Health, psychosocial wellbeing, internal safeguarding and insurance

1Health, the first risk

In many contexts, illness (malaria, digestive infections, poorly managed chronic diseases) and accidents cause more sick leave, repatriations and sometimes deaths than violence. Protecting health is therefore part of risk management.

Essential measures:

• Before departure or assignment: medical check-up, vaccinations, appropriate malaria prophylaxis, a health briefing on the context.
• On site: mapping of health facilities (quality, distance, opening hours, languages), contracts with clinics, first aid kits, staff trained in first aid (at least one person per team or per vehicle in isolated areas).
• Medical evacuation: written procedure, contract with a provider or an insurer, trigger criteria, realistic timeframes.
• National staff: health coverage that is equivalent in practice, including for families according to the organisation's policy.

Critical time. The "golden hour" after serious trauma is decisive. If the nearest surgical hospital is 6 hours away by road and no air evacuation is possible before the next day, the risk of a serious accident weighs much more heavily in the assessment, and advanced first aid training becomes a priority.

2Stress, burnout and trauma

Aid workers are exposed to three types of stress:

• Basic and cumulative stress: workload, living conditions, isolation, team conflicts, permanent insecurity. Left unaddressed, it leads to burnout.
• Traumatic stress: exposure to a violent event or to death.
• Vicarious trauma: from repeatedly listening to and witnessing the suffering of others.

Several surveys of aid workers have found high rates of symptoms of anxiety, depression and burnout, often higher than in the general population, and higher still among national staff exposed to the same violence as their own families.

Measures: a reasonable workload, leave and recovery breaks respected (rest and recuperation, R&R, depending on the context, for example every 6 to 12 weeks in a difficult context), confidential access to psychological support, training for managers to spot the signs, psychological first aid after an incident, a culture that does not stigmatise asking for help.

A manager who never takes leave sends a message to the whole team. Wellbeing is also a matter of setting an example.

3Measuring wellbeing

Team wellbeing is measured, like any risk:

• Leave and R&R uptake rate: days taken / days due.
• Average overtime and number of people above a threshold.
• Sick leave and staff turnover (early departures).
• Short, regular anonymous surveys (validated stress or burnout scales, questions on perceived support).
• Use of psychological support (in numbers, never names).

Example. A team of 40 people: 1,200 days of leave due over the year, 690 taken, i.e. 57.5%. 14 people regularly work more than 55 hours a week. Turnover: 11 departures in the year, i.e. 27.5%. These figures signal a high risk of burnout: action plan (mandatory leave planning, reinforcements, fewer meetings, follow-up by senior management).

4Harassment and sexual violence against staff

Harassment (psychological and sexual), discrimination and sexual violence against staff, including by colleagues, are under-reported risks. They fall at once under security, human resources and internal safeguarding.

A minimum system includes:

• a clear, signed code of conduct, which also prohibits sexual exploitation and abuse of affected populations;
• multiple, confidential reporting channels (including outside the line management and external ones);
• a survivor-centred approach: safety, confidentiality, respect for the survivor's choices, rapid medical care (HIV post-exposure prophylaxis and emergency contraception within the time limits), psychological support;
• investigations conducted by trained people, independent of the line management concerned;
• effective sanctions and information-sharing between organisations to prevent the recruitment of sanctioned individuals (inter-agency reference-checking schemes).

Post-exposure prophylaxis kits must be available and designated staff trained in their use, because the window of effectiveness is short (ideally within the first few hours, and at the latest within 72 hours).

5Insurance

Insurance transfers part of the financial risk. Usual coverage:

• Health (including abroad) and medical evacuation;
• Accident, disability and death, including war and terrorism risks, which are often excluded from standard policies;
• The organisation's civil liability;
• Property: vehicles, equipment, stocks, cash;
• Kidnap and ransom, which mainly funds specialist consultants and whose existence must remain confidential.

Points to watch: exclusions (areas, activities, war), ceilings, notification deadlines, equitable coverage of national staff, and consistency with local law (compulsory insurance).

A simple calculation. A premium of 4% of the payroll for accident and death coverage including war risks, on a payroll of USD 2,400,000: USD 96,000 a year. If the organisation insures only its 30 international staff (payroll USD 1,500,000) and leaves 120 national staff (USD 900,000) without equivalent coverage, the saving of USD 36,000 creates a serious inequality and a legal and reputational risk.

6First aid and medical preparedness

Field medical preparedness is planned like everything else:

• Training: basic first aid for everyone, advanced first aid in isolated or conflict areas (haemorrhage control, tourniquet, recovery position, burns).
• Equipment: individual kit (with a tourniquet in conflict areas), vehicle kit, base kit.
• Confidential medical records for staff (blood group, allergies, treatments, emergency contacts), accessible only in an emergency.
• Medical evacuation plan for each area: first-line facility, referral facility, means of transport, timeframes, numbers, cost.

Calculating training needs. 85 staff in an isolated area, target: at least 2 people trained in advanced first aid per team of 5 on the move. If 17 teams can be in the field at the same time, at least 34 trained people are needed; with a 30% margin for absences and turnover, about 45 people.