Managing Stress in

Humanitarian Aid Workers:

The Role of the Organization
John Ehrenreich
State University of New York
(jehrenreich@hotmail.com)

USAID OFDA, Washington, D.C.

July 27, 2004

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 I. Assumptions
1. Humanitarian aid work is inherently stressful.

2. Stress takes a toll on humanitarian aid workers.

3. Staff stress adversely affects the organization and

its mission.

4. Stress and its adverse effects can be lessened.

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 1. Humanitarian aid work is
inherently stressful

• Separation from family

• Physically demanding working and living conditions
• Lack of privacy and personal space
• Long hours, heavy work loads, chronic fatigue
• Lack of time, resources, support to do job
• Conflicts within work team
• Conflicts with local authorities
• Chronic danger
• Repeated exposure to tales of horrific experiences
• Direct exposure to gruesome scenes and terrifying
experiences
• Moral anguish over choices, triaging, limits to
effectiveness
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 2. Stress takes a toll on humanitarian
aid workers
One-third or more of staff show clinically significant sign of emotional distress at end of assignment

• Post traumatic stress syndromes

• Vicarious (secondary) traumatization
• Burnout and compassion fatigue
• Depression
• Pathological grief
• Anxiety
• Multiple psychosomatic complaints

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 3. Staff stress adversely affects the
organization and its ability to carry out
its mission

• Less commitment to agency and higher rates of turnover

• Higher accident rates and higher rates of illness;
increased absenteeism and greater health care
utilization
• Poor decision making; behaviors that place team
members and recipients at risk
• Lowered efficiency and effectiveness in carrying out
assigned tasks
• Increased legal liability

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4. Stress and its adverse effects can be
lessened
Mitigating stress is cost effective. It benefits the
organization and recipients as well as the aid worker.
Strategies

• Reduce exposure to stressors

• Lessen impact of stressors that do occur on
individuals
• Increase capacity of individuals to deal with stress

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Levels of action to reduce adverse
impact of stress

• Individual level

• Organizational level
Central organization
Team

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 II. Effective Organizational
Responses to Staff Stress
1. Create a general organizational commitment to
creating a culture of stress management

2. Provide effective leadership and efficient

management at all levels of the organization

3. Promote team cohesion

4. Develop specific organizational policies and

practices that reduce stress and its effects 8
 1. Develop a general organizational
commitment to creating a culture of
stress management

• Develop systematic organizational effort to

address the problem of stress
• Review policies, programs, and practices with
respect to effect on stress experienced by staff
• A tool: The “stress impact statement” – “What
will the effects of this policy or practice be on the
stress experience of staff?”
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 2. Provide effective leadership and
efficient management at all levels of the
organization

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 Assumptions

Leadership is a key variable in determining

the impact of stressful events on staff

Bad leadership creates stress on staff.

Good leadership helps protect staff from

stress originating outside the organization
itself.

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 Elements of leadership
Leadership style:
• How does leader treat staff?
• How are decisions are made and communicated?
• How are staff motivated, assisted, and rewarded?

Management skill
• How does the leader carry out the practical abilities needed
to organize and carry out programs, policies, and activities

Moral leadership
• How does the leader act, inspire staff, create sense of vision,
transmit own personality and vision and values?

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 Leadership style:
“Democratic/consultative” vs. “authoritarian/hierarchical:”

• If information is A good leader:

widely shared and • seeks staff input and
feedback
time pressures are
• keeps staff informed and
not enormous (as is
keeps informed about
usually the case), staffs
the “democratic” • is concerned with human
style is generally needs of staff as well as
the most effective task performance
• is a good role model

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 Management skill: Good
management skills reduce staff
stress
• Well run meetings
• Clear job descriptions
• Clear prioritizing of tasks
• Clear lines of authority
• Needed supplies obtained
• Competent budget preparation
• and management
• Consistent supervision
• Appropriate hiring of local staff
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 Moral leadership
The leader inspires staff, creates a sense of
vision, transmits organizations vision and
values

