Western Health Workers in Humanitarian Aid

© Springer International Publishing Switzerland 2015
Pat Gibbons and Hans-Joachim Heintze (eds.)The Humanitarian Challenge10.1007/978-3-319-13470-3_14

14. Western Health Workers in Humanitarian Aid

Magdalena Bjerneld 

International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, University Hospital, Uppsala, S-75185, Sweden



Magdalena Bjerneld

humanitarian actionhuman resource managementrelief workersaid workersvolunteersimagesmotivesqualitative research

14.1 Background

During the last decades more international organisations have been established in an attempt to support those in need of humanitarian assistance. Some of these big actors were the UN organisations, the Red Cross movement, and the Non-Governmental Organisations [NGOs], including Medicines sans Frontiers [MSF]. International organisations send thousands of aid workers of different professions to disaster areas. Different types of expertise are required for different stages of disasters and for different aspects of the missions.

Aid workers are normally supposed to leave their ordinary work in their home country at short notice and work for short periods, from some weeks to a year, partly due to the difficult working conditions being hard. Despite this, many people around the world are willing to help others during disasters (Hearns and Deeny 2007). Large recruiting organisations receive thousands of enquiries about job opportunities in the humanitarian field every year. But there is considerable competition for the most qualified and experienced aid workers (DeChaine 2002). One increasingly important method for organisations to present themselves to a wide audience and to attract new applicants is to use the World Wide Web [www] since that is cheaper than advertisements in newspapers and reaches a wider audience. The organisations use the World Wide Web for both presenting their mandate or mission statement and for recruitment purposes (Gatewood et al. 1993).

An organisation’s image, including how it is presented online, is important for applicants’ decision in making initial contact (Gatewood et al. 1993). As online recruitment is a new phenomenon, little research exists in this field. However, Cober et al. (2000) suggest a model for ideal online recruitment, and emphasise the importance of an attractive web page containing a structure with information that is easy to understand and follow. In order to foster the interest of the reader, some kind of a testimony is recommended, for example letters written by people who are currently employed by the organisation, which is seen as a way to build a relationship with the reader (Cober et al. 2000).

It is important for the organisations to find the ‘right’ people. Different strategies have been tested in order to identify which people are most likely to be successful in the field. More commonly, the focus is on criteria and characteristics of the people; however, there is little research proving their value in humanitarian action. In time of disasters, when time is short, some studies have indicated that priority is often given to filling the post quickly rather than ensuring careful recruitment, including a face-to-face interview (Macnair 1995; Simmonds et al. 1998).

Earlier research by Kealey (1996) identified the ideal expatriate as a so-called “cross-cultural collaborator”. This person should ideally have three sets of skills: adaptation skills [positive attitudes, flexibility, stress tolerance, patience, marital/family stability, emotional maturity, and inner security], cross-cultural skills [realism, tolerance, involvement in culture, political astuteness, and cultural sensitivity], and partnership skills [openness to others, professional commitment, perseverance, initiative, relationship building, self-confidence, and problem-solving (Kealey 1996).

For expatriates working in humanitarian action, additional characteristics include: having a sense of humour, ability to admit weaknesses, ability to share emotions, being a team player, having good communication skills, leadership abilities, abilities to motivate others and to stay calm under difficult circumstances, and maturity. In addition, knowledge of more than one language has been identified as important (McCall and Salama 1999). Important characteristics for an effective team leader are flexibility and diplomacy, ability to build teams and capacity, including the clarification of roles and responsibilities as well as being able to coach first time aid workers, command respect, to communicate, and build bridges between groups (Kealey 1990).

There are few studies focussing on aid workers’ motivation to volunteer for work in the international humanitarian sector. Research in United States during 1970s on volunteers’ motives (Anderson and Moore 1978) and a follow-up during 1990s (Liao-Troth and Dunn 1999) indicated that common motives included a desire to help others, feeling useful and needed, becoming self-fulfilled, improving the community, and personal development, showing that helping others ranked highest.

