guidelines2 qxp3 25-09-2006 11:08 pagina 6...2003 by the core working group. the research wor-king...

Managing stress in humanitarian workersGuidelines for good practice

second edition

F O U N D A T I O N

A N T A R E S

guidelines2_qxp3 25-09-2006 11:08 Pagina 6

Free copies of this revised, second edition ‘ManagingStress in Humanitarian Workers - Guidelines for GoodPractice’ can be obtained from the Antares Foundation.The latest updated version can be downloaded fromwww.antaresfoundation.org.

NGOs and other interested organizations or institutesmay reproduce this material for their own use only. Forany other use prior written permission from the AntaresFoundation is needed.

Please send all feedback, questions and enquiries to:

Antares FoundationW.G. Plein 2691054 se AmsterdamThe Netherlandstel: + 31 20 3308340fax: + 31 20 4221320e-mail: [email protected]

© Antares Foundation, July 2006

Managing stress in humanitarian workers

Guidelines for good practice

1Managing Stress in Humanitarian Workers - Guidelines for Good Practice

Foreword

IntroductionBackground

The Antares Foundation and CDCObjective

The process and progressNext steps

Guiding principle

The Principles

Principle 1: Policy

Principle 2: Screening and Assessing

Principle 3: Preparation and Training

Principle 4: Monitoring

Principle 5: Ongoing Support

Principle 6: Crisis Support

Principle 7: End of Assignment Support

Principle 8: Post Assignment Support

Acknowledgements

Contents

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This booklet is one of the outcomes of a long-established collaboration between professionals fromquite diverse fields of expertise. Throughout itsexistence the Antares Foundation has brought togetherindividuals experienced in humanitarian aid, psycho-logy and academic research, who share a passionateengagement with humanitarian aid provision. Thevoluntary effort of this group of Antares associatessets an excellent example of how knowledge can beshared and common goals can be set within a networkof individuals.

As a matter of fact, it is this very potential of socialcapital that can also make humanitarian action workbetter. The Antares 2006 conference ‘Care andCohesion’ addressed the synergy of actions of thedifferent players within the humanitarian aid theatreand within separate operational teams. It showed therelevance of mutual trust, knowledge sharing andcooperative action.

Humanitarian aid provision as a sphere of work,however, is often characterized by unpredictability,ongoing disturbances and insecurity. These circum-stances threaten the quality of the aid provided andmay also result in serious stress in aid workers.The need for aid agencies to manage stress in theirstaff is obvious. Activities of the Antares Foudationaim at raising awareness of this need amongst policymakers and managers, and at training and assistingteams and individual aid workers in better copingwith the stressors of humanitarian work.

Although all stress cannot be avoided and is intrinsic tohumanitarian work, some stress can be prevented orreduced. The consequences of stress in individual staffmembers can be mitigated or responded to by actiontaken by the staff members personally, colleagues,managers and the agency as a whole. We believe thatthere is a responsibility within the individual teammember and within the agency to address stress, forhealth and good practice reasons. And, ultimately, ourbeneficiaries, those who are affected by humanitariancrises, will also benefit.

These Guidelines for Good Practice intend to help theagency and its staff to address stress within the orga-nization and within themselves.

As Chair of the Board of the Antares Foundation, I amproud to be able to introduce this revised edition. I invite you all to read, use and comment on it.

Pim Scholte, MDChairman Antares Foundation

Foreword

2 Managing Stress in Humanitarian Workers - Guidelines for Good Practice

Visual Representation of the Guidelines


5Managing Stress in Humanitarian Workers - Guidelines for Good Practice4 Managing Stress in Humanitarian Workers - Guidelines for Good Practice

opinion and feedback from national and internationalfield managers was gathered during meetings inJerusalem, Melbourne and Canberra (Australia), NewYork, Tbilisi (Georgia) and Tuzla (Bosnia).

The working group, in cooperation with an inter-active design and communication specialist, developeda graphic, which visualizes the principles from theseguidelines and can assist as a tool for training andclarification. A sample of this graphic accompanies theguidelines. The graphic is available in poster size andcan be ordered through the Antares Foundation.

The Code of Conduct of People in Aid has been astarting point. We fully embrace and acknowledgethe Code and feel that these Guidelines are comple-mentary to the Code.

Next steps

The Antares Foundation will facilitate the develop-ment of a ‘workbook’ consisting of training materials,sample protocols for assessment of agency practicesand for monitoring stress in individuals and teams, aswell as case studies and sample policies. Next to that,the Antares Foundation will develop ‘pilot’ programswithin national and international NGOs. During thesepilots, developed materials, guidelines and programswill be tested before they will be made available toNGOs in future.

We will continue to seek feedback and commentsthrough our network of specialists, NGOs and insti-tutes. We hope these guidelines will assist you indeveloping stress management in your organization.We invite you to share your experiences and ideaswith us.

Background

Humanitarian aid administered through non-govern-mental organizations all over the world has developedfrom small-scale aid through private initiatives,missionaries, charities, communities and foundationsto institutionalized organizations and bodies.

