Staff care for national staff in the humanitarian sector:

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Staff care for national staff in the humanitarian sector:

An analysis of the situation and the obstructing context factors

Master Thesis

Angela C. Bütler S3728676

August 2020

Supervisor: Dr. Clara Egger

Master in International Humanitarian Action, NOHA University of Groningen

This thesis is submitted for obtaining the Master’s Degree in International Humanitarian Action. By submitting the thesis, the author certifies that the text is from her hand, does not include the work of someone

else unless clearly indicated, and that the thesis has been produced in accordance with proper academic practices.

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Illustration title page:Figure 1: Word cloud based on staff care guidelines for humanitarian organizations.

Source: Author’s work, generated based on the document corpus pp. 54-56

Abstract

National humanitarian staff faces specific risks and stressors in the context of their work which have a negative impact on their mental and general well-being. Humanitarian organizations not only have a duty of care towards them but can also make the biggest difference in mental health outcomes of traumas and stress through staff care programmes. Nonetheless, such programmes are generally lacking, especially for national staff. Research on the factors that influence staff care is scarce, however, a lack of inclusion of national staff in the prevalent discourse of the humanitarian sector on staff care and a failure to recognize their specific needs is likely a big obstacle for national staff to receive adequate staff care. This paper therefore assesses the discourses around national staff care in the humanitarian sector, national staff’s perception of staff care mechanisms and the contextual factors that hinder or drive organizations to implement quality staff care for national staff.

To achieve this objective, a self-administered online survey directed at national humanitarian staff was carried out and a document analysis of seven sector-wide staff care guidelines was realized. The results show that knowledge and awareness about the topic of staff care and organizational support are the most important factors influencing staff care in organizations, and that while national staff is recognized as a separate category of staff, not much is known or discussed about their specific needs in terms of staff care. Structural inequalities in the humanitarian sector further complicate the situation of well-being of national staff.

The study emphasizes the importance of discussing staff care topics and creating awareness of specific needs of staff, but also the need for individuals, organizations and other actors in the humanitarian sector to go beyond a legal duty of care and assume a moral obligation of organizational support. A shift of priorities and discourse needs to occur to better include national humanitarian staff not only in discussions about staff care policies but in decision-making spaces in general.

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List of abbreviations

CDC Center for Disease Control and Prevention CHS Core Humanitarian Standard

HAP Humanitarian Accountability Partnership HR Human Resources

IASC Inter Agency Standing Committee

INGO International Non-Governmental Organization LNGO Local Non-Governmental Organization MHPSS Mental Health and Psychosocial Support NGO Non-Governmental Organization

NNGO National Non-Governmental Organization NOHA Network of Humanitarian Action

NRC Norwegian Refugee Council

OCHA United Nations Office for the Coordination of Humanitarian Affairs POS Perceived Organizational Support

PTSD Post-Traumatic Stress Disorder UN United Nations

UNHCR United Nations High Commissioner for Refugees WEIRD Western, Educated, Industrialized, Rich and Democratic

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Preface

Working in a national NGO in Bogotá for over two years, I got to experience the pressure and job insecurity that national staff works under first-hand. I had the chance to meet many humanitarians, peacebuilders and activists who shared their stories of trauma with me and many people who suffered under long working hours, stressed managers, and the uncertainty of the next paycheck, to a point where it affected not only them but the way the organizations worked and people interacted. Their resilience and motivation to keep working in that difficult environment motivated me to look further into the topic of staff care of national humanitarian staff. To everyone working with me there I am forever grateful for including me, making me feel like part of the family and letting me experience the point of view of national staff, for teaching me the value of care and for being examples of strength and resistance.

My special thank also goes out to everyone who participated in the survey and shared their experience, and to my supervisor Dr. Clara Egger who guided me patiently and expertly through the process of writing this master thesis.

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1. Introduction

Working in humanitarian crises brings a certain amount of physical and psychosocial risk for staff that an organization must consider. The interest and knowledge on mental health of humanitarian staff has increased for the last two decades after a “ground-breaking” report (CHS Alliance, 2019) was published in 1995 by Rebecca Macnair called “Room for Improvement: The Management and Support of Relief Workers” (Macnair, 1995). The report started a conversation about staff care and its relation to the quality of performance and of programmes overall. Ever since, a growing number of studies has been undertaken and guidelines published, the role of organizational support in the mitigation of the effects of stress and trauma has been demonstrated by research (Thormar et al., 2012; Strohmeier and Scholte, 2015) and it has been demonstrated that a lack of staff care mechanisms will not only negatively influence the individuals, but will affect the quality of work of the organization as a whole (Ehrenreich and Elliott, 2004; ALNAP, 2018; Wright and Foster, 2018).

Two decades later, the well-being of humanitarian staff is still a topic of concern, with a high prevalence of burnout and other symptoms in aid workers (Jachens, Houdmont and Thomas, 2019). National humanitarian staff, based on the limited information available, is at least as highly if not more affected with mental health problems as international staff (Ager et al., 2012; Eriksson et al., 2013; Lopes Cardozo et al., 2013). In the meantime, many guidelines on the topic of staff care have been written (Inter Agency Standing Committee, 2007; Antares Foundation, 2012). However, national staff’s well-being does not receive much attention: most studies concentrate on expatriate workers (Strohmeier and Scholte, 2015). Further, little is still known about whether and how organizations implement these recommendations, especially for national staff: some research has been done on an international level (Ehrenreich and Elliott, 2004) and on specific contexts (Connorton et al., 2012), however, research was either directed at one specific organization (Solanki, 2017) or at international non-governmental organizations (INGOs) only (Porter and Emmens, 2009; Fee and McGrath-Champ, 2016; Dunkley, 2018). They found that staff care was at best inconsistent but mostly lacking. Ample studies about staff care amongst a diversity of organizations and

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8 focused on national staff have not been carried out yet. Therefore, there is almost no data on the situation of national staff care and whether humanitarian organizations have sufficient systems in place to prevent any harm to their national staff. At the same time, national staff make up the most part of the humanitarian system, and their number is even growing (ALNAP, 2018). In a context of localization, where local staff and local and national humanitarian non-governmental organizations (NGOs) are supposed to get an even more important role (Sphere Association, 2018), and where they are already mostly the actors that directly implement the activities on the ground, it is important to learn about their situation. The lack of knowledge around this topic leads to a deficiency of information about possible contextual factors that might influence it, and in turn about the issues to address in order to improve the situation. It is consequently imperative – not only for academia but for all humanitarian actors – to recognize the specific stressors national staff might face and to analyse the current obstacles and contextual factors that influence staff care programmes for national staff in humanitarian organizations.

