1. Managing Stress in Humanitarian Workers: A Qualitative
Study among Irish Humanitarian Organisations
Cliona Walshe
This thesis is submitted to University College Dublin in partial fulfilment of the
requirements for the Degree of Joint Master in International Humanitarian
Action
School of Agriculture and Food Science
Supervisor: Dr. Monica Gorman
January 2016
2. Table of Contents
Abstract……………………………………………………………………………………………………………i
Acknowledgements……………………………………………………………………………………………ii
1. Introduction……………………………………………………………………….1
1.1. Background Information and the Relevance of this Study for the
Humanitarian Sector …………………………………………………………………….1
1.2. Research Questions……………………………………………………………………….3
1.3. Aims and Objectives………………………………………………………………………4
1.4. Methodology…………………………………………………………………………………5
1.5. Limitations……………………………………………………………………………………9
1.6. Thesis Outline…………………………………………………………………………….10
2. Literature Review……..…………………………………………………........11
2.1. Understanding Common Stress Disorders, their Symptoms,
Causes and Effects………………………………………………………………………11
2.2. Humanitarian Action - a Context that Lends Itself to Stress
and Trauma……………………………………………………………………….……….24
2.2.1. Sources of Stress and Trauma in Humanitarian
Work………………………………………………………………………………..24
2.2.2. The Possible Negative Effects of Stress and Trauma
on both the Individual Aid Worker
and the Organisation…………………………………………………………26
2.3. Proven Methods of Stress Prevention and Mitigation……………………….29
2.4. Introducing the Guidelines……………………………………………………………34
2.5. Introducing the Organisations………………………………………………………38
3. Research Findings………………………………………………………………43
3.1. Policy…………………………………………………………………………………………43
3.2. Screening and Assessing………………………………………………………………51
3.3. Training and Preparation……………………………………………………………..56
3.4. Monitoring………………………………………………………………………………….60
4. i
Abstract
As it has been found that there is a lack of recognition of the importance of
supporting the mental health of workers in the humanitarian sector, this study has
been carried out to determine how to improve the provision of staff mental health
support across the sector. The study shows the extent to which a sample of Irish
humanitarian organisations have adopted the Antares Foundation guidelines,
Managing Stress in Humanitarian Workers: Guidelines for Good Practice, and what
the reasons are for non-adoption of these Guidelines among these organisations.
Before presenting the findings, this paper explains the negative effects of stress and
trauma, describes the stressful nature of humanitarian work is and presents proven
methods of preventing and mitigating stress. In total, seven interviews (one of the
organisations was represented by two informants in the same interview and one of
the organisations was represented by two different informants in two separate
interviews – Human Resources (HR) Partner and Country Director (CD)) were
conducted with staff members responsible for staff care in their organisations. The
percentage of which each of the principles have been adopted by the organisations
was calculated and the reasons for non-adoption, as identified by the informants,
were analysed. It was found that certain areas of mental health support receive
more attention than others. Some recommendations were then formulated based on
the findings in order to improve the provision of mental health support for
humanitarian workers across the sector.
5. ii
Acknowledgements
First of all, I want to thank the staff members from the Irish humanitarian
organisations who participated in this research, for their willingness and for taking
time out of their busy schedules to share their knowledge. Without them this study
would not have been possible. Secondly, I want to thank the many lecturers who
have taught me during my time at University College Dublin. I would especially like
to thank Dr. Anne Mulhall within the School of English, Drama and Film who gave
me the confidence to pursue a NOHA master’s degree. I feel very grateful that I had
the opportunity to attend your inspiring classes which you taught with such
infectious enthusiasm. I would also like to thank my supervisor Dr. Monica Gorman,
for providing me with her invaluable guidance and feedback over the course of this
project. Last but not least, I want to thank my loving family for their unconditional
support and for giving me courage to continue to study with determination
throughout the master’s programme.
6. 1
1. Introduction
1.1. Background Information and the Relevance of this Study for the
Humanitarian Sector
It is a well-established fact that humanitarian work is stressful and can also often be
traumatic. In fact, research shows that aid workers are at risk of developing
substantial mental health problems (McFarlane, 2004: 2). The humanitarian sector
shares many of the same pressures that are found in other sectors, such as
insufficient training, time, resources, and support, unclear job descriptions,
inadequate management or supervision, communication difficulties and an
inadequate amount of time away from work (Antares Foundation, 2015). As well as
these anxieties, aid workers must contend with crisis conditions and funding
constraints, and of course, aid workers also experience the pressures of everyday
life. Some may even be survivors of the disaster themselves (Antares Foundation,
2015).
Humanitarian staff work in unpleasant and challenging conditions and workers
frequently bear large workloads, long hours, chronic fatigue, and a lack of personal
space (Antares Foundation, 2015). Moreover, they are often required to work in an
ever-changing context of deteriorating security, a lack of respect for the work and
lives of aid workers, and dysfunctional government. This causes a great deal of
stress among staff and a diminishing quality of work (Antares Foundation, 2012: 7).
Many aid workers also experience significant trauma, and continuous work-related
trauma exposure can have profound consequences for mental health. In the field,
workers frequently hear about the frightening and heart-breaking experiences of
others, and they may themselves witness terrible acts, or, indeed, have terrible
experiences of their own. Meeting with a victim of violence and listening to their
stories can have an extremely damaging effect on one’s mental health, and
experiencing traumatic events or chronic stressors can often lead to the
development of depression, anxiety, burnout or Post-traumatic Stress Disorder (PTSD)
in an individual if they lack the sufficient resources to adequately cope with stress
and trauma. Indeed, PTSD is linked to the types of extremely traumatic events that
aid workers are likely to experience (Cardozo et al., 2005: 163). Further, studies
7. 2
have shown that individuals who work with traumatised populations are more likely
to develop PTSD (Connorton et al., 2012: 146), and aid workers suffer from more
PTSD, depression and anxiety when compared with the general population
(Connorton et al., 2012: 145).
Such disorders have profoundly negative consequences both for the individual and
the individual’s hiring organisation as a worker suffering from such a disorder
becomes ineffective and tends to disrupt the smooth running of the organisation’s
programmes. Such an individual is typically a poor decision maker, often absent from
work, and is more likely to cause an accident, to become ill, and to use more health
services. They might cause conflict in their team, and they are also more likely to
leave the organisation thereby causing a loss of experienced staff and a rise in
recruitment and training costs for the organisation (Antares Foundation, 2015).
Studies show that organisational policies have an impact on the mental health of aid
workers (McFarlane, 2004: 4). In fact, good staff care has been proven to
successfully prevent and treat traumatic and posttraumatic stress in aid workers.
Therefore, it is necessary for humanitarian organisations to take steps to prevent
and mitigate stress in their staff members (Inter-Agency Standing Committee, 2007:
87). Indeed, numerous best practice documents and guidelines exist regarding
humanitarian staff care. One such document, which is devoted to the management
of stress in humanitarian workers, is Managing Stress in Humanitarian Workers:
Guidelines for Good Practice by the Antares Foundation (AF) – a Dutch non-
governmental organisation (NGO) specialising in staff care and psychosocial support
for humanitarian and development staff (Antares Foundation, 2015). The Antares
Foundation collaborates with Centers for Disease Control and Prevention, Atlanta,
USA (CDC). Their Guidelines are “a comprehensive, systematic presentation of the
‘state of the art’ in managing stress in humanitarian workers” (Antares Foundation,
2012: 5) and are based on the knowledge and research of an international working
group of experts made up of “national and international NGO officials (including
Human Resources Directors, Safety and Security Directors and Country Directors),
academic and clinical experts in stress and in managing ‘normal’ and post-traumatic
stress, and NGO psychosocial staff with responsibility for staff support” (Antares
8. 3
Foundation, 2012: 5). These guidelines are based on a vast body of robust research
and it is claimed by the AF that these guidelines, if actively implemented, are
extremely effective at ensuring the prevention and mitigation of stress among aid
workers (Antares Foundation, 2012: 7). However, while most organisations are
aware of the importance of retaining healthy workers, there remains a sector-wide
issue of inadequate staff care as there tends to be a lack of attention and resources
dedicated to such systems (Antares Foundation, 2012: 5). Studies of
nongovernmental organisations (NGOs) have shown that pre-deployment training to
prevent psychological stress in the field is often inadequate, stress management
practices in the field varies widely, and staff support resources are generally weak
(Connorton et al., 2012: 147).
Research to determine the effectiveness of employing organisations in preventing
and mitigating stress in their staff is rather limited (Connorton et al., 2012) and to
the author’s knowledge, there has not yet been any studies carried out to determine
the extent to which the AF guidelines have been adopted by humanitarian
organisations. For this reason, the author has decided to address this gap in
research. This study investigates the extent to which a sample of Irish humanitarian
organisations have adopted the guidelines of the AF, and identify the reasons for
non-adoption of guidelines where this is the case in order to make recommendations
on how to better promote the implementation of the guidelines across the
humanitarian sector. This will be beneficial to the humanitarian sector as this
knowledge will help humanitarian organisations to strengthen their disaster response
through the improvement of the wellbeing of their staff.
1.2. Research Questions
As mentioned above, the AF has formulated guidelines which are based on a vast
body of robust research and which, if implemented correctly, ensure that stress in
staff of humanitarian organisations is very effectively prevented and mitigated. It is
for this reason that the author has decided to base the research on these guidelines
in order to determine how effectively stress in staff is currently being prevented and
mitigated in the humanitarian sector. The main research questions are as follows:
9. 4
1. To what extent have the AF guidelines been adopted in a sample of Irish
humanitarian organisations?
2. What are the reasons for non-adoption of guidelines in a sample of Irish
humanitarian organisations?
