Aid workers witnessing: What are the impacts on aid workers?

Aid workers at a bed facility for Ebola outbreak victims set up by Médecins Sans Frontières in Sierra Leone. Photo by: Cyprien Fabre / EC / ECHO / CC BY-NC-ND

Aid workers witnessing within the humanitarian context — the act of speaking out on behalf of individuals and communities in developing countries, based on what the suffering and injustice they have seen or experienced — can provide a powerful route to communicating with the public. Personal stories can help draw attention to human rights concerns or other abuses occurring within developing countries.

But what are the impacts on the humanitarian workers who are witnesses? Elizabeth Lennon, a professional psychologist and managing director of the Leader Factor, asked that question last year, conducting interviews with 12 Australian-based staff and volunteers for Médecins Sans Frontières who had returned from deployments. At the Asia Pacific Humanitarian Leadership Conference in Melbourne on April 28, Lennon presented her initial findings from the work.

From the study, Lennon found that simply being present was an important part of “witnessing.” Yet for the witnesses, a combination of poor self-care while in-field and struggles to make meaning of their experiences years later resulted in mental health problems from bottled-up grief. For the participants, the culture of MSF played an important role in these issues. Despite being focused on MSF workers, Lennon’s study provides an important insight into the physical and mental toll the experience can have on all humanitarian workers.

On the study

Harshness, disrespect and aggression were terminology [workers] frequently used to describe the internal structure and response to issues of staff and volunteers.

Lennon’s research prioritized narrative and qualitative experience. She spoke to seven men and five women, representing a range of backgrounds, ages, religious beliefs and levels of humanitarian experiences. Some had been deployed multiples times, with experiences occurring both recently and decades ago. All but two had faced physical threats as a result of their work with MSF. Lennon’s research focused on Australian volunteers and staff, providing insight into the impacts on expats. In-country response staff would face different challenges and emotions in witnessing abuses.

“The simplicity of being there” was the most important aspect of the experience, Lennon found. “It’s an immediate experience,” she told the audience. No amount of information or preparation could have prepared them for the hard reality of the graphic situations they would be faced with. “The theory is interesting, but there is a gap between the theory of these things and the reality in humanitarian work.”

Aid workers often don’t make meaning of a traumatic situation on site, Lennon said. It is an ongoing process that may take years. “For some whose experience happened eight to ten years ago, they were still involved in the process of meaning making.”

Witnessing in MSF

MSF was not originally intended to be an important focus in Lennon’s research. But it quickly became apparent that the organization itself was important for the lives of her interview subjects. Many had a “complicated love affair” with MSF. “I call it a love affair because it is passionate, it is complete, it is exclusive,” she said. “But it has a shadow side to it, and there is a lot of anger and other emotions associated with it.”

After its founding in 1971, Lennon said many MSF volunteers initially felt guarded about speaking out, feeling it could contradict their hippocratic oath — despite there not being a policy against it. But the Rwandan genocide in 1994 changed that. Speaking out and taking action has since become an important part of what it means to work with and for MSF.

Witnessing, Lennon said, became a well-understood process of accountability within MSF. “It’s consistently seen as an organization-mediated responsibility with clear process for consultation and decision making — you’re never alone.” Today, MSF help manage and mediate the process of speaking out.

For the aid workers, Lennon said action had many faces. Most spoke out in blogs, writing letters to their families and speaking with other NGOs. Trying to create change within a developing community or country, or even building systematic change within MSF to help prevent human rights abuses witnesses were common, but less frequent strategies. Taking and presenting testimony as part of judicial proceedings was an uncommon action. For the few subjects that did do this, the process was “extremely intense and traumatic.”

With the nature of the love affair between humanitarian worker and MSF, the impact of witnessing and speaking out always resulted in the workers putting MSF first. “The theory and the charter says witnessing is an individual action,” Lennon explained. “But the common knowledge is that it is collective.” If there was the possibility MSF would be thrown out of a country or speaking out would impact the organization’s ability to operate within a country, this was prioritized by Lennon’s subjects.