The present research is based on the following research-questions:

• How does national humanitarian staff perceive staff care in the humanitarian sector? • What context variables might influence staff care strategies for national staff in

humanitarian organizations and which factor is perceived to have the biggest impact on national staff care?

• Is national staff care addressed by the international humanitarian sector and if yes, how does the humanitarian sector define and recommend staff care for national staff?

Based on the thesis that the fundamental obstacle to national staff care lies in the lack of inclusion of national staff in the prevalent discourse of the humanitarian sector on staff care and a failure to recognize their specific needs, the aim of this research is to assess the perspective of national humanitarian staff about the staff care they receive and the contextual factors that influence this staff care. By capturing their views, I want to gain a nuanced understanding of their lived experiences in relation to stress and organizational support, in order to contribute to the discussion around stress and care in the humanitarian sector, underline the importance of including national staff in this discussion, and to formulate

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9 concrete recommendations for INGOs and national NGOs, for international partners, donors and national governments and for the sector as a whole, in order to create better conditions for organizations to realize their duty of care of national staff.

In an interdisciplinary manner, the legal, social, economic, and organizational vectors that might influence the organizational context of humanitarian organizations and the perceived consequences for national staff care programming were analysed in a qualitative approach with a multi method framework. The first two research questions were explored through a self-administered online survey directed at national humanitarian staff and disseminated through Facebook groups dedicated to humanitarian action. For the third question, a document analysis of seven sector guidelines regarding staff care was carried out in order to assess an example of the prevalent discourse regarding national staff care.

Although the chosen approach is limited in its representativeness by the heterogenous nature of “national humanitarian staff”, the limited document corpus and a low response rate for the online survey, it still generated eye-opening results about the job insecurity situation and lack of staff care for national staff, as well as clear opinions on contextual factors that are the reason behind this reality: The data confirmed that the aspect of knowledge and awareness about the topic is likely the most important obstacle for the implementation of staff care programmes for national staff. Further, social aspects such as the stigma around mental health and inequalities based on systemic racism in the sector contribute to a lack of staff care programmes for national staff.

For ethical reasons, the present research avoided touching on mental health topics or personal history of trauma in the survey, as the author does not have the capacities to manage discussions of this type responsibly. It is also important to mention that the author herself might have her own bias based on her western education and work experience, which might have influenced the design and analysis of this research.

More research is needed not only about what staff care for national staff looks like but also about how humanitarian organizations can provide adequate staff care and how other actors such as networks of organizations, donors or government agencies can positively influence

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10 staff care programmes in humanitarian organizations. It is important that both academia and humanitarian organizations start listening more and better to the marginalized voices who have mostly been excluded from the discourse.

The thesis is divided into seven chapters. After this introduction and problem formulation, the conceptual framework will outline the concepts of national humanitarian staff, staff well-being and duty of care and will draw a conceptual framework about the impact of staff care on staff well-being. In chapter 3, I carry out a literature review to assess the current knowledge on national humanitarian staff well-being and specific stressors for national staff. I will also clarify what academia and guidelines recommend for staff care programmes in humanitarian organizations and assess the current situation of staff care for national staff in the sector. Further, four possible obstacles will be identified and a final framework for analysis constructed. Chapter 4 then describes the methodology and the chosen approach in detail and reflects on the methodological limitations. In chapter 5, the empirical results are presented for both the document analysis and the online survey. Those results are discussed in chapter 6 in relation to the theoretical framework. Finally, in chapter 7, I will summarize the major findings of the research, propose topics for future research and formulate recommendations on the topic of national staff care.

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2. Conceptual framework

In order to build the conceptual framework for this research, I will first go into the definition of national humanitarian staff, then outline the concepts of staff well-being and duty of care in humanitarian action and finally illustrate the importance of staff care for national staff’s well-being.

2.1. National humanitarian staff

The definition of “national humanitarian staff” is crucial in order to understand who is included or not in the scope of this research. The aim of defining “national” as a specific category is not to create different opposed categories with different values, or even categories of “us” versus “them”, as it might be used or interpreted in some contexts, but to allow an analysis of that group of humanitarian personnel which, in different countries, contexts and emergencies, have similarities in their heterogeneity and thus specific staff care needs that organizations should respond to.

Strohmeier and Scholte (2015, p. 2) define the concept “national humanitarian staff” as “nationals of developing countries who provide paid or unpaid humanitarian activities in their homeland through the government or humanitarian organizations”. This definition includes three components. First, the individual is a national of the country they work in. For this research, this will be widened to long-term residents without citizenship, because they might live under similar circumstances, especially if they have lived in the country for a long period of time. Therefore, their experience is likely similar to that of citizens of a country and their perceptions can contribute to the discussion on staff care of national humanitarian staff. The second component of the definition includes them providing humanitarian activities. For this research, this includes any work for a humanitarian organization in a broad sense, whether they work directly on humanitarian issues or as support staff such as drivers or cooks. As the definitions mentions, it does not matter whether they are professionals, interns or volunteers. The glossary of humanitarian terms by ReliefWeb supports this in its definition of “humanitarian worker”: “Includes all workers engaged by humanitarian agencies, whether internationally or nationally recruited, or formally or informally retained from the beneficiary

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12 community, to conduct the activities of that agency” (ReliefWeb Project, 2008, p. 33). It does not matter which activity according to both definitions and also for this research, because contextual conditions, organizational climate and even trauma exposure might be similar for any position. The difference likely lies more in whether the staff is in direct contact with affected people or not.

The third component of the definition by Strohmeier and Scholte is that the individual works “through the government or humanitarian organizations”. For this research, I will narrow the field and focus on the United Nations (UN) system and NGOs only, leaving out national government organizations, other humanitarian organizations such diaspora networks and other actors such as military or private security, as UN organizations and NGOs account for most of the organizations working in the humanitarian field. The different type of organizations analysed will therefore be UN organizations, INGOs, national NGOs, and local NGOs. Both UN organizations and INGOs usually have national staff, who work in their home countries, as well as expatriates or international staff, who are not citizens of the country they work in. In national and local NGOs, most staff are usually national staff.

