It is difficult for most people to comprehend exactly how PTSD affects individuals. We hear horror stories of PTSD occurring weeks or months after traumatic events and having a potentially devastating impact on the person’s life. Unfortunately, those who fail to receive treatment for PTSD can have suicidal thoughts which may lead to fatalities.

Before we look at International development work and PTSD, what exactly is PTSD?

The American Psychiatric Association defines PTSD as:

“A psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist attack, war/combat and violent personal assaults”

While this is a condition which is often associated with military veterans, the above definition highlights an array of traumatic scenarios in which PTSD can emerge. Will now take a look at the situations in which international development workers may be exposed to scenarios often associated with PTSD.

Serious accidents

The majority of injuries and deaths amongst international development workers/aid relief workers revolve around road traffic accidents and unsafe buildings. Even though governments and relief agencies around the world have been investing large amounts of money into infrastructure development, there is still much work to be done in developing countries. As a consequence, serious road traffic accidents are still commonplace and can have a major impact upon a person’s well-being and mental health.

Initially many international development workers may assume they will be working in a like-for-like situation with regards to health and safety when assigned overseas. Unfortunately, very quickly many of them will realise this is not the case. International development agencies are legally obliged to carry out risk assessments and will do everything possible to reduce the threat of accidents and serious injury. However, in these scenarios it is impossible to cover every potential eventuality.

Abuse

Physical and verbal abuse is still experienced by many aid relief workers posted to challenging environments but the situation is improving. If we take for example the recent outbreak of Ebola in the DR Congo, we know the local community blame the politicians and are reluctant to trust relief workers. As a consequence, many have been physically and verbally abused with some attacks leading to hospitalisation. When in your mind you are literally putting your life on the line to help others, how do you cope with such a serious backlash from those you are there to help?

In the past there have been cases of abuse by international development workers but thankfully the days of “sweeping abuse under the carpet” have long gone. Whistleblowers and the Internet have proved to be extremely useful tools to expose malpractice often leading to criminal action. While the frequency of abuse may be reducing these can still be extremely traumatic and potentially life changing events.

Health problems

Those posted to war-torn countries and those experiencing the aftermath of a major natural disaster can be exposed to an array of different infections and diseases. It is safe to say that many of these infections and diseases can be terrifying, leaving victims fighting for their lives, and lead to a whole array of different medical/mental conditions. When you are staring death in the face it may be difficult to pull yourself back mentally even if you appear to be physically sound. Even those who make a full recovery may be faced with nightmares and increased anxiety/stress which can start anywhere up to 6 months after the event.

As a consequence, many international development organisations now have support services which remain in contact with salaried and volunteer workers weeks and months after they have returned home.

War and conflict

Perhaps the most harrowing of experiences for international development workers are those associated with war and conflict. Many will see sights which they cannot even describe yet leave a vivid image in their minds. In some of the war-torn countries of years gone by there were literally no rules and no laws when it came to war. There was no surrender, no prisoners taken and we can only imagine how it was like working in this type of environment. In many ways this is akin to military veterans many of whom are placed in a life-or-death situation and forced to make life changing decisions.

Symptoms of PTSD

No incident of PTSD is ever the same as any other because by definition the flashbacks and the images are very personal. Some of the recognised symptoms include:-

Reliving events

• Lifelike flashbacks
• Torturous thoughts and images
• Constant nightmares
• Feeling of real distress as a consequence of symbolic reminders
• Physical sensations such as sweating, nausea and trembling

Feelings of constant anxiousness

• Panic attacks
• Volatile temper
• Hypervigilance
• Insomnia/lack of sleep
• Aggressive behaviour
• Inability to concentrate
• Reckless behaviour

Masking PTSD

• Constantly busy leading to exhaustion
• Avoiding any potential reminders
• Subconsciously burying details of the incident
• Emotional numbness
• A feeling of being physically detached from your body
• Inability to show affection
• Use of alcohol/drugs as an emotional crutch

Emotional turmoil

• An inability to trust anybody
• Constant anxiety no matter where you are
• Feeling isolated and alone
• Blaming yourself
• Uncontrollable feelings of anger, sadness, guilt and shame

Many people may look at the list of PTSD symptoms and recognise a number they may experience in their everyday life. In many ways it is the amalgamation of symptoms and emotions listed above which creates an environment in which PTSD can emerge.

There is a term known as “fight or flight” which is in the human DNA. In the event of a challenging situation your body will automatically decide in a split second whether to fight it or remove yourself from the situation – this is natural. Those suffering mental health issues such as PTSD are constantly anxious and drawn to severe fight or flight reactions; everything they do is exaggerated because of their constantly high levels of anxiety.

Post deployment therapy

In recent times we have seen a massive increase in the money invested in post deployment therapy which can help to diagnose issues such as PTSD. For some people, PTSD may be a short-term issue while for others it may be something they have to live with for the rest of their life. Whatever the case, it is imperative that treatments such as cognitive therapy are made available so the people can talk through their issues. In effect, understand their feelings and know what they are fighting.

Around 30% of those who return home from challenging work overseas will experience some kind depression in the immediate aftermath. Again, it is imperative that this type of experience is recognised and diagnosed as soon as possible and all relevant help made available. When you bear in mind the terrifying situations that many international development workers will find themselves in, it could be argued that employers have a legal obligation to ensure their well-being even after they have returned home.