Trauma in Aid Workers a Growing Concern

Trauma in Aid Workers a Growing Concern

Monica Indart brings real-world, international experience in crisis intervention into the classroom
Trauma in Aid Workers a Growing Concern

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

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. 

Recently, Indart collaborated on a project for UNICEF
(United Nations Children’s Fund)  looking
at how humanitarian aid workers’ varying cultures help them cope with
life-threatening incidents in the field and the psychosocial distress,
including traumatic stress

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

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.”