|Year : 2018 | Volume
| Issue : 1 | Page : 38-45
‘Our NGO family has suffered a tragedy, and we will survive.’ Evaluating a crisis response intervention with expatriate aid workers in Afghanistan
PhD, MSW, MPH, Assistant Professor, McGill University School of Social Work, Montreal, Canada
|Date of Web Publication||28-Mar-2018|
McGill University School of Social Work, Montreal
Source of Support: None, Conflict of Interest: None
In 2008, Taliban forces killed four aid workers in Afghanistan. Immediately afterwards, expatriate and national field staff undertook crisis management activities on the ground. While this was a devastating event, field and headquarters staff agreed that the organisational response to the crisis was positive. Nine months later, 19 expatriate staff members involved in the crisis response participated in an evaluation to reflect on personal and organisational factors that contributed to their post crisis resilience. Results suggest that clear security protocols, crisis simulation preparedness training, team cohesiveness, strong leadership, staff mobilisation, well timed psychological support and support from managers may all contribute to staff resilience in high stress environments. Recommendations are offered to the international nongovernmental organisation community seeking to support staff following critical incidents.
Keywords: Afghanistan, crisis response, critical incident, humanitarian aid workers, resilience
|How to cite this article:|
Kahn S. ‘Our NGO family has suffered a tragedy, and we will survive.’ Evaluating a crisis response intervention with expatriate aid workers in Afghanistan. Intervention 2018;16:38-45
|How to cite this URL:|
Kahn S. ‘Our NGO family has suffered a tragedy, and we will survive.’ Evaluating a crisis response intervention with expatriate aid workers in Afghanistan. Intervention [serial online] 2018 [cited 2019 Feb 20];16:38-45. Available from: http://www.interventionjournal.org/text.asp?2018/16/1/38/228772
Key Implications For Practice
- Pre crisis team cohesiveness and trauma informed crisis management training can promote staff resilience following critical incidents
- Immediately post crisis, strong leadership conveying hope and compassion and providing clear assignments can give staff members a sense of purpose and mitigate helplessness
- Culturally matched, psychosocial support should be integrated into crisis intervention strategies for staff affected by critical incidents, tailored to the stages of recovery
| Introduction: background|| |
The proxy war between the USA and the Soviet Union in Afghanistan, from 1979 to 1989, produced six million refugees who fled to Pakistan and the USA. One million Afghans were killed and 80% of the remaining population was displaced to escape the war and severe drought (Iqbal & Lipson, 2017). Shortly after the Soviet invasion, in December 1979, a large international nongovernmental organisation (INGO) based in the USA began assisting Afghan refugees in Pakistan. After the Soviet withdrawal in 1989, operations were expanded to Afghanistan, continuing even under the Taliban, who took over the country in 1996. When the Taliban was ousted in 2001, the organisation intensified its programmes, especially in education. By 2008, 500 Afghan nationals and 10 expatriates were working with the organisation’s programmes.
That summer, a senior manager of the organisation’s security staff conducted crisis management training for senior expatriate and national staff. The day after the training, Taliban forces ambushed and killed five staff members who were travelling back to Kabul from a work site in the provinces. Only one—an Afghan national driver—survived. On learning of this incident, the programme team in Kabul, senior managers at the USA headquarters and regional managers for Middle Eastern and African programmes began crisis response activities.
The visiting security manager initially led the Kabul team in implementing the plan they had practised only the day before, then handed over leadership to the team leader. At headquarters, senior managers divided up tasks, including liaising with regional and Afghan sites, interacting with the families of the deceased, communicating with the media and the international community and coordinating return of the bodies. Approximately 60 hours post incident, three senior managers from the USA based headquarters arrived in Kabul, the organisation’s crisis counsellor (the author) arrived in Kabul shortly thereafter.
Nine months post incident, the author evaluated the crisis response process and the outcomes of the intervention in terms of individual wellness, job retention and attitudes toward the organisation and aid work in general. The analysis presented here includes reflections of expatriate staff in the organisation’s Afghanistan programme. It also includes perspectives of managers from headquarters and regional offices who provided post incident support to the Afghanistan team. The purpose of this case study is to examine the strengths and weaknesses of the crisis response and to offer lessons learned that may be applicable to other humanitarian organisations.
| Humanitarian workers in high stress and increasingly dangerous environments|| |
Until recently, humanitarian workers were considered neutral parties immune from attack during armed conflicts (Barnett, 2011). However, as armed rebel groups and insurgencies by foreign powers have increased, ‘humanitarian safe space’ has virtually disappeared; the real and perceived militarisation of aid relief has led to deliberate targeting of aid workers by renegade factions and state actors (Fast, 2010). The well documented resulting risks to humanitarian workers include threats of violence and death, bombings, shootings, physical and sexual assaults, kidnappings, banditry and accidents (Egeland et al., 2011). The year 2013 saw a 66% increase in attacks, driven primarily by the humanitarian crises in Syria, South Sudan and Afghanistan. In that year, 460 aid workers were victims of violence, including 155 who were killed (Stoddard et al., 2014).