Though more professional, better equipped andprepared, the humanitarian organizations today aremuch more affected by the changing consequences oftheir work e.g. direct exposure to misery, magnitudeof numbers of affected people of humanitarian crises,deteriorating safety and security context and limitedavailable resources.

Good staff care and psycho social care for aid workershas proven to be an important asset in stress manage-ment and the prevention and treatment of traumaticand posttraumatic stress.Though the awareness on these issues exists in mostorganizations, adequate care systems for national andinternational staff are often underdeveloped and lackattention and resources.

Having worked both within and as a consultant tonational and international humanitarian agenciesworldwide, the Antares Foundation has recognizedthe importance of addressing stress on all levels inmany organizations. Requests for information, ideasand strategies for developing a stress program forhumanitarian workers has led to the development andrevision of these Guidelines.

The Antares Foundation and the Center for DiseaseControl and Prevention (CDC)

Since 2001 the Antares Foundation and the Centersfor Disease Control and prevention in Atlanta, USAjointly organize conferences and meetings on ‘Stressand the Humanitarian Aid Workers’ in Amsterdam ona yearly basis.

The conferences resulted in a long term project,funded by CDC, with the objective to mitigate stresswithin humanitarian organizations. Next to raisingawareness on consequences of stress, development ofthe ‘Guidelines for Good Practice’, a longitudinal studyamongst on stress started with the aim to provide indepth and scientifically valid information regarding

mental health status of humanitarian workers workingunder stress and in hardship.

In this unique cooperation, practical experience andtheoretical knowledge are combined and networksfrom research institutes, NGOs and health specialistsare brought together, and are working towards anintegrated approach for mitigating stress in the huma-nitarian aid workers.

Objective

The objective of the Guidelines for Good Practice is tofacilitate the NGOs in defining their own needs inrelation to stress management in their organization.This will be different for every NGO, whether nationalor international, big or small. And although the prin-ciples should be universal, the implementation andindicators will depend on the context and culture ofthe organization.

The guidelines are meant as an orientation for organi-zations that are interested in developing their ownstaff care system. We believe that the principles arevalid for all organizations, small or large, national orinternational. Protocols and policies can vary fromjust one page to a comprehensive book; however themanagers of the organizations will need to feel respon-sible for the implementation and we hope theseprinciples will assist them in this task.

This second edition of the guidelines is not meant tobe prescriptive. It has been developed by national andinternational NGO workers and health specialists.We whole hearty invite you to provide us with com-ments, your feedback on feasibility, and your ideasand experiences with staff support.

Process and progress

This draft is a result of three years of working with aninternational specialist working group, coordinated bythe Antares Foundation. The initial principles weredeveloped in a three day meeting in Amsterdam in2003 by the core working group. The research wor-king group contributed valuable comments during allthose years. Participants of the conferences gave their

Introduction



Principle 1

Policy

Principle 2

Screening and Assessing

Principle 3

Preparation and Training

Principle 4

Monitoring

Principle 5

Ongoing Support

Principle 6

Crisis Support

Principle 7

End of Assignment Support

Principle 8

Post Assignment Support

The agency has a written and active policy to prevent ormitigate the effects of stress

The agency systematically screens and/or assesses thecurrent capacity of staff members to respond to andcope with the anticipated stressors of an assignment.

The agency ensures that all employees have appropriatepre-assignment preparation and training in managingstress.

The agency ensures the monitoring of the response tostress of its staff on an ongoing basis.

The agency is providing training and support, on anongoing basis, to help its staff deal with the dailystresses of humanitarian aid work.

The agency provides staff with specific and culturallyappropriate support in the wake of critical or traumaticincidents and other unusual and unexpected sourcesof severe stress.

The agency provides practical, emotional and cultu-rally appropriate support for staff at the end of anassignment or contract. This includes a personal stressreview and an operational debriefing.

The agency has clear written policies with respect tothe ongoing support they will provide to staff mem-bers who have been adversely impacted by exposureto stress and trauma during their assignment.

The principles

Managing stress in staff of humanitarian aid organi-zations is an integral management priority inenabling the organization to fulfil its field objectives,as well as necessary to protect the well being ofthe individual staff members, their teams and thecommunities they work with.

Why is that important?

Humanitarian aid work is inherently stressful. Whilestress can be a source of growth and although manyhumanitarian aid workers withstand the rigors oftheir work without adverse effects, many others donot. Both anecdotal reports and empirical studies haveabundantly documented the negative emotional conse-quences of exposure to these stressors on variousgroups of humanitarian workers. These adverse conse-quences may include post-traumatic stress syndromes,burnout, depression and anxiety, over-involvement orover-identification with beneficiary populations or,conversely, callousness and apathy towards beneficia-ries, self destructive behaviours such as drinking anddangerous driving, and interpersonal conflict with co-workers or with family members

Staff stress and burnout have an adverse impact on theability of the agency to provide services to thosedirectly impacted. Workers suffering from the effectsof stress are likely to be less efficient and less effectivein carrying out their assigned tasks. They become poordecision makers and they may behave in ways thatplace themselves or other members of the team at riskor disrupt the effective functioning of the team. Theyare more likely to have accidents or to become ill. A consequence for humanitarian agencies is that staffstress and burnout may impede recruitment and retention of qualified staff, increase health care costs,compromise safety and security of staff and createlegal liabilities.

