Intended for healthcare professionals

Education And Debate

Selection, training, and support of relief workers: an occupational health issue

BMJ 1999; 318 doi: (Published 09 January 1999) Cite this as: BMJ 1999;318:113
  1. Maureen McCall, primary care physiciana,
  2. Peter Salama (, emergency medical coordinator.b
  1. aRed Deer Regional Hospital, Red Deer, Alberta T4N 6R2, Canada,
  2. bConcern Worldwide, Camden Street, Dublin 2, Republic of Ireland
  1. Correspondence to: Dr Salama
  • Accepted 14 August 1998

Courage rather than cowardice, compassionate human concern of one for the other; and resilience in the face of overwhelming stress.1

Many of today's violent conflicts can be characterised as “complex humanitarian emergencies.” Complex humanitarian emergencies are defined by Leaning as “Crises in life support and security that threaten large civilian populations with suffering and death and impose severe constraints on those who would seek to offer help.”2 Lauttze interprets these emergencies as “complicated disaster situations that have political, military and humanitarian dimensions and are often associated with natural disasters, especially drought.”3 Kosovo, Rwanda, Sudan, and Afghanistan are recent examples.

The rapid growth, in capacity and number, of humanitarian relief organisations in response to complex humanitarian emergencies has created concern about the professionalism of their relief workers. The risk to the psychological wellbeing of relief workers caused by exposure to traumatic events is a particular worry and has been studied little.4 Research on the psychological sequelae to trauma has focused on primary victims,57 domestic rescue workers, 8 9 military personnel,10 and psychologists.11

Complex humanitarian emergencies may generate more stress among relief workers than “natural” disasters for several reasons. Firstly, an element of physical insecurity, with the risk of violent personal assault or injury, is increasingly present.12 Secondly, work in these situations necessarily involves moral and ethical dilemmas—for example, negotiating with warlords; witnessing human rights abuses, but being constrained from responding by operational considerations; and concern that humanitarian aid may perpetuate conflicts.1316 Finally, caring for people with serious injuries caused by violence, witnessing unnatural deaths, and handling dead bodies or body parts are highly traumatic experiences in themselves.17

Summary points

  • Although emergency relief workers are at considerable physical and psychological risk, their mental health has been studied little

  • Procedures for …

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