In my previous blog I looked at the number of aid workers who had been victims of major attacks, while I argued for the need of better data to analyse risks and rates. In this blog I’ll discuss other types of risks faced by aid workers, and show that in most environments, it’s these ‘other risks’ which are the main threat to aid workers.

Operating in a violent environment is a great risk for aid workers. In some areas it can be the main risk. Even if not the main risk directly, it indirectly affects many aspects of aid workers’ well-being contributing to other risks to their physical and mental health. But I feel there are other risks which are often neglected.

Data for aid workers who are killed in violent attacks tends to be very good, since these cases are frequently reported. Data on kidnappings is less reliable, as many are not reported. Data from non-violent threats, such road traffic accidents or malaria deaths is very weak. Data from other diseases is even weaker, and data on mental health of aid workers weaker still.

I would very much like to present you with a pie chart showing you the different components of the overall risk rates for aid workers, but the data is just not good enough. Instead, I’ll look at some of these other dangers faced by aid workers, and attempt to provide some estimate of the risk they pose based on the available data.

Road Traffic Collisions and Other Accidents
Road traffic accidents are believed to be one of the greatest danger to humanitarian aid workers. According to some, like Fleet Forum, they are responsible for the largest proportion of aid worker deaths. While there isn’t good data available on casualties of aid workers due to road traffic collisions, Fleet Forum estimates that around 25% of aid worker deaths are caused by traffic accidents.

Diseases
Studies have shown that over 35% of aid workers report deteriorating health during their missions. An ICRC study found one-in-ten (10.1%) of humanitarian aid workers returning from Sub-Saharan Africa had tested positive for malaria. Worldwide it was just under one in 20 (4.2%).

Malaria is just one of many other diseases which are endemic in many of the countries aid workers deploy to. Since I don’t have access to data, I will make an exception to my dislike for anecdotal evidence to point out health problems appear to be the main issue amongst the aid workers I’ve spoken to in South Sudan and India (note the emphasis: please don’t draw any conclusions from my anecdotal observations). I hear of people falling seriously ill far more often than I hear of aid workers being victims of violence or being involved in traffic accidents.

Mental health
A recent study showed over 40% of aid workers found their deployments more stressful than expected, which strongly suggests training and communication need to be improved. A study of 212 humanitarian aid workers from 19 different NGOs found symptoms of anxiety in three times as many aid workers post deployment as pre-deployment. For depression, the rates were twice as high post-deployment as pre-deployment. The study showed some of these effects were long lasting: three to six months post deployment, while there was some improvement in rates of anxiety, rates of depression were even higher than immediately post deployment.

Conclusion
So what does all this add up to? If calculating risk is difficult, so is working out the overall effect of all these hazards. Being an aid worker is dangerous, but it’s hard to quantify exactly how dangerous. A comprehensive comparative study found aid workers are approximately twice as likely to die than non aid workers. The risk is probably higher, as the study only looked at aid workers who died during deployment, and not those who died post-deployment as a result of diseases contracted during their deployment. The study also doesn’t tell us of the long-term health effects of being an aid worker.

Most agencies spend considerable time and effort addressing security, to minimise the risk to their staff. I am among those who applaud these efforts. But I’d also like to see more effort in measuring, communicating, and addressing other risks, especially in environments where these ‘other risks’ are greater than the risk of targeted violence. While dying from malaria or from a traffic accident might not attract headlines, it does leave you equally dead.
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References and further reading:
Data on road traffic collisions comes from this report. This contains more recommended reading.
The Centers for Disease Control and Prevention (CDC) has published this overview of the risks to aid workers and how to mitigate them. It contains an extensive bibliography.

This section is rather short. Do you have any other reference materials to recommend? In particular, do you know of any comparative studies on the morbidity of aid workers? Let us know!