In crisis, leader helps restore sense of

control: “We can handle this”

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 Implications

Leadership ability should be a major factor

in agency hiring and promotion decisions
(at all levels of management)

Leadership abilities can be taught;

organizations should provide managers
with training in leadership/managerial
skills
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 3. Promote team cohesion

Team cohesion and the availability of

other forms of social support are key
variables in determining the impact of
stressful events

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Team Building: The Team Leader’s
Responsibility
A good team leader
• fosters communication among team members
• seeks to build bonds among team members (work together, meet
together, get to know each other)
• creates positive environment for collective problem solving and
support; creates atmosphere in which differing opinions are valued
but in which clear decisions can be reached
• is alert to cliques, bickering, scape-goating, etc. and acts to address
them; maintains atmosphere in which sexual, racial, ethnic, national
or other harassment is not acceptable
• monitors individual staff members for signs of stress and provides
basic support
• models good individual stress management practices
• seeks to base expatriate/national staff interactions on mutual respect,
transparency, and partnership
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 Team building: The Organizational
Responsibility
• The agency identifies team-building skills as an essential
qualification for prospective managers
• The agency trains staff and managers in team work skills
(e.g., conflict management)
• The agency helps build team cohesion (e.g., through
common experiences such as safety and security
training)
• The agency regularly reviews team functioning and has
policies for addressing the problems of dysfunctional
teams and of staff members who have difficulty
functioning in their team

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 4. Develop specific organizational
policies and practices that reduce stress
and its effects

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 Organizational policies and
practices
The organization’s human resources
policies and practices conform to
industry standards:

•InterAction (1997) Private Voluntary

Organization (PVO) Standards
•People in Aid (2003) Code of Good Practice

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Specific organizational policies and
practices I
• The agency has a clear structure (e.g., lines of authority, job
descriptions

• The agency periodically scrutinizes its “bureaucratic” procedures with

respect to their impact on staff stress

• Recruitment, hiring and assignment seek to match skills to task

demands and take assignment stress/stress tolerance into account

• The agency provides staff members with a full operational orientation

before deployment, including stress management training

• The agency undertakes to provide staff with adequate facilities and

services, and maintains appropriate policies and practices with respect
to safety and security
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Specific organizational policies and
practices II
• The agency supports individual activities to reduce stress (e.g., limits to
hours of work; periodic breaks mandatory; facilitates maintenance of
communication with family)

• The agency has arrangements in place for outside support for staff on “as
needed” basis (e.g., after “critical incident”)

• The agency has clear policies with respect to potential evacuation

• The agency has clear policies forbidding harassment (sexual, racial, ethnic,
national, or other) and mechanisms in place to enforce these

• The agency provides staff with both an operational debriefing and a personal
stress debriefing at the end of an assignment

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 Some Additional Resources
• Action Without Borders/Idealist.org (forthcoming, Fall 2004). Website on stress
management for aid workers, managers, families) . Http://www.Psychosocial.org

• Antares Foundation (forthcoming, Fall 2004) Guidelines for Good Practice in

Managing Stress in Humanitarian Workers. Amsterdam, Antares Foundation
(http://www.antaresfoundation.org)

• Centre for Humanitarian Psychology (forthcoming, 2004). Management of

extreme stress and of crisis in humanitarian work. Interactive CD-ROM. Geneva:
Centre for Humanitarian Psychology. (http://www.humanitarian-psy.org).

• Ehrenreich, J. (forthcoming, Fall 2004). The Humanitarian Companion: A Guide

for Staff of Humanitarian Aid, Development, and Human Rights Projects.
London: ITDG Publishing.

• Ehrenreich, J.H. (forthcoming, 2005). Managing stress in humanitarian aid

workers: The role of the agency. In G. Reyes and G. Jacobs, Eds., Handbook of
Disaster Psychology. Wilton, CT: Greenwood/Praeger

• Fawcett, J. (2003). Stress and Trauma Handbook. Monrovia, CA: World Vision

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