Help wanted – local aid workers need psychosocial assistance too

Back-to-back emergencies during the last three months in the Philippines have exposed the need for more psychosocial support (clinical and social assistance to ease mental suffering) for local aid workers who are often the first responders – even when they have also been seriously affected – but are among the last to get help.

“What interests me most is that there is always sufficient money available to pay… [for] psychosocial support services of internationally hired staff, but hardly ever enough to consistently provide similar services to locally hired staff,” said John Fawcett, who has worked on NGO staff wellness for the past 20 years, including directing staff support services at the global NGOs, Save the Children and World Vision.

In the Philippines, the Moro National Liberation Front (MNLF) laid siege to the port city of Zamboanga on the southern island of Mindanao on 9 September 2013 to protest on-going peace talks between the government and a breakaway rebel faction. Two weeks of fighting followed, displacing more than 100,000 people.

On 15 October a 7.2-magnitude earthquake hit the central island of Bohol, displacing about 150,000 people, about half of whom are still unable to return home.

Ronnel Villas, a local humanitarian coordinator for the UN Population Fund (UNFPA), was still on a medical mission in Zamboanga when Typhoon Haiyan struck his hometown of Tacloban in the central Philippines on 8 November 2013. Communication lines were cut, commercial flights were suspended and he could not reach his family. To date, an estimated 207,000 people out of Tacloban’s 221,000 population (2010 estimate) remain displaced.

“The hardest part was the three days of not knowing the whereabouts of my family,” said Villas. When he finally found a way to get to Tacloban, he was shocked by the devastation. All 138 of the city’s subdivisions (locally called ‘barangays’) were affected.

Typhoon Haiyan (local name Yolanda) made landfall a total of six times in central and western Philippines with winds of up to 315km per hour pummelling residents and buildings with gusts as strong as 380km per hour, according to the government.

The latest report from the Philippine National Disaster Risk Reduction andManagement Council said some four million people remain displaced and more than 5,000 have died.

“We are used to getting storms in this part of the country, but never had I seen devastation like this. I also had a duty to respond to this crisis. Once I had secured my family, I knew I had to help rebuild my community, too,” said Villas.

“In the first 24 to 48 hours of a disaster, the community bears the burden of response. It is a fallacy to rely on external help,” the World Health Organization’s (WHO) Southeast Asia adviser for emergency and humanitarian action, Roderico Ofrin, told IRIN in 2010.

Community responders are even more important today as the number and intensity of disasters multiplies, said Gwen Pang, secretary-general of the Philippine Red Cross, which trains local emergency responder volunteers.

In 2012 the UN Office for Disaster Risk Reduction (UNISDR) ranked the Philippines as the 12th country globally most prone to tropical cyclone, flood, earthquake and landslide risk.

“First responders are effective. They know the community, the needs and available resources,” Pang told IRIN. “But as first responders, who are also survivors, they also need psychosocial support for them to cope better.”

First to respond, last to get help?

Yet local relief workers are often among the last to receive such support because of their perceived equanimity, said Jorge Sierralta, a clinical psychologist with the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“They are composed. Their adrenaline-fuelled productivity and heightened sense of purpose because this is their own community [they are helping], gives the appearance they are coping well,” said Sierralta, who is in the Philippines to assess the psychological health of OCHA staff and advise other UN agency managers about staff welfare.

Even if offered grief counselling, some will decline, due to local stigma against any perception of mental weakness, he added.

Or perhaps they sometimes do so simply out of overwhelming gratitude for having survived, as was the case with Jamilla Arasid, a government social worker who processed displaced persons in Zamboanga, where her home was burnt down on the second day of the siege.

“We couldn't save anything – I had no vehicle to haul things. I tried to hire [public transportation]. I even said, ‘name your price’ but none of them dared to help us. Yes, it is sad, especially when I think that everything that we saved up for [over] so many years is now gone. But then I'd think of others who are displaced, [how] they had no work during the siege and even after. At least I still had a job, and all throughout the siege I was still receiving a salary for doing my job. I am still thankful to God that we survived.”

Financial stress was the top worry reported by surveyed local aid workers, according to the 2012 edition of Stress management guidelines for humanitarian workers by the Stockholm-based Antares Foundation, in collaboration with the US Centres for Disease Control.

“Following or during a disaster the ability to earn wages are negligible,” said Fawcett, previously with OCHA, but now an independent consultant based in New Zealand. “No one who gains employment in such circumstances is going to compromise that by demanding more than they already receive.”

