How do international humanitarian aid workers stay healthy in the face of adversity?

Abstract

Background International humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health. Methods and findings The stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional. Conclusion In addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.

Health trajectories of international humanitarian aid workers: growth mixture modelling findings from a prospective cohort study

“…Moreover, in accordance with our hypothesis, those with high levels of sense of coherence and coping self-efficacy pre-assignment are more likely to stay healthy (higher odds of membership of the ‘healthy/normative’ trajectory). Considering that high levels of pre-assignment sense of coherence and coping self-efficacy were associated with fewer symptoms of PTSD and anxiety ( 26 and Supplementary Appendix 1), it is less likely that those who score high on the CSE-7 and SOC have any need for health indicators to improve.…”

Occupational support for aid workers: Aid Organizations’ Stress Prevention and Intervention (AOSPI): A model

“…Because sense of coherence and meaningfulness are strong predictors of better health outcomes for AW (De Jong et al, 2022), the personal effect of the politicisation of humanitarian aid can challenge the resilience of AW. Aid organizations may create hostile environments by their mere presence, raising the security profile of AW (Fee et al, 2019).…”

“…Sense of coherence is a determinant for well-being, and a key component for sense of coherence is meaningfulness (De Jong et al, 2022). For support AW lacking contact with beneficiaries, the absence of recognition and direct contact with aid recipients undermines sense of coherence (Thomas, 2016), individual motivation (Friesen, 2022), and meaning of work (Montaiuti, 2013); all factors that psychologically can aggravate existing strain.…”

“…All AW, regardless of position or assignment, benefit from intercultural and training programmes addressing possible partialities, conflict and specific field offices qualities (Dass-Brailsford, 2008;McFarlane, 2004). Gender balanced teams promote the overall health of AW (De Jong et al, 2022), efforts are made to gender-balance teams. Leadership demonstrates commitment to inclusivity and diversity by acknowledging bias and the risks of racism and by attending training (Arthur & Moutard, 2016).…”

Incidence and Severity of Sexual Harassment, and its Impact on Mental Health in a Cohort of International Humanitarian Field-Workers

“…Second, we investigated whether experiencing sexual harassment is associated with changes in psychosocial health between before and after a humanitarian field assignment and the use of health care following a field assignment. An earlier investigation based on the same sample indicated that other stressors than sexual harassment—namely field assignment-related stressors (e.g., health risks, high workload team stressors, security incidents)—were associated with higher mental health symptoms after an assignment (De Jong, Martinmäki, Te Brake, Kleber, et al, 2021). Therefore, we chose to control for the effect of field stressors in our analysis.…”