Have you experienced or witnessed situations when staff wellness, including psychological health, had an impact on the effectiveness of humanitarian response?

This question was posed to participants in PHAP's online consultation event on Humanitarian effectiveness and staff wellness. You can read more about the event at phap.org/WHS-30Jul2015.

Yes. Cultures of working seven days and long hours in high-stress environments led to people having stress-related incidents and not completing projects (leading to money wasted, in very large amounts); managers with psychological issues and substance abuse problems not directing effective work from staff; People at the highest levels of decision-making breaking down in meetings and important work being left to inexperienced staff who weren't 'battle-worn' yet; good staff leaving due to lack of support (time and again).
- Advisor, World Food Program (Italy)

Absolutely - staff fatigue can lead to burnout, early departures, implementation delays, poor decisions, security risks... all of which affect our response.
- Emergency HR Coordinator, International NGO

This is something [our organization] pays a lot of attention to, both during responses and between responses. It has impacted the effectiveness of responses in many cases, but I think our efforts have mitigated the negative impacts to some extent.
- Senior emergency response manager, International NGO

Yes - particularly the overuse/ abuse of alcohol as a means to manage stress.
- Cash Transfers and Social Protection Specialist (France)

Yes. Staff who experienced trauma and PTSD
- Principal, Consultant group (United States)

When you face high turn-around rates for field staff, it puts strains on all the other staff, not only in terms of workload but also an environment of lower morale in the office.
- Field Coordinator, International NGO (Japan)

In my experience working with, training and coaching humanitarian aid workers, psychological health plays a direct role on their ability to do their jobs. When extreme stress, complex trauma and PTSD goes untreated, aid workers are not at their full potential. Especially in post-conflict and emergency contexts, staff support around psychological health is pivotal to staff welfare, with secondary benefits extending to environmental health and an improved working environment. Days lost to morbidities including trauma, anxiety and depression decrease when wellness and mental health are openly supported and prioritized. When they are not, negative behavior including anxiety and panic attacks, substance abuse and even suicide have been noted. Quite simply, we cannot help others until we ourselves are well.
- Wellness Trainer (Indonesia)

Yes - particularly during the Ebola Response! The protocols for this were very weak and frontline staff were at risk. Additionally many staff working in the Middle East and Afghanistan burn out and suffer long-term effects from PTSD due to lack of serious wellbeing protocols.
- Global Advisor, International NGO (United States)

Throughout my last 10 years+ working in humanitarian sector.
- Advisor, Intergovernmental agency (Kenya)

Yes I have, in various conflict situations where I have deployed to, as well as in natural disaster situations where the work rhythm and environment leads to burn out and choice of non-healthy coping mechanisms.
- Humanitarian Affairs Officer, UN Agency (Switzerland)

I think that has happened in almost every case. If moral is low engagement is low as well.
- Capacity Building Manager, NGO (DRC)

Yes. Staff health, including psychological health, is a main component of humanitarian work. Most of the contexts where we work are volatile, work pressure is high because things need to be done fast, the consequences of mistakes can be huge... Stress is part of the work, and ensuring a supportive environment is part of the organisation's duties.
- Deputy Director of Human Resources, International NGO (Switzerland)

Yes, on my day to day routine, so many UN staff approach our office, complaining about how stressed they are, that they are no longer productive, that they only have negative thoughts, not making any positive inputs.
- Welfare Assistant, UN Agency (DRC)

I have seen cases where psychological issues have impacted on the humanitarian worker's motivation and enthusiasm for the project or program thus decreasing the effectiveness of the work being done and the motivation of the volunteers.
- Travel Health Advisor, Red Cross and Red Crescent Movement

I have experienced PTSD, but was not offered any form of support, in the past. Further, after having been raped while working as a humanitarian earlier this year, I found it frustrating to get the psychological help that I needed, and in fact ended up paying for my own therapy in order to get better.
- Consultant (Canada)