A further four sub-questions were formulated in order to answer the main research
questions above because in order for Irish humanitarian organisations to have
adopted the AF guidelines, the organisations must be aware of the potential
stressors their staff might face and they must aim to prevent and mitigate stress in
their staff. As well as this, it is necessary to determine what factors support or limit
the ability of Irish humanitarian organisations to prevent and mitigate stress in their
staff in order to determine how limiting factors may be overcome. This is why the
following sub-questions were formulated:
Sub-questions:
1. Are Irish humanitarian organisations aware of the potential stressors that
their staff may face and do they aim to prevent and mitigate stress in their
staff? If so, how?
2. Are Irish humanitarian organisations effective at preventing and mitigating
stress in their staff?
3. What are the factors which enable or inhibit stress prevention and mitigation
of staff of Irish humanitarian organisations?
4. How can humanitarian organisations improve their staff care to better prevent
and mitigate stress in their staff?
1.3. Aim and Objectives
Aim
While most humanitarian organisations are conscious of the importance of staff
wellbeing, from reviewing the literature there appears to be a sector-wide issue of
inadequate staff care and there tends to be an inadequate amount of attention and
resources given to such systems (Antares Foundation, 2012: 5). Therefore the aim
of this thesis is to determine how effectively stress in staff is currently being
10. 5
prevented and mitigated in the humanitarian sector. In order to achieve said aim
and to frame the studied topic, this thesis has the following objectives:
Objectives
1. To review academic literature and studies on the concepts of stress, trauma
and their related mental disorders as well as peer-reviewed studies on the
mental health of aid workers in order to define a theoretical base to guide this
study
2. To determine the extent to which stress in staff is being prevented and
mitigated in Irish humanitarian organisations and to examine how this is
achieved
3. To formulate recommendations on how to better promote the provision of
mental health support for aid workers across the humanitarian sector
1.4. Methodology
The research was of a qualitative nature in order to explore the specific situation of
each organisation and to gain an understanding of reasons behind the decisions
being made by the organisations regarding stress prevention and mitigation. The
data was collected through semi-structured interviews with key informants who were
chosen purposely. The interview questions were based on the AF guidelines and the
guidelines were also used as a framework for analysis. The interviews were recorded
using a sound recorder application on my laptop and the recordings were then
stored as files on the author’s laptop.
In total, 7 semi-structured interviews were conducted with individuals responsible for
staff care in Irish humanitarian organisations. These individuals were sourced
through both purposive and snowball methods. These interviews were conducted
between September 3rd 2015 and November 13th 2015.
11. 6
Sampling Procedure
On 1st August, the author compiled a list of Irish NGOs which were found through
the Dochas1 website and drew up a list of organisations to contact: Concern, GOAL,
Médecins Sans Frontières (MSF) Ireland, Oxfam Ireland, Plan Ireland, Trocaire,
World Vision Ireland, UNICEF Ireland and Tearfund Ireland. The author aimed to
source HR managers or members of the HR team or someone in a similar position
with responsibility for staff welfare at Headquarters (HQ) which would have the
relevant knowledge and ability to answer my interview questions comprehensively
and also a Country Director (CD) or other field staff member who would also meet
these criteria. The reason the author wished to interview two different staff
members (one from HQ and one field staff member) was because these staff
members would have a different experience from one another, there would possibly
be a difference of opinion between them and this would bring greater depth of
knowledge in terms of how mental health support is provided by the organisations.
Initially, the author had difficulty finding contact details for the staff they wanted to
interview but they found the contact details for a HR staff member from Plan
Ireland’s HQ and MSF Ireland’s HQ. The author emailed both of these staff members
on 3rd August explaining the topic of the study and requesting to speak to the
relevant persons in their organisations and the author emailed the general email
addresses of the other organisations on their list. The author received a swift reply
from both staff members saying that they were willing to be interviewed. The author
had not at that point, however, finalised the interview questions so the author
replied to their emails to say that they would contact them as soon as possible to let
them know when they would be available.
The interview questions were finalised on September 1st but the author had not yet
heard back from any organisation except Plan Ireland and MSF Ireland. The author
contacted both of these staff members to let them know that they were now
1
“Dóchas is the Irish Association of Non-Governmental Development Organisations” (Dóchas, 2015).
12. 7
available to conduct the interview. The Plan Ireland staff member replied to say that
they would be available to be interviewed at 10am Thursday 3rd September.
However, the author did not receive a reply from the MSF Ireland staff member. On
September 1st the author also decided to call each of the organisations (except Plan
Ireland) by phone to try and source key informants. Each of the organisations took
the author’s contact details, promised to pass on the message to relevant persons
and assured the author that they would be contacted in due course. The author was
contacted by UNICEF Ireland and Tearfund Ireland on September 2nd to say that
they were not suitable organisations for the study as they are not responsible for the
care of staff overseas and so the AF guidelines did not apply in these cases. By
September 23rd the author still had not been contacted by any of the remaining
organisations so they decided to call again and request to speak to the relevant
persons directly. The author spoke with the HR staff members from GOAL, MSF
Ireland, and Oxfam Ireland, and was contacted by Trocaire and World Vision Ireland
HR personnel. The GOAL, MSF Ireland and Oxfam Ireland staff members assured me
they would like to participate in the study and said they would get back to me in due
course. The author received emails from the CD for Sierra Leone of one of the
aforementioned organisations on September 21st and a member of the HR team in
Trocaire’s HQ in Maynooth on September 14th. They both agreed to be interviewed.
A HR staff member of World Vision Ireland contacted the author on September 23rd
also agreeing to be interviewed. On October 16th the author was contacted by HR
members of Concern who agreed to be interviewed. That same day the author was
told by MSF Ireland’s HR staff member that there wasn’t anyone available in the
organisation to be interviewed for my study. On October 27th the author was
contacted by the HR staff member of Oxfam Ireland who put them in contact with a
different HR staff member within the organisation that was suitable to be
interviewed as they had the relevant knowledge that the author required and was
willing to be interviewed. Finally, the GOAL HR staff member contacted the author
on November 6th to say that one particular colleague of theirs would be a suitable
interviewee for the study. The author then emailed that colleague directly to arrange
a time to conduct the interview. The times and dates for conducting interviews were
set by email and the interviews took place via Skype. It’s also important to note that
13. 8
when contacting the organisations requesting interviewees the aim of the research
was explained before the requests were made. In the end, the author interviewed
six organisations: Concern, GOAL, Oxfam Ireland, Plan Ireland, Trocaire and World
Vision Ireland. (In appendix 1 of this document, the list of participants and job titles
is included)
Interview Process
Before each of the interviews, all interviewees were reminded of the goals of the
study, and told they could remain anonymous if they so wished. Indeed, to honour
the informants’ wishes to remain anonymous the author has not revealed the names
of any of the key informants and they have not directly attributed any of the quotes
to a specific organisation. As mentioned, the set of questions were based on the AF
guidelines which are divided into eight separate sections: Policy, Screening and
Assessing, Training and Preparation, Monitoring, Ongoing Support, Crisis
Management, End-of-Assignment Support and Post-Assignment Support. Thus, each
interview was divided into eight sections each correlating to those of the AF
guidelines and each of these sections was comprised of questions requiring ‘yes/no’
answers. The author pre-prepared follow up questions depending on whether the
interviewee answered ‘yes’ or ‘no’ such that if the interviewee answered ‘yes’ the
author would ask them to elaborate and if they answered ‘no’ the author would ask
them why that was the case. The author feels this type of interview was the best
possible way of discovering the extent to which the AF guidelines had been adopted
by the key informant’s organisation and the reasons for non-adoption where that
was the case. The author also feels that the questions which were formulated
allowed them to ascertain what kind of stress management activities the
organisations carry out and what the interviewee’s ideas were regarding the
supporting and limiting factors regarding prevention and mitigation of stress in staff.
All interviews lasted a minimum of 30 minutes with the longest interview lasting 70
minutes. (In appendix 2 of this document, the interview guide is included.)
14. 9
Data Analysis
As mentioned, the audio of all of the interviews were recorded with the use of a
sound recorder application on the author’s laptop with the permission of the key
informants and following the interviews they were then transcribed in order to be
analysed.
As can be seen in the ‘Research Findings’ chapter, the AF guidelines were utilised as
the basis for the data analysis and the transcripts were analysed section by section.
The author looked at how many indicators were adopted by the organisations for
each of the principles, how these indicators have been adopted and why indicators
have not been adopted where this is the case. Finally the findings were interpreted,
summarized and related back to the initial research questions.
1.5. Limitations
The author initially considered conducting interviews with staff members who could
share their personal experience with psychological difficulties and their need for
support to determine whether the support they needed had been provided by their
hiring organisation but this was later rejected as unethical as the author had no
training in counselling or psychosocial support. Instead it was decided to look at the
organisational perspective and to ask those responsible for staff care in humanitarian
organisations how psychosocial support is provided by their organisation. This is a
limitation in the sense that, though in some cases the interviewees have received
some psychosocial support during their time working for their organisation, the key
informants were generally providers or facilitators of support rather than recipients.
For this reason the research was limited to hearing ‘one side of the story’, so to
speak. Therefore, the true effectiveness of the organisations’ psychosocial support
has been difficult to assess. As well as this, the research was limited to a smaller
number of organisations than was anticipated as many Irish humanitarian
organisations are not responsible for the care of staff overseas and so the AF
guidelines did not apply in these cases. The research was further limited as the
author had planned to interview both a HR manager and a CD from each of the
15. 10
organisations but for all but one organisation, there was not any CDs available to be
interviewed. MSF Ireland also did not have any relevant persons available to be
interviewed for the study.
1.6. Thesis Outline
This thesis is organised into four chapters. In the first chapter the research topic is
introduced, the topic’s relevance to the humanitarian sector is explained and
research questions are posed. The chapter then describes the research process,
including how the data has been collected and analysed before reflecting upon the
limitations of this study.
