‘It was a long time before I admitted to myself that I’d nearly died’
I didn’t realise how my work affected me at the time. Within five months of arriving at my new post, I had been in a plane accident and nearly died of malaria. Though it was a long time before I admitted to myself that I’d nearly died, I had a few small breakdowns and would start crying about something that seemed trivial. I sometimes felt trapped in my town, which was accessible only by plane. My organisation had a counselling line I could call and those people listened but had zero experience with people working in humanitarian settings.
I’ve now been in the industry for a decade and I can’t believe the lack of security protocol we had then. I left because I felt that the aid agency wasn’t well placed to support the kind of work that they had me doing. I sought counselling but didn’t pursue it because I didn’t want to spend my own money. Several years later I decided to see a therapist for a few reasons and was able to better understand that I had experienced stress, anxiety and mild PTSD. I’m glad I’ve been an aid worker and that I still work in humanitarian settings, but organisations need to take better care of their staff.
‘The feelings of fear, confusion, shame and anger remained and even festered’
The organisation I currently work for handled my PTSD impeccably, both informally and formally. I was fully supported with counselling and was given sick leave with full pay. I feel the way it was dealt with genuinely saved my life.
However, this is the sixth international non-governmental organisation (INGO) I have worked for and the first time I have experienced anything near this level of support. Several years ago I went through a number of highly traumatic experiences in a short space of time and was clearly demonstrating symptoms of PTSD. The organisation that I worked for at the time, rather than offer support, tried to make me accept blame for the things that happened to me. They were clearly trying to cover up negligence on their own part and this was confirmed when I heard a security evaluation of the events that had happened to me found the organisation’s security management had been seriously lacking. I was accused of insubordination and immaturity when I said I did not feel that my safety was being adequately managed. My contract was not renewed. I then took five months off from work in a spiral of depression, anxiety and confused anger.
I eventually went back to work and was able to put some of it behind me, but as it had never been properly dealt with some of the feelings of fear, confusion, shame and anger remained and even festered – I was short tempered and easily spooked. It wasn’t until I got full-on PTSD again at the end of last year after a series of violent incidents in a conflict zone, and was given the support that I needed by my current organisation, that I realised how traumatised I had been and how great the lasting impact was. It’s hard not to resent my previous organisation for the years of guilt and anger.
‘The best support we received was from each other’
During a traumatic experience for my colleagues (several were abducted and executed) and I last year, I felt a massive lack of mental health support. What can be best defined as tokenistic support was made available to staff. But it was brief, late and hugely insufficient. As a senior manager I could not participate in the one group support session (in case colleagues may not be comfortable speaking up in front of me), and I was offered no other support. Overall, the total mental health support was inappropriate. Instead the best support we received was from each other.
‘We all had coping mechanisms – negative and positive’
I was on the frontline of a lot of events and issues related to conflict and insecurity that arose during my time in the field. Crossfire, shelling in the camp, wounded soldiers, triage, attacks on humanitarian workers, threats against myself and others, lack of water for the internally displaced people and us for more than 36 hours (a tank drove over the pipeline) ... there’s a long list.
There were times I thought I was going to die. I lived in a compact, isolated environment along with an amazing group of humanitarians, and we all had coping mechanisms – negative and positive. I felt cared for by individuals in my organisation, if not necessarily always psychologically looked after in the best way as NGOs struggle with making psycho social support more than a tick-box exercise.
Because of the high turnover in the field I think it’s easy for organisations to forget people and the things they went through. The mental health issues such as depression, anxiety, sleep disorder and issues with reintegration came after I left the field. I dealt with it in my own way and think there will always be a part of me that will. Once you leave the organisation, it’s hard to get care unless you have identified issues beforehand, and have it organised through them before your contract is up. Meaningful action on this issue will not happen until it becomes mandatory for donors to fund NGOs to provide this follow up care as a standard part of their budgets and HR policies.
‘After two weeks I collapsed in the field’
I spent four months on a project in west Africa under difficult political circumstances. I then commuted every month from London as funding didn’t allow for a permanent position. The travelling on weekends and work during the week, as well as splitting time between two continents led to a gradual social isolation. The feeling of restlessness and fatigue started to take its toll and I spent more and more time alone.