Expatriate workers most often reported restrictions on movement due to security concerns, housing problems, conflicts with fellow staff members, lack of direction from management, and an excessive workload.

Data from surveys of close to 1,000 national aid workers from Iraq, Jordan and Sri Lanka revealed that between half and two-thirds had clinically significant levels of depression, and nearly half had clinically significant signs of anxiety. Between one-fifth and one-quarter of local staff surveyed showed prominent signs of post-traumatic stress disorder (PTSD).

Their international counterparts reported lower levels of depression (20 percent) and anxiety (12 percent) post-deployment, and very few cases of clinically significant PTSD.

Most workers in Sri Lanka reported having lost property or needing to flee suddenly during the civil war, and over one-third also reported having to live in a camp for displaced persons, going without food and water, or experiencing the loss of a family member or friend due to violence.

Duty of care – for some?

International staff are more likely to seek and receive mental health support, said Fawcett, explaining how their home countries most likely honour “duty of care”, a part of common law, or even an explicit legal obligation, in most developed countries, in which there is an implicit responsibility by an individual to not harm others, which includes preventing psychological injury.

Resources

Managing Stress in Humanitarian Workers

Managing Stress in Humanitarian Work : A Systems Approach

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

European Consensus on Humanitarian Aid

Approaches to Staff Care in International NGOs

Critical incident stress debriefings

USAID Staff Care Centre

“International staff of both for-profit and non-profit organizations have been successful in courts and in actions against employers for lack of duty of care. It has been, to my mind, amazing that such cases have not been pursued in courts on behalf of locally hired staff,” said Fawcett.

There have been a number of notable efforts to improve mental health support to local aid workers. Sierralta said the UN has doubled the number of staff counsellors in the past seven years. Fawcett commended the Staff Care Centre recently set up by the US Agency for International Development’s (USAID), which aims to provide comprehensive support services to all USAID personnel worldwide.

But such initiatives are too few and too poorly funded, or simply result in some one-off workshops with no institutional change. Fawcett suggested that one way to cement such efforts would be for USAID to require its funding applicants to ensure staff welfare programming, which “has the potential to change the way such services are delivered”, given USAID’s prominence in humanitarian funding.

Without donor pressure little would change, as was the case in Haiti, where Fawcett said there was an “egregious” lack of concern for aid workers from disaster-affected communities.

“Despite the hundred so millions of dollars pouring into the agencies, it was virtually impossible to find a few tens of thousands [of dollars] to support local staff,” he wrote to IRIN in an email. “There was not one staff [member] hired locally who had not experienced calamitous loss… In western contexts these people would have been sent home and advised to seek help.”

More resources are needed to address the psychosocial needs of local humanitarian workers, whose need for support is equal, if not greater than, that of international staff, said Sierralta. “They can hear the stories in their own language. They can sense things we [international aid workers] cannot sense.”

Resources

Jeoffard Montejo Jr was part of a team of Philippine government nurses who attended to emergency maternal healthcare needs following Typhoon Bopha (local name Pablo) in the southern Philippines in 2012, which ranked as the country’s deadliest in two decades (with an estimated 1,900 dead or missing) until Typhoon Haiyan hit.

He was recently deployed to central Philippines for Typhoon Haiyan relief efforts. “We need stress de-briefings, too. It would be ironic if we health workers could not provide healthcare,” said Montejo.

Some five years ago a prominent UK-based Cochrane Review meta-study said “no evidence has been found” that post-trauma briefings (also called critical incident stress debriefings, or CISD) were effective, and they could actually cause harm.

But other researchers have defended the practice of CISD for emergency workers, which is the original purpose for which these debriefings were first employed.

The Antares Foundation calls for “practical, emotional and culturally-appropriate support for staff at the end of an assignment or contract”.

Sierralta said some of the recommendations being implemented in the Philippines to ease workers’ stress are shorter durations in the field, with periods of rest and more staff rotations.

Psychosocial support programmes are in place for disaster survivors – mostly led by NGOs, the Department of Health or the Department of Social Welfare Department (DSWD) – but the Philippine government only provides help for emergency workers on an “as-needed basis”.

Narradelle Bue, information officer for the DSWD local office in Zamboanga, pointed out that “The urgency is to attend to victims first. But it is true that now the lines between victims and responders are blurred.”

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