The second chapter is divided into three constituent parts: Part one presents the
causes and symptoms of burnout as well as common stress- and trauma-related
mental disorders (anxiety, depression and PTSD). Part two explains the stressful and
traumatic nature of humanitarian work as well as the potential negative
consequences of stress and trauma on humanitarian staff members and
organisations. And Part three presents numerous proven methods which
organisations can utilise to successfully prevent and mitigate stress and trauma in
their staff.
Chapter three presents the extent to which the AF guidelines have been adopted in
the organisations studied, how the guidelines have been adopted and why part of
the guidelines have not been adopted. The chapter concludes with a discussion of
the findings.
In the fifth and final chapter, conclusions are made and recommendations are
formulated as to how the adoption of the AF guidelines might be better promoted
across the humanitarian sector.
16. 11
2. Literature Review
2.1. Understanding Common Stress Disorders, their Symptoms, Causes
and Effects
I will begin this chapter with an overview of the most common stress- and trauma-
related mental disorders (anxiety, depression, burnout, and PTSD). It is necessary to
have a basic understanding of these disorders in order to understand the importance
of preventing and mitigating stress and trauma. While each of these disorders are
similar to one another, there are also significant differences between them and, for
this reason, I will describe each of these disorders separately, explaining their
symptoms, causes and effects.
What is Stress?
Though stress is a common phenomenon, it is not one that is easily defined or
understood (Baum, 1990: 654). Indeed, there does not exist one single and concrete
scientific definition of stress, but instead, there is a variety of different definitions
and ways of describing the phenomenon to be found in the literature on the subject.
Though there is no universally agreed definition of stress, it is clear from the
literature that stress is comprised of three main component parts: a physical or
psychological stimulus (also known as a stressor), a response to a stimulus and a
physiological consequence of such a response (Kemeny, 2003: 124). Further, stress
is a state in which one is motivated to reduce negative feelings or sensations (Baum,
1990: 661) and chronic stress occurs when stressors or stress responses persist for
long periods of time (Baum, 1990: 662).
What Causes Stress?
From my research I have found that there are many different causes of stress some
of which include, but are not limited to, low self-esteem (Pruessner et al., 1999:
477), public speaking, difficult cognitive tasks (Kemeny, 2003: 125) and
organisational changes (Greubel & Kecklund, 2011: 353). From my research I have
also found that some people experience stress while others do not (Baum, 1990:
661), but this variance is more often found in situations which are not universally
17. 12
considered stressful (Baum, 1990: 662). Research demonstrates that a physiological
stress response is more likely to be activated in a person who perceives a situation
or event to be outside of their control (Kemeny, 2003: 128).
Stress Response
Stress responses are adaptive and have the purpose of helping one to cope when
experiencing a stressor (Baum, 1990: 659). It is believed that the physiological
response to a stressor is as a result of evolution and is also known as the ‘fight or
flight’ response (Kemeny, 2003: 124). The physiological stress response involves an
increased heart rate which rushes blood, oxygen and energy to the brain and
muscles and the release of stored energy into the bloodstream while diverting blood
flow from the gut and skin. As a result, bodily systems which are needed to deal
with threats are prepared and bodily systems which are not needed for this are
inhibited (Kemeny, 2003: 124). This response supports behavioural and
psychological coping, as such an arousal may help one to think and act quickly and
also help with rescue efforts following one’s own escape in situations such as
earthquakes or fires (Baum, 1990: 660).
What are Possible Negative Consequences of Stress?
This bodily reaction to a stressor can have physiological and psychological health
effects if it becomes chronic (Kemeny, 2003: 124). In a study by Greubel & Kecklund
(2011) which set out to determine the impact of organisational changes of a
company on its workforce, gastrointestinal complaints and depressive symptoms
were found (Greubel & Kecklund, 2011: 353). As well as these types of negative
consequences of stress, it has been shown that exposure to stress can also cause a
reduction of function in the immune system (Kemeny, 2003: 125). As well as these
directly harmful consequences of exposure to stress, stress can also lead to poor
decision making on the part of a stressed individual in an attempt to reduce their
stress. Indeed, there are many methods a person may choose in order to help cope
with stressors; some positive, some negative. Negative coping methods include drug
use, smoking and overeating (Baum, 1990: 661).
18. 13
As will become clear further into this paper, if stress is not dealt with and mitigated
effectively it can lead to the development of mental disorders of which anxiety,
depression and burnout are very common.
What is Anxiety?
Anxiety involves “the detection of and preparation for danger” (Chorpita & Barlow,
1998: 3) and has been defined as “a future-oriented mood state in which one is
ready or prepared to attempt to cope with upcoming negative events” (Barlow,
2000: 1249). Indeed, excessive fear and anxiety and associated behavioural
disturbances are features of anxiety disorders. “Fear is the emotional response to
real or perceived imminent threat, whereas anxiety is anticipation of future threat”
(American Psychiatric Association, 2013: 189). When a person is experiencing
anxiety they have a belief that they are helpless and lack the ability to predict or
control2 possible future threats, dangers or other potentially negative events
(Barlow, 2000: 1249). An individual suffering from an anxiety disorder focuses their
attention strongly on their lack of ability to deal with a threat and their anxiety is
triggered by certain situations or objects which represent an earlier trauma.
It is the types of objects or situations that induce fear, anxiety, or avoidance
behaviour, and the related cognitive ideation that differentiates one anxiety disorder
from another. Anxiety disorders are also different from developmentally normative
fear or anxiety as fear and anxiety within anxiety disorders are excessive or persist
beyond developmentally appropriate periods. It is in childhood that many anxiety
disorders develop and the disorder tends to persist if left untreated (American
Psychiatric Association, 2013: 189). Indeed, anxiety disorders are extremely
common and are the most chronic of mental disorders as, if they are not treated
effectively, they can last for a lifetime (Barlow, 2000: 1248). Interestingly, for most
of the anxiety disorders, more females suffer from the anxiety disorder than males
(approximately 2:1 ratio) (American Psychiatric Association, 2013: 189).
2
Control has been defined as “the ability to personally influence events and outcomes in one's environment”
(Chorpita & Barlow, 1998, p5) and it is in this sense that the word is used here.
19. 14
The Diagnostic and Statistical Manual of Mental Disorders (DSM) “is the standard
classification of mental disorders used by mental health professionals in the United
States” (American Psychiatric Association, 2015) and the latest edition, the DSM-5,
“is the product of more than 10 years of effort by hundreds of international experts
in all aspects of mental health” (American Psychiatric Association, 2015). According
to the DSM-5 an individual will be diagnosed with generalised anxiety disorder (GAD)
if they are excessively worried or anxious for more days than not for at least 6
months, about a number of events or activities, and this “anxiety and worry are
accompanied by at least three of the following additional symptoms: restlessness or
feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind
going blank, irritability, muscle tension, and disturbed sleep, although only one
additional symptom is required in children” (American Psychiatric Association, 2013:
223). The crucial feature of GAD is extreme anxiety and worry (apprehensive
expectation) about numerous events or activities where the intensity, duration, or
frequency of the anxiety and worry is far greater than is warranted as the
anticipated event is either not likely to occur or is not likely to have the impact that
the individual is anticipating.
Risk Factors for the Development of Anxiety Disorders
There is evidence to suggest that the experience of a lack of control may be a causal
factor in the development of anxiety in an individual (Barlow, 2000: 1256). In fact,
individuals with a history of a lack of control are considered to have a psychological
vulnerability and may be at risk of developing chronic anxiety or related negative
emotional states (Chorpita & Barlow, 1998: 5). Research suggests that an
individual’s childhood experiences may condition them to perceive situations to be
outside of their control as an adult. Therefore, an individual who has been
conditioned to perceive situations as outside of their control has a psychological
vulnerability to the development of anxiety (Chorpita & Barlow, 1998: 5). An
individual with a specific phobia or anxiety disorder focuses anxiety on certain life
circumstances due to an early learning experience, for example, an individual
suffering from social phobia and social anxiety disorder would have learned to
perceive social evaluation as threatening and dangerous (Barlow, 2000: 1258). A
study carried out by Gershuny and Sher (1998) has also shown that an individual
20. 15
with both low extroversion and high neuroticism has a strong vulnerability to the
development of anxiety (Barlow, 2000: 1253).
As well as the existence of psychological vulnerability to the development of anxiety,
there also exists a generalised biological vulnerability through genetics as studies
have shown that anxiety and related mental states run in families (Barlow, 2000:
1252). As well as this, data across the globe shows that there is a much higher
percentage of women with phobias and anxiety disorders than men. This suggests
that women are more likely than men to develop phobias and anxiety disorders
(Barlow, 2000, p.1248). Indeed, as already mentioned, females are twice as likely as
males to suffer from anxiety disorders (American Psychiatric Association, 2013: 223).
However, it should be noted that this gender difference may or may not be due to
genetics. In any case, the co-occurrence of a generalised biological vulnerability and
a psychological vulnerability in an individual could be sufficient to lead to the
development of negative mental health, particularly GAD and depression (Barlow,
2000: 1252).
What are the Possible Negative Consequences of Anxiety Disorders?
When in an anxious state one’s attention focuses on sources of threat or danger
causing distortions in the processing of information through attentional or
interpretive biases and this negatively impacts upon the individual’s concentration
and performance (Barlow, 2000: 1250). Individuals suffering from anxiety disorders
lack the ability to focus or carry out everyday tasks quickly and efficiently due to
“symptoms of muscle tension and feeling keyed up or on edge, tiredness, difficulty
concentrating, and disturbed sleep” (American Psychiatric Association, 2013: 225) as
a result of distracting and worrisome thoughts related to all or almost all aspects of
their lives “such as possible job responsibilities, health and finances, the health of
family members, misfortune to their children, or minor matters” (American
Psychiatric Association, 2013: 222).
