Business Case For Investing In Aid Workers

You can’t fully #ReShapeAid with Sick Aid Workers

The business case for investing in aid worker wellness programmes.

Last July I deployed to Iraq to support the management of the OCHA Country Office and report on how UN Agencies were using a $500 million dollar grant from the Kingdom of Saudi Arabia.  In a matter of days the situation and my mission changed dramatically.

That month the State of Iraq and the Levant (ISIL) rapidly conquered considerable territories in northern Iraq and were rapidly approaching Erbil. On 3 August ISIL attacked Kurdish-held territory in northern Iraq, capturing three towns close to the autonomous region of Iraqi Kurdistan, including Sinjar and neighbouring settlements.

An estimated 200,000 civilians, mostly Yazidis along with Shia and some Kurds, fled the fighting in and around Sinjar city and headed towards Dohuk.  It was estimated that 50,000 of those Yazidis fled into the Sinjar Mountains,‪ where they were trapped without food, water or medical care,‪ facing dehydration and possible starvation. As a result, on 7 August the U.S. military started humanitarian airdrops of food, water, and medicine for the civilians on Sinjar Mountain. The next day, 8 August, the U.S. military began airstrikes against ISIL positions in Iraq, including just outside of Erbil.

Photo by John Moore/Getty Images News / Getty Images  2014: Civilians Flee War As ISIL Frontline Shifts Following Kurdish Sinjar Offensive by John Moore

Photo by John Moore/Getty Images News / Getty Images

2014: Civilians Flee War As ISIL Frontline Shifts Following Kurdish Sinjar Offensive
by John Moore

In the days that followed the capture of Sinjar by ISIL, Arabic speaking OCHA staff, as well as national staff from IOM and WHO, were in the OCHA office speaking with Yazidis displaced from Sinjar. Some of these people were in the mountains, others, including a group of women and children were in small settlements to the south of Sinjar mountain, surrounded by ISIL.  We were focused on trying to ascertain their humanitarian situation so that we could plan a humanitarian response, even though in reality there was little we could do. It was far too dangerous for aid workers to directly deliver aid into ISIL controlled areas; the social media images and videos of their atrocities were all too real. Too many people, including aid workers and journalists, had been captured and brutally murdered.

OCHA Iraq Country Office, Erbil, 2014. TweetDeck, for monitoring social media, is on the television in the background. © Brendan McDonald

OCHA Iraq Country Office, Erbil, 2014. TweetDeck, for monitoring social media, is on the television in the background. © Brendan McDonald

Throughout August, staff worked incredibly long hours to collect and analyse information on the situation in and around Sinjar. I clearly recall the calmness of a particular staff member, who himself was from a country in conflict, talking to a group of Yazidi women surrounded by ISIL. We both knew there was nothing that we could do to directly help them as humanitarians. At best we could tell their story. Although we did pass the information on to those who possibly could do something, within a few days their phones went silent. Our live monitoring of social media was full of horrific stories of Yazidis being executed or captured by ISIL or sold as slaves. We imagined the worst.

Outside the walls of the UNAMI compound, aid workers, mostly Iraqis, were responding directly to the massive influx of people into Dohuk and other governorates. What the Yazidis and other Iraqis experienced at the hands of ISIL was horrendous. Words fail to fully describe what had transpired. By mid-August that humanitarian situation on Sinjar Mountain was manageable; by the end of August many of us working in Iraq were emotionally and physically drained. Even though we had not directly experienced what the Yazidis had gone through, in many ways their trauma transferred to us. I did the best I could as a manager to look after my staff with the tools available to me. I enforced compulsory rest days, held team meetings where we talked about the need to ‘buddy up’ with a colleague and monitor each other for signs of stress. But this was not enough. Some staff appeared to cope; others less so.

UNAMI Compound, Erbil, 2014. The only place where we could walk alone in Erbil. © Brendan McDonald

UNAMI Compound, Erbil, 2014. The only place where we could walk alone in Erbil. © Brendan McDonald

The pace of work in September was also unrelenting. Every day there was news of ISIL atrocities and more displacements. Despite the efforts of hundreds of dedicated aid workers, professionals and volunteers, we were always playing catch up. Like in most high profile emergencies, the media had a field day in criticizing the inadequacy of the response. They were right though; it was inadequate. For aid workers the situation was going to get worse.