“MSF are a world within a world,” Lennon said. “Despite there being ambivalence about the organization, MSF have a hold on workers.”

Cultural impacts on self-care and coping

“[Grief] cannot be put on a shelf — it will come up. And this is what concerns me about humanitarian workers and MSF in particular.”

— Elizabeth Lennon, managing director of the Leader Factor

The process of making meaning of a traumatic experience cannot happen on-site. Lennon said she noted how many humanitarian workers avoided the process of making meaning from their experiences entirely.

Rather than coming to terms with their experiences, aid workers have a tendency to simply redeploy, she said. “It is a coping mechanism. It’s an avoidance of meaning making and layering, layering, layering of stress and distress.” Yet Lennon warned that grief cannot be escaped. “It cannot be put on a shelf — it will come up. And this is what concerns me about humanitarian workers and MSF in particular. There does not seem to be a lot of space to deal with grief, sadness, fear, loss or threat.”

The nature and culture of the humanitarian sector, particularly within MSF, meant that humanitarian workers were also given very few opportunities to discuss and display emotions in the field.

While in the field, Lennon found self-care was uniformly lacking. As a psychologist, she said her experience showed that taking time to notice emotions and reflect was better for mental health. Yet the nature of humanitarian responses and the hold of MSF over workers meant that self-care came second to the organization’s response and needs.

“It is taboo to talk about how you feel in the field,” Lennon said.

Workers said they were unsupported, with a lack of recognition on the impact trauma had on them personally. Harshness, disrespect and aggression were terminology they frequently used to describe the internal structure and response to issues of staff and volunteers.

The result manifests in burnout, anxiety, depression and subjects questioning whether their work made a difference, according to Lennon’s interviewees.

Q&A: Phil Connors on leadership and training needs for the humanitarian sector

At the inaugural Asia Pacific Humanitarian Leadership Conference in Melbourne, Phil Connors, director of the Centre for Humanitarian Leadership, spoke with Devex on the growing demand for leadership research and training, and directions for both the center and the humanitarian sector — including the development of a new Graduate Certificate for Humanitarian Health.

Leaders and teams can make a difference

Lennon urged organizations to consider the impact on staff and volunteers in crafting humanitarian response. Aid workers can be better equipped with techniques and strategies prioritizing self-care.

“You can get people to be aware of their emotions, but whether they have the self-development to use those strategies in times of stress is another thing,” she said. “But that is where leadership comes in.” Field coordinators and leaders are a “vital” asset in identifying and responding to trauma in the field, Lennon said.

“It would be good for MSF and other organizations to think about what they could do in the field to better equip team leaders to understand the dynamics and the natural developmental process of coping with disasters and trauma,” Lennon said. “We need leaders who are sensitive to what people can cope with. You can pick when someone is heading towards a burnout. And then it is a question about the broader support network available.”

A stronger consideration of aid worker impact can make for an improved response, Lennon said, ensuring workers are at their best — and are supported in their experiences — to help.

Following the presentation of the research, Devex contacted MSF Australia for a response and insights into their mental health policies and practices, but they were unable to comment in time for publication.

Devex is the media partner for the inaugural Asia Pacific Humanitarian Leadership Conference. Follow discussion from the conference on Twitter using #bethechange.

About the author

  • Lisa Cornish

    Lisa Cornish is a Senior Reporter based in Canberra, where she focuses on the Australian aid community. Lisa formerly worked with News Corp Australia as a data journalist for the national network and was published throughout Australia in major metropolitan and regional newspapers, including the Daily Telegraph in Melbourne, Herald Sun in Melbourne, Courier-Mail in Brisbane, and online through Lisa additionally consults with Australian government providing data analytics, reporting and visualization services. Lisa was awarded the 2014 Journalist of the Year by the New South Wales Institute of Surveyors.