry 2004).  Failing to do so can contribute to burn out among staff and poor productivity.

8.  Enforcement of Organisation's Code of Conduct and Policies

Failing to follow the organisation's code of conduct can compromise the safety of the worker themselves, their colleagues as well as the health and well-being of the populations they are there to assist.  It can also reflect very poorly on the agency and interfere with their efforts, it may even lead the host nation recalling that organisation's permission to remain and work in the area.  Therefore, there should be clear and specific consequences for workers who fail to uphold the organisation's code of conduct and/or break national or international laws.  The organisation should explain the various rules and consequences to workers prior to their deployment and should enforce their policies consistently and fairly.


CDC 2013, Traveler's Health: Humanitarian Aid Workers, viewed 10 January 2015, <http://www.peopleinaid.org/resources/enhancingqualityinhr>.

Council on Foreign Relations 2015, Global Conflict Tracker, viewed 10 January 2015, <http://www.cfr.org/global/global-conflict-tracker/p32137#!/?marker=17>.

Dunham J 2014, Health Aspects of Disaster, Course study guide, University of Queensland, Brisbane.

Henry J 2004, Enhancing Quality in HR management in the humanitarian sector, People in Aid, viewed 10 January 2015, <http://www.peopleinaid.org/resources/enhancingqualityinhr>.

The Sphere Project n.d., Core Standard 6: Aid worker performance, viewed 10 January 2015, <http://www.spherehandbook.org/en/core-standard-6-aid-worker-performance/>.


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