On 13 September ISIL released a video showing the brutal murder of David Haines, an ACTED aid worker, in Syria. It was all over the news. The next day, at our weekly general coordination meeting, the ACTED Iraq Country Director spoke about David and his death. I had never met David, but like everyone else in the room, he was an aid worker doing his job.  As we paused for a minute’s silence, an overwhelming sense of sadness and loss washed over me. Like a child not wanting to cry in front of his classmates, I bit my inner lip and tried to think of pleasant things. I broke the silence by moving on to the next agenda item, a situation update from UNAMI where we learnt of the previous week’s death toll across Iraq and the continued march of ISIL towards Baghdad.


A few weeks ago I caught up with a friend I had met in Erbil who was visiting Geneva. Like many international aid workers in Iraq, she had deployed on surge to Iraq from her regular headquarters job in an agency. She had worked three months straight in Erbil. When she was in Iraq she was unable to take a break, as she did not qualify for the UN Rest and Recuperation entitlement as she had only deployed for 12 weeks, not 13. Before she left Erbil she asked her manager in headquarters if she could take a break before returning to work. However, due to pressing work commitments, she was asked to return to work immediately upon her return. She flew out of Erbil on a Friday. On the Monday she returned to her regular job working on humanitarian policy. Upon walking into her office that Monday she was greeted, perhaps partially in jest, with; “welcome back from your holiday in Iraq, now it is time to do some real work.”

In the months that followed she was unable to take leave. Her manager displayed no interest in what she had experienced, and on the wellness front, she was neither offered nor informed of any support available should she need it. I asked her how she was coping. 

She said she was doing “fine” except that she had a constant feeling of fatigue and was totally disengaged at work. She told me that she was simply turning up and going through the motions; doing just enough to ‘stay out of trouble.’ This was the same person who had worked incredibly hard in Iraq and had a great reputation in our small Erbil community. Now she was a different person; tired and disengaged, and no one appeared to care. I know that her story is not unique among aid workers.

But her story got me thinking. What was the cost of such indifference to the wellness of aid workers? Although she was physically at work, her mind was absent. In the literature this is called presenteeism; being on the job, but because of illness or other medical conditions, not fully functioning. According to one study, presenteeism can cut individual productivity by one-third or more.

According to IRIN there are an estimated 450,000 aid workers globally. If presenteeism affects just five percent of aid workers (22,500 people) this reduction in productivity could translate into an equivalent loss of the full-tme equivalent of 7,425 aid worker years per annum. In monetary terms this runs into millions and millions of dollars. I believe that the rate of presenteeism is probably much higher than five percent given the research on mental health issues affecting aid workers and the prevalence of presenteeism in the private sector. 

In an age where we are urged to do more with less; not addressing this issue is not just unacceptable, it is simply stupid.

The loss of aid worker productivity goes beyond the affected individual. There are other unintended side effects of presenteeism; the morale and motivation of other workers are affected, which in turn reduces their productivity. There is also the opportunity cost of presenteeism. By not treating the underlying mental illness, the quality of the aid worker’s outputs is diminished, irrespective of whether they work in headquarters or in the field. This negatively impacts the affected communities and people we seek to assist, either directly or indirectly. They deserve better than this.

Calculating how much aid worker productivity would increase through reduced presenteeism is difficult to calculate. As far as I am aware there have been no studies specifically looking at the productivity of aid workers, nor could I find a model by which to measure aid worker productivity. This is an area that I would like to see more research in. According to the Harvard Business Review, in the US every dollar invested in wellness programmes yielded $6 in health care savings and considerably reduced staff turnover.  According to the Journal of Occupational and Environmental Medicine for a typical employee, the gain in productive time generated through wellness programmes amounted to about 0.5 percent per annum. If applied to the aid sector this would translate into an additional 2,250 aid worker years per annum. 