Humanitarian aid organizations bear a dual responsi-bility. They must effectively carry out their primarymission and, at the same time, they must protect the wellbeing of their staff. The latter role goes beyonda mere duty to shield employees from harm and ensure that they are ‘good workers’, however. Theagency has a responsibility, consistent with theirhumanitarian objectives, to foster resiliency andstrengthen human capacity. The agency should be

committed to encouraging staff to develop their ownskills and knowledge and to enhancing expertisewhich will increase the likelihood of the agencyachieving its field-based objectives.

Although stress is intrinsic to humanitarian aid work,some stress can be prevented or lessened and theeffects of stress on individual staff members can bemitigated or responded to by actions undertaken byindividual staff members, by managers and super-visors, or by the agency as a whole. The following guidelines are intended to enable the agency to act inways that minimize the risk of adverse consequencesfor its employees.

The Guidelines for Good Practice are organizedaround eight key Principles. Each of the principles hassupporting Indicators and Comments designed toassist the reader to more fully understand the conceptsunderpinning the principles and how they translateinto management practice. The accompanying dia-gram provides a visual representation of the Principlesas they apply to the phases of humanitarian work.The principles and indicators are intended to apply toboth international and national staff, office and fieldstaff, recognizing that adjustments may be necessaryto take into account the unique needs and characteris-tics of each group. They constitute a tool for learning,reflection and planning rather than a set of rigid rulesor solutions that are applicable under all conditions.

Guiding PrincipleManaging staff stress is good management practice



Indicators

1. The agency has a written policy for responding tostress that covers:a. normally expected stresses of humanitarian work;b. unexpected circumstances (such as forces evacu-

ations or critical incidents).

2. The agency warns and educates potential staffmembers about the general risks of humanitarianwork including the specific risks of the project(s)they will be assigned to, and any individual risksthey may face as a result of their gender, sexualorientation, race, ethnicity, nationality, or otherpredisposing personal factors.

3. The agency has a specific strategy for reducing risksfor each individual project. This should include forexample, an assessment of safety and security risks;physical health risks; risk of exposure to trauma,death, suffering and destruction.

4. The agency routinely reviews protective and suppor-tive organizational policies and protocols aimed atreducing staff stress. For example: a. policies forbidding discrimination against staff

based on gender, race, nationality or sexual orien-tation, and forbidding bullying or sexual, racial,and emotional harassment of any individual orgroup of staff members;

b. personnel policies that reduce potential organi-zational and ‘bureaucratic’ sources of stress andenhance staff resilience;

c. policies and protocol for training and evaluatingcurrent capacity of managers and team leadersto ensure that they have the requisite compe-tencies to lead teams in complex humanitarianaid environments;

d. policies and protocols for promoting a culture ofstress awareness amongst staff.

5. The agency recognizes that the support needs oflocal, national and international staff are likely to bedifferent and subsequently devises stress policies andsupportive practices that match the specific needs ofstaff.

6. The agency regularly evaluates and updates itspolicies and practices to reduce and mitigate theeffects of stress.

7. The agency asks its staff members to comply withagency policy and procedures aimed at reducingstress.

8. The agency encourages individual staff membersto hold the agency to its commitment to activelymitigate the effects of stress.

Comments

It would be easy to imagine that stress is somethingthat happens to staff in the field solely as a result oftraumatic or very stressful field experiences. If thiswere the case, then stress management would consistmerely of intervening when something goes wrong, forexample, when a critical incident occurs or a staffmember shows signs of burnout.

In reality, every aspect of an agency’s functioningthrough each of the phases of assignment has animpact on the stress experienced by staff, for example,hiring and assignment procedures at the pre-assign-ment phase.

Other factors such as contract terms, staff benefits,procedures for decision making, grievance proceduresand administrative efficiency can also be sources ofstress for a staff member. Likewise policies regardingcommunication and information sharing within theorganization as well as provisions for supervision andsupport of field workers; rules and regulations concer-ning vacations; policies regarding work hours andpolicies for communicating with home all have thepotential to add to the stress of being in the role of ahumanitarian aid worker.

Principle 1

Policy

The agency has a written and active policy to prevent

or mitigate the effects of stress

The policy reflects the agency’s understanding of the impact of stress on

their staff and integrates staff support within the organization’s operational

framework. It describes specific policies, programs, and practices to create

a comprehensive supportive environment for staff. It carries a commitment

to examine all aspects of the agency’s operations with respect to their effect

on managing and mitigating stress in employees (screening and assessing;

training and preparation; monitoring; ongoing support; crisis support;

debriefing & re-entry support; end of assignment specific support). The plan

includes observable outcome indicators with regard to staff well-being.



Indicators

1. The agency has an understanding of the minimumhealth and resiliency requirements for high risk andhigh stress assignments.

2. Both prospective staff and staff seeking new assign-ments are screened and/or assessed as to the likeli-hood of adverse or maladaptive responses to the risksand stresses of humanitarian aid work.