Another aspect of the above-mentioned definition, the part where national humanitarian staff can only be “nationals of developing countries” working in their own countries, is rather problematic. The term “developing countries” is contested and out of date, and both this term as well as the suggestion that only citizens of those countries can be national humanitarian workers – implicitly arguing that all citizens of so called “developed” countries will thus be the “internationals” – both represent the hierarchies and stereotypes still nowadays structuring the humanitarian sector. This research will be open to national staff of any nationality because disasters that ask for intervention of humanitarian staff can occur in any part of the world.

In conclusion, national humanitarian staff as described in this research may work in either a UN organization in their home country, as national staff of an INGO, or for a national NGO, whose goal it is to provide humanitarian assistance and protection to a population in crisis, especially to the most vulnerable, through any activity in the organization.

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13 It is important to stress that neither the definition of humanitarian organization, nor the exact definition of national staff, is always used uniformly in literature, and therefore classifications differ in different studies. Additionally, parallels and conclusions for all national staff must be drawn with care, as each national context and each organization is different. Comparative research is difficult for this specific topic. Hence, the goal of the present research is not to compare, but to illustrate this heterogeneous world of national staff and look for common denominators. The details of the definitions used by different studies will not be too relevant in this case.

2.2. Humanitarian work and staff well-being

The inherent nature of humanitarian work makes stressful situations quite likely for staff. Several studies have documented high levels of stress in humanitarian workers (Holtz et al., 2002; Lopes Cardozo et al., 2012), and this is not surprising, as they work in crises and disasters. Humanitarian staff might be exposed to traumatic events, stressful living conditions, ethical dilemmas, violence and suffering (Young, Pakenham and Norwood, 2018). Therefore, the mental health of humanitarian staff has been gaining attention in the past decades, and not only the physical but also the emotional risks of the field are now being addressed by a lot of research focusing on stress and mental health of humanitarian staff (Connorton et al., 2012).

Stress mostly is an individual experience. It is a physical response to a situation of pressure or threat. Stress can be healthy, but it becomes excessive when a person feels that a situation exceeds their coping capacities and resources (Mental Health Foundation, 2020). A stressor is the situation to trigger this experience. A build-up of stressful experiences can have a negative impact on mental wellbeing (Young, Pakenham and Norwood, 2018; Jachens, 2019). Traumatic stressors are situations that involve exposure to traumatic events and physical danger (Stoddard, Harmer and Didomenico, 2009). When people are exposed to a trauma, most recover naturally after a few weeks. However, for some people, symptoms continue and they develop mental illnesses such as a Post-Traumatic Stress Disorder (PTSD), anxiety or depression (Dunkley, 2018). Nevertheless, studies in humanitarian workers have found that chronic stress can be just as detrimental to mental health as traumatic stressors

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14 (Ager et al., 2012; Young, Pakenham and Norwood, 2018). A typical consequence of chronic stress is burnout, a syndrome most likely to occur in people whose jobs require caring for others (Lopes Cardozo et al., 2012).

Most studies focus mainly on PTSD as a “signature disorder” of trauma, but mental illness is not the only consequence of trauma and chronic stress. People can also suffer from individual symptoms such as chronic pain, fatigue or bad sleep, detrimental health in general, or from unhealthy coping strategies or reactions such as unsafe behaviour, bad performance, alcohol misuse or drug abuse (Musa and Hamid, 2008; Thormar et al., 2012). However, these less “quantifiable” outcomes are less clearly documented (Dunkley, 2018). As not all of the people suffering from different consequences of stress will be diagnosed with a mental illness, it would be very reducing to use a narrow concept of mental health in the scope of this research. Further, using a medical model focussed on pathology puts the focus on the individual and on individual treatment, instead of looking at the organization and putting the responsibility to prevent and reduce stress there (Jachens, 2019).

Therefore, I will use the broader concept of well-being instead of mental health. Well-being is based on minimum conditions and perceptions of physical security and safety, but is also inextricably linked with mental health (Solanki, 2017). Employee well-being includes subjective job evaluation, job emotions, the quality of psychological experiences at the work place, negative effects the work can have on employees, and the consequences of this whole experience on other aspects of employees’ lives (Ilies, Aw and Pluut, 2015). Thus, staff well-being would mean that staff feels positively about their work, evaluates it positively, and does not get negatively affected on a psychological level, nor on their other spheres of life.

2.3. Duty of care

Organizations in general and humanitarian organization especially have a duty of care. The fact that humanitarian work involves a great number of physical and psychological risks places responsibility on the employer to mitigate those risks. Duty of care extends on two levels: legal and ethical.

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15 Organizations and employers of any kind have a legal obligation to protect and safeguard their employees. As humanitarian action is carried out in more dangerous contexts, this has implications on their duty of care, as proven in the case “Dennis versus the Norwegian Refugee Council” in 2012, where the Canadian humanitarian worker Steven Patrick Dennis was kidnapped in Kenya while working for the Norwegian Refugee Council (NRC). After being released after four days, Dennis sued the NRC for negligence to their duty of care and won the case, proving that humanitarian organizations have a legal duty of care towards their staff (Dunkley, 2018). According to the judgement, they need to adapt their measures to the context and carry out risk analyses to have a sufficient understanding of the context. They also need to actively make an effort to mitigate possible risks (Kemp and Merkelbach, 2016). In humanitarian action this might be more complicated where boundaries between private and professional life are more fluid. The legal obligation is therefore often related to workplace health and safety and differs from country to country according to national legislation. In some countries, this obligation might not exist. Organizations should therefore have their own standards as well. The more dangerous the context, the higher the standards of care should be (Nobert and Williamson, 2017). Where the legal obligation exists, however, it does not necessarily extend to the staff of local partner NGOs, for example. This is why arguably, there is also an ethical dimension to duty of care which suggests that this duty should extend to all staff an organization has an influence on, independent of the minimal legal requirement (Stoddard, Harmer and Haver, 2011).

2.4. The importance of staff care

The importance of staff care however lies not only in an organization’s legal or moral duty of care and to safeguard their staff, but to contribute to their general work-well-being. Several studies have proven the benefits of staff care not only for the employees, but for the organization itself.