There is another malady that affects aid workers: absenteeism. In early 2014 I was burnt-out. According to my Psychiatrist, the cumulative effect of working in emergencies had eventually taken its toll on my personal and professional life. The symptoms were there well before medical intervention was required, but I was not smart enough to recognise them, nor were my colleagues. The two months of medical leave worked wonders, and as a person who was once skeptical of therapy, I admit in hindsight that it was one of the best things that ever happened to me. But those two months came at a cost. My organization lost two months worth of output from a P5 Senior Humanitarian Affairs Officer. If we had a comprehensive wellness programme in place, it is probable that I would not have been burnt out. But I am not the only aid worker to take sick leave because of work-induced, stress-related illness.

A 2009 People in Aid study looked at 20 aid organisations. The report concluded that maintaining a healthy working environment is sine qua non for reducing absenteeism. In a 2007 report, the United Nations Joint Inspection Unit noted that at various duty stations, a number of sick-leave absences were due to conflict in the workplace, including work-life balance issues. Although not specific to the aid sector, a joint ILO and WHO study showed that psychological and psychiatric disorders were the main cause of absenteeism for both men and women in the European Commission, of which 30 per cent were directly related to work. I am sure that many an aid worker has taken a “mental health day” simply because of the stress generated at the workplace. 

Despite the evidence across sectors demonstrating the benefits of wellness programmes, very few aid agencies have a comprehensive wellness programme, endorsed and supported by senior management, that looks at all aspects of staff wellness on a day-to-day basis, including their physical and psychological wellbeing. Wellness also includes creating a workplace that is free from abusive behavior, sexual harassment, and discrimination (but perhaps that is a whole other topic).

Although aid agencies should introduce wellness programmes simply because it is the right thing to do (i.e. they have a duty of care to their employees), there is another reason that aid agencies should look at wellness programmes. In an age where there is insufficient humanitarian funding for humanitarian programmes; any changes that could reduce indirect costs should be rigorously pursued.

I believe that the introduction of comprehensive wellness programmes may not only increase productivity, it may also reduce health insurance premiums. For example, looking at the UN, in 2004 the total number of contributors in the UN system to health insurance schemes was approximately 84,000 people, with an annual cost exceeding US$305 million. A 2007 report by the United Nations Joint Inspection Unit argued that insurance premiums could be reduced by providing health education and health promotion activities, as well as counseling services on the rational use of health care. A recent CDC study showed that employers could benefit from workplace health programmes through enhanced productivity, decreased employee absenteeism, decreased staff turnover, as well as lower insurance and workers compensation costs.

As we approach the World Humanitarian Summit next year, the issue of staff wellness must be addressed if we are to fully #ReShapeAid. Frankly, we owe it to the communities affected by crisis to maximise every aid dollar for their benefit.

Allowing preventable presenteeism and absenteeism to continue unchecked is unacceptable and a waste of resources.

This task is an urgent one: until we improve aid worker wellness our humanitarian response to crisis will inevitably be imperfect and inadequate. It’s unrealistic to expect aid agency senior managers to do this on their own – donors, specialist wellness institutions and organisations, as well as aid workers themselves, have an important role to play. But this task will be made infinitely easier with a simple change of attitude by senior management; all they have to do is recognise that aid workers are central to the achievement of the humanitarian mission and commit to creating a work environment that systematically cares for the physical, mental, and psychological welfare of their staff.

To improve aid worker wellness please consider supporting a petition to the UN Secretary-General Ban Ki-moon, Emergency Relief Coordinator Stephen O'Brien, and all involved in the World Humanitarian Summit to include the issue of staff wellness on the WHS agenda.

For an insight into the psycho-social impact of working in high stress emergencies, I encourage readers to watch “Kick at the Darkness.” The topic is presented through a series of candid interviews with individuals whose experiences span from the 2004 Tsunami, to the bombing of the United Nations building in Iraq, 2005 Pakistan earthquake response, ongoing conflicts in Darfur, South Sudan, Somalia and Chad, the 2010 Haiti Earthquake, and 2013 Typhoon in the Philippines. Source: