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A series of accidents in the late 1980s and early 1990s,
such as the disaster in which a car ferry sank off the Belgian
coast, brought the issue of “psychological wounding”
to the attention of European Red Cross Societies. The tragedies
threw light on the needs of victims who had not seen the destruction
of their homes or possessions, but who had suffered the loss
of loved ones and witnessed scenes of horror. In these cases,
the usual assistance such as food, blankets and medical care
was secondary to providing psychological support.
“The term ‘psychological wounds’ applies
to survivors of an accident who are physically unharmed but
psychologically traumatised. It also aptly describes the con-dition
of many humanitarian workers who have been involved in crisis
or trauma,” explains Dr Barthold Bierens de Haan, ICRC
delegate psychiatrist in charge of stress management programmes.
“Just as rescue workers, police, fire-fighters and health-care
personnel at home are subject to intense emotional reactions
in the course of their duties, so Red Cross and Red Crescent
delegates and humanitarian aid volunteers, working abroad
in emergency or disaster situations, suffer severe stress
or psychological overload reactions.”
The Federation has divided those who need access to psychological
support into roughly three categories: the victims themselves;
people in contact with the victims such as friends and relatives;
and, since 1994, rescue workers and volunteers. The Federation’s
Relief Health Adviser, Dr Jean-Pierre Revel, who develops
and coordinates psychological support programmes to cope with
the stress experienced by victims, widened his scope to cover
delegates after fighting flared up in Kabul, obliging the
Federation to close its delegation and evacuate its delegates.
Some of the delegates, mainly health workers who were not
accustomed to war situations, received psychotherapy after
their experience.
This approach was not new to the Movement. Already in 1982,
the Amer-ican Red Cross was aware of how stressful conditions
could affect relief workers. Red Cross personnel in Santa
Cruz, California, were the first to benefit from a programme
of psychological support, set up for relief workers assisting
victims of the mud slides that had devastated the region.
By 1990, disaster mental health teams were providing psychological
services to chapters elsewhere in the United States.
Jill Hofmann, an American social welfare officer and psychotherapist
on loan to the Federation, explains how psychological treatment
for delegates differs from traditional psychotherapy: “This
type of therapy is aimed at discharging emotions. It does
not dig deep into the past.”
The ICRC’s stress management programme has been operational
since 1992 and contains three components: training before
leaving on mission and support during and after the mission.
It begins with an introductory course attended by all new
delegates. Delegates are made aware of the range of emotional
reactions they will experience and of the need to discuss
their feelings.
Dr Revel is also adamant about the importance of this preparatory
stage. “Adequate preparation not only defuses the situation,
it also helps to boost confidence so that delegates are better
equipped to handle difficulties and are ultimately more efficient.”
A special course has been devised for future senior personnel
and heads of delegation at which they are trained to recognise
stress in their staff. They are encouraged to identify likely
reactions to traumatic incidents, which are not necessarily
obvious in the heat of action. “They are advised to
look out for minor behavioural changes, increased alcohol
intake, reckless
driving, slight changes of character, abusive, depressive
or aggressive statements, and self-neglect on the part of
their colleagues,” explains Dr Bierens de Haan.
The ICRC has also introduced a field debriefing at the end
of a mission. In the case of Rwanda, both the ICRC and the
Federation organised rapid de-briefings in the field.
Finally, after a difficult mission, delegates are granted
an additional period of rest to ensure an adequate interval
be-tween assignments. Whenever possible, high-risk missions
are alternated with low-risk assignments.
Results of the first 100 ICRC debrief-ings have confirmed
the importance of adequate debriefing and follow-up. Although
38 per cent of the subjects were suffering from immediate
or delayed-onset traumatic stress, and 49 per cent, most of
whom had returned from Rwanda, from cumulative stress, some
85 per cent of these were able to leave on another mission
within a few weeks after airing and dealing with their feelings.
By helping its staff to withstand the hardship involved in
humanitarian activity, the Movement hopes to assist and protect
precisely those who volunteer their services to bring assistance
and protection to the innumerable victims of war and disaster.
“In the most inhumane conditions, human values such
as group solidarity and strength of will are essential in
the fight against adversity,” concludes Dr Bierens de
Haan.
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