Most humanitarian organisations require previous field experience from people going to the field. There is an assumption among NGOs that the people who will be most competent are those who have at least one experience from the field. However, the limited research on this question (Kealey 1990) does not reveal any relation between earlier experience and effectiveness.

The methods of preparation for humanitarian work are diverse and not always satisfactory (Macnair 1995; McCall and Salama 1999; ALNAP 2002). Some organisations have unrealistic expectations of their volunteers and neglect to provide adequate preparation and support. In the difficult situations humanitarian workers often find themselves, preparatory training would have been extremely valuable (Hammock and Lautze 2000). Although some are sceptical about academic education and imply they are surrogates for more specific schooling (Mowafi et al. 2007), there is a demand for high quality training, ideally standardised. Standards in emergency management training should define the minimum qualifications of trainers, and provide guidelines for curriculum and content (Alexander 2003).

Many problems in the area of human resource management [HRM] in humanitarian action are identified. In disasters, the recruitment officer is required at short notice to find qualified persons willing to go to sometimes dangerous and insecure locations (Taylor 1997). It is especially difficult to recruit for contracts that are longer than 3 months, which is considered the minimum period to be effective (Taylor 1997; Simmonds et al. 1998). The reasons for the difficulties in finding personnel for these missions can either be that it is difficult for health professionals to get leave from their permanent work or that the international assignments do not assist their career in their home country. Therefore, many health professionals do not want to risk their future for humanitarian works. In order to solve these problems, some large organisations such as WHO and Oxfam have established task forces of qualified persons who are able to go into the field with short notice. However, this is an expensive solution, as the task force members must be paid, even during the periods they are not on assignment (Taylor 1997; Bugnion 2002).

Another often discussed problem is the high turnover of personnel, meaning they take part only in one mission (Richardson 2006; Loquericio et al. 2006). This is costly for the organisation, as recruitment of a new delegate for ICRC in 2005 was estimated to cost about £ 15.000, including advertisement, selection process, medical checks, debriefing, travel expenses and other administrative procedures (Loquericio et al. 2006). A variety of solutions to this problem has been proposed. For example, training programmes with training grants between assignments to keep volunteers updated, development of career plans, positions in headquarters between posting overseas, and job rotation (Macnair 1995; McCall and Salama 1999; Simmonds et al. 1998; Taylor 1997). The need for a coordinated and cooperative approach to training has been identified (McCall and Salama 1999; Mowafi et al. 2007; Richardson 2006; Schaafstal et al. 2001), but is still not in place.

Another problem is to find certain types of aid workers, especially those with long professional experience, language skills, management skills, and earlier experience of disasters. A possible explanation is that these people are in the phase of their life when they want to settle down with a more secure job in their home country and with a family (Taylor 1997).

Security has become a serious issue, as relief volunteers have to work under extreme circumstances and cope with cultural and climatic differences, sporadic or non-existent electricity, water, and other basic services. Their work involves trying to provide medical and public health assistance to a huge number of people who are stressed due to flight, exhaustion, and privation, and they are subject to many deaths. At the same time, they themselves are exposed to random and organised violence (IHE 1992; Leaning 1999). Solutions that have been suggested include in-depth discussions of hypothetical field scenarios during briefings and training sessions, more efforts to understand team dynamics, and support to relief workers in the field (Salama 1999).

The evaluation of the international response to the Tsunami in South East Asia in 2004 showed that hundreds of unprepared volunteers called ‘well-wishers’, working for old and new organisations failed to do a good job. Problems identified include aid workers with inappropriate experience from earlier disasters. Too many were unprepared for the work and were unaware of existing standards and guidelines and did not behave in a culturally correct manner (UN 2005). Unfortunately, one could see the same problems after the earthquake in Haiti (DARA International 2010).

The idea of making a personal contribution to help other people in the field of humanitarian assistance may contrast with growing individualism in modern western societies. Nevertheless, the mass media, the music industry, and the international aid community nurture the concept that it is important to ‘stand out’ and be someone special, with the frequent use of terms such as ‘hero’.