Moreover, those who suffer from anxiety disorders have a tendency to avoid objects
or situations which arouse a state of anxious apprehension (Barlow, 2000: 1250).
GAD, specifically, is a very distressing and disabling disorder, as most adult sufferers
are moderately to seriously disabled by the disorder. In fact, GAD accounts for more
21. 16
than 100 million disability days per annum in the U.S. population. It is not only the
individual who suffers from the disorder who is negatively impacted upon but in fact
the disorder can have a profound negative impact on friends and family members of
GAD sufferers. Further, individuals with GAD may also lack the ability to encourage
confidence in their children (American Psychiatric Association, 2013: 225).
What is Depression?
As mentioned, stress that is not adequately dealt with can also lead to the
development of depression. There exists numerous different depressive disorders
including disruptive mood regulation disorder, major depressive disorder (MDD),
persistent depressive disorder (dysthymia), premenstrual dysphoric disorder,
substance/medication-induced depressive disorder, depressive disorder due to
another medical condition, recurrent brief depression, short-duration depressive
episode, and depressive episode with insufficient symptoms, all of which involve “the
presence of sad, empty, or irritable mood, accompanied by somatic and cognitive
changes that significantly affect the individual’s capacity to function” (American
Psychiatric Association, 2013: 155).
Like anxiety, depression is extremely common and can be a chronic, lifelong illness
for many (Richards, 2011: 1117). According to the DSM-5, an individual will be
diagnosed with MDD if they display at least five of a possible nine symptoms, one of
which must be either depressed mood or loss of interest or pleasure, for most of the
day, almost every day for at least two weeks (American Psychiatric Association,
2013: 163). Symptoms include depressive mood, loss of interest in all or almost all
activities, appetite and sleep disturbance, psychomotor agitation or retardation,
fatigue, feelings of worthlessness or guilt, and suicidal thoughts and ideation
(American Psychiatric Association, 2013: 160-161). Moreover, these symptoms must
cause impairment of important areas of functioning and must not be attributable to
a particular substance or medical condition (American Psychiatric Association, 2013:
161). There is a high rate of mortality among MDD sufferers which is largely due to
suicide and individuals suffering from MDD often display “tearfulness, irritability,
brooding, obsessive rumination, anxiety, phobias, excessive worry over physical
health, and complaints of pain” (American Psychiatric Association, 2013: 164).
22. 17
According to the DSM-5, an adult will be diagnosed with persistent depressive
disorder (dysthymia) if they suffer from depressed mood for most of the day, for
more days than not for at least two years, have two out of six specific symptoms
which, as in the case of MDD, cause significant impairment of important areas of
functioning (American Psychiatric Association, 2013: 168).
An individual is considered to be in remission if their symptoms have gone or
reduced for less than eight weeks, which is considered the point of recovery
(Richards, 2011: 1121). However, though it may appear that there has been a
positive response to treatment, individuals may relapse meaning that symptoms
return within a short period of time (Richards, 2011: 1122). A history of depressive
episodes or psychiatric illness and old age are factors which can make relapse more
likely to occur. As well as this, studies have shown that many individuals suffering
from depression experience recurrence after recovery. In fact, the possibility of
recurrence of depression is as high as 30%, and this rate tends to increase with
subsequent episodes (Richards, 2011: 1122).
Risk Factors for the Development of Depressive Disorders
Individuals who are at increased risk of developing depression are individuals who
have had negative childhood experiences or have experienced trauma as a child
(especially when faced with additional stress) (Heim et al., 2008: 693), individuals
with neuroticism (American Psychiatric Association, 2013, p.166), individuals with a
chronic or disabling medical condition (American Psychiatric Association, 2013: 166),
and individuals who have suffered loss or experienced events which have devalued
the individual in a primary role (Kendler et al., 2003: 789). Indeed, it is well known
that MDD is commonly preceded by stressful life events (American Psychiatric
Association, 2013: 166) and, as with anxiety, depression is more prevalent among
women of all ages than men (Birkhäuser, 2002: 3). As well as this, Fava et al.
(1997) and Wittchen & Jacobi (2005) both found that around half of individuals with
MDD in their studies were also diagnosed with an anxiety disorder which suggests
that there could be a link between these mental disorders (Richards, 2011: 1119).
23. 18
What are the Possible Negative Consequences of Depressive Disorders?
The functional impairment caused by MDD can range from mild (where many people
who interact with the MDD sufferer are unaware of any depressive symptoms) to
severe (where the MDD sufferer is unable to take care of themselves and/or have
become unresponsive) (American Psychiatric Association, 2013: 167). The functional
impairment caused by persistent depressive disorder varies widely from one
individual to another but the impairment can be as pronounced or greater than it is
in MDD sufferers (American Psychiatric Association, 2013: 170).
According to a study carried out by Holma et al. most suicides are carried out by
individuals suffering from a major depressive episode (Richards, 2011: 1120).
Indeed, there is a possibility of suicidal behaviour for the entire duration of major
depressive episodes and the risk factor for suicide that is described most frequently
is a past history of suicide attempts or threats. However, while this is the case it is a
fact that most completed suicides are not preceded by failed attempts. Other factors
which increase an individual’s risk of completing suicide are being male, being single,
living alone, and having strong feelings of hopelessness. The existence of borderline
personality disorder also significantly increases the risk for future suicide attempts
(American Psychiatric Association, 2013: 167). As well as this, a study carried out by
Young, Mufson, & Davies (2006) found that depressed individuals that also had an
anxiety disorder suffered more severe symptoms and were less likely to respond to
treatment than those with depression only (Richards, 2011: 1119).
A study carried out by Üstün et al. (2004) found that the “reported prevalence
throughout the world of depressive episodes is 16 per 100,000 per year for males
and 25 per 100,000 per year for females” (Richards, 2011: 1119). The prevalence of
depression has a considerable societal and economic impact. A 2007 economic
review of the cost of depression, carried out by Donohue and Pincus, found that
depression is significantly costly due to high healthcare utilisation most of which is
not for the direct treatment of depression but for other depression-related health
issues (Richards, 2011: 1120). Indeed, the World Health Organisation (WHO) has
shown that depression is one of the leading causes of disease worldwide (Richards,
2011: 1119). It has in fact been shown that the global cost of depressive disorders is
24. 19
far greater than the cost involved in gaining a full understanding of depressive
disorders and successfully treating those who suffer from such disorders. In order
for individuals to be treated successfully, however, appropriate care needs to be
made accessible to those in need of such treatment (Richards, 2011: 1120).
What is Burnout?
Burnout is “a description for work-related distress that combines emotional
exhaustion, depersonalisation (treating people in an unfeeling, impersonal way), and
a sense of low personal accomplishment” (Ramirez et al., 1996: 724) and, as
mentioned, stress can lead to burnout in staff members if their stress is not dealt
with effectively. It “is a prolonged response to chronic emotional and interpersonal
stressors on the job” (Maslach et al., 2001: 397) and can occur in individuals who
work with people (Leiter & Maslach, 1988: 297). In burnout, an individual who was
once competent, energetic and found their work meaningful becomes incompetent,
cynical, exhausted and has come to find their work unpleasant, unfulfilling and
meaningless (McManus et al., 2002: 2089). Though burnout is related to anxiety and
depression, it is distinct from these disorders as its symptoms are work-related
rather than being of a physical or biological nature (McManus et al., 2002: 2089).
However, it has been found that individuals who are more prone to depression are in
turn more prone to burnout (Maslach et al., 2001: 404). The Maslach burnout
inventory (MBI), which has subscales of the three components of burnout (emotional
exhaustion, depersonalisation, and personal accomplishment) is used to determine
whether an individual is experiencing burnout (McManus et al., 2002: 2089).
What Causes Burnout?
Some individuals have cited interactions with coworkers as the greatest sources of
job stress and burnout (Gaines & Jermier, 1983; Leiter & Maslach, 1986) (Leiter &
Maslach, 1988: 298). One study which was carried out by Leiter and Maslach (1988)
to determine the effect of interpersonal relationships on burnout among nurses in a
small general hospital found that emotional exhaustion led to depersonalisation
which in turn led to reduced personal accomplishment. Interpersonal contact with
workers in the organisation was connected to the development of burnout at each
stage (Leiter and Maslach, 1988: 303). Indeed, research has shown that burnout
25. 20
appears to frequently occur as a response to an overload of contact with people
(Leiter & Maslach, 1988: 297).
Studies have also shown that acting as though one is happy when in fact one is
feeling unhappy is stressful as there is internal tension and physiological effort
involved in the suppression of feelings. In one study, the obligation to hide negative
emotions was positively related to burnout (Best, Downey, & Jones, 1997). It has
also been argued that an individual who continuously pretends to be happy when
unhappy may eventually come to feel detached from the feelings of others as well as
themselves, that is, they may become depersonalised (Brotheridge & Grandey, 2002:
22).
Burnout also occurs as a result of a lack of resources, such as social support, as well
as the existence of quantitative job demands, such as a heavy workload and time
pressure, and qualitative job demands such as role conflict (when many different
demands must be met) and role ambiguity (when there is a lack of adequate
information regarding the tasks that need to be carried out in order to do the job
well) (Maslach et al., 2001: 407). A lack of feedback is also consistently found to
contribute to all three dimensions of burnout and burnout is also found more often
in individuals who are denied the opportunity to participate in decision making
(Maslach et al., 2001: 407).
What are the Possible Negative Consequences of Burnout?
