Intended for healthcare professionals

Clinical Review ABC of conflict and disaster

Psychological aspects of providing medical humanitarian aid

BMJ 2005; 331 doi: (Published 14 July 2005) Cite this as: BMJ 2005;331:152
  1. Ian Palmer


    All those involved in catastrophes will be changed by the experience. Such change, however small, is irreversible but generally positive. Only a minority of survivors or aid workers will develop a mental disorder such as post-traumatic stress disorder. Humanitarian deployments may be isolating, rife with personal threat (from climate, endemic diseases, violence), and expose individuals to human misery, as well as human resourcefulness in the face of tragedy.

    You should deploy only if you are in good physical and mental health. Accept that everyone in your family will be changed by your deployment and that any problems you leave behind will be there on your return: sort them out before you go. Discuss potential outcomes with your family (such as death or being taken hostage) and make a will.

    Proper planning and preparation prevent poor performance. Preparation requires information: get as much as you can. The best sources are people who have been to the disaster area before. Beware of media selectivity and bias, and protect family and friends from this after deployment through regular communication.

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    Children left homeless and traumatised by the 2004 tsunami, Nagapattinam, Tamil Nadu, India. Misery and grief are inevitable consequences of catastrophes, and no one who encounters them will remain unchanged

    Expatriate work stressors

    Remember you are a “guest” in the country and are there to help local people to help themselves, not to create dependency. Treat all with dignity, especially the dead, who may have died without it. Aim to foster cooperation and the restoration of motivation, self belief, and self sufficiency.

    Humanitarian disasters are confusing, and teamwork is vital; leadership means leading by example, and praise and interest are key. Protocols, if understood and followed, are useful, but flexibility is crucial. Some colleagues may have personalities that make them difficult to get on with, or they …

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