Over 25% humanitarians are estimated to return from missions to be affected by psychological problems. The number is likely to be much higher. The majority do not return from field missions but stay abroad and mental health issues remain a taboo, with many not reporting their issues. But no matter how we slice and dice the data, the number gives a clear indication of the magnitude in a sector that requires frontline workers to be mentally strong given the context they are working in.

The symptoms of burn-out are clear. We feel emotionally overwhelmed, the problem is too big to be solved, which puts us in a state of apathy and a decrease in enjoyment and engagement. Most aid workers are not aware, including myself when I was going from emergency to emergency without any break for over ten years, until life forced me to take a long at my life and change my habits, attitude, and behaviour. We continue to see mental health as a sign of weakness and many think, it can cost their career when they speak about it or seek help, but the opposite is true. As a manager of an organization or company, can we really make a difference, when most of the workforce is disengaged? This can cost billions in loss of productivity, which is why major companies such as Google invest in meditation and yoga for their employees. They are ahead of the game and have acknowledged that mental wellbeing contributes to increased productivity and creativity. It’s even more important for aid workers, on the frontlines of war and famine. How can we truly help when we are drowning ourselves? The truth is, we cannot make an impact and a difference in the world if we are not healthy. It is that simple, and yet, it is complicated.

Covid-19 has shown that frontline workers are needed, and their job is critical but at the pace and the environment they work in demands extreme performance: long hours, exposed to a virus without a vaccine at the early stages of Covid-19, and witnessing people dying every day without their relatives nearby. This causes immense distress. Our brain is not wired to absorb constant shock. Chronic stress has a shrinking effect on the prefrontal cortex, the area of the brain responsible for memory and learning. While stress can shrink the prefrontal cortex, it can increase the size of the amygdala, which can make the brain more receptive to stress. It feels like your alarm system is switched on all the time. It is very likely that you will develop a hearing problem as most of us have never learned to switch it off. Therefore, many soldiers return from war with post-traumatic stress disorders (PTSD), as they are constantly exposed to threat, which the brain reacts to.

Because of the nature of the work of frontline workers, from health workers fighting Covid-19 to aid workers staving off famine and war around the world, a paradigm shift needs to happen, similar to when we recognized PTSD as a severe challenge to soldiers returning from armed conflicts. Stress affects not only memory and many other brain functions, like mood and anxiety, but also promotes inflammation, which adversely affects heart health, says Jill Goldstein, a professor of psychiatry and medicine at Harvard Medical School. Thus, stress has been associated with multiple chronic diseases of the brain and heart. In addition, it can affect men and women differently.

The constant exposure to stress due to the type of work has severe consequences. It requires organizations and companies to create support structures and reduce chronic stress through new business models that consider employees holistically, and not only during working hours.