Burnout has been related to numerous forms of job withdrawal such as
absenteeism, intention to leave the job, and actual turnover while those with
burnout who stay on the job are unproductive and ineffective. Thus, burnout is
related to diminished job satisfaction and a reduced commitment to the job or the
organisation. Individuals who experience burnout can also have a negative effect on
their co-workers, both by causing conflict and by disrupting job tasks. As such,
burnout can perpetuate itself through interactions on the job. There is also some
evidence that burnout has a negative effect on the personal lives of those who are
burned out (Burke & Greenglass 2001) (Maslach et al., 2001: 406).
26. 21
What is Trauma?
As with the concept of stress, the concept of psychological trauma is difficult to
define and there currently exists numerous different definitions of trauma. The
Substance Abuse and Mental Health Services Administration (SAMHSA) (a U.S.
Department of Health and Human Services’ agency which aims to “reduce the
impact of substance abuse and mental illness on America's communities” (The
Substance Abuse and Mental Health Services Administration, 2015)), has compiled a
list of existing definitions of trauma and noted that there are subtle differences
between them. Thus, SAMHSA decided to combine ideas contained in the existing
definitions into one new definition of the concept of psychological trauma that
includes all of the ideas relevant to it. This definition is as follows: “Individual trauma
results from an event, series of events, or set of circumstances that is experienced
by an individual as physically or emotionally harmful or life threatening and that has
lasting adverse effects on the individual’s functioning and mental, physical, social,
emotional, or spiritual well-being” (The Substance Abuse and Mental Health Services
Administration, 2014: 7). Violence, abuse, neglect, loss, disaster, war and other
emotionally harmful experiences are examples of such events or set of
circumstances that cause psychological trauma. As well as this, psychological trauma
can affect any individual regardless of age, gender, socioeconomic status, race,
ethnicity, geography or sexual orientation (The Substance Abuse and Mental Health
Services Administration, 2014: 2).
What are the Possible Negative Consequences of Trauma?
Trauma is a common and costly public health problem. Traumatic experiences
reduce an individual’s capacity to make sense of their lives and to create or maintain
meaningful relationships. In fact, research has shown that there is a relationship
between experiencing traumatic events, weakened neurodevelopmental and immune
systems responses and consequent health risk behaviours which bring about chronic
physical or behavioural health disorders. Indeed, an individual who has experienced
a traumatic event is at an increased risk of developing a mental or substance use
disorder and/or chronic disease if their trauma is not adequately addressed (The
Substance Abuse and Mental Health Services Administration, 2014: 2). According to
the DSM-5, trauma-related disorders include reactive attachment disorder,
27. 22
disinhibited social engagement disorder, PTSD, acute stress disorder, and
adjustment disorders (American Psychiatric Association, 2013: 265). As PTSD is the
trauma-related disorder by which humanitarian workers are most commonly affected
this is the only trauma-related disorder which will be focused on in this paper.
What is PTSD?
According to the DSM-5, an individual will be diagnosed with PTSD if they have been
exposed to “actual or threatened death, serious injury, or sexual violence” (American
Psychiatric Association, 2013: 271) in one of many ways (see Annex 3), the
individual will display one or more of a number of symptoms associated with the
traumatic event(s) (see Annex 3) and the individual must display these symptoms
for more than 1 month (American Psychiatric Association, 2013: 271-2).
Some examples of traumatic events that would satisfy the DSM-5 diagnostic criteria
for PTSD include, but are not limited to, “exposure to war as a combatant or civilian,
threatened or actual physical assault…, threatened or actual sexual violence…, being
kidnapped, terrorist attack, torture, incarceration as a prisoner of war, natural or
human-made disasters, and severe motor vehicle accidents” (American Psychiatric
Association, 2013: 274). Medical incidents that are classified as traumatic events
consist of unexpected, disastrous events. Observed events include, but are not
limited to, “observing threatened or serious injury, unnatural death, physical or
sexual abuse of another person due to violent assault, domestic violence, accident,
war or disaster, or a medical catastrophe in one’s child” (American Psychiatric
Association, 2013: 274). It is only the learning of a close friend or family member’s
violent or accidental traumatic events that qualifies as secondary trauma, and the
disorder tends to be especially severe or long-lasting when the traumatic event is of
an interpersonal and intentional nature (American Psychiatric Association, 2011:
274-5).
For most trauma victims, symptoms induced by the traumatic event subside within
three months. Therefore, the acute reaction to trauma can be characterised by an
extreme stress response, which is then followed by recovery and resilience, with only
a small percentage of traumatised individuals who develop chronic PTSD (Zoladz &
28. 23
Diamond, 2013: 861). In some cases, however, the disorder may not develop for
months or even years after the traumatic event (Brewin, 2001: 375).
Risk Factors for the Development of PTSD
One study carried out by Fullerton et al. (2004) has shown that exposed disaster
workers are at an increased risk of developing PTSD (Fullerton et al., 2004: 1370),
while other studies have shown that there exists a genetic vulnerability for the
development of the disorder (Skelton et al., 2012: 628). Other risk factors for the
development of PTSD include a family or personal history of emotional or mental
disorders, negative appraisal of one’s stress reactions and dissociation during the
traumatic event (McNally et al., 2003: 45). As well as this, the more intense a
traumatic event is, the greater the likelihood of an individual developing the
disorder. The risk of onset and severity of PTSD may differ across cultural groups
and therefore cultural factors should be taken into account by clinicians when
diagnosing the disorder. Furthermore, the disorder is seen more frequently among
females than among males and it tends to last for a longer period of time in females
than in males. It appears as though at least some of the increased risk for PTSD in
females is due to the fact that women are more likely to be exposed to traumatic
events, such as rape, and other forms of interpersonal violence (American
Psychiatric Association, 2011: 278). As mentioned, most victims of a traumatic event
recover within three months and studies have shown that there are protective
factors which can make certain individuals more resilient in the face of trauma.
Indeed, studies have shown that social support tends to buffer individuals against
PTSD while levels of cognitive ability is associated with the development of the
disorder whereby the higher one’s cognitive ability is the less likely they are to
develop PTSD (McNally et al., 2003: 45).
What are the Possible Negative Consequences of PTSD?
High levels of social, occupational and physical disability, suicidal ideation and
suicide attempts, as well as substantial economic costs and high levels of medical
utilisation are associated with the disorder (American Psychiatric Association, 2013:
278) as well as major functional impairment (Skelton et al., 2012: 628). Further,
there is a relation between PTSD and dysfunctional social and family relationships,
29. 24
absenteeism from work, lower income, and lower educational and professional
accomplishment (American Psychiatric Association, 2013: 278). PTSD is linked to
psychiatric and physical comorbidity, reduced quality of life, and considerable
economic costs to society.
2.2. Humanitarian Action - a Context that Lends Itself to Stress and
Trauma
2.2.1. Sources of Stress and Trauma in Humanitarian Work
Humanitarian workers respond in order to alleviate the suffering of those affected by
disasters such as armed conflicts, floods, earthquakes, famines, or refugee crises, or
chronic problems such as poverty, hunger, and disease. They may carry out relief
work in the immediate aftermath of a disaster, they may work for longer periods of
time providing aid or they may work in a more long-term developmental capacity
(Antares Foundation, 2015). This work can be dangerous and is inherently stressful
and during the course of their work, humanitarian workers are exposed to higher
levels of stress than those who work in other sectors (Antares Foundation, 2015).
Humanitarian workers and organisations operate in circumstances of long-term
adversities, unpleasant and physically demanding conditions and workers often must
endure substantial workloads, long hours, chronic fatigue, and a lack of privacy and
personal space (Antares Foundation, 2015). Moreover, humanitarian organisations
are required to operate in an ever-changing context of growing complexity and often
humanitarian work in the field is seriously hindered by worsening security, declining
respect for the work and lives of humanitarian workers who are sometimes targeted,
and dysfunctional government and authority. Because of these conditions
humanitarian organisations must work in situations of growing pressure and
discontinuity, and this causes a great deal of stress on their staff and a diminishing
quality of work (Antares Foundation, 2012: 7). Moreover, because they are
frequently required to work with inadequate resources in a large population of
beneficiaries, workers are often under great pressure and must make difficult
decisions which can lead to moral anguish (Antares Foundation, 2015).
30. 25
In both the field and in the office, workers of humanitarian organisations experience
pressures common to work in other sectors. For example, staff may not be
adequately trained or may have insufficient time, resources, and support to do the
job required of them, their job descriptions may not be clear, management or
supervision might not be adequate or staff may experience difficulties
communicating with co-workers or an inadequate amount of time away from work
(Antares Foundation, 2015). Indeed, many aid workers report insufficient managerial
and organisational support as their biggest stressor (Inter-Agency Standing
Committee, 2007: 87). These workplace anxieties are often exacerbated by the crisis
conditions and funding constraints in which much humanitarian work is carried out
(Antares Foundation, 2015). Humanitarian personnel also experience the pressures
of everyday life. Some work far away from family and friends while others have
families in close proximity and must deal with the stresses of daily life in extremely
stressed communities. Several staff members may themselves have survived the
same events as the people they are helping (Antares Foundation, 2015).
As well as this, many humanitarian workers experience significant trauma and
constant work-related trauma exposure has consequences for mental health. As
humanitarian crises are rising, humanitarian workers are repeatedly exposed to
trauma, both primary trauma involving direct danger and secondary trauma through
witnessing the suffering of others. In the field, staff often hear about the terrifying
and tragic experiences of others and they may themselves witness horrific scenes,
or, indeed, have terrible experiences of their own. For a humanitarian worker,
meeting with a victim of violence and listening to their stories is often a painful
experience and hearing such stories can have a seriously negative impact on one’s
mental health and it can be extremely emotionally demanding. This secondary
traumatisation, or ‘vicarious trauma’, can cause an individual to gradually develop a
negative mind-set whereby feelings, thoughts and memories are of a negative focus
and the individual’s self-esteem and sense of safety may also be reduced (Bouvier,
2012: 1546).