3. The results of such screenings / assessments are usedto suitably match staff members to specific assign-ments.

4. Appropriately trained interviewers are used forscreening and assessing staff.

5. The individual seeking employment or assignmentis held responsible for disclosing information thatmay be relevant to assessing the risks involved in anassignment.

Comments

Screening or assessing new and ongoing staff addressesboth the risks and stresses of humanitarian aid workin general and the risks and stresses specific to theparticular project to which the worker will be assigned.It also considers factors relevant to creating an effec-tive team. Assessment includes an evaluation of:a. physical and psychological health, past and present;b. influential life events (including past exposure to

traumatic events and how they have been dealt with);c. personal characteristics such as resiliency, coping

mechanisms, and motives for undertaking humani-tarian aid work;

d. the ability of the staff member to work in a team.e. how past difficulties in personal and professional life

have been dealt with;f. the staff member’s needs with respect to training and

or support if they are to carry out their assignmenteffectively and with minimal adverse effects from thestresses of the assignment.

In carrying out such screenings and assessments, theagency adheres to legal obligations and ethicalstandards as to what can be asked and what should not

be asked. It recognizes, however, that, if performing ajob properly requires certain psychological or physicalcharacteristics, then inquiry into these characteristicsand hiring or assignment decisions based on thesestandards is generally considered ethically and legallylegitimate.

The screenings and assessments should be seen as a con-structive guide to assignment, training, and ongoingsupport.

The agency maintains transparency to the prospectiveor actual employee with respect to expectations andthe nature of their future assignment. Conversely, theindividual seeking employment or assignment isresponsible for revealing information that may be rele-vant to assessing the risks involved in an assignmentfor that employee and the training and support thatthey would need to handle it successfully. Failure bythe individual staff member to disclose such informa-tion mitigates the responsibility of the organizationbut does not release the organization from the respon-sibility of carrying out a thorough assessment.

Principle 2The agency systematically screens and /or assesses

the current capacity of staff members to respond

to and cope with the anticipated stressors of an

assignment.

Screening of a staff member is recommended prior to general hiring.

A more thorough assessment should be made prior to a specific project.

Screening and Assessing

Case

An experienced aid worker applies to work in afield management role in Iraq, a country that heworked in three years ago. She had a difficult12 month assignment in Afghanistan prior toapplying for this one and has decided against avacation because of financial constraints. Theregion of the assignment is on high security alertand the political and social culture of the regionhas changed substantially over the past two years.

The hiring NGO acknowledges the competencyand capacity of the applicant but considers hercurrent level of fatigue and accumulated stressover time to be a risk factor to fulfilling theleadership roles of the job. The NGO is howeverinterested in employing the applicant but insiststhat she takes a three week vacation firstly. Theynegotiate to pay the applicant three weeks of a fulltime salary prior to hiring her.



Indicators

1. All staff has received education about:a. the expectable stressors of humanitarian work.b. how to recognize the signs and effects of stress.c. how to manage and cope with stress.

2. All staff have received updated briefing and trainingbefore a new assignment and when an assignmentchanges.

3. Supervisors and field managers are adequatelytrained and evaluated in stress management skillsand capacities: They are able a. to recognize signs of stress in their colleagues.b. to monitor levels of staff stress as a routine acti-

vity.c. to promote activities that help reduce stress.d. to arrange support for individual staff as and

when required.

Comments

Training with respect to stress and emotional self carein the field has several elements. In general, it shouldinclude: a. education about the expectable stresses of humani-

tarian work (with as great a specificity as possiblewith respect to the particular assignment and withrespect to risks faced by particular groups of staff);

b. education about the mechanisms of stress responseand about how to recognize signs of stress, burnout,critical incident stress, and vicarious traumatizationin oneself and fellow workers;

c. training in specific stress management techniquesand coping skills, (e.g., relaxation techniques, angermanagement techniques, self care, the value of sha-ring experiences with co-worker, the usefulness andlimitations/risks of defusing exercises, psychologicalfirst aid;

d. education about the risks of common behavioursthat are ineffective in coping with stress, such asheavy drinking;

e. preparation for dealing with the emotional res-ponses of people who have experienced traumaticevents;

f. provision of as much detailed, concrete informationabout actual conditions in the field as possible.Training in cultural and political awareness issuesrelated to the area of deployment is also helpful.

Although not specifically addressing stress manage-ment, adequate preparation with respect to operationaldemands of a position, safety and security, self care(health care), and cross-cultural issues that may affectwork all reduce stress on the worker.

Thus briefing and training should include: a. operational orientation and specific preparation for

the operational requirements of the project (inclu-ding development of skills needed for working witha team);

b. training with respect to safety and security inthe field (including training with regard to riskscommon to all humanitarian aid assignments anddetailed specific information about the risks to beexpected in the particular assignment and trainingin responding to those specific risks);

c. training with respect to physical (health) self-care inthe field (including provision of information aboutpre-deployment immunizations and malaria pro-phylaxis) and education about self-care in the field,such as hiv-aids prevention, infectious disease pre-vention, food and water safety, nutrition, physicalexercise, rest and sleep);

d. training in cultural and political awareness issuesrelated to the area of deployment. The briefing andtraining provided should be specifically tailoredboth to the characteristics of the assignment and thespecific needs and characteristics of the individualstaff member.

