When devastating earthquakes hit Türkiye and Syria in February, aid workers rushed to help, bringing desperately needed food, shelter, and healthcare to millions.
But almost immediately, some began to ask a question that lingers as the three-month mark approaches on 6 May: What about the needs of those who delivered aid — the frontline responders tasked with assisting the survivors of a disaster that killed more than 56,000 people and injured more than 100,000?
After all, many of those involved in the aid effort were impacted in some way by the quakes, losing homes, family members, and friends, or feeling the tremors – the Turkish city of Gaziantep is a major centre for NGOs that work in northwest Syria, and was hit hard. And while some NGOs say they were able to provide psychosocial care for their employees and give them breaks as needed, there were issues of funding, time, and inequities in who received — or is now receiving — adequate help.
Amany Qaddour is regional director for Syria Relief and Development, an NGO that works in rebel-held northwest Syria, where millions were in crisis even before the quakes hit. She said that when the first earthquake struck on 6 February, aid workers — the majority of whom are from the region, some even from places that were reduced to rubble — felt they had no choice but to act first and worry about themselves later.
“For those on the ground, there was no luxury of time to think. For those who were able-bodied in the aftermath and not incapacitated, they were focusing on responding,” Qaddour told The New Humanitarian. “They were like, ‘I’m physically OK, I can put my family somewhere safe.’ There was no leave or respite – it didn’t exist on the ground.”
A mixed response
Aid in the areas hit hardest by the earthquakes — southern Türkiye and northern Syria — is provided by a variety of governmental groups, NGOs, and UN agencies.
Multiple sources involved in the aid effort told The New Humanitarian that providing psychosocial care for those impacted by the earthquakes was a priority for the aid response. Aid workers at international agencies, small NGOs, and independent consultants all agreed that the shock of the earthquakes would impact the mental health of even the most resilient communities. But with different policies and procedures for how – and if – to provide that same care to aid workers, the help they were offered themselves varied significantly.
Dr Dujana Baroudi, a mental health consultant with the ATAA Humanitarian Relief Association, a nonprofit based in Türkiye that works in northwest Syria, said some aid groups banded together to provide psychological support for their employees, setting up helplines, which turned out to be much needed.
Baroudi said that many aid workers who called the helplines exhibited symptoms of anxiety, confusion, and concern about the future. Aid worker psychologists who were trying to help others called the helpline, struggling to understand why they themselves were having such a difficult time doing their jobs.
“It was so hard for these workers – they couldn’t sleep,” she recalled. “It’s normal to find it hard to sleep or eat well after an earthquake… However, these symptoms continued for so long.”
Some aid groups made the decision to prioritise their staff’s mental health despite the chaos, said Dr Makarem al-Fathi, a psychologist and leader of the mental health team at Rahma Worldwide, a US-based organisation that works in Türkiye and northwest Syria.
Usually, his team provides psychological support to parents and children with disabilities. But after the earthquakes, the NGO implemented regular support sessions for its staff of seven so they felt they had at least some control and were in a better position to truly assist others, al-Fathi said. It was only after about a week that they returned to providing their regular services.
Al-Fathi said his employees expressed fear and panic about the safety of their loved ones. They were also afraid of further earthquakes and showed early signs of PTSD, exhibiting noticeable behavioural changes, including anger and reporting that they felt survivors’ guilt.
An ongoing trauma
Sherine Ibrahim, country director for CARE in Türkiye, said it is important to keep in mind that the earthquakes are only the latest in a series of traumatic events for many Syrian aid workers.
“Many of our staff are impacted by the war in neighbouring Syria and have been displaced over and over again,” she explained. “They carry with them such a loss of homes, a separation from loved ones, an inability to fulfil their dreams, and a host of other issues associated with loss and despair and separation.”
“In Türkiye, after the earthquakes, this was no different,” Ibrahim continued. “What we experienced was obviously a loss of that assurance that you were in a safe place. There was an inability to reach your loved ones in time, and a separation from family members.”
Ibrahim told The New Humanitarian that CARE has factored in psychosocial support for its staff for many years, but, like Qaddour, she said that when the earthquakes struck, they focused first on finding people and their loved ones. “At the start, it was difficult to assess the [psychological] needs of employees.”
Her team — consisting of 420 staffers in Türkiye and northwest Syria — came together in online calls and meetings to talk about their experiences. Ibrahim said it has been important for leaders in the organisation to tell others they are walking the same journey and may also need to seek help.
“We do encourage people to seek support, but the challenge I see is that at the same time we are inviting people to seek support, we’re also telling them that it’s time to get going, as we also have that obligation to serve other people,” she said. “It’s almost like a moment of deep tension. Do I prioritise myself or do I prioritise other people?”