| Impacts of psychosocial stress|| |
In addition to threats to safety and security, humanitarian workers experience a range of other day-to-day stressors, including: separation from friends, family and support resources; staff conflicts; lack of boundaries between work and private life; restricted freedom of movement; insufficient training and orientation; lack of clear procedures; and, a hostile host environment (Eriksson, Bjorck, & Abernethy, 2003). Day-to-day work related stress has long been known to result in symptoms of job burnout, including irritability, withdrawal, cynicism, difficulties with relationships, substance abuse, concentration and memory impairment, headaches, backaches, hypertension and heart disease (Freudenberger, 1974).
To date, few studies have documented psychosocial distress in expatriate workers exposed to traumatic events. Eriksson et al., 2001 found that of 113 returned expatriate staff from five humanitarian aid organisations, approximately 30% reported posttraumatic stress disorder (PTSD) symptoms. Holtz et al., 2002 reported that human rights workers who had worked six months or longer, or experienced an armed attack or local violence, were most at risk for elevated anxiety. Exposure to traumatic events has been shown to be a significant factor in post deployment depression in humanitarian workers (Cardozo et al., 2005). A study of 212 aid workers from 19 NGOs found that extraordinary stress increased burnout, while chronic stress during deployment contributed to depression, and that workers with mental health histories are also at increased risk for anxiety (Lopes Cardozo et al., 2012). Burnout in humanitarian workers may reduce staff productivity and effectiveness, compromise staff security in the field, increase healthcare costs and legal liabilities for employers and impede staff recruitment and retention (Antares Foundation, 2006).
Data suggest that social support and organisational services can mitigate the negative physical and mental health impacts of day-to-day and critical incident stress. Eriksson et al. (2001) found that even when aid workers experienced high traumatic event exposure, strong social support helped minimise their severest symptoms. Across studies, authors have identified recruitment for hardiness, adequate training, strong leadership and supervision in the field and access to psychosocial resources as important mediating factors for preventing psychological distress and supporting resilience in humanitarian workers, including those exposed to traumatic events (Cardozo et al., 2005; Ehrenreich, 2005; Shah et al., 2007).
A growing body of research documents the relationship between staff resilience, effective security procedures and team cohesion (Eriksson et al., 2013), ongoing wellness support (Ehrenreich & Elliott, 2004), strong leadership (Wigley, 2011) and post mission reintegration (McCormack, Joseph, & Hagger, 2009). Few extant studies invite aid workers, and those who support them, to reflect on the experience of these elements following an incident of targeted violence. This study contributes to this growing body of knowledge by providing accounts of the experiences of aid workers involved in a critical incident and their organisation’s response to it.
| The case study|| |
Programme evaluation design
This case study method provided a structure for participants to reflect on their personal experiences regarding the critical incident and its aftermath. The hallmark of case study design is its focus on a single unit, whether an individual, organisation, community, or event (Anastas, 1999). Case studies incorporating qualitative methods provide insider perspectives of real life events and processes (Creswell, 1998) and may be effective means of exploring processes and outcomes of programme interventions (Stake, 1995).
The author conducted 19 in-depth interviews between May 2009 and July 2009 with all eight expatriate staff members based in Afghanistan at the time of the incident, 11 managers who had either been deployed to the field or based at USA headquarters, and four members of a technical team based in the USA headquarters who were coworkers of the deceased staff members. The organisation requested that national staff members not be included in the post incident case study in order to protect their privacy and safety, and reduce exposure to retaliation and threat.
Semistructured interview questions were developed from preliminary conversations in May 2009 with senior staff at headquarters and staff in the Afghanistan office. Questions were based broadly on the crisis response phases described by the International Association of Emergency Managers (IAEM) (2007): pre crisis or mitigation, crisis preparedness, crisis response and crisis recovery. Pre crisis or mitigation activities prevent or minimise losses from crises; preparedness is derived from plans and capacities for disaster response; crisis response is the immediate reaction to a crisis; and recovery aims to restore personal and organisational functioning post incident (IAEM, 2007). Interviews were conducted in person where possible, and otherwise by telephone and Skype. Interviews lasted approximately 90 minutes and were audio recorded and transcribed. The case study was reviewed by the organisation’s research ethics board and adheres to its protocols and requirements.
