Hi, my name is Barbara Lopes Cardozo. I'm an adjunct assistant professor in the School of Medicine, Department of Psychiatry and Behavioral Sciences. As well as an adjunct assistant professor in the Hobart Department of Global Health Rollins School of Public Health at Emory University. I spent more than 30 years working in humanitarian emergencies. As a psychiatrist, I currently work at the Center for Diseases Control and Prevention on Mental Health in countries affected by war, violent conflict and natural disasters around the globe. And before that, I worked for Doctors Without Borders. [INAUDIBLE], an organization, I helped start in Netherlands in the 1980s. Today, I'm going to share with you why the mental house of humanitarian aid workers, first responders, and primary healthcare workers working in war and conflict affected countries is so important. First of all, working in stressful environments is not easy. The working hours are long. The security conditions often precarious. You are surrounded with misery, death, and destruction. And often lack management and organizational backup. So aid workers are at risk of becoming emotionally and mentally drained. Additionally, it has become increasingly dangerous to do this work. Of 385 deaths among aid workers between 1985 and 1998, 68% were due to intentional violence. And violence has increased and aid workers have become a target. The number of critical incidents have also increased. In 2008, aid workers were at higher risk than UN peacekeeping troops, according to an article in 2009 by. This has not really changed, but the difficult environment that aid workers find themselves in contribute to the numerous stressors they are faced with. The work and living conditions are difficult. International aid workers may experience isolation, and the workload is heavy. On top of that, organisational stressors are common. Emergency settings are often chaotic. And organizations don't always have the experience in maintaining clear organizational structures in the chaos of this type of work. Job descriptions and terms of reference are not always well defined, and aid workers may end up doing work that they were not prepared for, or did not receive training in. All these factors may lead to psychological distress among aid workers in the form of burnout or mental illness. It may also lead to risk-taking behavior. And other negative consequences could be alcohol or drug abuse or workaholism. All these could eventually lead to poor work performance and dissatisfaction with the work or the job. Risk-taking behavior can also lead to increased security risks for the aid workers, as well as their teams and organizations. After international aid workers return home, they can have a difficult time reintegrating into society and their regular lives after their assignments. Unfortunately, some aid workers show signs of psychological distress or even symptoms of mental illness, such as acute stress disorder, post traumatic stress disorder, depression, anxiety, or psychosomatic symptoms. Mental health problems and burn-out of staff may also result in a number of negative consequences for the organizations. That may lead to a high turnover of aid workers, decreased efficacy, increased costs and an increase in risk-taking behavior. And may even pose a danger to other workers and projects in the organization. If work of aid workers involves listening to many trauma stories of their clients or patients, they also run the risk of becoming traumatized themselves. This has been called secondary traumatization, or vicarious traumatization. In 2000, the CDC conducted a mental health survey among international and local aid workers in Kosovo. The conclusions from the survey showed that there was substantial trauma exposure, especially among locals there. However, PTSD was common among international staff, with depression most common. Aid workers on their first nation and those who have a lot of experience and were on their fifth or more assignment, are at higher risk of having symptoms of depression. Being able to connect with family and friends and good organizational support were mitigating factors. From 2007 to 2011, the CDC and the Research Consortium conducted a longitudinal study of international aid workers. This was published in Plus One in 2012. The CDC and the Research Consortium also conducted surveys among national staff in Uganda, Jordan, and Sri Lanka. Based on the practical experiences of aid workers, humanitarian organizations, and the findings of the CDC Research Consortium, we formulated guidelines around the following eight key principles. Number one, policy. Screening and assessing. Number three, preparation and training. Four, monitoring. Five, ongoing support. Six, crisis support. Number seven, the end of assignment support. And eight, post assignment support. We made the following recommendations based on the results of the longitudinal study I mentioned earlier. Prior to deployment, to screen aid workers for history of mental illness and family risk factors. To provide stress awareness and stress management training. To provide preparation and training courses. And during deployment, ensure clear organizational structures to ensure staff security, to decrease chronic stressors by providing the best possible living recommendations, workspace, and reliable transportation. And to ensure a reasonable workload and adequate management recognition for achievements. And to provide psychological support is necessary. And to institute liberal telephone and Internet use policy paid for by the organization, which will help increase social support networks of deployed staff. After deployment, to encourage involvement in social support and peer support networks. For example, organizations can organize social events to tell their stories and celebrate a participation. After the Ebola response, it became clear that stigmatization against response was not an issue. Organizations need to provide the clear messages across the agencies on how to deal with this troubling issue. For example, to provide administrative leave, recognition for achievement and provide psychological support as necessary. So in summary, aid workers are at risk for psychological distress and mental health problems. There has been an increase in danger and security issues over the last 15 years. Aid workers face multiple chronic stressors and secondary traumatization. Potential problems are burnout, risk taking behavior, work performance, depression, anxiety, PTSD, and adjustment problems. And not only first timers are at risk. Guidelines and recommendations for organizations do exist, and are evidence-based.