Many managers are selected based on experiencerather than managerial skills. Given the expectablestress of humanitarian work, it is recommended thatagencies provide specific and culturally sensitivetraining in stress and stress management techniquesfor project leaders or managers.

Principle 3The agency ensures that all employees have appro-

priate pre-assignment preparation and training in

managing stress.

The preparation includes stress education and how to mitigate the effects of

stress as well as a briefing on the expectable stressors likely to be encountered

on the assignment.

Preparation and Training



Indicators

1. Team managers are appraising staff members forsigns of stress on a regular, routine basis.

2. Team managers are monitoring staff members closelyfor signs of stress during and after a critical incidentor traumatic event.

3. Individual staff members are monitoring and, ifappropriate, reporting signs of stress in themselves.

4. The agency has an explicit written policy that it willrespond constructively (not punitively) to any revela-tions of stress.

Comments

Most stress among humanitarian aid workers is theresult of the ongoing, every day pressures of theirwork (e.g., separation from family, physically difficultliving and working conditions, long and irregularhours, repeated exposure to danger, intra-team con-flict). Poor administrative or managerial abilities onthe part of team leaders and conflict within the teamare also potentially major sources of stress. Stressmay also result from non-job-related experiences(e.g., marital conflict, sickness or death in a staffmember’s family). Many aid workers develop afaçade of toughness and believe that they shouldn’tcomplain. Others may not recognize the signs of stressin themselves. It is the presence of the expectablestressful experiences rather than worker complaintsthat should trigger agency scrutiny of stress responsesin its employees.

The purpose of monitoring stress is to provide a morecaring and enabling environment for staff. At the sametime, there is a potential for stress evaluation (andsubsequent requirements for staff to cooperate withstress reduction programs) to be seen by staff asintrusive or as means to evaluate or control them. Toensure staff participation and cooperation with stressmanagement programs, the agency must explicitlyrecognize this potential problem and must seek todesign policies and procedures that protect staff mem-bers from misuse of the process.

Intra team conflict, scapegoating or harassment ofindividual team members, unusually high staff turn-over, or reduced work effectiveness may reflect stressin individual team members or whole team dynamics.In such instances, it is recommended that systemiccauses of stress be evaluated including the efficacy ofteam leadership and management by an external body.

Principle 4The agency ensures the monitoring of the response

to stress of its staff on an ongoing basis.

This can be done through informal observation by supervisors, periodic

routine questioning by supervisors, routine administration to staff of self-

report questionnaires, or periodic informal or formal group stress evaluation

sessions.

Monitoring

Case

A staff member in Uganda is observed by colleaguesoften to be working back late in the office andspending a lot of time at the computer. When toldby colleagues that he is working too many hours,the staff member becomes quite upset and with-draws from social contact. Colleagues mentiontheir concern to their team manager who thenappraises the work load of the staff member andany other circumstances that may be causing anystress. The team manager also remembers toenquire how the staff member is now feeling abouta serious event that had previously upset the staff

member three months prior and checks if this isstill causing worry and painful reminders. Theteam manager also invites concerned colleagues toshare their observations of their team memberdirectly with him in a personal and positive way.

The team manager draws the staff member’s atten-tion to the agency’s supportive policy on mitigatingthe effects of stress and suggests that a plan forreducing and managing the stressors be constructedtogether and reviewed in a week or two.



Indicators

1. The agency provides ongoing training and supportfor staff with respect to safety and security, physicaland emotional self-care.

2. Organizational and management practices areperiodically reviewed with respect to their impacton staff stress, possibilities to mitigate stress andstrengthening team cohesion.

3. Staff members are being encouraged to engage ingood practices of self care and collegial support withrespect to their health, to safety and security, and tostress reduction.

Comments

Psychological support for staff is driven by the under-standing that a high level of stressful experiences isinevitable in most humanitarian aid assignments andthat, over time, most employees will feel the effectsof this chronic stress. Providing pro-active supportshould be routine and should not be dependent ondemands or concerns expressed by the staff membersthemselves or by observations that an individual is‘under stress’.

The agency ensures that field managers and supervi-sors are trained and qualified with respect to updatingknowledge of safety and security practices and proce-dures; knowledge of practices promoting physicalhealth in the field; knowledge of the potential impactof organizational culture, policies, and practices onstaff stress; techniques of team building, includingfacilitating communication and conflict management;ability to recognize signs of stress, burnout, and vica-rious traumatization; and skills in stress managementand psychological first aid. Field managers are expec-ted to be role models for staff under their supervisionwith respect to conducting themselves in ways thatmitigate stress (e.g., taking appropriate work breaks,carrying out stress reduction procedures such asrelaxation exercises). The agency provides periodicrefresher training in these areas for field managers andsupervisors.

Much evidence suggests that social supports are themost important protective factor supporting workersin dealing with stress. From a management perspective,team-building and managing of any conflict withinthe team are very high priorities. The agency alsoencourages and facilitates regular access to communi-cation between staff members and their families orloved ones.