A hero is a symbol that people have used for hundreds of years to summarise what people are thinking. In the Greek mythology, a hero symbolised the two sides of the human nature: the divorce and the conciliation. The hero was often a person of lower class [or a higher class without knowing it]. He or she was tested for his/her strength, fought against evil or temptations, but often lost and was killed. The heroes were generous to their admirers, but merciless to their enemies (Cooper 1986; Nationalencyklopedin 1994). The values of a hero are fearless, applied, instructed, tireless, and humble (Wellman 2004). Lanara (1981) describes heroism as the ‘absolute good’—the highest manifest of humanity, being helpful, doing extraordinary acts of bravery, and having high ideals.

Many improvements have been achieved in the humanitarian sector. However, research on aid workers’ perception of their experiences in the humanitarian field is sparse and has been carried out mainly with structured questionnaires (Simmonds et al. 1998).

Due to limited research, organisations working in the humanitarian sector lack much of the information required in order to develop better personnel policies and programmes and to strengthen their operations in disasters. This research project aimed to fill parts of this gap.

14.2 Aims and Objectives

The overall aim of this project was to investigate how humanitarian organisations attract, recruit, and prepare expatriate health professionals for fieldwork, and how these professionals are utilised, in order to identify possibilities for improvements.

The specific objectives were as follows:


To describe how aid workers returning from humanitarian action missions perceive their experiences in the field, and the preparation and support they received in connection with the assignment.



To identify the main motivating factors and perceived problems and obstacles for health professionals planning to volunteer for humanitarian action work.



To explore how humanitarian fieldwork is presented through letters written by health professionals working for MSF, and published on MSF home pages to attract new field staff. The objective was to look at both ‘what the letters said’ and ‘how they said it’.



To describe how recruitment officers in selected large humanitarian organisations perceive humanitarian aid work, how they recruit, prepare, and support their staff in order to achieve high retention, and what concerns and recommendations they have for future work.


14.3 Theoretical Framework

Many theories exist regarding human behaviour and needs and some have formed the framework for this research project, particularly Herzberg’s theory on work satisfaction (Herzberg et al. 1993), Maslow’s hierarchy of needs (Maslow 1970), Organisational Socialisation (Flanagin and Waldeck 2004), and Learning Organisations (Britton 2002; Senge 1990).

Herzberg et al. (1993) organised factors that affect how people feel about their work into two primary groupings which were ‘satisfiers’ and ‘dissatisfiers’. According to this theory, motivation, satisfaction, and long-term positive job performance are determined by five factors, which he called ‘satisfiers’ and include achievement, recognition, the work itself, responsibility, and advancement, all of which relate directly to what people do in their jobs. Other factors, which Herzberg called ‘dissatisfiers’ do not motivate or create satisfaction, but their absence can lead to job dissatisfaction. These factors all relate to the situation in which work is done and include policy, supervision, interpersonal relations, working conditions, and salary (Herzberg et al. 1993; Gawel 1997).

Maslow (1970) proposed a different theory describing the role of work in satisfying personal needs and proposed that human beings have similar needs they try to satisfy, usually in the same order. According to the concept, people must have one level of need satisfied to a substantial degree, before they will pursue the next higher need (Heylighen 1992; Gawel 1997; Maslow 1970). The needs described by Maslow can be shown as a pyramid. At the base are physiological needs such as food, water, shelter, and sex. This is followed by safety, including security and freedom from fear. The next tier involves social needs—loving, being loved, feeling that one belongs, and not being lonely. Esteem, including self-esteem, is yet higher and involves achievement, mastery, respect, and recognition. Self-actualisation, fulfilment of personal potential and the pursuit of inner talents, is at the top of the pyramid.