Transcripts were analysed by the author according to the recommendations of Stake (1995). For Stake, a case is ‘a specific, a complex, functioning thing,’ an ‘integrated system’ with ‘a boundary and working parts’ (Stake, 1995, p. 2). In this instance, the crisis preparedness, response, and medium term aftermath for an INGO’s programme in Afghanistan represented the case. Data analysis began immediately and continued simultaneously with data collection. Both direct interpretation (finding meaning in a single instance) and categorical aggregation (amalgamation of instances until a class or a theme is identified) were used to find patterns in the data. The author also looked for patterns occurring between two or more categories. Finally, naturalistic generalisations were made. In order to provide overall context, a description of the case and its facts (Creswell, 1998) was also employed. The analysis generated eight themes, coinciding with the broad phases of pre crisis mitigation and preparedness, crisis response and crisis recovery. The themes included: trust, training and team cohesiveness; hope, mobilisation and purpose; feeling supported and valued; psychological support; collectively grieving; declining and ‘crashing’; divergent perspectives of security; and reconciling, healing and moving on.
| Findings|| |
Pre crisis mitigation and preparedness: trust, training and team cohesiveness
All senior managers noted that the longevity and quality of the organisation’s commitment to Afghanistan and its people had fostered a deep sense of mutual loyalty between the organisation and Afghan national staff, some of whom had been with the organisation for decades. The result, as one participant observed, was a feeling of family that ‘mirrored the Afghan culture’s valuing of family and tribe.’ Furthermore, participants credited their team leader for building a strong, cohesive country team. They noted how valued they felt working in an environment where ‘everyone was respected for what they did,’ with a reliable and caring team leader. Some expatriate workers in the study mentioned chafing at the strict security protocols, radio check-ins and curfews, but felt that such serious attention to security helped them feel that the team leader was committed to their safety.
All participants noted how vital the crisis management simulation training was in preparing for, and responding to, the crisis. Several expatriate staff participants said that the crisis training was especially useful in establishing a crisis management team comprised of both Afghan national and expatriate staff, and clarifying their roles and responsibilities. Managers from the regional office and headquarters highlighted the strength and psychological preparedness of the Afghan national team. Several managers observed that the Afghan team was prepared to handle crises because of their years of experience working within a high risk environment.
Hope, mobilisation and purpose
At the time of the incident, the team leader was in transit and could not be reached for several hours, and the security manager was at the Kabul airport preparing to leave Afghanistan. For a short time, the team had no designated leader. Participants noted that in these initial hours, the team’s cohesiveness was strong. Expatriate and Afghan national managers naturally moved into their crisis management team roles and established a positive climate for the unfolding crisis response. According to one expatriate staff member present at the time:
‘They demonstrated extraordinary sensitivity and gave space to each other, so each could focus on what needed to be done. It lent an air of confidence and direction to other staff, conveying that there were still people at the helm, and the sense that “we’re going to make it.”’
When the security manager returned to the organisation’s office from the airport, she assumed the role of crisis manager. She recalled:
‘I took a deep breath and said, “We’ve had a tragedy today. It’s shocking, it’s terrible. However, we will be doing three things: first: we will stop out of respect for our colleagues and manage the immediate crisis; then we will suspend our programmes to learn what we can do and heal; thirdly, all families suffer tragedies, our organisation’s family has suffered a tragedy, and we will survive.” I knew, instinctually, it was the right thing to say to create cohesion.’
At that point, the security manager reported, the mood of the meeting changed: ‘the faces in the room changed, the body language shifted. Staff members started asking what they could do to help.’ The security manager emphasised the importance of conveying messages of hope and belief in the team’s capacity to perform even in the darkest of times: ‘[You’ve got to] create a positive vision for hope, and keep pointing everyone to it. If people have no hope, they stop.’ The crisis management team engaged in their specific tasks, including retrieving the bodies of their colleagues and organising autopsies, coordinating the return of the bodies to the next-of-kin and coordinating itineraries and visas for expatriates attending funerals in North America. Expatriate staff without specific tasks were requested to formulate ideas for memorials for their colleagues. Others were asked to ensure that all staff had water, food and comfort items. Several staff who were not on the crisis management team mentioned the positive impact of being assigned specific tasks, as one described: ‘the first day I felt useless. There were thoughts of “I can’t do much, so I have to think about it all day.” But the next day I helped with the press release and planned the memorial service. That gave us something to do.’ The security manager explained, ‘if you treat them like victims, they will act like victims.’
Feeling supported and valued
Two days post incident, the team leader returned. Several participants noted feeling that a supportive and trusted manager was back at the helm: ‘it was a boost: we were all starting to run on low batteries.’
