The power of mindfulness in a war zone

JUBA, South Sudan — After more than a year conducting mindfulness workshops in South Sudan, Paula Ramirez is struck by how emotionally shut off many aid workers in the country have become.

Ramirez is the co-founder of Swiss-based NGO Breathe International, which promotes mindfulness for peacebuilding in conflict-affected areas, and has spent 13 years working around the world. She has helped survivors of torture, sexual assault, and landmines, as well as school teachers and those who have been internally displaced, affected by conflict in countries such as India, Thailand, Nepal, and Colombia.

Now, she’s brought her expertise to the most dangerous place in the world for humanitarians to operate. South Sudan can be an emotionally challenging place to live with a constant fear of violence and a general feeling of unpredictability, Ramirez said.

“It’s sad somehow,” said Ramirez, the only mindfulness expert currently working in South Sudan. “What I’ve realized is that some [humanitarians] tend to be very disconnected from themselves.”

Yet focusing on the mental health of aid workers isn’t always a priority for organizations or donors in emergency contexts such as South Sudan, especially when it comes to using less traditional approaches. Mindfulness, for instance, is a mental training and personal development practice linking concentration exercises with self-observation in order to deepen personal and social awareness.

To date, the United Nations International Organization for Migration is the only group in the country experimenting with this practice. Ramirez has worked on and off with the aid agency as its mindfulness specialist since January 2017, helping both beneficiaries and humanitarians use the practice to find freedom and center themselves by bringing attention to the natural flow of breath, bodily sensations, and the ability to feel the body through mindful movement.

A mindfulness experiment

Earlier this year, Ramirez spearheaded IOM’s pilot project focused on training humanitarians who work with survivors of sexual abuse and people living with HIV/AIDS. Forty-seven staff from three local organizations took part in the two-and-a-half month program, where they met twice a week at a hotel in the center of town. The goal was to assist aid workers in becoming more present, more aware, and more in touch with their bodies and emotions.

“When you are more present for yourself, you’re more present for others,” Ramirez said.

People don’t just experience things in their minds, but in their bodies, said Catherine Hingley, a gender-based violence specialist for IOM who recruited Ramirez. Mindfulness makes sense when overcoming difficult issues and stress, she said. So far, preliminary results from the pilot confirm her theories: “What really stood out was more the fact that actually a lot of the people that want to help survivors are also survivors themselves,” Hingley said.

Without recognizing and working through with their own trauma first, they aren’t able to effectively support survivors’ recovery, she said. The mindfulness process was helpful in allowing them to heal.

Aid workers who participated in the training reported being less aggressive, less reactive, sleeping better, and sharing stress reduction tips with colleagues, according to preliminary results recorded by IOM.

“Before the training, my mind used to wander a lot wildly thinking about so many challenges of life,” said Elungat David, program director for Voice for Humanity Uganda, a Ugandan NGO. David participated in the training while living in South Sudan when he worked with National Empowerment of Positive Women United, an organization supporting women living with HIV/AIDS.

Since the workshop, he now spends time in the morning doing relaxation exercises, which has allowed him to better control his thoughts throughout the day, he said. He’s also informally sharing what he learned with his staff in Uganda.

While working with IOM in South Sudan’s town of Bentiu, Ramirez focused on the local gravediggers, charged with burying the bodies of people who die in the U.N. protected sites, who had become mentally and physically exhausted. Ramirez focused on teaching them to connect with their bodies, especially before going to sleep, so that their minds wouldn’t continuously think about the dead. She also taught them how to practice proper posture and take care of themselves physically.

“They were burying so many people that at the end they were just saying a short prayer and that was it,” she said.

In order to regain meaning in the work they were doing, Ramirez encouraged the team to discuss local practices for honoring the dead, recalling stories they’d forgotten of how they used to honor their grandfathers and grandmothers during burial.

Finding a place for feelings

Despite Ramirez’ reports of a largely positive reception from aid workers engaged with mindfulness work, not everyone is familiar with the concept. Several aid workers told Devex that it can sometimes be considered a less attractive option for people who have suffered severe trauma. And regardless of the type of psychosocial support one might seek, stigma in the sector persists if someone expresses they don’t feel strong enough to deal with stress in a challenging context.

“There’s this internal stigma against myself for letting these stories affect me because it’s not my pain or trauma. If people here survive it, I feel like it shouldn’t be me who feels the effects,” Chanel Marin, a former aid worker in South Sudan, told Devex. Marin did not seek psychosocial support while in the country, and it wasn’t until she left that she realized how deeply impacted she’d been by her experiences, she said

Secondary trauma is a very real concern for aid workers in many contexts, said Nancy Nyambura, a psychologist for Médecins Sans Frontières in South Sudan. It’s one of the issues aid worker patients speak to her about the most, she said.

IOM is advocating for more organizations to lobby donors to invest in self-care and incorporate practices, such as mindfulness trainings into broader mental health and psychosocial support programs, which currently isn’t the norm. “There’s enough and growing evidence that we can’t do a good job without supporting ourselves, especially people on the frontlines who themselves have experienced traumatic events,” Hingley said.

Funding for its recent pilot project with humanitarians who work with survivors of sexual abuse was provided by U.S. Agency for International Development as part of a grant for its gender-based violence and response programming. The total cost of funding two mindfulness projects as well as contracting Ramirez as a consultant for roughly a year came to approximately $150,000.

A USAID official declined to comment on whether funding for these types of programs would continue, but told Devex that it supports trauma awareness and gender-based violence prevention and treatment in its programming.  

IOM advises aid groups interested in adopting mindfulness into their budgets to make sure it fits within a broader mental health package and isn’t a standalone project. It also works best when implemented with existing groups already doing other activities, such as a women’s group. Most importantly, however, an organization has to identify someone with experience in practicing mindfulness and the ability to tailor the program to different cultures and needs.

For humanitarians left wondering if they’ve become too disconnected from their feelings, Ramirez says there are signs to watch out for, such as “when you really stop really feeling, when you are in front of a situation and you say, ‘OK, just one more case of gender-based violence or one more displacement.’”

She offers a few pieces of advice in order to reconnect with oneself, including doing three minutes of breathing each morning to steady the mind and being aware of — and releasing — tension areas in the body. For the latter, Ramirez makes sure she’s conscious of micromovements within her own body. For example, when she’s angry her left shoulder will rise slightly, prompting her to move the tension from her mind toward her shoulder and lower it.

“Doing this job and not being connected with your humanity doesn’t make sense,” she said. “Because at the end of the day we are humanitarians.”