In an analysis of Maslow’s work, Heylighen (1992) pointed out that people who have met all the lower needs appear to have everything they need; they are secure, have friends and families, are respected and enjoy high self-esteem. However, if they have not achieved self-actualisation, they may feel that something is lacking. If they experience life as boring and meaningless, they will look for ways to develop their own capacities more fully (Heylighen 1992). A self-actualised person is identified as eager to undergo new experiences, attracted towards the unknown, and can see new things to appreciate in well-known situations. In relation to problems, they are spontaneous and creative, but can have difficulties in making decisions. Even so, they have ‘a well-developed system of personal values’ and are open-minded and friendly, and they easily feel empathy.

Organisational socialisation is the process through which the individual learns the values, accepted behaviour, and social knowledge within an organisation. The aim is to reduce uncertainties about the organisation and the job, and to help newcomers to build relationships and to feel part of the organisation (Flanagin and Waldeck 2004).

The concept of ‘learning organisations’ is used in different kinds of organisations. Britton characterises a learning organisation as an organisation that recognises the need for change, provides continuous learning opportunities for its members, and explicitly uses learning to reach its goals. A learning organisation links individual performance to organisational performance, encourages inquiry and dialogue, making it safe for people to share openly and take risks, embraces creative tension as a source of energy and renewal, and is continuously aware of and interacts with its environment. Five forces in learning organisations should be considered. These include: personal mastery, mental models, team learning; shared vision; systems thinking (Senge 1990).

14.4 Material and Methods

The starting point for this research project was personal experience as a course leader and teacher in preparatory courses for health professionals intending to do humanitarian action work and the NOHA modules in Public health in humanitarian action and Disaster management, respectively. The health professionals in these courses often expressed unrealistic expectations of their future humanitarian work and anticipated themselves as mainly performing medical tasks. They appeared unaware that they may supervise and lead others and had difficulty comprehending the complexity of the humanitarian context, including frustrations from non-functioning infrastructure.

In response to these observations, four studies were initiated, with the intention of identifying means for improvement.

In the first study, 20 health professionals (15 women and 5 men) who had returned from humanitarian action work during the last 12 months participated. An interview guide covered the preparation they had received, their work, roles and responsibilities, and how well they felt they had handled the situation, what knowledge they lacked, and how the working conditions affected their performance. Finally, they were asked what recommendations they would give to colleagues contemplating similar work.

In the second study, four focus group interviews with 19 Scandinavian health professionals, who were planning to work in humanitarian action, were performed. The interview guide covered motivation to work in humanitarian action abroad, their expectations about themselves and the organisations recruiting them, and their concerns about their assignments.

The results from the two first studies raised questions regarding applicants’ expectations about humanitarian work. In the third study we therefore explored how organisations present themselves and attract potential workers to the field. In total 137 letters written by health professional field workers for the websites of MSF’s offices in six European countries (Belgium, Denmark, Norway, Sweden, the Netherlands and the United Kingdom) that were published in August 2007 were collected, together with 129 attached photos.

As a complement to the earlier studies, in the fourth study, recruitment officers in seven large humanitarian organisations, including the World Health Organisation/Health Action in Crisis [WHO/HAC], ICRC, International Federation of the Red Cross and Red Crescent Societies [IFRC]; the Swedish Red Cross; MSF in Sweden and the Netherlands; and the Swedish Lutheran church were interviewed in order to determine their opinions and concerns around the recruitment process in humanitarian action. An interview guide covered the portrayed images of humanitarian work, the standard recruitment procedures, concerns, trends, and implications for future work.

In the analysis of the four studies qualitative content analysis, photo analysis, and discourse analysis were used.

14.4.1 Qualitative Content Analysis

In the four studies conventional qualitative content analysis was used, which is appropriate when theory and research literature on the phenomenon is limited (Hsieh and Shannon 2005).

The text was repeatedly read to obtain a holistic sense of the content and then read sentence by sentence in order to identify codes reflecting the content. Similar or linked codes were sorted into categories and similar categories into themes. A second researcher performed parallel independent analysis of the material, and the two groups of categories and themes were compared and modified after discussion. Representative quotations were selected, and when necessary, translated from Swedish into English (Hsieh and Shannon 2005; Granheim and Lundman 2004).

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