The majority of the participants expressed appreciation for the visit by senior headquarters staff and a regional manager. Their presence was especially valued for handling external relations, including interactions with the media and the international community in Afghanistan and at the initial meetings with family members of the Afghan drivers (one was killed and one had been injured). One staff member noted, ‘it was important for us and our national team to see senior HQ staff. It felt like someone was taking notice and valuing us. We hadn’t been abandoned.’ Another described the swiftness of the response as ‘remarkable.’ Two expatriate managers, however, observed that visitors also created a burden for staff. One reported:
‘We feel that we have to entertain you, take you out to dinner, take you shopping. Visitors are great, but we have to get involved in hosting. Even if they’re staying at a hotel, we have to make sure they’re eating, that they’re safe. It creates a lot more work for the national staff especially.’
All expatriate staff members in the study praised the response from the Afghan national staff, finding their fortitude and resourcefulness ‘awesome’ and inspiring. One was struck by the Afghan national team’s sense of responsibility for the event: ‘after [the incident] they felt as if their guests had been killed, that was their attitude. They were, in their own way, taking care of us.’
The crisis counsellor arrived on the ground three days after the incident, shortly after senior managers from headquarters and the regional office. At that time, surviving expatriate staff members were preparing to leave Afghanistan to attend their colleagues’ funerals. All participants agreed that having psychological support immediately after the crisis, in the form of psychological first-aid group meetings and optional one-on-one sessions, was helpful for: (1) normalising emotional and behavioural reactions; (2) preparing for a possible post incident ‘crash’; and (3) understanding the diversity of individual grief reactions and recovery. Several participants mentioned the value of discussing strategies to address the reactions of family and friends to the incident. One participant noted: ‘it was good to discuss not only about your own mental state, but the mental state of your family and friends and what you can expect. Also, how it will feel to re-enter society.’
All expatriate participants mentioned that the length of time the crisis counsellor stayed in the country (five days) was too short and the timing of the visit less than optimal. According to one staff member, building a relationship with the counsellor under such circumstances was difficult:
‘I feel like the visit was very brief. It was hard to build a rapport and talk about much. And many of us were getting ready to leave for the funerals. I think it’s important to have someone there with that expertise in the moment, specifically to support you. But, how much can people be supported in five days after going through a horrific event? The crisis counsellor was helpful in preparing me to meet my family, but that was one step in a multi-step process.’
Other staff stated that they were reluctant to use the telephone or Skype follow-up counselling that was offered as it felt impersonal, and several acknowledged that more intensive counselling would have been helpful in dealing with troubling reactions experienced over time. One observed; ‘I should have talked. At the time, I didn’t feel that counselling would be helpful, but now I see that it might have helped to get it out of my system.’ Although a number of English-speaking Afghan national staff participated in individual crisis intervention sessions with the crisis counsellor, at least two expatriate participants expressed concern over what they felt was a lack of ongoing psychosocial support for national staff who did not speak English. But one manager observed that western approaches are a poor fit with Afghan cultural norms: ‘I’d say that (grief/loss) is something they deal with in their own way in their own culture. We have to be sure we don’t upset that process.’
Recovery 1 day to 4 weeks post crisis
Participants who attended funerals mentioned how meaningful it was to connect with the families of the deceased and honour their lives through the ritual of community remembrance. Everyone appreciated that the organisation gave them the opportunity to attend funerals. However, upon returning from the funerals, most participants expressed that the sense of being ‘on automatic pilot’ or that operating ‘on adrenaline’ was beginning to wear off. Many noted that they would have preferred to take a break before returning to Afghanistan after the funerals, but they felt a responsibility to return to the team. One explained, ‘[Afghan national staff] didn’t have that option. It seemed so unfair to leave them. They were suffering the way we were. That was part of the reason I came back, I felt I could not leave the Afghan staff.’
There were differing perspectives on the evacuation. Several participants expressed surprise that the organisation had not evacuated them to a neutral place for debriefing and rest. In contrast, another staff member, whose primary social supports were in Afghanistan outside the organisation team, disagreed: ‘the worst thing would have been to evacuate us. The centre of my life was in Afghanistan.’ One manager noted that evacuating staff or granting leaves would have been challenging because leaders on the ground were attempting to ‘keep things moving forward.’
All expatriate team members agreed that the most important support they received immediately after the incident came from their teammates. Several recalled the strength that individuals garnered from the team as they began to face the ‘outside’ NGO world. One participant remembered the first night out at an external United Nations event where the team ‘had to be together, had to do it together.’ Another remembered a ritual the team engaged in for several weeks after the crisis:
‘When we went out, we always had to be in a circle. If you weren’t in a circle then you would be exposing yourself on one side. You didn’t want to explain anything to anyone. You wanted to be exactly with people who knew what you were going through and not anyone else.’
Recovery 1–2 months post crisis
Declining and ‘crashing’
By six weeks post crisis, expatriate staff members began to feel ‘out of sync with each other’ in their grief experiences. Some reported that tensions were high: ‘I saw a lot of anger, people bursting into tears, people saying, “I can’t look so-and-so in the face; it reminds me of [the deceased].”’ Their ability to support each other began to flag. One expatriate noted: ‘people increasingly relied on each other, but nobody had the competence to deal with other people’s grief/anger/outrage/confusion. The families of younger staff members were putting pressure on them to come home. They didn’t know what to do.’