It sounds logical than an organization can only be as strong as its members. And when they get affected negatively by stress, poor decision-making or risky behaviour are only two examples of how it might affect their performance (Antares Foundation, 2012). In consequence, the work of the organization will be affected negatively as well: the quality of

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16 the work will suffer, health costs rise for the organization, and recruitment of qualified staff will be more difficult, additional to possible legal consequences as described above (Ehrenreich and Elliott, 2004; ALNAP, 2018; Wright and Foster, 2018).

On the opposite, staff care and the resulting employee well-being will have a positive impact on reducing employee turnover (Baran, Rhoades Shanock and Miller, 2012; Ilies, Aw and Pluut, 2015; Fee and McGrath-Champ, 2016) and increasing employee performance and in turn organizational effectiveness and efficiency (Baran, Rhoades Shanock and Miller, 2012; Ilies, Aw and Pluut, 2015; Strohmeier and Scholte, 2015; Wright and Foster, 2018; Aldamman et al., 2019). Already in 1997, Mark Walkup published an article about how psychosocial stressors influence not only the individual coping mechanisms of humanitarian workers, but can shape organizational culture as a whole and lead to “policy dysfunction”, such as defensiveness and delusion and the inability to learn and adapt as an organization. He underlined the importance not to look only at external factors that influence the behaviour of an organization, but to look at the organizational culture as the total of values, rules, code of conduct, standard operating procedures, rituals and myths within an organization (Walkup, 1997).

For the employees, especially in humanitarian action, staff care is not only a “nice to have” but crucial to their well-being, as argued by many authors (Ehrenreich and Elliott, 2004; Jachens, 2019; Jachens, Houdmont and Thomas, 2019). Several studies on humanitarian organizations have proven that staff care is not only helpful in increasing employee well-being, but that the organization’s actions and climate is the biggest variable in predicting the impact of stress on staff (Connorton et al., 2012; Strohmeier and Scholte, 2015; Young, Pakenham and Norwood, 2018). A higher perceived organizational support (POS) predicts less emotional exhaustion, less stress and anxiety, less PTSD and depression, decreased burnout and anger, more perceived well-being and general health, and job satisfaction (Baran, Rhoades Shanock and Miller, 2012; Thormar et al., 2012; Lopes Cardozo et al., 2013; Aldamman et al., 2019). Most studies use the concept of “organizational support” or “staff care”. Both terms will be used interchangeably in this research to describe actions and principles an organization can and should follow in order to care for the well-being of its

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17 staff (Jachens, 2019) The field of organizational theory has found that three factors have an influence on this POS: fairness, favourableness of organizational rewards and job conditions such as preparation, training, stressors, and role of management. Other factors such as personality or demographics were not found to have an influence on POS (Baran, Rhoades Shanock and Miller, 2012; Lopes Cardozo et al., 2012), however they do influence the resilience and capacity of an individual to deal with stressful situations (Aldamman et al., 2019).

According to the literature, POS also influences employees’ safe behaviour and choices of coping strategies. If employees perceive that their organization cares about their safety and well-being, they might report errors and unsafe conditions more often and therefore reduce risks at the workplace. In this way, POS acts as a buffer on the negative relationship between perceived stressors and well-being (Baran, Rhoades Shanock and Miller, 2012).

This is especially important to take into account when looking at the fact that several studies have suggested that organizational stressors are more important determinants of mental illnesses than traumatic events (Curling and Simmons, 2010; Thormar et al., 2012; Young, Pakenham and Norwood, 2018). Jachens (2019) defines these different categories of stressors as “job content”, which is inherently stressful in the humanitarian sector because they work in crises, and “job context”, defining the factors that depend on the structure of the organization. Given the evidence of the importance of organizational support and the fact that it has a bigger impact on the mental health and well-being of staff than exposure to traumatic events, more attention should be put on “job context” factors, because they are the main source of negative stress for humanitarian staff and also where an organization can make the biggest contribution to employee well-being. In turn, they will not only protect their staff but also improve the quality of their work, reduce employee turnover and improve their ability to retain qualified staff. However, to date not much research has focussed on organisational stressors in the humanitarian sector (Jachens, 2019).

It is therefore evident that a model that only focuses on providing support after a critical incident is not enough. Organizations need to focus also on the prevention of traumatic and chronic stressors, even though with limited resources it might seem easier to only treat

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18 problems that already exist (Solanki, 2017). Quality staff care is not only related to having psychological first aid available or providing psychologist to talk to. In general, an organization can reduce the number or intensity of stressors, strengthen the individual’s capacities and resilience to stress and help staff members cope with stress and trauma (Antares Foundation, 2012). The Antares Foundation (2012) therefore uses three categories to group staff care activities: actions to reduce stress, training and preparation of staff, and helping staff cope. Other authors define categories according to time: pre-deployment, during deployment and post-deployment (Porter and Emmens, 2009; Brooks et al., 2016). Even though this last definition is very much focused on expats and not directly applicable to national staff, it is a similar idea of what to do before, during and after stress occurs. Mixing both sets of categories, the following four categories of organizational support will be used for this research:

1. Selection, preparation, and training

2. Prevention of stress: aspects of the organization and the job context

3. Reaction to traumatic events: helping individuals cope with stress

4. Follow-up: offering support and follow-up even after a contract or assignment has ended

Figure 2 shows in summary that these four categories of staff care do on one hand shape the “job context” and psychosocial work conditions, meaning the stressors that arise from the conditions of the employment and from the organization itself. On the other hand, staff care can also buffer negative impacts from stressors arising from the external context or from the job content, such as traumatic events or exposure to stressful situations, which the organization can’t directly influence and are simply “part of the job”. In this way, staff care has an impact on staff well-being.

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Figure 2: The importance of staff care for staff well-being. Source: Author’s work, based on the literature of

the previous chapter.

The literature review will show in detail which aspects of staff care are especially important for staff mental health and well-being in organizations, and those will be looked at in more detail in the methodological framework in order to operationalize this concept.

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3. The situation of national humanitarian staff care: a review of

the literature

After having defined national humanitarian staff and analysed the role and phases of staff care in humanitarian action, this chapter will now assess the state of current knowledge about staff care of national humanitarian staff. In the first part, the well-being of national humanitarian staff will be described, followed by an analysis of specific contextual stressors that national humanitarian staff faces. After, based on literature and guidelines, evidence-based efficient staff care strategies for all four phases will be described. This will give a frame of reference to how staff care should look like in order to be of most use for national humanitarian staff. In the next chapter, this “ideal” staff care will be contrasted with an assessment of existing staff care strategies for national humanitarian staff. Following this, different contextual factors will be analysed to see to what extent they might or might not have an influence on the implementation of staff care strategies for national staff. In the last part, this information will be synthesised in a theoretical argument and framework.