31. 26
In terms of stress and trauma exposure, differences exist between national staff and
international staff of humanitarian organisations and though staff supports provided
by humanitarian organisations should be equal for national and international staff,
some structural differences generally exist between the two across the humanitarian
sector. For example, national staff are frequently recruited from the disaster zone
and thus are more likely to have experienced enormously traumatic events or
conditions. Thus, national humanitarian and development workers are often more
vulnerable than international workers because they are affected by the context
themselves (Antares Foundation, 2015). National staff are certainly more vulnerable
in terms of security as if the security situation deteriorates, they and their families
are often unable to leave the disaster zone, whereas international humanitarian
workers usually have good access to evacuation operations. In general,
humanitarian work is more dangerous for national staff than international staff as
there are higher casualty rates among national aid workers compared with
expatriates. Moreover, families of national staff are usually exposed to danger while
the family of expatriate staff are usually safe back home. It is also often the case
that international staff have better access to psychological and medical support than
national staff (Connorton et al., 2011: 152). However, international staff members
have stressors that would not be usual for national workers, such as separation from
their support base, culture shock and adjustment to harsh living conditions (Inter-
Agency Standing Committee, 2007: 87).
2.2.2. The Possible Negative Effects of Stress and Trauma on both the Individual Aid
Worker and the Organisation
As already mentioned, while most individuals who experience trauma do not develop
a mental disorder (Connorton et al., 2011: 145), experiencing traumatic events or
chronic stressors can often lead to the development of depression, anxiety, burnout
or PTSD. There is an ever-increasing recognition that humanitarian work is
inherently stressful and of how serious the impact of trauma and chronic stress can
be upon mental health. Indeed, as mentioned, humanitarian work is characterised
by challenging living conditions, substantial workloads, and increased risk of
experiencing traumatic events and these stressors are well-established risk factors
32. 27
for depression, anxiety, burnout and PTSD (Ager et al., 2012: 713). Moreover,
evidence suggests that humanitarian staff are at risk of developing substantial
mental health problems (McFarlane, 2004: 2) and, humanitarian workers do in fact
have higher rates of PTSD compared with the general population owing to their
exposure to traumatic events (Connorton et al., 2011: 146). As mentioned, PTSD is
related to enormously traumatic events, such as the unnatural death of a family
member or friend or the handling of dead bodies (Ursano et al., 1990). These kinds
of traumatic events are rather common in humanitarian work and, consequently,
humanitarian staff are likely to experience these kinds of events (Cardozo et al.,
2005: 163).
Many studies have been undertaken to evaluate the prevalence of anxiety,
depression, burnout and PTSD among humanitarian staff and volunteers, and to
determine the causes and risk factors for developing such disorders. Analysis of the
large amount of studies carried out in the area of mental health of aid workers
shows that PTSD, depression, subjective health complaints (SHCs) and chronic
fatigue are the most frequently reported mental health related complaints among aid
workers (Thormar et al., 2013, p.624). A study carried out by Cardozo & Salama
(2002) on the mental health of international humanitarian workers found high levels
of depression (15%), anxiety (10%) and alcohol abuse (15%) in their sample of
workers while many other studies show a correlation of distress, culture shock and
burnout among humanitarian staff (McFarlane, 2004: 3). As well as this, a study
carried out by Eriksson, Vande Kemp, Gorusch, Hoke, & Foy (2001) found that 10%
of a sample of repatriated humanitarian workers had developed PTSD after being
home for three years (McFarlane, 2004: 2 and 3).
In a study carried out by Ager et al. which examined the mental health of national
aid workers in northern Uganda, it was found that said workers were highly exposed
to chronic stress and traumatic events and were at high risk of developing poor
mental health. The study found that the greater the exposure to chronic stressors
the greater the amount of workers reporting symptoms of depression, anxiety,
emotional exhaustion and depersonalisation. In the study, 68%, 53%, and 26% of
33. 28
respondents reported symptoms of depression, anxiety disorders, and PTSD,
respectively and between 25-50% of respondents reported symptoms of burnout.
Interestingly, a significantly higher percentage of female workers reported symptoms
of anxiety, depression, PTSD, and emotional exhaustion than males (Ager et al.,
2012: 713).
A 2007 Headington Institute study of distress among humanitarian workers in Darfur
assessed the overall well-being of a sample of workers by assessing if individuals
were experiencing physical stress (headaches, sleep disturbance, stomach upset,
tight muscles), emotional stress (irritability, mood swings, feeling depressed, anxious
or numb), mental stress (difficulty concentrating, forgetfulness), interpersonal stress
(withdrawn, lonely, overwhelmed by people) and/or spiritual stress (feeling empty,
feeling as though you have lost your purpose, hope or connection). Workers taking
part in the study were asked to rate their overall well-being out of 10 with 1 being
‘very bad’ and 10 being ‘very good’ and 42% of respondents rated their overall well-
being as 5 or below. More than 50% of respondents reported symptoms of physical
stress, just under half reported symptoms of emotional stress, almost one third of
respondents reported symptoms of mental stress, and 13% reported symptoms of
interpersonal stress and/or spiritual stress. Furthermore, approximately 50% of the
respondents had reported somatic and emotional difficulties (Welton-Mitchell, 2013:
25).
Humanitarian organisations are becoming increasingly concerned about the potential
impact of stress on the ability of their staff to competently deliver aid to beneficiaries
(Welton-Mitchell, 2013: 9). As mentioned, stress can lead to the development of
mental disorders which hampers an individual’s ability to work efficiently and
effectively. In the humanitarian sector there is a wide array of stressors which have
the potential to negatively affect the wellbeing of humanitarian staff. Humanitarian
staff frequently report poor leadership, bureaucracy and a lack of career
opportunities as sources of chronic stress (Welton-Mitchell, 2013: 28). As well as
this, humanitarian organisations have to operate in an ever-changing context which
continually grows in complexity over time. In the field, the work of humanitarian
staff is frequently hindered by a situation of deteriorating security, a lack of respect
34. 29
for the work and lives of staff who are sometimes targeted, and a lack of functioning
authority. This kind of situation can be very stressful and can create an atmosphere
of tension which may in turn result in a deterioration of the quality of work carried
out by humanitarian organisations (Antares Foundation, 2012: 5). The multicultural
nature of humanitarian work can also be a source of stress and interpersonal conflict
both within humanitarian teams and between humanitarian staff and beneficiaries as
different cultural norms may cause miscommunication and misinterpretation of
expression. This can negatively affect work performance and the security of
humanitarian staff (McFarlane, 2004: 5 and 6). There are many possible negative
consequences of chronic stress not just for the individual experiencing stress but
also for the hiring organisation. Such an individual is usually a poor decision maker,
absent from work more often, is more likely to cause or be involved in an accident,
to become ill, and to use more health services. They may cause internal conflict and
scapegoating in their team, and they are also more likely to show a lack of
commitment and to quit their position resulting in a loss of skilled staff and an
increase in recruitment and training costs for the organisation (Antares Foundation,
2015).
2.2.3 Proven Methods of Stress Prevention and Mitigation
As has been shown, humanitarian workers are highly exposed to stress and trauma.
However, organisations can reduce the amount and intensity of stressors through
the implementation of appropriate policies. Indeed, studies show that organisational
policies have an impact on the mental health of aid workers (McFarlane, 2004: 4).
Although it may probably be controversial due to the considerable stigma associated
with mental illness, individuals should be screened and assessed in order for the
organisation to determine whether they are both mentally and physically fit for a role
and to consider ways of supporting workers during and after their employment.
“Organisations need to be aware that those relief workers with a history of
psychiatric illness are more likely to experience psychological morbidity while
abroad” (Cardozo et al., 2005: 167). Such individuals, or individuals who have
experienced significant personal stressors prior to deployment, may be in need of
counselling and support as they are at increased risk for developing mental
35. 30
disorders. Therefore, organisations should aim to learn whether individuals are at
increased risk of developing mental disorders before deployment in order to plan
how to provide support during and after the assignment. As well as this,
humanitarian workers should be informed of the risk of potential exposure to stress
and trauma and the possible negative consequences of this, prior to deployment
(Connorton et al., 2012: 153). Indeed, pre-deployment screening and assessing has
proven successful in reducing mental health problems and medical evacuations in
the US military (Connorton et al., 2011: 147 and 152).
Once an organisation has determined whether an individual is at increased risk for
developing a mental disorder it is important to adequately train and prepare the
workers for their role because inadequate training and preparation can create high
levels of uncertainty about the role and the disaster zone (McFarlane, 2004: 4).
Humanitarian work is dangerous and sometimes aid workers experience traumatic
incidents, and although it is unlikely that violent situations can be easily prevented, it
is extremely important for organisations to have well-planned security procedures
and to provide security training. A lack of security training puts the lives of staff
members at risk and is likely to cause a sense of fear in staff members, in turn
creating an increased likelihood that staff members will experience psychological
distress (McFarlane, 2004: 4). As well as security training, it is also important for
organisations to provide other types of trainings, for example, trainings in
communication skills, management skills (Ramirez et al., 1996: 727), medical care,
psychological stress management, and team building, and workers should also be
educated about the host country and its culture in order to reduce the amount of
stressors and thus the potential for psychological distress. Thus, humanitarian
organisations can prevent the development of mental illness among their staff by
training and informing workers prior to their departure (McFarlane, 2004: 4).