In general, study participants reported impaired concentration due to heightened fears, lack of clear expectations regarding tasks as time went on, and unprocessed grief and trauma reactions. The majority of expatriates acknowledged that their productivity was quite low after the initial wave of post crisis activities followed by funerals and memorials. Suspension of programmes for internal and external review also contributed to an overall sense of uncertainty.
Although long distance psychological support was offered to expatriate team members and email outreach messages were sent, none of the expatriates reached out for psychological support at the time. Some cited the difficulty of speaking about such personal matters over the telephone, others cited lack of ‘time and psychological space’ to process feelings. An experienced mental health professional nearby was identified by the organisation’s crisis counsellor, but managers did not enlist her services. Some managers reported that they believed the best healing would occur ‘organically’ among team members themselves.
Some expatriate participants observed that formal, in-person psychological support at this juncture might have helped prevent the decline in team members’ capacity to function and facilitated decision making for expatriate staff as they struggled with whether and when to leave Afghanistan.
‘Maybe having the psychological support person come back a month or six weeks later would have helped. That’s when people crashed. It was a shock period when [the crisis counsellor] was here. As the next few weeks went on, people were coming out of shock and sadness and turning into anger. Intervention at that point would have been useful, to require people to talk it through.’
Several expatriate managers recalled being concerned that the post incident reactions and needs of expatriate staff might have negatively affected Afghan national staff.
‘The way we deal with tragedy and grief in the west is different from cultures where life is lost every single minute. The process in the office, where we were not really functioning for a time, that isn’t the way the Afghans would have dealt with it. There was a cultural clash in the office. After the memorial service, the grieving was done, the Afghans pick up and life goes on because they deal with this day in and day out. The month of work suspension, the multiple memorial services—I think it made it more difficult for the Afghan staff.’
For several participants, decline in staff functioning was exacerbated by a ‘lack of clarity’ from headquarters regarding their expectations of the field team in the wake of the incident. Many observed that uncertainty about how programmes would continue post crisis contributed to a marked decline in staff morale, leading to a pervasive sense of futility among staff and even beneficiaries. One expatriate participant observed: ‘a clear timeline, concrete outcomes/expectations, and additional resources to complete the review and recommendation process would have helped to alleviate this.’
Divergent perceptions of security
According to respondents, at the four to six week juncture, a split began to appear in the expatriate team between those who felt a heightened sense of danger—and consequently felt the operation should be doing more to protect them—and those who were confident about the security protocols and more philosophical about the risks of working in Afghanistan. Expatriate managers observed ‘breakaway cliques’ at the office where individuals shared and fed in each other a sense of ‘heightened paranoia’ about possible violence against expatriate staff, especially the threat of kidnapping. One expatriate participant described their experience as follows: ‘we felt like security was getting worse and worse; we were in a pressure cooker getting tighter and tighter. There were security incidents [with other NGOs]—expatriates getting kidnapped. It all started to weigh us down really quickly after that.’
Another participant felt that such security concerns were not being taken seriously enough by senior management on the ground: ‘every day the violence was coming closer and closer. [The leadership staff] kept telling us our systems were all OK, but they didn’t provide us with reassurance that our security was being taken care of.’ Another participant wondered about the role of gender in diverging perspectives.
‘Someone raised the issue that the team was all women and the leadership was all men. We wanted more tangible things—contingency planning and not travelling in marked vehicles. Not much changed in terms of security after the incident. It wasn’t enough for those of us who lost colleagues and felt unsafe. It was like, “oh, these girls, they’re blowing it all out of proportion.”’
Some expatriate participants observed that those most worried about security tended to be staff members who continued to voluntarily assume risks to their personal security. As one expatriate participant described: ‘they still went out in the evening, travelled between several locations, stayed out right until curfew and travelled when the streets were empty.’
Some expatriate participants who remained in Afghanistan questioned the impact on the entire team of allowing visibly impaired staff members: those who seemed depressed or fearful, were ‘negative about Afghanistan’ and had severe concentration problems, to remain in country.
‘I think some people should have been moved out earlier. They became quite negative about Afghanistan. I thought at the time, managers here should work with headquarters to help those people leave because it’s not healthy for them, and really not healthy for the organisation’s Afghanistan family.’