Instead of taking a break, I applied for a transfer to South Sudan where I thought life would be more stable and support systems would be better, especially as more people of my organisation were based there. However, after two weeks I collapsed in the field. I took immediate sick leave, but left to my own devices in my room and in the hospital in Juba I just wanted to get out of the whole situation. I also felt an element of shame, afraid of being judged that I “couldn’t handle it”.
In this very fragile state I decided to hand in my notice instead of speaking out and seeking support. I am still coming to terms with what happened, the financial loss and coping with finding a new job.
I wish I had been more honest with the organisation I worked for, demanding better support and making sure that this does not happen to other young idealistic aid workers who put the job first and their wellbeing second.
‘Family and friends could not fathom what he had been through’
I think this [mental health] is a huge, hidden and important issue. I have worked in the sector for about 10 years and have many friends and colleagues working in the sector. I have witnessed many of the issues you have mentioned [in the survey] including people I know feeling isolated, overworked, underpaid and extremely affected by feelings of guilt, apathy, cynicism and hopelessness because of the difficult circumstances they have worked in and witnessed.
My partner worked in Haiti during the time of the 2010 earthquake. He continued to work and received little or no care from his organisation at the time or after. Over a period of several years he experienced extreme stress compounded by a delay in processing his experience, as well as anger, guilt, and I would suspect undiagnosed PTSD.
He did not know how to handle this, and as his partner neither did I. The relationship suffered, as did many of his other close relationships with family and friends who could not fathom what he had been through. As his partner I experienced extreme anxiety, and a feeling of hopelessness in terms of being able to help him, as well as the stress of a relationship breakdown. I don’t think these experiences are unique.
‘I am in no way an exception within the sector, which is what I find most disturbing’
I was never diagnosed with mental health issues by a professional, but I have identified signs of PTSD and burnout myself. I left my last position and organisation because of the lack of attention to mental and physical wellbeing and I am happy to say I found an organisation that seems to place more attention to these issues. In over five years of field work, I have experienced direct threats to my life, lived in extremely insecure conditions with strict security measures which led to isolation, sustained unreasonable rest and recuperation (R&R) policies and worked an average of 60-65 hours per week for over three years without significant breaks. I am in no way an exception within the sector, which is what I find most disturbing.
‘I couldn’t sleep, but I was always tired’
I worked on the response to the Pakistan floods. We all worked outrageous hours – 18 hours a day, no weekends. I cried. I couldn’t sleep but I was always tired. I took a variety of prescription meds without a prescription to make myself sleep. I couldn’t disconnect. I worked every day. I lost my temper at work. I stopped doing the things I loved. I stopped seeing my friends. I only worked.
After about eight months of this insanity, I was incapable of doing my job well. I broke down during in my performance appraisal and my line manager suggested I resign. I did. My friend said at the time: “I know how you feel: like a lemon. Cut in half, squeezed, and thrown away”, and I did. I took time off and got a part-time job but I couldn’t concentrate and I had short-term memory loss. I went to a counsellor, who referred me to a psychiatrist. I was diagnosed with depression, and started taking antidepressants. As for the short-term memory loss, my doctor said I had damaged my hippocampus and that with two to three years of sleeping properly and not getting stressed, I might get better. But I’ve never really gotten back the capacity to work like that, not even for a day or a week. I’ve never felt as sharp as I did before that.
‘Staff are expected to go home and return to life within “normal” society’
Most aid workers are prone to burnout and many that I have worked with have PTSD. Little or no psychological support is provided post- or pre-deployment to help aid workers deal with these issues. While organisations expect their staff to have “coping mechanisms, adapt to stressful environments, work long hours in basic conditions”, no support is provided for staff to be able to do so. Working in conflict-affected countries in these conditions, staff are then expected to go home and return to life within “normal” society without any reintegration support. Many organisations have a hotline that staff can call to talk to a psychologist in another part of the world that they have never met - but this is simply a tick-box process. INGOs need to place additional focus on the wellbeing of their staff and provide obligatory psycho social support sessions.
We will be continuing to explore the issue of mental health and well being in the aid sector this week on Global Development Professionals Network. You can follow the coverage here. Get in touch on globaldevpros@theguardian.com if you would like to comment on the topic.
- If you have been affected by the stories in this article, the Samaritans can be contacted on 116 123 in the UK. If you live outside the UK, a list of organisations providing support internationally can be found here.
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