Many ‘bureaucratic’ aspects of work managementpractices can be sources of stress or can provide respitefrom stress. Although it is common for staff membersto use the agency management style or the behaviourof a particular supervisor as a ‘scapegoat’, this doesnot lessen the need to carefully analyze and correctagency or managerial practices that may, in fact,augment stress. The agency should have clear, writtenpolicies that specify maximum shift time (save inemergencies), maximum work load, time for requiredrest and recreation, and requirements that staff useleave or vacation time. The agency should have aclear written policy that establishes procedures toimplement these standards and hold field managersand supervisors accountable for implementing thesestandards.

At the same time, the staff member, too, has an obli-gation to behave in ways that reduce the likelihood ofadverse effects of stress. These include followingroutine safety and security and health self care guide-lines promulgated by the agency, participating in stressreduction activities (such as regulating their own workschedule, taking breaks, taking time off, participatingin agency provided stress reduction activities, andengaging in personal stress reduction activities).

Principle 5The agency is providing training and support, on an

ongoing basis, to help its staff deal with the daily

stresses of humanitarian aid work.

The agency hold managers, supervisors and team leaders accountable for

creating a pro-active culture of stress mitigation. Team building, resolution

of intra-team conflict, organizational practices that reduce stress, and

encouragement of individual staff members’ stress management activities

are valued and given concrete support.

Ongoing Support



Indicators

1. All staff members are provided with explicit guide-lines as to the kinds of critical or potentially stressfulincidents that must be reported to higher manage-ment.

2. All managers and supervisors are trained in approp-riate front line responses to traumatic incidents (forexample, managing team response to traumatic inci-dents, monitoring of individual and team responses,and timely requests for back-up management supportand specialised resources during the crisis period).

3. The agency has arranged for staff with specific trai-ning in psychological first aid to be available, on an‘as needed’ basis, to consult with staff members aftertraumatic incidents or other sources of acute stress instaff.

4. The agency has standing arrangements with local,regional or international specialists during a crisisperiod to provide culturally relevant trauma assi-stance as required.

Comments

Sources of extreme stress may include ‘traumatic’ or‘critical’ incidents such as a serious motor vehicle acci-dent, being kidnapped or taken hostage, experiencinga serious physical assault, being raped, having one’slife threatened, or witnessing horrendous eventshappening to others. Other sources of unusual stressmay include emergency evacuations, other unplannedterminations of assignments, or personally traumaticevents (e.g., acute family crises such as an unexpecteddeath in the family).

Experiencing or witnessing such events very commonlycauses distressing responses in those who experiencethem. These responses include, but are not limited toAcute Stress Disorder, anxiety, somatic complaints,depression, pathological grief reactions, PostTraumatic Stress Disorder, destructive or self destruc-tive behaviors, and difficulties in interpersonal func-tioning (e.g., within the team). Even in the absence ofdirect exposure to horrific experiences, repeatedexposure to accounts of the gruesome or terrifyingexperiences of others may cause secondary or vica-rious traumatization.

Responses may be evident in the immediate wake of acritical event or only after some delay, and may vary inform and degree. They may affect all staff who expe-rience them or only some staff. Even team memberswho did not directly experience the traumatic eventsmay be affected. However, the ‘culture’ of humanitarianaid work often leads to aid workers denying or minimi-zing the distress they are experiencing or resistingefforts at providing them support. The response of theagency should be contingent on the occurrence of theevent, not the expressed distress of team members.

Front line managers and supervisors necessarily providethe immediate responses to critical incidents, both forthe staff members directly affected and for the teamas a whole. This may include psychological first aid,psychoeducation about the effects of extreme stress,and assessing individual and team responses. However,helping others deal with traumatic stress, whether dueto direct exposure to traumatic events or due to ‘secon-dary’ exposure, requires specific training and specialistknowledge. Neither field managers nor psychosocialworkers normally have such training. The agencyshould employ or contract with specialists in suchinterventions to provide assistance when it is needed.

Principle 6The agency provides staff with specific and cultu-

rally appropriate support in the wake of critical or

traumatic incidents and other unusual and unex-

pected sources of severe stress.

The agency ensures it is promptly informed about any extremely traumatic

experience that happens to one or more staff members and is prepared to

respond immediately.

Crisis Support

Case

A national staff member is working in a tsunamiaffected area in Sri Lanka fifty kilometres from hishome town which was also decimated by thetsunami. He needs the work because his familyhas no other form of income and has lost most oftheir possessions and livelihood. Colleagues haveobserved that he often shouts out in his sleep andeasily forgets details of his tasks. His female teammanager invites another male colleague (from anearby region and of an allied community group)to talk with him to identify his support needs andto suggest that he consider some healing

support from a person or source that he wouldconsider to be most helpful in order to help himreduce his levels of stress and grief reactions andthe impact of his traumatic memories. Furthermore, she organizes a team meeting to dis-cuss the impact of the day to day stresses on thepersonal wellbeing of all staff members and sugge-sts to meet as a team in an ongoing way at leastonce a week. The team manager also invites astress and trauma specialist in the local area tocome in and deliver some psychosocial educationabout stress and trauma responses.