Several expatriate participants described that those who were most frightened negatively impacted the overall morale of the expatriate team. One explained:
‘I wouldn’t be doing this work if I couldn’t accept that this job brings a certain amount of danger. I didn’t have any big issues with personal security [after the incident]. But I was living with colleagues who became very scared. That affected me. If you’re hearing for 24 hours a day that they’re scared, whenever you’re watching TV, driving or sitting in the evening. When they ask, “did you hear that?” Or say every few minutes, “what was that?”, no matter how strong you are it starts getting to you. I told this to [the team leader] and said, “do something, or else soon I’ll be scared, too”’.
Some managers stated that objective standards and external assistance from a mental health professional would have been helpful in assessing the capacity of affected staff members to sustain their performance and personal wellbeing.
Recovery 3–9 months post crisis
Reconciling, healing and moving on
As the weeks post crisis turned into months, study participants reported that productivity remained low, and for many expatriate staff tension continued to mount. Senior managers reported that they adopted a ‘hands off’ policy regarding decisions about who should leave the country and when. One manager explained the stance as a desire to enable people to ‘stay in control’ and remain connected with their colleagues in order to ‘help them heal.’ Several expatriate participants expressed gratitude for this freedom to decide for themselves when to leave Afghanistan. However, all expatriates who had left Afghanistan by the time of the evaluation interview cited guilt over abandoning colleagues, national staff and even their deceased colleagues, as a predominant factor in their decisions about whether or when to leave Afghanistan. One reported;
‘I felt so bad when I left. You feel so bad, you can leave and [the Afghan staff] can’t. Especially when you know security is getting worse and you know how much hardship they’ve had. Guilt is what brought me back after the funeral. Guilt is what kept me there longer.’
Another departing expatriate staff member explained: ‘I felt like we were leaving [our deceased colleagues] behind; I still feel that.’
By the time of this study, nine to ten months post crisis, four out of the eight expatriate workers who were in Afghanistan at the time of the incident were no longer working for the organisation. One returned to the field for the organisation in another country, one returned home for family reasons, one went on to work with another humanitarian organisation in Africa and one decided not to work in high risk humanitarian aid settings. They said that their psychological state had improved over time, although they were ‘still affected,’ as one expatriate participant described: ‘it took me a long time. I developed a neurosis when I got back home—not going out, looking over my shoulder, not sleeping. It was only after a couple of months [at home] that I started feeling OK.’
Several participants noted the ongoing role of team support in the recovery process: ‘we’re all still trying to cope. I’m still in touch with the other expat team members, we have sort of a support group.’
At the time of the interviews, the majority of expatriates present in Afghanistan at the time of the incident mentioned that they had evolved personally and felt more confident about their capacity to face adversity because of the experience. One explained:
‘I’m not afraid of death as I was before, and I’m open to talking about it. I’m surprised how easily I can talk about the incident with my friends. I feel like I’ve learned so much in how to cope and how to get through it.’
According to research on crisis recovery in humanitarian aid workers, management of the crisis can either reinforce a sense of helplessness and victimisation or strengthen self-efficacy and self-worth in survivors (Hearns & Deeny, 2007). Most attributed their positive self-regard and resilience after the crisis to having been given a clear role to play—something tangible to contribute—during the crisis response.
| Limitations|| |
This study has several limitations. First, this study was inevitably influenced by the biases of the author, who had a long history of providing occupational stress consultations to the organisation and its staff members. Further, she was the external crisis counsellor brought in to provide immediate psychological support after the event. Certainly, these circumstances may have influenced participants’ responses. On the other hand, the author’s history with the organisation and her role in the crisis response meant that she had pre existing relationships with virtually all of the participants. This allowed for frank conversations in an atmosphere of trust that might not otherwise have been possible. Nonetheless, the analysis included strategies for rigor mentioned by Padgett (2008), relying specifically on member checking (reviewing emerging findings with participants) and negative case analysis (deliberately searching for quotes that disconfirm emerging themes to counteract potential bias). A second limitation of this case study is that it did not include Afghan national staff involved in the incident and its aftermath, but it did include statements from expatriate staff about their Afghan colleagues. Respondents were not specifically asked to discuss their views of the Afghan national staff, but if they volunteered this information and it was deemed relevant to the emergent theme, such comments were included. However, the validity of these accounts is not implied and can only be considered as perspectives of the expatriate respondents toward their Afghan colleagues. Third, this study is a case study evaluation of an intervention and did not examine causal factors and other variables, nor was it designed to measure outcomes longitudinally. Future studies should include research methodologies that can capture the wide range of variables that may impact the ultimate outcomes over time for aid workers experiencing a traumatic event.