Organisations need to do more than prepare staff members prior to deployment
however. As mentioned above, determining which staff members are at increased
risk of developing a mental disorder is important in order for the organisation to
ensure that adequate support is available for such staff members during and after
36. 31
their deployment. It is important that staff members are monitored throughout
deployment for signs of stress and to provide staff with ongoing support in order to
prevent the development of a mental disorder. In terms of monitoring, team
managers should receive training before deployment in stress management, and
management and leadership skills, and in these trainings they should learn how to
detect signs of stress in themselves and their team members. However, merely
informing managers as to what they should do is not sufficient to ensure that
managers do in fact apply this knowledge in practice. Therefore, there should be a
way for staff members to evaluate how well their managers monitor their team
members for signs of stress, in order to better ensure that managers are truly and
adequately fulfilling this duty (Welton-Mitchell, 2013: 12). It has been shown that
management has a profound effect on the wellbeing of staff members such that
there are lower levels of emotional exhaustion among staff members whose
managers show concern for staff welfare (Deery et al., 2002: 491). Unfortunately,
not all managers show concern for the wellbeing of their team members as United
Nations High Commissioner for Refugees (UNHCR) found in their 2013 report
UNHCR’S Mental Health and Psychosocial Support: For Staff. This report states that
while there were managers who were found to be very supportive and encouraging
towards their team managers, “some managers contribute to staff stress by being
verbally abusive, and unwilling to allow national staff in particular to work
reasonable hours” (Welton-Mitchell, 2013: 50). Indeed, managers who manage their
teams poorly and thus contribute to staff stress should be held accountable but
without formal processes to evaluate managers in terms of stress management, this
kind of managerial behaviour can continue unnoticed by those at the top of the
organisation thereby perpetuating an organisational culture wherein staff wellbeing
is undermined. Therefore, it is essential to hold managers accountable in order to
change organisational culture and to adequately prevent and mitigate staff stress
(Welton-Mitchell, 2013: 52).
Other studies have shown that there are many protective factors which can help to
prevent the development of mental disorders. “Protective factors that have been
identified include, but are not limited to, coping, resources (e.g., social support, self-
37. 32
esteem, optimism), and finding meaning” (Schneiderman et al., 2005: 612). A
longitudinal study carried out by Cordozo et al. has shown that humanitarian
workers with strong social support networks are less likely to develop mental
disorders (Cordozo, et al., 2012) while another study has shown that “team cohesion
and support from colleagues and management as particularly valuable resources”
(Ager et al., 2012; 719) in terms of coping with stressors. Indeed, UNHCR has also
recognised that “Informal social support is crucial for effective coping among
humanitarians” (Welton-Mitchell, 2013: 30). Thus, it is clear that social support is a
very effective way to help individuals to cope with stress and organisations should
strive to make social support available to staff as far as it is possible. For example,
organisations can provide staff retreats, social gatherings, access to loved ones (in-
person, during annual leave and R&R cycles, and through phone, e-mail or Skype),
and formal peer support networks (Welton-Mitchell, 2013: 30). As well as making
social support available to staff and providing adequate management, stressors can
also be reduced by allowing staff to rest in between assignments, by providing
reliable transportation, the best possible accommodation facilities and workspace, a
reasonable workload, and providing recognition of achievements. (Cordozo, et al.,
2012). As well as this, organisations should provide appropriate evidence-based
support services in the field for psychologically distressed workers (Connorton et al.,
2011: 153).
Not only is it important to provide ongoing support to staff members in order to
prevent and mitigate stress in staff but it is also important for organisations to be
prepared in the event that staff members experience a traumatic incident. As
research has shown that with the provision of suitable supports, people can recover
from traumatic experiences, organisations should provide such supports for staff
members who experience traumatic events (The Substance Abuse and Mental Health
Services Administration, 2014: 2). In the UNHCR report cited above, the agency has
noted the importance of responding appropriately when traumatic incidents occur
and of following up to assess the wellbeing of survivors of critical incidents after the
event (Welton-Mitchell, 2013: 10). The report has also included recommendations
for ensuring an appropriate critical incident response which includes having trained
38. 33
staff members who know exactly how to respond in such situations, having clear
guidelines for staff members on how to respond in such situations, and mandatory
psychological first aid training for staff (Welton-Mitchell, 2013: 18).
As there are also stresses associated with ending an assignment or contract such as
“practical, interpersonal, and cultural difficulties in readjusting to life ‘back home’ or
in a new assignment or new job” (Antares Foundation, 2012: 31). It is important for
organisations to provide support for their workers to help them to cope with these
stresses. One way in which organisations can do this is by providing operational
debriefs in which workers can share their experience and raise concerns regarding
the organisation’s practices. Though these debriefs are not focused on stress
management, stress of workers can be relieved when they feel their opinions are
being heard (Antares Foundation, 2012: 31). The provision of stress assessments
which focus “on how staff have responded to the stresses they experienced during
their contract…and any needs they may have for ongoing support or other
interventions” can also be used to help organisations determine which staff
members are in need of support (Antares Foundation, 2012: 31). Sometimes
humanitarian workers are no longer able to continue working due to job stress-
related disabilities and in these cases humanitarian organisations have a duty to
provide whatever support is required by such workers (Antares Foundation, 2012:
34).
Generally, humanitarian staff are resilient and find their work rewarding. Certainly,
alleviating suffering and helping to rebuild communities may be protective for their
wellbeing (McFarlane, 2004). While this is the case, humanitarian work is inherently
stressful. However, as has been shown above, stress in humanitarian workers can be
prevented and mitigated when organisations make stress management a priority and
implement appropriate policies which have an element of stress management
(Antares Foundation, 2015).
A theoretical framework has been derived from the above information and has been
used to guide the research of this thesis. This framework is as follows: Humanitarian
39. 34
work is stressful and traumatic and if an individual’s stress or trauma is not dealt
with adequately then the individual could subsequently develop a mental disorder
which would be likely to negatively affect the individual’s hiring organisation as well
as the personal life of said individual. Therefore, humanitarian organisations should
take necessary measures to adequately prevent and mitigate the negative effects of
stress and trauma on humanitarian workers.
2.3. Introducing the Guidelines
As mentioned, the AF guidelines have formed the basis of this study and it is the
current third edition upon which the study is based. Before discussing the guidelines
in detail I will first provide some background information about the AF itself and
explain who they are and what they do. The AF is a Dutch non-profit organisation
which works “across all ranges and aspects of staff care and psychosocial support
for humanitarian and developmental organizations worldwide” (Antares Foundation,
2015). The organisation provides direct psychosocial support in emergency settings,
carries out research on staff care systems, offers practical solutions for better staff
care for individuals, teams and organisations, and campaigns for better care systems
and support for both national and international staff (Antares Foundation, 2015).
The AF has wide experience of national and international humanitarian organisations
across the globe, and the importance of addressing stress in many organisations has
been made evident. The Guidelines for Good Practice have been developed due to
many “requests for information, ideas and strategies for developing a stress program
for humanitarian workers” (Antares Foundation, 2012: 5).
While the guidelines are based on a vast body of robust research and there is strong
evidence that the full implementation of all eight principles and their corresponding
indicators would be the best way for humanitarian organisations to prevent and
mitigate stress in their staff, the AF admits that it would not always be feasible for all
of the guidelines to be adopted by each and every organisation, and in this way the
guidelines are flexible to an extent. However, in order to provide the best staff care
possible, managers and organisations should strive to adopt the guidelines as far as
it is possible (Antares Foundation, 2012: 5).
40. 35
Since 2003, the AF has been collaborating with the CDC (Antares Foundation, 2012:
5). This partnership has brought together NGO managers, mental health specialists
and researchers who have produced the Guidelines which serve “as a
comprehensive, systematic presentation of the ‘state of the art’ in managing stress
in humanitarian workers” (Antares Foundation, 2012: 5). The Guidelines have been
made available in French, Spanish, Swahili, Albanian and Arabic as well as English,
and numerous supplementary materials have also been developed (Antares
Foundation, 2012: 5).
Revision of the Guidelines
Revisions have been made to the guidelines due to several new developments:
1. Changes in the humanitarian workforce itself:
• Humanitarian workforce has increased dramatically.
• Humanitarian workforce is composed of a great deal more national than
international workers.
• Violence against humanitarian staff has become common in numerous areas.
• Humanitarian aid has been progressively intertwined with the foreign policy and
military policy of major powers.
2. An increase in knowledge regarding the psychosocial needs of staff and the
factors that affect staff wellbeing:
The Antares/CDC partnership has carried out a major longitudinal research project
on stress in international aid workers, as well as surveys of stress among national
staff in Uganda, Jordan, and Sri Lanka. As well as this, other individuals and
institutions have carried out additional studies of the staff of aid and development
organisations (Antares Foundation, 2012: 5).
41. 36
To address these issues, many discussions with a diverse group of researchers, NGO
staff, and people with direct experience in providing psychosocial support began.
The current edition of the Guidelines is based on these talks and is largely consistent
with the earlier editions. Changes have been made to make the guidelines more
appropriate for national staff and organisations, first responders, human rights
workers, and development workers. As well as this, recent research findings have
been incorporated, the role of managers in reducing risk is reemphasised, the
language has been simplified, and supplementary materials have been included in
the document (Antares Foundation, 2012: 5).
What are the Guidelines Based On?
The interventions recommended in the Guidelines address the causes of stress in aid
workers. Their aim is to lessen the causes of individual vulnerability and to reinforce
the causes of individual resilience that have been identified by research. They also
address features of team functioning, of managerial practices, and of organisational
policies that have been found to affect staff stress.
The Guidelines’ are based on generally accepted models of the stress response
(which have been outlined in chapter 2) and on interventions used in numerous
other sectors. Stress occurs when a person is confronted by a challenge which can
be a threat to their wellbeing or a chance to undertake demanding tasks. The person
needs to determine the nature of the challenge, the degree to which it is a threat,
and whether or not they have the ability to cope successfully. Based on this
appraisal, the person then tries to ‘cope’ with the stress. They may act in such a way
that directly deals with the challenge or they may act in such a way to protect
themselves from physical or emotional harm. Following this model, organisations can
(1) aim to lessen the number of stresses a staff member faces; (2) aim to increase
the person’s resilience; and (3) help persons to cope more successfully with stress.