Comments

It is easy to recognize the stresses of humanitarian aidwork itself. The stresses associated with ending serviceand or returning home are more subtle, but can never-theless be problematic. They include the pain of sayinggoodbye to people you have worked with closely, theconcrete tasks associated with relocation, and thepractical, interpersonal, and cultural difficulties inreadjusting to life ‘back home’ or in a new assignmentor new job.

Ending an assignment (whether in a planned orunplanned way), involves the need to attend to amyriad of practical tasks. These may include comple-ting assignment reports, conducting hand-overs, findingnew housing, finding a new job or identifying a newassignment, dealing with professional issues such asupdating credentials and licenses, dealing with healthissues and insurance, for international staff, copingwith reverse culture shock and attending to homeresponsibilities. This can be a stressful process espe-cially when feeling tired at the end of an assignment.Staff members should be encouraged and providedassistance in developing a re-entry plan.

An operational debriefing focuses on what the staffmember observed, experienced and learned duringtheir assignment, and how potentially the organizationcould benefit from this experience. Although an opera-tional debriefing is not explicitly concerned with stressmanagement, the experience of feeling listened toabout field experience and reviewing agency practicescan also reduce stress in the individual staff member.

By contrast, a more formal personal stress assessmentand review focuses on how the worker has respondedto the stresses they experienced during their period ofservice. It may explore what their experiences were,what their thoughts and feelings about these experien-ces are, and how they are dealing with those thoughtsand feelings. It focuses especially on their currentemotional state and any needs they may have forongoing support or other interventions. It includesfurther education about the possible delayed impactof stressful experiences on an individual. Stressassessments and reviews should not be dependent onthe staff member having experienced unusual stresseson the job.

In a stress assessment and review, an employee isasked to be open about personal feelings about theirwork. This can only be done in an atmosphere ofconfidentiality, in which the employee feels assuredthat their reactions will not affect their possibleongoing employment by the agency. They should al-ways be conducted by someone appropriately trained.

Unplanned endings whether the result of evacuation,an unanticipated termination of a program, or a staffmember’s personal needs can present special pro-blems. After an unplanned ending it is usually helpfulfor staff members to be given support in assessingtheir own needs and creating a personal managementplan.

A staff member is faced with many challenges over thecourse of weeks or months following the end of theirassignment (e.g. home relationships, social adjust-ments, vocational changes, delayed grief and fatigue).Follow up by the agency, with referrals to services anddevelopment of peer support networks may reduce theresulting stress.

Principle 7The agency provides practical, emotional and cul-

turally appropriate support for staff at the end of an

assignment or contract. This includes a personal

stress review and an operational debriefing.

Leaving an assignment, returning home or transferring to a new assignment

can often be an underestimated and challenging experience and staff members

need to be adequately prepared for it.

Indicators

1. The agency has a program for assisting staff mem-bers who are completing an assignment to preparefor the stresses involved in leaving a project andreturning home (or taking on another assignment).

2. All staff members are offered an exit operationaldebriefing at the end of their assignment or con-tract.

3. All staff members have access to a personal stressassessment and review at the end of their assign-ment or on an annual basis. a. the assessment is conducted by someone who is

not associated with human resources manage-ment within the agency;

b. the agency agrees that the staff member’s confi-dentiality is maintained with respect to stressassessments and reviews.

4. The agency has standing arrangements to makepsycho social services available for staff members inthe wake of an evacuation or other premature orunexpected termination of a project or contract.

5. The agency has an explicit commitment to providepractical support to help employees make necessaryarrangements associated with relocation after anevacuation or other premature or otherwise unex-pected termination.

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Indicators

1. The agency has a clear policy aimed at monitoringand supporting employees who have job stress-related disabilities such as burnout, severe stress,compassion fatigue or post trauma symptoms.

2. The agency has developed policies for employeeswho are unable to continue working for the agencydue to job-related stress or injury.

This addresses issues such as continuation of salaryand benefits and provision (or financing) of medicaland /or psychosocial support services.

Comments

Humanitarian aid agencies’ activities place their workersat significant risk of physical injury, stress and fatigue oradverse psychological effects. On occasion, these maymake continued work in the field problematic. Nationallaws vary in the requirements they place on employersin such circumstances and in the practical supports(e.g., income, health care) provided by the governmentitself. Regardless of national law, humanitarian aidagencies make all efforts to ensure that staff memberswho are physically or psychologically disabled as aresult of their work for the agency can continue inemployment. This may require assigning the staffmember to a position in which they are less exposed tosignificant stress or trauma, for whatever time isrequired for recovery.

Humanitarian aid agencies duty to provide humanita-rian aid to those in need extends to their own workers.In some cases, the extent of disability may make itimpossible to offer ongoing employment. Agenciesmay provide disability insurance coverage to fill ingaps in governmental programs of support and insistthat health insurance coverage for their staff includesadequate coverage for mental health services andincludes provisions for the employee to maintaincoverage if they are no longer employed by the agency.

Because of the many different national laws applyingto agency staffing various countries, the agency givesespecially careful attention to the impact of theseissues with regard to national staff.

Principle 8The agency has clear written policies with respect to

the ongoing support they will provide to staff mem-

bers who have been adversely impacted by exposure

to stress and trauma during their assignment.