Implications for policy and practice
While this case study focused on one specific critical incident, the analysis offers implications for organisations involved in high risk humanitarian environments. First, this evaluation aligns with extant research demonstrating the importance of team cohesiveness (Lee & Ashforth, 1996), strong leadership and ongoing stress management and crisis preparedness training (Fawcett, 2002; Hearns & Deeny, 2007) for personnel working in high stress contexts. Research demonstrates that trauma affected individuals benefit from establishment of safety, connectedness, self and collective efficacy, calm and hope (Fox et al., 2012) and a restored sense of control (Fallot & Harris, 2009). It can be surmised that staff affected by the incident presented here fared well because these elements were present throughout the crisis response. This study’s findings suggest that all managers should receive training in trauma informed crisis management and building and managing cohesive teams.
Despite the rise in deliberate targeting of foreign aid workers, some agencies lack security protocols or standardised strategies (Fast, 2010). Organisations can help destigmatise concerns over security as a sign of weakness by establishing security standards and normalising adherence to them. When a crisis occurs, pre existing criteria for defining what constitutes a critical incident and formal protocols regarding when and how to respond can help alleviate stress for managers responsible for crisis response, as well as affected staff. Because traumatic events can disrupt an individual’s capacity to assess threat, directly impacted staff may need external support for decision making. Pre-established objective criteria may assist managers in making decisions about who is fit to stay in a high risk country programme and who should leave after a critical incident. These measures should be undertaken sensitively to ensure that affected staff members feel part of the decision making process.
Psychological First Aid (Fox et al., 2012) may be an important first step following a critical incident. This case study confirms the relevance of individual and group psychoeducation regarding common reactions and strategies for self management and interactions with friends and family. The timing and nature of support at each phase of the crisis recovery trajectory should be further explored. This study suggests that it may take time before affected staff begin to integrate the full weight of the experience; after initial Psychological First Aid to strengthen coping and link people with resources, additional culturally appropriate psychological support may be useful to more fully process the traumatic event. It is well established that survivors may either over, or under, respond to sensory stimuli that remind them of the traumatic event (Van der Kolk, 2014). While some may recover naturally through their social support networks, others, particularly those with childhood trauma histories or unresolved symptoms from prior traumatic events in adulthood, may require more intensive intervention (Courtois & Ford, 2009).
For expatriate and national staff preferring western counselling models, community resources should be identified and well vetted for their clinical and cultural expertise before a crisis occurs. If no appropriate services exist and counselling via telephone or Skype feels too impersonal, on-site support may be required. Spiritual or social support may be more relevant to both expatriate and national staff than western counselling models. Indigenous approaches to healing should be discussed with national staff and facilitated by the employing organisation (Shah, 2012). However, national staff should also have access to the same resources as expatriate personnel (Shah et al., 2007).
Finally, mechanisms to promote staff resilience and retention, including strong, enforceable security protocols, management training in leadership and teambuilding, regular crisis preparedness training, routine access to psychological support for day-to-day stress and ongoing wellness activities, must be built into budgets, implemented by management, and considered as natural and necessary components. When an organisation is perceived to minimise attention to security or other staff wellness factors, eventually skilled workers may leave their posts, leaving organisations with gaps in staff and costs for their replacements (Kantor, 2016). In contrast, ongoing support from the organisation may create an environment where day-to-day challenges may be weathered and crises managed effectively (Loquercio et al., 2006; Hearns & Deeny, 2007).
| Conclusion|| |
This study of the immediate and medium term responses of an expatriate team of aid workers exposed to a critical incident adds field based knowledge to the literature on supporting aid workers in high risk environments. Ongoing attention by management to ensure cohesive teams, establishing strong security and post incident protocols, engaging team leaders in ongoing trauma informed crisis mitigation training, and integrating overall wellness strategies are vital elements to support staff resilience and retention.
This paper is dedicated to all humanitarian aid workers who have lost their lives in the course of their work, and those who continue their work despite risks to their welfare.
| References|| |
Anastas J. (1999). Research design for social work and the human services
. New York, NY: Columbia University Press.
Barnett M. (2011). Empire of humanity: A history of humanitarianism
. Ithaca, NY: Cornell University Press.
Cardozo B. L., Holtz T. H., Kaiser R., Gotway C., Ghitis F., Toomey E., Salama P. (2005). The mental health of expatriate and Kosovar Albanian humanitarian aid workers. Disasters, 29
(2), 152-170. doi: 10.1111/j.0361-3666.2005.00278.x.
Courtois C. A., Ford J. D. (2009). Treating complex traumatic stress disorders: An evidence-based guide
. New York: Guilford Press.
Creswell J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions
. Thousand Oaks, CA: Sage.
Ehrenreich J. H. (2005). The humanitarian companion: A guide for international aid, development and human rights workers
. Rugby: ITDG.
Ehrenreich J. H., Elliott T. L. (2004). Managing stress in humanitarian aid workers: A survey of humanitarian aid agencies’ psychosocial training and support of staff. Peace and Conflict: Journal of Peace Psychology, 10
(1), 53-66. doi: 10.1207/s15327949pac1001_4.
