Aid workers operate in harsh environments and find themselves in the most unimaginable of situations, witnessing human suffering. They could be caught up in civil violence in South Sudan or be providing support during post-earthquake recovery.

"A few weeks after arriving home from the Philippines, I found myself bursting into tears one evening when out with friends," says Jessica*, who has covered humanitarian crises in Indonesia and Pakistan. "I thought I was just relieved to be in a social situation after a long time of living a closed-in type of life. I realised it was something more serious though, because I had been drinking more wine than usual following my return. It helped to block out some scarring memories."

Jessica's experience is common, especially among field staff deployed to isolated areas. Plenty has been written about how the energy sapping nature of the job can lead to burnout; but not so much on post-traumatic stress disorder (PTSD). The lines between the two are blurred. Burnout, if not dealt with, can develop into something serious like PTSD. The three common symptoms of PTSD are hyper-alertness, avoidance of reminders of the traumtaic event and intrusive memories.

The Antares Foundation suggest that around 30% of aid workers report significant symptoms of PTSD upon returning from assignment. Others put the figure at 5 to 10%. If this is to be believed, it means that between 70-95% of aid workers have the mechanisms to cope. For those that do experience PTSD, is it a case of lack of preparation or are they not suitable to the job?

The majority of large NGOs offer staff pre-deployment stress management workshops and provide them with coping skills and counselling. But, psychologist Gwen Vogel argues the development sector should be doing more. Vogel is also director of clinical and international services at Salus World, an NGO focused on treating mental health issues among populations recovering from large-scale trauma.

"Some aid workers feel the support options offered to them are either inadequate (time-limited or inaccessible), ill-fitting (the available clinicians or programmes offered don't understand or tackle the issues faced) or unsafe (they fear that a call for help could result in professional blemishes on personnel records)," says Vogel. "Others believe support offered, like a list of self-care tips or brief rest and relaxation, is too simple."

One of the main problems is that workers don't always recognise trauma symptoms, despite advice given to them by employers. Vogel says they may be "unaware it is happening and they often find themselves 'chasing the next crisis'" in the hope of "re-experiencing the feeling of satisfaction they originally experienced when they signed up to do the work". When this happens workers "stop responding to the human suffering", which impacts on the validity of the support they're providing.

Should being able to spot the onset of PTSD, or secondary trauma (STS) – where the aid worker has not experienced trauma directly, but has been affected by dealing with others who have – be a prerequisite of the pre-deployment process?

InterHealth advises that NGOs rethink their recruitment policies to reduce the potential level of trauma and PTSD among staff and employ only those who have the qualities to be resilient. Larger organisations (such as Oxfam Australia) are better equipped to deal with this and may already have such policies in place.

Smaller NGOs that are less likely to have such policies can receive support elsewhere. The Achilles Initiative for instance provide trauma management training programmes to increase the psychological resilience among NGO staff. Aid workers and emergency responders can also receive direct support during missions, via online tools that can be accessed remotely, provided by organisations like the Headington Institute. They offer training modules in multiple languages on how to spot trauma and how to deal with it and hope the guides can prevent the onset of PTSD.

If NGOs fail in their duty of care to their employees, it not only has an impact on staff turnover, but it reduces the quality of the work they are doing. Preventing PTSD means that organisations are better prepared for future humanitarian crises.

Six tips on how to prevent PTSD for development workers

• Read and listen to resources provided by organisations like the Headington Institute and InterHealth before you head out on assignment.

• Encourage your organisation to set up regular meetings to confidentially discuss wellbeing.

• Be aware that it is normal to be disturbed and feel slightly stressed.

• If you're concerned that your stress could be something serious, avoid excesses (alcohol, drugs, sex) which could exacerbate the condition.

• Learn to take yourself out of the situation when you start to feel disillusioned – your wellbeing could affect the quality of your work and put those you are supporting at risk.

• Find out which intervention method (for instance, peer counselling or rest and relaxation) is best for you.

* Name changed due to sensitive subject matter

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