While laws in effect in many countries may provide a minimal level of

protection or support for disabled workers, the agency itself evaluates

what support it owes its staff.

Post Assignment Support

Case

A manager and his team are evacuated fromColombia after one of many violent outbursts inthe town where they are working and living.Several of their national staff colleagues wereseriously injured in the rioting and they weredevastated to leave them behind. The managerhimself was hit by a stray stone on the back of hershoulder which could easily have hit her head.The agency is making arrangements to leave thecountry for the medium term. The manager issurprised by his very emotional reaction to thisevent and cannot stop thinking of the best way toreturn to this town to resume working with ‘his’local staff. Sometimes in the middle of the day, heimagines the distressed faces of the local stafflooking up at the helicopter as they are evacuating.The agency at headquarters arranges for the

manager and his team to meet with a mental healthand trauma specialist who also has knowledge ofworking in a humanitarian context. The agency wants to find out what happened tothe town after the evacuation and tries to makecontact with the national staff that remained there. The manager gets paid leave for a three monthperiod and provides ongoing confidential counsel-ling. They also arrange his full medical check-up.They offer the same package to the team. The HRmanager regularly makes contact with thismanager to check how things are going and a morecomprehensive review of his health is arranged atthe end of the three month period.The situation for the national staff membersremains very insecure and the agency tries to iden-tify ways to extend support to them as well.


General information on the Antares Foundation:

Mission statement

The mission of the Antares Foundation is to improve the quality of humanitarian assistance and overseasdevelopment through advice, training and support.

Antares’ areas of work

Training & Support• Assistance with designing staff care and psychosocial support systems within humanitarian organizations for

international and national staff.• Stress & security briefing and debriefing for field staff.• Training and coaching in stress management to national and international NGOs.• Direct psychosocial support after critical incidents and prolonged severe stress in teams.

Management supportTo the managers of humanitarian organizations the Antares Foundation offers project-analysis and evaluation,tools for project management and direct coaching and support in the field.

Consultancies• Assessments of management systems, HRM systems, psychosocial support systems or any particular issues

related to project management.• Project evaluations: management and staff care issues and of mental health projects.

ConferencesAntares organises international conferences or workshops in Amsterdam on a yearly basis on Managing Stress ofthe Humanitarian Aid Worker.

Research & PublicationsThe Antares Foundation cooperates with academic institutions in research projects and in developing psycho-social systems and professional management tools.

Advocacy & LobbyTo raise awareness of the urgency of her mission the Antares Foundation develops guidelines, models, educationmodules and raises awareness amongst NGOs and donors.

For further information, please look at our website www.antaresfoundation.org or contact the Antares Foundation,see address below.

W.G. Plein 269, 1054 se Amsterdam, The Netherlandsantares@antaresfoundation.orgwww.antaresfoundation.org telephone +31(0)20 3308340, fax +31(0)20 4221320Bank account: 39.38.16.966Chamber of commerce Amsterdam number: 34115815

Antares Foundation: advice • support • training

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Alastair Ager, Columbia University, New York, USAAmanda Allan, Antares Foundation AustraliaTon Berg, Antares Foundation, the NetherlandsAnnemiek Buskens, Antares Foundation,the NetherlandsMarilyn Disirio, CDC, USAJohn Ehrenreich, State University of New York, USABen Emmens, People in Aid, UKCynthia Eriksson, Fuller Theological Seminary, USAJohn Fawcett, Consultant, New ZealandErik Flapper, Antares Foundation, the NetherlandsDavid Foy, Fuller Theological Seminary, USAFrida Ghitis, International Insights, Inc., USAMax Glaser, Consultant, the NetherlandsDerk de Haan, Consultant, the NetherlandsTon Haans, Consultant, the NetherlandsHanneke Hoogstrate, Consultant, the NetherlandsJan Janssen, Eleos, the NetherlandsJana Javakhishvili, FDHR, GeorgiaReinhard Kaiser, CDC, SwedenBarbara Lopes Cardozo, CDC, USAErik Mispelblom Beyer, Antares Foundation, the NetherlandsViola Mukasa, Consultant, Uganda

Miranda Olff, AMC, University of Amsterdam, the NetherlandsTineke van Pietersom, Antares Foundation, the NetherlandsJonathan Potter, People in Aid, UKBert van Ruitenbeek, Cordaid, the NetherlandsMiriam Sabin, CDC, USANodar Sarjveladze, FDHR, GeorgiaJack Saul, International Trauma Studies Program, USAPim Scholte, AMC, University of Amsterdam,the NetherlandsRolf Schwarz, De Geestgronden, the NetherlandsLiz Sime, Care USAWinnifred Simon, Antares Foundation, the NetherlandsPriya Stocks, Antares Foundation, the NetherlandsLeslie Snider, Tulane University, USAJasminka Tadic-Husanovic, UHD Prijatelijice, Bosnia and HerzegovinaAlbertien van der Veen, MSF-Holland, the NetherlandsJan Vorisek, GIP, GeorgiaJos Weerts, Dutch Veteran Institute, the NetherlandsFrans Wierema, Cordaid, the Netherlands

AcknowledgementsWe thank the following persons for their ongoing contributions:


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