Yes, several direct and indirect cases. I've been working at the moment for six years in war-affected countries doing humanitarian field work, where mostly you can find a high degree of pressure, insecurity and psychological or physical impact, I can re-count how many cases of staff who took either wrong or possibly dangerous decisions hampering perhaps the whole team safety and in some instances even the impact on the beneficiaries we are to serve.
- UN Agency (South Sudan)

I have from a distance. The second earthquake in Nepal recently really raised some concerns.
- Senior Recruiter, International NGO (United States)

Yes I have. Where staff work for longer periods in a hardship area without taking a break. they end up slowing down and lowering their output.
- Legal officer, NGO (Kenya)

Yes, I have seen staff unable to fit in a team and creating disruptive workflows; I have seen projects going very wrongly for lack of adequate management support.
- Officer, Humanitarian network (Switzerland)

Yes; in a number of settings where workers fear for their own security as well as those they are caring for.
- Consultant (United States)

I have seen people burn out, have moments where they breakdown in the office and require immediate leave in order to deal with the cumulative stress of the response - long hours, heavy workloads, lack of understanding with regards to personal and professional problems. There's an attitude where you have to keep going until you break, and then and only then when you're visibly in need of support will you get it, but never preventatively.
- Coordinator, International NGO (South Sudan)

We need to be very mindful of the risks of secondary trauma and how the exposure to traumatic stories impact our behavior and ability to help vulnerable populations.
-UN to stop competing with INGOs and become strong, advocates for humanitarian principals, interdependently and without being influenced by of certain member states that may have other motives in certain contexts.
- Project Coordinator, foundation (United States)

Yes. In my organization sometimes staff suffer vicarious trauma after listening to traumatizing experiences that our clients go through in the process of fleeing their countries amid conflicts.
- Country Director, International NGO (Tanzania)

Yes, I have mainly witnessed negative spiral of humanitarian colleagues due to heavy work burden and high stress. I have not witnessed adequate support from organisations in this respect, with staff wellbeing primarily being seen as an individual responsibility and not as joint responsibility of the organisation.
- Project manager, International NGO (United Kingdom)

Yes! I have experienced such situations. Members of the international team that I was a part of, who went to the Philippines in the wake of Typhoon Haiyan to assist people there, were able to manage the psychological stress of working in a disaster zone.
- Psychosocial services provider (United States)

In my experience as a researcher working on this topic, I have had the chance of interviewing a number of humanitarian and development workers. The ones that were suffering from stress had also lost their motivation and interest in what they were doing. This emotional exhaustion and cynicism are core elements of burnout. Many had left the profession as a consequence.
- Researcher (United Kingdom)

Yes. The increase in conflict and natural disasters globally means that there are more humanitarian workers working in very dangerous environments for long periods of time. In extreme cases, humanitarian workers have lost their lives or witnessed such horrid atrocities with long-term effect on their psychological health and of course, the effectiveness of humanitarian response.
- Chairperson of staff association, UN Agency (United States)

I have witnessed situations where involvement in humanitarian response has broken colleagues down. Asking an aid worker to move to the next crisis without a chance to recover from the last and prepare is like driving a car without engine oil.
- Humanitarian Affairs Officer, UN Agency (Switzerland)

Yes - in every setting where I have worked.
- Senior Programme Officer, International NGO (United States)

Yes. While leading a team of young medical doctors while I was the only one with psychology background, I witnessed team members (including me) overcome by exhaustion and grief after only two weeks at the field. Crowd control was an issue as we were outnumbered by patients, that temper flared and angry shouts were directed at people needing care. Speed of service was reduced and effectiveness of the operation was under scrutiny during evaluation by a senior staff. Despite a thorough briefing before mission, lack of experience might contribute to the problem.
- Consultant (Indonesia)

Yes, as this is manifested in terms of sensitivity with dealings with colleagues and affected population.
- Humanitarian Trainer (Philippines)

Clearly yes. Burn out of staff leading to inefficiency or awkward behavior leading to HR issues.
- Head of mission, International NGO (OPT)

Very much so - from an NGO perspective in particular the impact of staff stress levels and staff burnout impacting on their ability to deliver quality work and therefore quality programming, thinking particularly of personal experience in the Iraq L3 response last year. Lack of institutional response to acknowledge these issues, let alone offer support to staff.
- Coordinator, International NGO (Ukraine)

