Brian D. Gushulak

Through their association with organizations and agencies or their own individual activities, many thousands of people are involved in the delivery of humanitarian aid in diverse locations every year. Following very large-scale events, such as the Asian earthquake and tsunami of 2004, the number of those traveling to provide humanitarian aid and assistance can increase significantly.

In common with other travelers, persons who travel to provide humanitarian aid or disaster relief must first address their personal health and welfare, before, during and after travel. This includes knowledge and preparation for all the usual elements associated with travel to the area. In addition, aid workers can experience specific risks and situations related to the provision of humanitarian care, such as—

• Exposure to the environment that precipitated or sustains a crisis or event, such as a natural disaster or conflict
• Working long hours under adverse or extreme conditions, often in close contact with the affected local population
• Damaged or absent local infrastructure, including availability of food, water, lodging, transportation, and health services
• Reduced levels of security and protection

Accidents and violence are documented risks for humanitarian workers and cause more deaths than disease and natural causes. Thirty percent of these deaths occur during the first 3 months of service. A recent study of deaths among Peace Corps volunteers noted that unintentional injuries were the cause of nearly 70% of deaths, followed by homicide at 17%. Illness was responsible for 14% of the Peace Corps fatalities.

Pre-Travel Considerations

Evaluation and Pre-Travel Medical Care

Giving careful attention to pre-travel evaluation, both medical and psychological, in addition to educating travelers, can help reduce the likelihood of illness and repatriation. Comprehensive medical examinations can prepare travelers by helping to identify previously unrecognized disease and allowing for treatment (e.g., dental work) before travel. Careful evaluation of risk factors (family history, history of alcohol or substance abuse, sexually transmitted diseases, and psychiatric illness) may direct additional evaluation and identify previously unrecognized psychological problems or chronic conditions.

• Identifying alcohol or substance dependence, depression, or other psychiatric illness is important, as these conditions may be exacerbated by stress of the circumstances and can often be a reason for emergency repatriation.
• Those who will be providing medical care as part of their humanitarian activities should be considered in terms of occupational risk and the need for preventive or postexposure interventions.
• Humanitarian workers destined to areas of active conflict or limited policing presence may benefit from specialized security briefings, either provided by the employing agency or private sources.
• Medical facilities may be compromised by the disaster or overwhelmed in responding to the disaster. Therefore, volunteers with underlying conditions or pregnant women should be counseled against travel and encouraged to support the response in other ways.

Regardless of the area of the world in which the aid worker will be deployed, certain basics should be addressed in the pre-travel encounter, including routine vaccinations, malaria prophylaxis (if appropriate), food and water precautions, self-treatment for travelers’ diarrhea, risks from insect bites, and injury prevention.

Counseling and Advice

Pre-deployment education and training are essential, as personal illness or injury places a burden on the community the worker has come to support.

• Injuries and accidents are a common risk for travelers anywhere in the world; thus, travelers should be sensitive to their surroundings and carefully select the type of transportation and hour of travel, if possible.
• In disaster and emergency situations, the traveler should also be aware of physical hazards such as debris, unstable structures, downed power lines, environmental hazards, and extremes of temperature.
• Travelers to conflict areas should be aware of landmines and other potential hazards associated with unexploded ordnance.

The amount and detail of health, safety, and security training may increase with the size of sponsoring organizations, but the ultimate responsibility still rests with each individual.

Preparation

Health Items

The traveler should be advised to prepare a travel health kit that is more extensive than the typical kit and should also be familiar with basic first aid to self-treat any injury until medical attention can be obtained. Aid workers may need to disinfect their own water and may want to carry nonperishable food items for emergency use. In addition to a basic travel health kit (see the Travel Health Kits section in Chapter 2), humanitarian aid workers should consider bringing the following items:

Toiletries

• Toothbrush/toothpaste
• Skin moisturizer
• Soap, shampoo
• Lip balm
• If corrective lenses are used:
  • Extra pair of prescription glasses in a protective case, copy of prescription
  • Eyeglasses cleaning supplies and repair kit
  • Extra contact lenses and lens cleaner
• Razor, extra blades¹
• Nail clippers¹
• Toilet paper
• Menstrual supplies
• Sewing kit
• Laundry detergent
• Small clothesline/pins

Clothing

• Comfortable, light-weight clothing
• Long pants
• Long-sleeved shirts
• Hat
• Boots
• Shower shoes
• Rain gear
• Bandana/handkerchief
• Towel (highly absorbent travel towel if possible)
• Gloves (leather gloves if physical labor will be performed; rubber gloves if handling blood or body fluids)

Activities of Daily Living

• Sunglasses
• Waterproof watch
• Flashlight
• Spare batteries
• Travel plug adapters for electronics
• Knife, such as a Swiss Army Knife or Leatherman¹
• If traveling to an area where food and water may be contaminated:
  • Bottled water or water filters/purification system/water purification tablets
  • Nonperishable food items

Safety and Security

• Money belt
• Cash
• Cell phone, equipped to work internationally, or satellite phone (with charger)
• Candles, matches, lighter in a ziplock bag
• Ziplock bags
• Safety goggles

¹Note: Pack these items in checked baggage, since they may be considered sharp objects and confiscated by airport or airline security if packed in carry-on bags.

Personal Items

Because of the loss of life, serious injuries, missing and separated families, and destruction often associated with disasters, relief workers should recognize that situations they encounter may be extremely stressful. Keeping a personal item nearby, such as a family photo, favorite music, or religious material, can often offer comfort in such situations. Checking in with family members and close friends from time to time is another means of support. Satellite phones are now nearly as small as cell phones, can work almost anywhere in the world, and can be rented for less than $10 per day.

Important Documents

In uncertain circumstances extra passport-style photos may be required for certain types of visas or for additional work permits. Travelers should bring photocopies of important documents, such as passports and credit cards, as well as copies of their medical or nursing license, if applicable. Medical information, such as immunization records and blood type, is also helpful to have. The traveler should carry these copies, and also leave a copy with someone back home. In addition, they should carry contact information for whom to notify in an emergency.

Registration with Embassies

Travelers should register before departure with the U.S. Embassy in that country, so that the local consulate is aware of their presence, and they may be accounted for and included in evacuation plans. They should also consider supplemental health insurance to cover medical evacuation should they become ill or injured. See the U.S. Department of State website for additional information: https://travelregistration.state.gov/ibrs/ui/.

Post-Travel Considerations

Returning aid workers should be advised to seek medical care if they sustained injuries during their travel or become ill upon return. To ensure proper evaluation, they should advise their providers of the nature of their recent travel.

Depending upon the length of time away or their activities (i.e., work in health care), returning aid workers may benefit from a complete medical review.

• Homecoming has also been identified as a risk period for difficulties in psychological adjustment, and appropriate treatment or counseling should be sought.
• Individuals who witnessed or have been involved in situations of mass casualties, deaths, or serious injuries of associates or who have been victims of violence (assault, kidnapping, or serious accident) should be considered for referral for critical incident counseling.

Studies have indicated that >30% of aid workers report depression shortly after returning home. The adjustment process can be assisted by a skilled debriefing. Generally, humanitarian workers are able to adapt to the acute and chronic stressors of their work and demonstrate considerable resilience, but they will also benefit from proper rest and support to help them fully adjust back into the home environment.

References

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