Eriksson C. B., Bjorck J., Abernethy A. (2003). Common sources of day-to-day stress for humanitarian staff. In: Fawcett J. (Ed.), Stress and trauma handbook: Strategies for flourishing in demanding environments
. Monrovia, CA: World Vision International.
Eriksson C. B., Vande Kemp H. V., Gorsuch R., Hoke S., Foy D. W. (2001). Trauma exposure and PTSD symptoms in international relief and development personnel. Journal of Traumatic Stress, 14
(1), 205-212. doi: 10.1023/a:1007804119319.
Eriksson C. B., Lopes Cardozo B., Ghitis F., Sabin M., Gotway Crawford C., Zhu J., .Kaiser R. (2013). Factors associated with adversemental health outcomes in locally recruited aid workers assisting Iraqi refugees in Jordan. Journal of Aggression, Maltreatment & Trauma, 22
(6), 660-680. doi: 10.1080/10926771.2013.803506.
Fast L. (2010). Mind the gap: Documenting and explaining violence against aid workers. European Journal of International Relations, 16
(3), 365-389. doi: 10.1177/1354066109350048.
Fawcett J. (2002). Preventing broken hearts, healing broken minds. In: Danieli Y. (Ed.), Sharing the front line and the back hills: Peacekeepers, humanitarian aid workers, and the media in the midst of crisis 223-232
. Amityville, NY: Baywood.
Fox J. H., Burkle F. M., Bass J., Pia F. A., Epstein J. L., Markenson D. (2012). The effectiveness of Psychological First Aid as a disaster intervention tool: Research analysis of peer-reviewed literature from 1990–2010. Disaster Medicine and Public Health Preparation, 6
: 247-252. doi: 10.1001/dmp.2012.39.
Freudenberger H. J. (1974). Staff burnout. Journal of Social Issues, 30
(1), 159-165. doi: 10.1111/j.1540-4560.1974.tb00706.x.
Hearns A., Deeny P. (2007). The value of support for aid workers in complex emergencies: A phenomenological study. Journal of Emergency Nursing, 5
(2), 28-35. doi: 10.1016/j.dmr.2007.03.003.
Holtz T. H., Salama P., Cardozo B. L., Gotway C. A. (2002). Mental health status of human rights workers, Kosovo, June 2000. Journal of Traumatic Stress, 15
(5), 389-395. doi: 10.1023/a:1020133308188.
International Association of Emergency Managers (2007, Sept. 11). Principles of emergency management supplement
. Washington, DC: Federal Emergency Management Agency. doi: 10.13140/RG.2.2.32021.93925.
Iqbal R. A., Lipson J. G. (2017). Afghans and Afghan Americans. In: Giger J. N. (Ed.). Transcultural nursing: Assessment and intervention (7th ed., pp. 343-356)
. St. Louis, MO: Elsevier.
Lee R. T., Ashforth B. E. (1996). A meta-analytic examination of the correlates of the three dimensions of job burnout. Journal of Applied Psychology, 81
(2), 123-133. doi.org/10.1037/0021-9010.81.2.123.
Lopes Cardozo B., Gotway Crawford C., Eriksson C., Zhu J., Sabin M., Ager A., Simon. (2012). Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: A longitudinal study. PLoS ONE, 7
(9), e44948. doi: 10.1371/journal.pone.0044948.
Loquercio D., Hammersley M., Emmens B. (2006). Understanding and addressing staff turnover in humanitarian agencies. Humanitarian Practice Network
. London: Overseas Development Institute. Retrieved from http://www.odihpn.org/documents/networkpaper055.pdf
McCormack L., Joseph S., Hagger M. S. (2009). Sustaining a positive altruistic identity in humanitarian aid work: A qualitative study. Traumatology, 15
(2), 109-118. doi: 10.1177/1534765609332325.
Padgett D. (2008). Qualitative methods in social work research: Challenges and rewards (2nd ed.).
Thousand Oaks, CA: Sage.
Shah S. A. (2012). Ethical standards for transnational mental health and psychosocial support (MHPSS): Donoharm, preventing cross-cultural errors and inviting pushback. Clinical Social Work Journal, 40
(4), 438-449. doi: 10.1007/s10615-011-0348-z.
Shah S. A., Garland E., Katz C. (2007). Secondary traumatic stress: Prevalence in humanitarian aid workers in India. Traumatology, 13
(1), 59-70. doi.org/10.1177/1534765607299910.
Stake R. (1995). The art of case study research
. Thousand Oaks, CA: Sage.
VanderKolk B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma
. New York, NY: Viking.
Wigley B. (2011). Not off the hook: The relationship between aid organisational culture and climate and the experience of workers in volatile environments. In: Bowie V., Fisher B. S., Cooper C. (Eds.), Workplace violence 141-159
. Oxford: Routledge.