Even if they don’t accept the help on offer, for some aid workers, especially those who work with large international NGOs like CARE or UN agencies, psychosocial support is readily available. So when the earthquake hit, standard procedures were in place and were supposed to be followed.
No UN agency would comment on the subject. But a worker at the UN’s refugee agency (UNHCR), deployed to support the region a few weeks into the disaster, said they had been sent specifically to replace others who had been given time off to relieve stress.
“Despite a greater recognition of this aspect of the duty of care, it seems that addressing it is not systematically happening and there is a great diversity on how much organisations have it well embedded in their systems."
“One of the reasons I deployed was to alleviate the pressure and stress on those who had gone through the… earthquakes,” they said, asking not to be named because they weren’t authorised to speak to the media. “All I know is that all staff based in Gaziantep were given two weeks compensatory leave in addition to their usual holidays, and access to our internal psychosocial team.”
Dr Carmen Valle-Trabadelo, who works to ensure that psychosocial support is an integral part of the humanitarian response when delivering aid and relief, acknowledged that there are still gaps when it comes to the assistance that aid workers receive.
“Despite a greater recognition of this aspect of the duty of care, it seems that addressing it is not systematically happening and there is a great diversity on how much organisations have it well embedded in their systems," said Valle-Trabadelo, who co-chairs the Inter-Agency Standing Committee Mental Health and Psychosocial Support Reference Group, which involves 65 member agencies.
"While some agencies have staff counsellors, some offer hotlines and debriefings, and others include psychological support in their care packages, many don't have a system in place,” she explained.
Despite high-level guidelines, Marwa Eissa, director of partnership development and management at the Syrian NGO Takaful al-Sham, which focuses on helping youth in Syria, said there’s no real or consistent approach across the sector for aid workers when it comes to psychosocial support: “It’s very much based on random aid workers speaking to a friend or to a colleague or a line manager in their workplace.”
For Eissa, donors must acknowledge there’s a need for dedicated funds to be allocated for aid worker support and a “fair and consistent duty of care” for everybody. She said it wasn’t just for those who remained in earthquake-affected locations, “but also those who had to flee – and continue to work – while still suffering psychological challenges.”
Who gets help often comes down to an international-local divide, said Qaddour of Syria Relief and Development, pointing to a major gap in donor funding for mental healthcare, and adding that what does exist isn’t passed along to local aid groups.
This often leaves local NGOs responsible for caring for their own workers — often the “local partners” of UN agencies and international NGOs.
“These duty of care packages, danger or hazard pay, rest and recuperation (R&R)... oftentimes don’t get channelled in the same meaningful way to organisations on the ground or to local responders,” said Qaddour.
“The blueprint needs to change in terms of how trauma support is being integrated in a culturally and contextually appropriate sort of nuanced way,” she argued. “And it’s not a question of waiting until the next disaster happens. We have to change that system, because we then run the risk of perpetuating the same inequalities that we are there trying to combat in the first place in the humanitarian sector.”
Impetus for change?
Some in the region still view psychological services with suspicion.
“We understand that our culture is not an easy culture where you can accept or confess that we all are sick and we need help,” said Ammar al-Selmo, Aleppo manager of the Syria Civil Defense — better known as the White Helmets.
But al-Selmo, who experienced some of the worst scenes as he and his colleagues dug through rubble to try to find survivors, said the earthquakes have helped to shift some stigmas about mental health: “It was a natural disaster, so it made it far easier to say you have also been affected.”
“There’s a question in my mind about why I didn’t die with the others.”
Like others, al-Selmo said the need for help was not new.
“Before the earthquake, we were in dire need of psychological support [because of the war in Syria],” he said. “But we would always prioritise any funds to serve the communities and beneficiaries rather than direct it at ourselves – so that’s why there were no budgets for help like this.”
After the earthquakes, al-Selmo said, some donors and other organisations did offer mental health support to the White Helmets, and some of the volunteers did take it up.
But just like it will take years to rebuild what was lost in the earthquakes, the trauma suffered by millions in the region is unlikely to go away anytime soon. And while helping others may be a part of that process, healing takes time too, and survivors’ guilt is also a real concern.
Hiba Ezzideen, a Syrian aid worker used to defending women in her role as CEO of Equity and Empowerment, which works in northwest Syria, goes quiet when she talks about what happened the day the tremors wreaked havoc in Gaziantep, where she lives.
“There’s a question in my mind about why I didn’t die with the others,” she said.
This project was funded by the H2H Network’s H2H Fund, which is supported by the Disasters Emergency Committee (DEC) and the Foreign Commonwealth and Development Office (FCDO).
Edited by Annie Slemrod.