Yes, I had many many times through my own experience or through other colleagues. In my case one particular experience I was sent on back to back missions, following an intense mission to Haiyan as cluster lead, I was already burn out in Myanmar and counting the days to end. When I was sent to Haiyan I had to find energy to make it everyday, particularly after week 2 I was struggling, I wanted to leave but there was no replacement available immediately. I felt awful not only for being tired but because I knew I was not giving my 100%. Still I managed to move things and do a good response but I think if I would have been more rested and energized, then I could have done a lot more. Similarly, I know of colleagues who have been even fired because their performance after being on back to back difficult missions, iinstead of being supported for PTSD. I also find it with national colleagues who often don't have the same access to support mechanisms as internationals do. For example in Nepal following the earthquake, many colleagues continued coming to work also feeling the need to help but also that the response needed them, many in the surge had never been to the country or spoke the language so they relied on national colleagues, who were still in great state of shock and trauma following the earthquake, many also taking care of their families and other affected, and yet also working on high demand, many of the surge staff often forget about this and expected their national colleagues to perform at their speed which is unfair – particularly when they will be there on the long term. Other colleagues who are working under an abusive manager, the psychological effect is huge and it does result in the performance because the person is under a lot of stress in the context and even more by its daily working environment. Not even talking in situations of sexual harassment when you add all stresses possible to the situation and yet still supposed to be able to perform and deliver.
- Regional advisor, UN Agency (Thailand)

Indeed. We all have limits - even when highly motivated, physical limitations are there. One element that may be to take into account is the physical capacity (related to the body size, the training, also gender aspects), in the case of long walks for example, in complex terrains.
- University Professor (Portugal)

On numerous occasions during my work with [International NGOs], fellow team members faced difficult situations that required action to be taken to address their psychological well being.
- Independent Consultant

Accumulative stress that goes with the work context leading to a variety of stress symptoms, interpersonal difficulties, and maladaptive behaviours to deal with the same leading to burnout.
- Psychologist (Switzerland)

Yes - overwork after the Japanese tsunami.
- Intern, International NGO (Australia)

Yes, in Aceh after the tsunami of 2004.
- Medical Advisor, Red Cross and Red Crescent Movement

Yes. In all my postings I have encountered situations where effectiveness of the NGOs' response was impacted by poor management processes (e.g. unclear Terms of Employment on simple issues such as leave, R&R or holidays, per diems...) as well as lack of capacity among line managers to recruit, develop and retain staff (in particular to implement performance management in a proper documented way). Also most manager level staff I encountered lacked awareness and training on indentifying problematic stress or people at risk of burn out, and ways to adress work overloads in a constructive manner. In several occassions, after a critical incident or evacuation of staff, I witnessed the importance of coordinators knowing about defusing techniques. In some succesful critical incident management cases, I could see the importance of having the entire structure (meaning all departments) involved in the response and in a coordinated manner around the crisis cell (e.g. Logistics needs to make sure staff is relocated in a comfortable and secure location; HR needs to clarify rapidly what will happen the next days in terms of contractual obligations – are the evacuated employees on forced leave? is the NGO asking them to be off duty? how long?; Program coordinators need to adress the questions related to operations – stop, standby or continuation?; etc. Overall, humanitarian NGOs often put staff in positions where they are not enough capacitated to respond to critical incidents or to just do qualitative team management. I can say that most of the problems I encountered in projects were related to staff wellbeing not being prioritized by predecessors or colleagues. NGOs need to learn that investing in capacity building as well as strenghtening internal processes in this field will only improve project performance.
- Country Director, International NGO (Iran)

Although I work more in the human rights than humanitarian sector, I have nevertheless witnessed staff struggle and feel overwhelmed by the work that they do. A lot seem to be in denial but 'soldiering on' – but one wonders how long this can last. With others, the way to cope is through excessive alcohol or drug use. For these cases too there is the concern of how long they can sustain the work without further harming themselves and possibly others.
- PhD Candidate (United Kingdom)