As discussed earlier, failure of individual staff members to manage their own stress
has negative consequences for their team, their managers, and the organisation. As
well as this, the conduct of the team, manager, and organisation has a great effect
42. 37
on the stress experienced by a staff member. A unified team, a sympathetic
manager, and a stress-conscious organisation can considerably lessen the amount of
stress experienced by staff members. Equally, a conflict-ridden team, an
incompetent manager, or an organisation whose policies fail to meet the needs of
staff can also be major causes of stress on staff members. For this reason, the
Guidelines involve not just the individual, but also their team, their manager, and the
organisation as a whole (Antares Foundation, 2012: 5)
The guidelines have a heavy focus on the differences in the causes of stress
between different types of staff, for example, national and international, men and
women, LGBTQ and heterosexual, office and field staff. Moreover, although not all of
the indicators within the guidelines are universal and prescriptive, there are some
parts of the guidelines that are.
The ‘Core Principles’ from the Inter-Agency Standing Committee (IASC) Guidelines
on Mental Health and Psychosocial Support in Emergency Settings, which apply to
humanitarian staff as well as beneficiaries, have also been incorporated into the
Guidelines (Antares Foundation, 2012: 5).
The IASC principles are as follows:
1. Human rights and equity: Humanitarian actors should promote the human rights
of all affected persons.
2. Participation: Humanitarian action should maximize the participation of local
affected populations in the humanitarian response.
3. Do no harm: Humanitarian aid is an important means of helping people affected
by emergencies, but aid can also cause unintentional harm.
4. Building on available resources and capacities: All affected groups have assets or
resources that support mental health and psychosocial well-being.
5. Integrated support systems: Activities and programming should be integrated as
far as possible (Inter-Agency Standing Committee, 2007: 9-13).
43. 38
The Organisation of the Guidelines
The Guidelines are organised around eight main Principles corresponding to the
course of a staff member’s contract:
1. Policy
2. Screening and Assessing
3. Training and Prep
4. Monitoring
5. Ongoing Support
6. Crisis Support Management
7. End-of-Assignment Support
8. Post-Assignment Support
Each principle has accompanying Indicators, Comments and Case Studies to help the
reader to better understand the concepts upon which the principles are based and
how they can be put into practice.
2.4. Introducing the Organisations
Concern Worldwide
Concern Worldwide is an international humanitarian organisation which was
established in Ireland and which focuses on health and nutrition, education, HIV and
AIDS and livelihoods in the world’s poorest countries. The organisation cooperates
with the very poorest people in these countries in a way that enables them to
improve their lives, and engages in advocacy to help ensure that authorities make
decisions that considerably reduce extreme poverty (Concern Worldwide, 2015).
Concern was established by John and Kay O’Loughlin-Kennedy in 1968, in response
to the famine in the Nigerian province of Biafra (Concern Worldwide, 2015). Since its
foundation, the organisation has worked in over 50 countries, responding to major
crises and implementing long term development programmes. Currently, the
organisation is comprised of more than 3,200 staff of 50 nationalities, and works in
26 of the world’s poorest countries, helping people to improve their lives by
44. 39
continuing to respond to crises and by implementing its disaster risk reduction (DRR)
programme to prepare people living in vulnerable regions for future disasters
(Concern Worldwide, 2015).
GOAL
Like Concern, Goal is also a humanitarian organisation which was founded in Ireland.
The organisation was established in 1977 and continues to deliver a wide range of
humanitarian and development programmes across 4 sectors (emergency response,
health, child protection and livelihoods). In an emergency response GOAL’s priority is
to guarantee access to food, shelter and clean water, and guarantee a shift from
emergency aid to rebuilding and DRR initiatives. The organisation distributes food,
water and shelter materials, and also establishes healthcare and sanitation facilities
(GOAL, 2015). In 2014, GOAL responded to disasters in numerous locations during
the course of the year, including Sierra Leone, South Sudan, the Philippines and
Syria (GOAL, 2015).
Oxfam Ireland
Oxfam Ireland is a secular, independent, not-for-profit organisation and is one of
seventeen Oxfams operational in more than ninety countries (Oxfam Ireland, 2015).
The Irish branch does not directly implement projects but works alongside the other
Oxfam branches by carrying out office-based work and providing funds.
The organisation’s vision is a just world without poverty, and around the globe,
Oxfam works to help people lift themselves out of poverty and to prosper. The
organisation saves lives and helps to rebuild livelihoods when disaster strikes. Oxfam
also campaigns in order to help ensure that decisions which are made by local and
global authorities take into account the needs of the poor. As well as this, the
organisation works with partner organisations and vulnerable people to bring an end
to the causes of poverty (Oxfam Ireland, 2015).
Oxfam provides disaster-affected people with clean water, food, shelter and security.
The organisation remains in the affected area following the disaster in order to help
people rebuild their lives, and the organisation also works in camps for displaced
people assisting them to secure a basic means of making a living, protection from
45. 40
violence and a voice. As well as responding when disasters occur, Oxfam also work
with local partners and vulnerable people to prepare in case disaster strikes in order
to reduce the risk of a disaster occurring or to mitigate the impact of a disaster on a
community when it strikes (Oxfam Ireland, 2015).
Plan Ireland
Plan International was founded by journalist Langdon-Davies and refugee worker
Eric Muggeridge in 1937 to care for children whose lives had been affected by the
Spanish Civil War and was originally named “The Foster Parents Plan for Children in
Spain” (Plan Ireland, 2015).
Plan International currently works in 70 countries and is one of the largest
international child-centred development organisations in the world. It is a secular
and independent organisation with no political or governmental links and is focused
on the area of children’s rights and helping to improve the lives of children living in
poverty. Plan Ireland was established in 2003 and is part of Plan International which
itself was founded over 76 years ago (Plan Ireland, 2015). The Irish branch does not
directly implement projects but works alongside the other Plan branches by carrying
out office-based work and providing funds.
With the guidance of the United Nations (UN) Convention on the ‘Rights of the
Child’, Plan International works to address the sources and consequences of child
poverty through encouraging and enabling children, families and communities to
play an active role in their own development (Plan Ireland, 2015).
Plan International rapidly mobilises people and resources when an emergency occurs
to protect and meet the needs of affected children. This disaster response focuses
on children’s urgent needs, such as food and water, and once these urgent needs
are met, child protection and education is then prioritised to help restore a sense of
security and normality (Plan Ireland, 2015).
46. 41
Trocaire
“Trócaire is the overseas development agency of the Catholic Church in Ireland” and
“was established by the Bishops of Ireland in 1973 as a way for Irish people to
donate to development and emergency relief overseas” (Trocaire, 2015). From the
moment the organisation was established it set out to support the most vulnerable
people in the developing world and also raise awareness of development at home in
Ireland. Trócaire currently works in over 20 countries across Africa, Asia, Latin
America and the Middle East, and its work focuses on humanitarian response,
livelihoods, justice and human rights, climate change and climate justice, women’s
empowerment and HIV. In Ireland, the organisation raises awareness about the
sources of poverty through outreach programmes in the education sector, through
parish networks, and through public campaigns and advocacy work. As well as this,
Trocaire aims to provide long-term support to people living in extreme poverty in the
developing world in such a way that they are enabled to work their way out of
poverty, to provide aid to the most vulnerable people affected by emergencies and
helping communities to prepare for future disasters; to tackle the structural sources
of poverty by mobilising people for justice in Ireland and abroad (Trocaire, 2015).
World Vision
World Vision is the largest international children's charity and non-governmental,
non-profit overseas development and aid organisation in the world, reaching 100
million people worldwide. It has been in existence for six decades and currently has
44,000 staff members operational in more than ninety countries. The organisation
aims to eliminate poverty and aims to transform the lives of vulnerable people in
developing countries through “relief and development, policy advocacy and change,
collaboration, education about poverty, and emphasis on personal growth, social
justice and spiritual values” (World Vision Ireland, 2015). The organisation’s goals
are “to protect children, save lives, reduce suffering, protect livelihoods, strengthen
community resilience and promote peace” (World Vision Ireland, 2015). The Irish
47. 42
branch does not directly implement projects but works alongside the other World
Vision branches by carrying out office-based work and providing funds.
48. 43
3. Research Findings
In this chapter the research findings will be presented. Each of the eight AF
principles are dealt with in turn one-by-one in their own separate sections and each
of these sections follow the same format. In each section I firstly present, with the
use of a table, the extent to which the particular principle has been adopted by the
organisations. I will then describe how each organisation has adopted the principle
and this will be followed with a sub-section describing the reasons for which
indicators have not been adopted by the organisations. I will then conclude the
chapter with a section in which I discuss the significance of the findings.
It is important to point out that, though I present the findings in terms of how many
indicators have been adopted by the organisations, the data cannot be considered
entirely accurate due to the fact that I was unable to ask each of the informants if
they had adopted each of the indicators simply because there is a large amount of
indicators and so that would have been extremely time consuming. For this reason I
decided to ask relatively broad questions which would allow informants the
opportunity to elaborate and mention all of the ways that their organisation has
adopted the principle in question. Therefore, though it cannot be said with certainty
whether some of the indicators have been adopted, as that question was not asked
of the informant, the questions gave the informants the opportunity to give this
information. Thus, in the case where an informant has not said that such an
indicator has been adopted, it has been considered as not being adopted in the
sense that, when calculating the percentage of principle adoption, the indicators
which were not mentioned in the interviews have been treated as ‘No’s. Of course, it
is true that these indicators may in fact be adopted by the organisations. However,
this fact does not significantly affect the results presented below.
3.1. Policy
The indicators for ‘Policy’ are as follows:
1. The agency integrates staff support into its operational framework.
2. The stress management policy is contextually and culturally appropriate.
