Introduction: Humanitarian work and trauma

“I left Bosnia…three years ago. What I didn’t realize then is that Bosnia…will never leave me. Loud sudden noises still make me duck for cover as if there were shellfire nearby. I still dream, from time to time, about a foot clad in a tennis shoe that I saw poking from a mass grave. I now always sleep lightly, one ear cocked for danger. But most of all what stays with me is the guilt…”

Elizabeth Neuffer
(quoted in Danieli, 2002, p. 286)

International humanitarian work is an inherently dangerous undertaking. Whether the result of natural disaster, civil conflict, or domestic crime, violence and its aftereffects are something few humanitarian workers can escape witnessing, or even becoming targets of themselves. Many humanitarian workers around the world live with a certain level of chronic uncertainty and fear.

The fact that humanitarian work can be risky is not surprising given that the purpose of the work is to help civilian victims of disaster and conflict. Humanitarian workers are therefore often exposed to many of the same risks facing the people they are working to help. As a result, the recent changes in global conflict patterns have increased the chances that relief and development workers will become targets of threat and violence.

Consider the following research findings:

• During the 1990’s, intentional violence became “the leading cause of death among aid workers in complex emergencies, with death from motor vehicle accidents a distant second” (Cardozo & Salama, 2002, p. 242).
• Since the end of the Cold War, the ICRC (International Committee of the Red Cross) has reported a six-fold increase in the number of physical threats to its staff during an average year. Cases in which the ICRC was deliberately targeted have increased steadily from 3% to 20% (Grossrieder, 1998).
• Most humanitarian workers in the field, whether expatriate or national, experience at least one seriously frightening or disturbing incident during the course of their work (Cardozo & Salama, 2002; Holtz et al., 2002; Eriksson et al., 2001; Eriksson et al., 2003).
• At least 25% of humanitarian workers in complex humanitarian emergencies (CHE’s) can expect to undergo a potentially life-threatening experience (Cardozo & Salama, 2002; Holtz et al., 2002; Eriksson et al., 2001; Eriksson et al., 2003).

Humanitarian workers are not immune to being deeply impacted by disturbing and dangerous events just because they are working for a noble cause. A limited but growing number of research studies suggest that a significant proportion of relief and development workers will eventually experience some serious traumatic-stress-related reactions (such as symptoms of post-traumatic stress disorder, depression, anxiety, and substance abuse). Humanitarian workers helping people who are hurting run a real risk of being hurt themselves in the process.

The news is not all bad, however. There are a number of ways to support humanitarian workers and reduce their risk of developing enduring trauma-related difficulties. One important method of support is providing information about stress and trauma, normal reactions to traumatic events, and helpful coping strategies. All humanitarian workers should understand the dynamics of trauma and know how to help manage or alleviate trauma reactions. This knowledge decreases their risk of experiencing enduring trauma reactions and increases their resilience – their ability to “bounce back” – more effectively after traumatic events.

This is the second in a series of online training modules on traumatic stress and humanitarian work provided by the Headington Institute. This online training module is written for humanitarian workers and aims to help you:

1. Understand the dynamics of trauma and stress reactions
2. Recognize common trauma reactions
3. Learn how to care for yourself and others after a traumatic event

By the end of the module you should better understand:

• What can make an event traumatic for you
• How trauma can affect your body and mind
• What common trauma reactions are
• When to seek professional help
• How to monitor your own well-being
• How to take better care of yourself after you experience traumatic events
• How to care for others after they experience traumatic events
• Where to get more information for continued learning or personal assistance

This study module is not a comprehensive treatment of the subject of trauma and humanitarian work. It is designed to provide an introduction to the topic and a framework to help you learn at your own pace and enhance your understanding with additional resources.

This module builds on material presented in the first module in this series, Understanding and coping with traumatic stress. Readers who have not completed that module are advised to do so before continuing.

Additional online modules provided by the Headington Institute include:

Understanding and coping with traumatic stress (series introduction)
Understanding and coping with vicarious trauma
On the road again: Coping with travel and re-entry stress
Humanitarian work, traumatic stress and spirituality
All in the family: Self-care for spouses and family members of humanitarian workers

As you work through the different sections in this module, take the opportunity to reflect on how this information is relevant to your work and life. To help you in this process, we have included questions at the end of many study sections in boxes that look like this:

At the end of the module try testing your comprehension by taking the online quiz.

Next: Research summary: Humanitarian work and trauma