<< Return to InPsych December 2004 

By Steven Gregor, InPsych production editor

A conference held last month in Melbourne, titled "Cross-cultural perspectives on psychosocial issues of humanitarian staff care", aimed to give psychologists insight into the context of humanitarian aid work, as well as to share with members of NGOs the application of psychological theory and practice that may be helpful in supporting the work of aid agencies. A joint project of the APS Directorate of Social Issues and representatives of Australian NGOs, the aim of the conference was to increase awareness of how psychologists can best support the wellbeing of staff working for western humanitarian NGOs. It examined ways in which humanitarian organisations employing personnel for the field can better prepare and support staff for cross-cultural interactions at both individual and organisational levels in order to effect meaningful and sustainable aid intervention.

The importance of being culturally aware

NGO security advisor and keynote speaker at the conference John Fawcett says, in the early stages of humanitarian work, the focus of support was on meeting the practical, or physical, requirements of those in need; there was little appreciation of mental health issues until sometime later. However, he believes humanitarian aid is now at the stage "where there is recognition that the psychological distress caused by even simple things, like drought, if you can call drought a simple thing, is significant."

It has become clear that, to be effective, psychology needs to be cultural aware and work in conjunction with the traditional "practical" interventions. Fawcett continues: "The whole idea of 'what is mental health?' and 'how do we protect against psychological stress?' must come out of a psychosocial framework. Psychologists need to be open to working along side anthropologists, sociologists, and historians to create a model that is going to be (culturally) appropriate.

"There is a tendency (for humanitarian aid workers) to assume that the local people have no history or knowledge of how to manage their problems. But, just about every culture that exists has very sophisticated ways of dealing with pain - both physical and psychological."

Psychologist and researcher Amanda Allan agrees, believing a shift in thinking is needed. She believes the psychological support provided needs to encompass the physical, spiritual, social, and psychological aspects of being and within the context of the culture and society where intervention is requested. "All of those aspects need to be equally valued to be able to go and do this work competently - whether it be supporting the agencies, the people in the field, or implementing collaborative interventions for the distressed population directly."

Support for the aid workers

Not surprisingly, there has been an increasing need for agencies to provide psychological assistance and support to the workers carrying out humanitarian aid. Fawcett highlights that "most of the actual frontline work is done by people who are employed by the country where the disaster (for example) has occurred; probably 80 per cent of humanitarian work is provided by national (local) staff." He says that national aid workers are among the impacted community profile and are therefore exposed to the likelihood of "vicarious and secondary trauma".

"There was some good research done by the (US-based) Centers for Disease Control and Prevention (2000) looking at the longitudinal impacts on humanitarian aid workers over a period of time. What they found is that at around the fifth assignment there was a dramatic increase in levels of clinical anxiety, depression, cumulative stress, burn out and potential post traumatic stress disorder. So, the longer people are working (as aid workers) does not necessarily mean they are going to have more resilience. It could be, in fact, that the longer people work in this field the more they are going to be exposed and affected," Fawcett said.

Psychologist and consultant to the United Nations Institute for Training and Research (UNITAR) Eleanor Wertheim also believes the role psychologists can play in assisting the aid workers is an important one. "Psychologists have a role to play in supporting humanitarian aid workers through the many stressful experiences and difficulties they will face in their jobs. Humanitarian aid workers often work in very stressful environments, called upon to respond to challenges that will affect many peoples' lives and in some cases loss, and threats of loss. For those humanitarian aid workers who go into severe conflict situations, the context has changed hugely over the past 15 years in that the workers can potentially be under threat themselves. Support from psychologists can help them deal with the stress and the experiences they have in the field."

Working organisationally to implement change

Allan believes there is a significant amount of educative work that needs to be done within humanitarian aid agencies. She believes it would be helpful for psychologists to offer educative work from a psychological perspective at the pre-deployment phase. The thinking behind this is simple - prevention is better than cure. However psychologists should firstly be oriented to the context of humanitarian work if their contributions are to be effective and practical and to adopt a systemic and cross cultural approach to the work.

Fawcett agrees, believing: "the organisational context of humanitarian aid is critical. Psychology can really assist by looking at how can aid workers be better prepared to do the work and avoid, or at least manage, some of the astringent stresses and traumas that potentially arise from doing the work."

A need for further training and research

Allan believes more research needs to be done examining the provision of psychological services to the humanitarian aid fraternity. "There is a need for universities and psychology departments to start seriously looking at how to link in with this field and start developing appropriate and collaborative research agendas that go beyond a focus on trauma. Surprisingly, very little research is done in universities world wide that adopt a more systemic approach to the field, assessing for example, the efficacy of selection processes and training of aid workers and the phenomenon of post-deployment adjustment for both national (local) and expatriate staff.

"Also, I would certainly like to see a very deliberate statement put out by the profession on the ethics of psychologists working in humanitarian work and I think in time, the profession endorsing some sort of certificate or fundamental training is required," Allan said.

However, ensuring the service psychologists provide, within the cultural context, is of a help and not a hindrance is crucial. Fawcett believes: "what humanitarian aid can offer the psychology profession (when working within the humanitarian aid sector) is the description of minimum standards. The Sphere Project, established by a consortium of NGOs, including the United Nations and The World Health Organization, has set very detailed minimum standards on how to do humanitarian work. So, for example, if a water supply is being provided to a community, it is known exactly how many cubic metres of water is needed per person, per day; and, these minimum standards must be adhered to. In the area of psychological intervention, some minimum standards of the psychosocial care of humanitarian aid workers are currently being developed by the Antares Foundation, based in Amsterdam. Crucially, the basic principle, and one that humanitarian work internationally agrees on, is: 'do no harm'.

"Part of the concern with psychological interventions is that there's potential for a lot of harm if we get it wrong," Fawcett said.