Trauma in Aid Workers a Growing Concern

Monica Indart brings real-world, international experience in crisis intervention into the classroom

Credit: Courtesy of Monica Indart

Monica Indart studies and teaches about the effects of traumatic events, with a focus on how culture influences trauma response and healing.

When natural disasters, wars, or other large-scale traumatic events hit a country, most of us watch images of the action from a safe distance. We may write a check – or text a donation – to help, but that’s usually the extent of our involvement.

Humanitarian aid workers have no such distance from emergencies. They staff field operations around the world, providing food, medical care, and other services to those who are suffering from either natural or human-directed catastrophes. Yet despite the benevolent purpose of their mission, they are often in danger.

“In the last seven years, humanitarian aid workers have increasingly been ‘soft targets’ in civil conflict and terrorism,” says Monica Indart, a visiting assistant professor in the Graduate School of Applied and Professional Psychology (GSAPP). “Aid workers used to be seen as off-limits (for violence). They’re not seen as sacrosanct anymore.” 

Statistics from the United Nations Office for the Coordination  of Humanitarian Affairs show that, in 2008, 260 humanitarian aid workers were attacked and seriously injured, kidnapped, or killed. The relative rate of attack increased by 61% in three years.  

In addition to life-threatening incidents, humanitarian aid workers encounter other stressors. Indart notes that there’s a prolonged emotional and physical toll from “the day-to-day life of stress, being on mission in a resource-poor country.” Many aid workers live with heightened security concerns, restrictions on movement, and the grueling pressure of seeing human suffering up close. 

Indart, who is a GSAPP alumna and has a private clinical  practice in Maplewood, New Jersey, studies and teaches about the effects of traumatic events, with a focus on how culture influences trauma response and healing.

As a consultant to the U.N. and to local and international NGOs, she has worked on projects in Thailand, Uganda, and Rwanda, among other countries.  Indart brings that real-world, international experience into the Rutgers courses she teaches on crisis intervention and integrative perspectives on trauma. 

that may result from those threats.

Penelope Curling, staff counselor for UNICEF and principal investigator on the study, says the research sought to identify whether “people’s perceived reactions fit the (diagnostic) symptoms for PTSD (post-traumatic stress disorder) or acute traumatic stress and whether people from different cultures had different symptoms.” Indart provided statistical analysis of a database of UNICEF aid workers who had been through security incidents.

The two researchers will present their findings in a future paper and hope to uncover what helped workers cope with trauma in order to “tailor counseling or recommendations for self-care to people from different cultures,” Curling says.

Although neuroscience shows that human brains react similarly immediately following a traumatic event, culture mediates that experience very soon afterwards, Indart says. People from what she calls “individualist” cultures (such as the United States) experience trauma, such as rape, as a personal event. By contrast, in “collectivist” cultures (such as Rwanda), the trauma is seen as happening to the individual and also to that person’s family and community.

“The shame in the experience is doubled,” she says.

Culture also colors expectations about trauma. “In the U.S., the hidden assumption is that the trauma experience is outside the norm. In developing countries, trauma is part of life,” Indart adds. She saw this firsthand when she worked in Thailand after the 2004 tsunami. “Thai culture, influenced by Buddhism, has the sense that, well, bad things happen to people. They react differently because of these beliefs about the inevitability of suffering.

Aid missions often have complex cultural profiles, as workers might not be in their home environments and refugees from several cultures might be gathered in a newly created community. The UNICEF research is “looking at how people define themselves – by nationality of the passport they hold, race or ethnicity, tribe, or clan,” and then adding where they are working to analyze findings, Curling explains.  

Studying the influence of culture – religion, prayer, ethnic traditions, and other factors – on traumatic stress may lead to better, more culturally-informed ways for humanitarian organizations to train aid workers before they go into the field and treat them after their missions are over.

According to Indart, “All of the science around trauma comes largely from the developed world. The issue is how to make that science usable and applicable to very different cultures.” In the U.S., for example, cognitive processing therapy is one of the best treatments for trauma. “The question becomes, can you deliver it in countries where people have a different world view?”

Indart’s current work includes a project in Rwanda with genocide victims, which she hopes will “co-create a trauma model, and not just adapt a Western model.”

She brings such issues into her Rutgers classes. “Both courses have a strong multicultural component,” Indart says. “And the UNICEF study is an example I try to weave in when I talk about different populations.”