3.1. Assessment of national humanitarian staff well-being

To analyse the situation of staff care and well-being of national humanitarian staff, this chapter will first describe the literature on the mental health impacts of work in the humanitarian sector as an indicator of the effectiveness of staff care in the humanitarian sector. Practitioners like Walkup (1997) have been warning about the mental health impact on of humanitarian work on staff for decades. Different case studies and some longitudinal studies have since been carried out. Connorton et al. (2012) analysed them in a systematic literature review to find out about the mental health impact on staff. They found eleven studies on relief workers and mental health, and five studies on relief worker organizations. Their results were limited, because the different studies used not only different definitions of relief workers and organizations, but also analysed different mental health outcomes. Additionally, they did not differentiate between national or expatriate staff when selecting the studies for their analysis. Still, they found evidence that the prevalence of mental illness is higher in humanitarian personnel than in the general population.

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21 Their results were confirmed by other studies (for example Thormar et al., 2012; Sifaki-Pistolla et al., 2017). The evidence of adverse mental health impacts of humanitarian work has been collected over the past two decades and is quite alarming. A very illustrating case is the survey carried out by the United Nations High Commissioner for Refugees (UNCHR) on their staff in 2014. Between 25 and 38 % of their staff were at risk for anxiety, depression, PTSD, secondary stress and alcohol misuse, and up to 43 % (almost half of their staff) for burnout (United Nations High Commissioner for Refugees, 2016). This study is only focused on one organization and might have some important limits such as people not speaking out against their mental health problems when it’s their employer carrying out the survey, and again it does not differentiate between national and international staff, but it confirms the trend of mental health risks for humanitarian staff.

In 2015, Strohmeier and Scholte (2015) realized a literature review focusing on national staff only. National staff is used in that study as a category opposed to expatriates, working for a national or international NGO or for a UN body or even government, very similarly to the definition used in this paper. Only 14 articles matched their inclusion criteria. They found that PTSD, depression, and anxiety exist among national staff at least as often or in higher numbers than in reference groups (Strohmeier and Scholte, 2015). However, similarly to Connorton et al. (2012), they found conclusions difficult because of the varied definitions of the term humanitarian/relief personnel, and of the term “national” staff. Studies included both paid personnel and volunteers and both trained and untrained staff.

Research projects lead by the Antares Foundation examined sources of stress in humanitarian staff, both expatriate and national staff, through research in different contexts. One of the projects was a major longitudinal research project on national staff in Uganda (Ager et al., 2012), Jordan (Eriksson et al., 2013) and Sri Lanka (Lopes Cardozo et al., 2013). In these studies, they found an alarming rate of mental health risks and symptoms in national staff: over half of the staff in all three contexts presented clinically significant signs of anxiety and almost one-quarter presented signs of PDTS (Antares Foundation, 2012).

However, as Aldamman et al. (2019) point out, research on humanitarians is not representative of the field yet, as most studies still examine expatriate personnel and paid

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22 personnel, while most humanitarian workers are national and volunteers. As a result, Dunkley (2018, p. 9), points out that the numbers in studies on mental health “are likely to be greater, particularly for national staff, where legal procedures and the cultural implications of discussing mental ill-health can make reporting more difficult”.

Further, Strohmeier and Scholte (2015) point out that definitions of medical disorders, additionally to excluding less severe sets of symptoms that are still relevant for the affected individual, are culturally insensitive and that some studies did not take this into consideration. Concepts are often applied to a population without testing them or adjusting them to context; or various populations are simply compared to the most studied reference group which is the predominantly white population in the United States.. Joseph Henrich (2010) already in 2010 warned about research, especially in psychology, being based mostly on WEIRD (Western, Educated, Industrialized, Rich and Democratic) societies, which according to them are “among the least representative populations one could find for generalizing about humans” (Henrich, Heine and Norenzayan, 2010, p. 61) and it should therefore not be assumed that there is no variation across human populations.

Not only are national humanitarian workers therefore often excluded from research on humanitarian staff, but when they are included, research is often blind to cultural differences. Nevertheless, the studies have proven that mental health is a concern to be taken serious amongst national humanitarian staff, and that they are at least equally affected by the stressors of their job and context as the well-researched expatriate staff.

3.2. Contextual stressors specific to national humanitarian staff

Seeing that mental well-being is a concern for national humanitarian staff, it is important to analyse the possible reasons for this. This chapter will analyse the contextual stressors specific to the work and reality of national humanitarian staff. Those stressors are related to the perception of safety and security, where national staff does not only experience different risks but also limited options to confront and change the stressful situation.

National humanitarian staff operates in a different context than international staff or expats and is exposed to different stressors consequently. National humanitarian staff in general is

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23 for example more often affected by physical threats. The majority of aid workers affected by violence, according to Dunkley (2018), were nationals of the country they were working in. In 2016, there were five times more national staff involved in incidents of violence than international staff (Dunkley, 2018). Even though expatriate humanitarian staff is affected in a higher per capita rate by violent attacks than national humanitarian staff, the later form the majority of victims, due to representing a much higher proportion of staff working in humanitarian action and to the fact that they are more exposed in field positions (Stoddard, Harmer and Haver, 2011).

In many cases, international organizations work through local partners in contexts of security constraints or host state restrictions on international staff movement, based partly on the assumption that local actors will face lower risks than international actors. However, this is an assumption that is not guaranteed in most of the contexts (Stoddard, Harmer and Haver, 2011). National organizations or national humanitarian staff of international organizations are then often under a certain pressure to downplay or ignore security threats in order not to threaten their contracts, jobs and livelihoods, or the financing of their organization (Stoddard, Harmer and Haver, 2011). Another way that national humanitarian staff will be more exposed to threats and traumatic events is the fact that civil society organizations and local actors are usually the first to respond to any disaster or incident (Sphere Association, 2018). At the same time, those organizations and individuals often cannot decide to leave a context when it gets too dangerous. INGO and UN policies for the most part don’t provide evacuation for nationals as they do for internationals, because they don’t want to create refugees (Stoddard, Harmer and Haver, 2011). National organizations are committed long term and obliged to act with whatever resources are available to them, while INGOs can define whether a context fits their strategic decisions, where to withdraw when resources are limited, and to uphold in this way a certain professional standard (Ferris, 2006).

When working in humanitarian action in their home countries, national staff have reported stress related to their work as well as to their daily life, as they often live "in highly stressed societies and often from themselves being survivors of the events that led to the humanitarian intervention" (Antares Foundation, 2012, p. 10). Over two thirds reported that the primary

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24 source of stress are economic or financial problems. Half reported tensions between national and international staff, including unequal treatment, as a major source of stress (Antares Foundation, 2012). While their own communities and families might be affected by the humanitarian disaster they are responding to, they also have different terms of employment, benefits and salary scales than expatriate workers (Stoddard, Harmer and Haver, 2011).

One factor where national staff might be better equipped is that of the social network: International staff in many cases leave their families and loved ones behind in their countries of origin and do not have to worry about them. However, this also means that they often lack a social support network, which in turn national humanitarian staff are more likely to have in place (Connorton et al., 2012). This social support is very important for the mitigation of the impact of trauma and stressors (Curling and Simmons, 2010).

National staff will be impacted differently by stressors because of not only their relation to the humanitarian context and personal circumstances, but also to the type of organization they work in and the context and conditions of those organizations and their capacities and resources to provide adequate working conditions and staff care, and the type of role they assume within an organization. The next chapter will present how efficient staff care can concretely look like in the four phases.

3.3. Evidence-based staff care policies

The conceptual framework stresses the importance of a four-phased staff care programme. This chapter will now look at how academia and guidelines suggest staff care should look like for national humanitarian staff in each of the four phases, in order to analyse the current situation of staff care in the following chapter.

3.3.1. Preparation and Training

There are two components to staff care: to provide positive support and to mitigate stressors. For this it is important to know where they can provide support, and at the same time which the most prevalent stressors are. The most important factors influencing the mental health outcomes of staff are preparedness and training, and organizational factors, as several studies

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25 analysed by Strohmeier and Scholte (2015) indicated. Training has two main objectives: Having the knowledge and capacities to fulfil one’s responsibility and being prepared to confront occupational trauma and stress.

The duty of an organization is first to employ the right person for the job. This decision will have an impact on how prepared and experienced a person is, but also what personal factors they bring with, both strengths and weaknesses. The selection process should be according to job-specific criteria and depending on the job an evaluation of knowledge, capacities and even psychosocial resilience might be necessary (Bills et al., 2008; Thormar et al., 2012; Brooks et al., 2016; Aldamman et al., 2019). Once a person is selected and hired, it is the responsibility of an organization to prepare them for their tasks and for possible situations they might encounter. According to Connorton et al., (2012), there is not enough research on how to prepare staff for traumatic events, and none of the studies allowed for staff to suggest what specific training and support would be helpful to them. However, a few specifics about preparation and training have been studied. Trainings should be focused on content of the job, but also on increasing their resilience. This can be done through stress management and security trainings, or trauma awareness campaigns, for example (Dunkley, 2018).

The following table summarizes the stressors and protective factors in relation to preparation and training of national humanitarian staff and suggests how an organization can include these factors in their general staff care policies. It defines specific factors of each of the action categories that an organization can take, which can be used to measure the staff care of an organization in relation to preparation and training.

Table 1: Training and preparation of national humanitarian staff: Summary of recommendations

Protective Factor (+) / Stressor (-) Source Action an organization can take

Being prepared + (Aldamman et al., 2019)

Having an adequate selection

process with job-specific criteria

and assessment strategies Job experience + (Thormar et al., 2012;

Brooks et al., 2016; Aldamman et al., 2019) High level of training + (Bills et al., 2008;

Thormar et al., 2012) Unhealed trauma and personal history - (Bills et al., 2008;

Brooks et al., 2016) Having information on stress and

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Being aware of trauma and symptoms + Provide training, workshops

and campaigns on stress and trauma

Knowledge of psychological first aid + Information about stress

management/resilience building + Sexual violence awareness +

(Dunkley, 2018)

Provide training, workshops

and campaigns on physical security

Kidnapping and hostage-taking survival knowledge +

Security training + First Aid training +

As research on national humanitarian staff is very limited, studies on humanitarian staff in general are also included in the analysis above, as there are a lot of similar and general needs for staff care in humanitarian action. Two of the five sources mentioned (Thormar et al., 2012; Aldamman et al., 2019) are studies on national humanitarian volunteers, the other three (Bills et al., 2008; Brooks et al., 2016; Dunkley, 2018) are on aid workers or disaster responders without specifying the contractual status or the nationality. This shows that while there are some studies on national humanitarian staff, there is still a lack of information on the appropriate and necessary strategies for preparation and training related to their well-being. Even though parallels to other studies of disaster responders in general can easily be drawn because the circumstances might be very similar, more studies should focus on the specific needs for national humanitarian staff.

3.3.2. Prevention of stress: the role of the organizational climate

Work stressors and organizational factors were identified as the most prevalent stressors in studies on humanitarian staff (Young, Pakenham and Norwood, 2018). Different authors use different categories for these stressors, but they can be resumed as psychosocial work characteristics (Jachens, 2019). Cooper and Marshall (1978) (as cited in De Simone, 2014) conceptualize the sources of occupational stress as follows:

• Intrinsic job-related factors • Role in the organization • Relationships

• Job security and perspectives

• Organizational structure and climate, participation, and communication • Social support and link with family

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27 According to Young, Pakenham and Norwood (2018), factors related to relationships and job-intrinsic factors (workload) are the most mentioned stressor amongst humanitarians. Curling and Simmons (2010) also found in a workplace stress survey conducted on national and international staff of an INGO that job-intrinsic factors such as workload and working hours were the highest rated stressor. The fact that humanitarian staff often reports a high workload and long working hours is probably related to the fact that the needs of the affected population are mostly greater than what an organization can offer, and staff is thus doing their best to fulfil them. This leads to a normalization and even expectation of such behaviour in organizations (Solanki, 2017).

Other important stressors relate to status of employment contract, political situation and uncertain security situation (Curling and Simmons, 2010). Job security and general security of staff should therefore be taken seriously by any organization, by not only having the adequate security evaluation and protocols in place, but also by providing human resource policies such as health insurance and support to cover the basic needs of staff and their families (Stoddard, Harmer and Haver, 2011). Very high rated were also stressors related to role and organizational climate, such as communication, feeling undervalued, and corruption (Curling and Simmons, 2010). The factor related to the role in the organization can be related to the fit between individual values and organizational values (Curling and Simmons, 2010), but also depend on personal factors like motivation, autonomy and control over work (Ager

et al., 2012).

When asked about the most useful interventions of staff support, the most prevalent were social activities, information on stress and stress management, counsellors and peer helpers (Curling and Simmons, 2010). From the stressors and risks, conclusions for effective organizational support can be drawn. The stressors or protective factors as well as the possible actions for organizations are summarized in the following table. However, there are also some stressors that an organization has no influence over, such as life events of staff (Lopes Cardozo et al., 2012; Brooks et al., 2016). Other stressors might be systemic to the organization or the sector, such as excessive bureaucracy (Young, Pakenham and Norwood, 2018).

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28 Of the literature presented here, only three studies focus specifically on national humanitarian staff (Ager et al., 2012; Thormar et al., 2012; Aldamman et al., 2019). They focus on the importance of fair treatment, clear role descriptions, reduced trauma exposure, the quality of management and supervisors, the risk of excessive work hours and limited work-life balance, and the problems arising from communication within the organization.. These studies don’t mention living conditions as something an organization should keep in mind for staff care of national staff, likely because with national staff this is not seen as a responsibility of the organization, contrary to international staff who might have housing offered by the organization. Other seven studies (Bills et al., 2008; Curling and Simmons, 2010; Lopes Cardozo et al., 2012; Brooks et al., 2016; Dunkley, 2018; Strohmeier, Scholte and Ager, 2018; Young, Pakenham and Norwood, 2018) focus on humanitarian staff in general, while sometimes analysing the different staff categories. Seen that research on national staff specifically is still limited, it can be of benefit to include these results as well and to analyse whether they apply to national staff as well. One study on organizational support theory and perceived organizational support (Baran, Rhoades Shanock and Miller, 2012) confirms some of the findings and is included as well in the analysis. Table 2 presents more details about each category as a summary of the literature reviewed.

Table 2: Prevention of stress: Summary of recommendations

Stressors (-)/ Protective Factors (+) Source Action an organization can take Strong team cohesion +

Lack of teamwork - Social activities + Team building +

(Lopes Cardozo et al., 2012; Young, Pakenham and Norwood, 2018)

Offer team building and social

activities

Communication issues - Being listened to + Lack of information -

(Ager et al., 2012; Strohmeier and Scholte, 2015; Brooks et

al., 2016)

Have appropriate

communication, information and complaint channels

Excessive workload - (Curling and Simmons, 2010; Lopes Cardozo et al., 2012)

Have enough personnel for the tasks

Defining roles and

responsibilities clearly Limit working hours Provide rest and recreation

Undefined or excessive working hours -

(Curling and Simmons, 2010; Young, Pakenham and Norwood, 2018; Aldamman et

al., 2019)

Work-life balance +

(Young, Pakenham and Norwood, 2018; Aldamman et

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Status of employment -/+

(Curling and Simmons, 2010)(Porter and Emmens, 2009; Curling and Simmons, 2010)

Provide long term contract Provide contract with benefits Job security -/+ (Young, Pakenham and

Norwood, 2018) Health issues - (Young, Pakenham and

Norwood, 2018) Provide health insurance Poor management - (Aldamman et al., 2019)

Have trained and qualified

managers

Difficult supervisors - (Curling and Simmons, 2010) Supervisor support + (Thormar et al., 2012; Brooks

et al., 2016)

Perceived lack of support - Involvement in decision making processes +

Interest of management +

(Baran, Rhoades Shanock and Miller, 2012; Brooks et al., 2016; Young, Pakenham and Norwood, 2018)

Security concerns -

(Curling and Simmons, 2010; Brooks et al., 2016; Young, Pakenham and Norwood, 2018)

Provide security trainings,

protocols and policies

Exposure to trauma -

(Thormar et al., 2012; Brooks

et al., 2016; Young, Pakenham

and Norwood, 2018)

Reduce exposure to trauma

Role ambiguity - Clear job description +

(Brooks et al., 2016; Young, Pakenham and Norwood, 2018; Aldamman et al., 2019)

Define clear roles and job

description

Feeling powerless –

Perceiving a lack of impact - Finding meaning and satisfaction in the work +

(Brooks et al., 2016; Young, Pakenham and Norwood, 2018)

Manage expectations Have psychosocial support available

Make sure personal values and mission are compatible when hiring

Gap between personal values and actions -

Knowing the mission of the organization +

(Curling and Simmons, 2010; Young, Pakenham and Norwood, 2018)

Fair treatment/equality +

(Baran, Rhoades Shanock and Miller, 2012; Strohmeier, Scholte and Ager, 2018; Aldamman et al., 2019)

Ensure fair treatment between staff

Separation from loved ones, loneliness, lack of intimacy - Social support +

Contact to family, rest and recreation (+)

(Ager et al., 2012; Young, Pakenham and Norwood, 2018)

Ensure social support, communication with family

Living conditions - (Young, Pakenham and

Norwood, 2018) Support minimal conditions for staff

Support autonomy Flexibility to personal circumstances Private circumstances (finances,

health, family, etc.) – Political, economic, social situation -

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3.3.3. Organizational reaction to traumatic events and follow-up

Having mechanisms in place to support staff that was affected by a traumatic event is probably the most “obvious” staff support strategy a humanitarian organization can put into place. This can be any sort of psychosocial support, whether provided within the organization or by outside support (Dunkley, 2018). If stigma and taboos within the workplace are an obstacle, then outside experts might be a good solution. On the other hand, it might just contribute to maintaining mental health issues quiet and stigmatized (Solanki, 2017). Further, literature stresses that psychosocial support should not be focused only on acute cases of trauma, but that organizations should adopt a more proactive approach, discuss mental health issues and contribute to an open environment for discussions around mental health and well-being in the humanitarian sector (Solanki, 2017).

A trauma management programme should include peer support, psychological first aid, crisis management, trauma assessment, specialist counselling and follow-up on cases. While there are staff care materials and guidelines, there are no empirically tested psychological interventions adapted to the needs of humanitarian staff. Ideally there would be training and interventions that could be applied sector wide in order to support humanitarian staff (Young, Pakenham and Norwood, 2018). However, trauma was interestingly not often mentioned in a big study with open questions about stressors for staff in the humanitarian sector, contrary to studies which specifically focus on aid worker reactions to trauma. While this is by no way an indication of a low impact of trauma, it still suggests that other stressors might be more common and thus more detrimental to staff well-being (Young, Pakenham and Norwood, 2018).

The following table summarizes the actions an organization can take. The fourth component of staff-care – follow-up after traumatic incidences and after contracts or assignments end – is included here, because there are very few specifications in literature about how this follow-up should look like for the greatest benefit of national staff.

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31 Table 3: Organizational reaction to traumatic events and follow-up: Summary of recommendations

Stressors (-)/ Protective Factors (+) Source Action an organization can take

Psychological first aid + Peer support +

(Strohmeier and Scholte, 2015; Dunkley, 2018)

Train all staff on trauma awareness Train some staff on PSA

Motivate peer initiatives Psychosocial support +

Professional support + Counsellors +

(Strohmeier and Scholte, 2015; Brooks et al., 2016; Sifaki-Pistolla et al., 2017; Dunkley, 2018; Aldamman et

al., 2019)

Provide in house counsellor Provide outside professional support

Again in this chapter, two studies (Strohmeier and Scholte, 2015; Aldamman et al., 2019) focus on national humanitarian staff specifically, the other three (Brooks et al., 2016; Sifaki-Pistolla et al., 2017; Dunkley, 2018) on humanitarian staff in general. The recommendations from all studies are however similar for this phase of staff care. Regarding staff care for national specifically, the difficulty of finding skilled and experienced counsellors with the appropriate language abilities was mentioned as a challenge. When translators are employed, it should be assured that they are qualified for those kind of issues (Stoddard, Harmer and Haver, 2011).

3.3.4. The importance of individualised and adapted staff care

The existing literature gives quite some information about stressors and possible mitigation actions for a humanitarian organization. There are some indicators of stressors specific or more prevalent for national humanitarian staff, but more research is needed on how and if they relate to specific staff care mechanisms. Obvious differences may lie in factors of context and personal circumstances, social support, culture, and fairness. However, differentiating between international and national staff is not the most important thing an organization should do: staff care should rather be focused on individuals with different needs that might change according to age, educational level, experience, religious values, marital status or sex, for example (Antares Foundation, 2012). Other subgroups such as LGBTIQ+ staff (Dunkley, 2018) or female aid workers (Young, Pakenham and Norwood, 2018) might face other risks and perceive additional stressors. Staff care should take this into account just

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32 as it should be aware of different risks for national staff: an ideal staff care programme is adjusted to all possible individual needs.

Further, staff care also greatly depends on the organization and on the context. Individuals and circumstances vary widely, and an organization might struggle to decide upon the best staff care to apply. However, this is where minimum standards in staff care come into play and are important as a starting point for organizations (Porter and Emmens, 2009).

3.4. Assessment of existing staff care strategies

The aim of this section is to compare the staff care recommendations by academia and guidelines presented in the previous chapter with the actual situation and current practices in the organizations. While studies about the stressors in humanitarian action and for national humanitarian staff exist, research about the actions of organizations is much scarcer, especially for national NGOs. However, there is some information on how organizations handle staff care, even though the studies are mostly focused on expatriates. One reason for the lack of research on the topic might again be a lack of common definitions and the lack of appropriate frameworks, both obstacles that I encountered in the present research as well. This leads to different authors creating their own frameworks which in the end are difficult to compare (Thormar et al., 2012).

The Macnair report from back in 1995 already recognized that mental health of staff and their general well-being is not properly addressed, and neither are the conditions to prevent stress within humanitarian organizations (Macnair, 1995). It seems that little has changed since then. Fee an McGrath-Champ (2016) studied ten European and US-American INGOs on their staff care of expatriate staff, trying to identify “good practices” for the sector to learn from, recognizing that there was still very little research focusing on the human dimension and human resources domain of organizations. People in Aid and Interhealth (Porter and Emmens, 2009) published a survey of 20 INGOs about staff care policies in place. They found that practices were very inconsistent and only about 30 % of organizations had specific staff care policy. A lack of consistent definitions regarding staff care was discovered also on the level of organizations. Not even a third of organizations had evaluated their staff care

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33 programmes and not a single organization had conducted research on staff care that was publicly available (Porter and Emmens, 2009). In a more recent study on humanitarian staff, Young, Pakenham and Norwood (2018) confirmed the results of previous findings that organizational support for humanitarians mental well-being is generally lacking: Humanitarian staff is stressed by work, “but did not see helpful support options within their organisations” (Young, Pakenham and Norwood, 2018, p. 10), all the while the same study support the thesis that organisations actually are the leading cause of stress for staff.

Regarding preparation and training, good practices were found in the 2009 survey of INGOs in the standardization of induction processes (in 60 % of organizations) and in regular medical check-ups (in half the organizations) (Porter and Emmens, 2009). Fee and McGrath-Champ (2016) confirmed in 2016 that a lot of focus goes into screening and selection of the participants. Medical check-ups and psychological screenings were common in the INGOs they assessed. Some but not all organizations also trained line managers to be aware of expatriates’ psychological well-being (Fee and McGrath-Champ, 2016). Further, they found that safety and security training was offered by all organizations for staff before deployment, and that they focused a lot on “people services” such as training and development and physical and psychological well-being. Psychological well-being is not further defined however, and it is not clear how much focus lies on this during the trainings, as compared to physical safety (Fee and McGrath-Champ, 2016).

In a worldwide study on UNHCR staff, which can serve as an illustrative example with UNHCR employing over 8600 staff members across 125 countries, researchers found that there is no regular training for all staff about stress management. Only 12 % of respondents had received information about how to cope with stress and about common stressors of humanitarian work by their organization (Solanki, 2017).

Information on the perceived organizational climate and the prevention of stress in different organizations is very limited. However, as an illustrative example, it is interesting to see that only one of the ten INGOs analysed by Fee and McGrath-Champ (2016) had mandatory rest and recuperation periods at a periodic interval.

Staff care for national staff in the humanitarian sector: