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Table of Contents
ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 151-160

Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic


1 Assistant Protection Officer, Community Based Protection Unit, UNHCR, Cox’s Bazar, Bangladesh
2 Associate Professor, School of Psychiatry, University of New South Wales, Sydney, Australia
3 Mental Health and Psychosocial Support (MHPSS) Officer, MHPSS Unit, UNHCR, Cox’s Bazar, Bangladesh
4 Senior Staff Welfare Officer, UNHCR Regional Bureau for Asia and Pacific, Bangkok, Thailand
5 Senior Mental Health and Psychosocial Support Officer, Public Health Section, Division of Resilience and Solutions, UNHCR, Geneva, Switzerland

Date of Submission17-Jun-2021
Date of Decision06-Sep-2022
Date of Acceptance06-Sep-2021
Date of Web Publication31-Oct-2022

Correspondence Address:
MPhil Tahmina Parvin
Assistant Community Based Protection Officer and Peer Advisor, United Nations High Commissioner for Refugees (UNHCR); Sub-Office, Motel Road, Kolatoli, Cox’s Bazar
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/intv.intv_18_21

Rights and Permissions
  Abstract 


Humanitarian workers are at risk of experiencing emotional distress and mental health problems. The COVID-19 pandemic created additional stress and challenges for staff in ongoing emergencies who had to continue delivering humanitarian assistance. The primary objective of this study was to assess the mental health status of humanitarian staff working in the Rohingya refugee operation in Cox’s Bazar, Bangladesh, amid the COVID-19 pandemic. A sample of 307 national and international humanitarian staff working in person or remotely within the Rohingya refugee operation in Cox’s Bazar anonymously completed an online questionnaire. Outcome measures included 1) the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings which measures six symptoms related to mental health problems, 2) the Perceived Social Support Questionnaire and 3) questions about help-seeking. The self-reported mental health burden among humanitarian workers was high. The result demonstrates that most participants felt so afraid and severely upset about the emergency/COVID-19 pandemic that they avoided people or places. One in three respondents felt so angry that they were unable to carry out essential activities at least some of the time. Significant differences between national and international staff were found, with national staff more likely than international staff to feel afraid, angry, hopeless and unable to carry out essential activities (all P-values < 0.05). Nearly three out of 10 humanitarian workers reported a lack of social support. Less than one in five had sought professional help, while around half of all respondents indicated that they would want mental health support. The need for mental health support for humanitarian staff in Cox’s Bazar, Bangladesh, during the COVID-19 pandemic was high. It is important to strengthen strategies to proactively make services for mental health support available and accessible to humanitarians, building upon existing structures and allocating appropriate resources.

Keywords: Bangladesh, COVID-19, Cox’, s Bazar, humanitarian workers, mental health, perceived social support


How to cite this article:
Parvin T, Rosenbaum S, Ozen S, Ewagata L, Ventevogel P. Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic. Intervention 2022;20:151-60

How to cite this URL:
Parvin T, Rosenbaum S, Ozen S, Ewagata L, Ventevogel P. Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic. Intervention [serial online] 2022 [cited 2022 Dec 3];20:151-60. Available from: https://www.interventionjournal.org/text.asp?2022/20/2/151/359987




  Key implications for practice Top


  • Humanitarian staff in Cox’s Bazar during the COVID-19 pandemic expressed high levels of psychosocial needs and indicated a need for support, but in actual practice, they rarely sought such support.
  • More efforts are needed from humanitarian agencies to facilitate staff in accessing mental health and psychosocial support services for their staff.
  • National staffs are more likely than international staff to report mental health issues and need targeted attention, including the availability of national staff counsellors in the duty station who can proactively reach out to staff.
  • Humanitarian agencies must pay attention to their staff’s mental health and wellbeing and take initiative to reach out to them to address stigma or hesitation to seek mental health support during public health emergencies.





  Introduction Top


The COVID-19 pandemic has had adverse effects on the population’s mental health all over the world (Pfefferbaum & North, 2020; Vindegaard & Benros, 2020). Many people have experienced distress due to the impact of COVID-19 on their lives, including fear of infection, dying, losing loved ones or separation from family members (United Nations, 2020a). The pandemic has compounded pre-existing inequalities and socioeconomic vulnerabilities, which has led to increased poverty, gender-based violence and family tensions (Connor et al., 2020; United Nations, 2020b, (2021)). The infectious nature of COVID-19 has exacerbated existing mental health issues and triggered psychological problems such as panic disorder, anxiety and depression (Qiu et al., 2020). Countrywide or local lockdowns, mandatory quarantine and isolation are associated with mental distress (Sibley et al., 2020; Xin et al., 2020). Several studies have documented the mental health consequences of the pandemic, with increasing calls for mental health to be prioritised as part of the global COVID-19 response (Ghebreyesus, 2020; Holmes et al., 2020; Torales et al., 2020; United Nations, 2020a). Bangladesh responded to this emerging need by establishing a tele-counselling helpline, “Moner Jotno Mobile E” (“caring for the mind on mobile phones”), which was launched in April 2020 to meet the rise of mental health problems in the context of COVID-19. The helpline reported that 86% of callers described psychological symptoms, such as anxiety and/or sleeplessness related to the pandemic, often accompanied by worries about their physical health, family or interpersonal problems, financial problems and concerns about managing the quarantine requirements during the ongoing COVID-19 pandemic. In the first month, 4.6% of the callers were frontline workers who expressed concerns regarding infecting family members and their own health (Iqbal et al., 2021). During the COVID-19 pandemic, health care staff and other staff who are providing direct in-person support (“frontline staff”) are at heightened risk of experiencing mental health problems (Greenberg et al., 2020). Many have experienced both physical and psychological stress yet may avoid seeking psychological support for themselves (Chen et al., 2020). For frontline workers in the COVID-19 response, increased workload associated with the pandemic, self-isolation, fear of transmitting the virus to loved ones and excessive guilt have been documented, which can also increase the long-term risk of experiencing mental health issues (Ehrlich et al., 2020).

Little is known about the mental health effects of the COVID-19 pandemic on staff working in humanitarian settings such as refugee camps. In general, even before the COVID-19 pandemic, humanitarian workers are at highrisk of experiencing mental health and psychosocial distress. Common sources of stress in humanitarian staff include the rapidly changing context, the multiple and urgent demands, lack of safety or security, overload of work, uncertainty about employment contracts which are often of short duration and difficulties in managing work–life boundaries (Curling & Simmons, 2010; Jachens et al., 2018). Working in such conditions has major effects on both professional and personal lives including loss of productivity, feeling emotionally exhausted, stress-related conditions and depression and unhealthy lifestyles with limited sleep (Elnakib et al., 2021; Macpherson & Burkle, 2021; Sanderson & Andrews, 2006; Strohmeier, 2019; United Nations High Commissioner for Refugees, 2016). Humanitarian workers are therefore at greater risk of experiencing mental health-related symptoms including those of depression, anxiety, burnout and compassion fatigue than the general population (Connorton et al., 2012; United Nations High Commissioner for Refugees, 2016). For international staff, it is known that this increased risk of depression, health-related issues and compassion fatigue can be maintained following completion of their assignment (Cardozo et al., 2012; De Jong et al., 2021), but far less is known about national staff (Strohmeier & Scholte, 2015). There are indications that humanitarian staff, already prone to stress and burnout, are disproportionally affected by the COVID-19 pandemic (Budosan, 2020; Inter-Agency Standing Committee, 2020), but there is limited research on this group. A survey among the staff of the International Movement of the Red Cross and Red Crescent estimated that almost three in four frontline workers and first responders during COVID-19 had needed mental health support (International Committee of the Red Cross & International Federation of Red Cross and Red Crescent Societies, 2020). The limited literature that exists on this topic focuses on frontline humanitarian workers during COVID-19. In this study, we refer to “frontline staff” when humanitarian staff visited refugee camps at least once a week during the lockdown period to ensure basic services for refugees such as health, food, WASH and protection. Staff in humanitarian organisations who work in supportive roles, such as in human resources or administration departments, are also likely to face increased stress during the pandemic, but as far as we know, no research has been done in this group. This article attempts to contribute to filling this knowledge gap on mental health issues of humanitarian workers during the COVID-19 pandemic.

Cox’s Bazar in southern Bangladesh is one of the largest ongoing humanitarian contexts in the world, with many national and international workers providing humanitarian assistance to close to 1 million Rohingya refugees and members of the surrounding host community since 2017 (Strategic Executive Group, 2020). Working in the humanitarian context of Cox’s Bazar is generally stressful as this area is prone to natural disasters and other challenging situations, including fires, landslides and insecurity due to the presence of extremist groups in the camps. Seasonal cyclones, occurring from April to May and from September to December, are associated with outbreaks of communicable diseases, including diphtheria and cholera (Inter Sector Coordination Group, 2019).

In the last week of March 2020, the Bangladesh Government announced a countrywide lockdown to reduce the transmission of COVID-19, with only critical services permitted to continue, forcing many humanitarian workers to work from home on a rotational basis. During the pandemic, different working modalities emerged to ensure the continuation of services. Many national and international humanitarian staff were affected by the lockdown and were unable to return to their duty station and were forced to work remotely. Others continued to work in the camps — albeit with reduced visits — to continue essential activities. COVID-19 posed an additional risk to most of the national humanitarian workers in Cox’s Bazar because of their frequent exposure associated with frontline work (United Nations, 2020a); many faced the dilemma of balancing their responsibilities to the Rohingya refugees with the need for self and family care. They often experienced challenges associated with adapting to different working modalities and job insecurity due to the restriction of services, severely impacting overall programme activities. For international staff, major challenges and stressors included continuing to work in a stressful environment for a prolonged time due to travel restrictions which impacted their rest and recuperation breaks (Kasztura & Duroch, 2020).

Social support structures were disrupted in the context of COVID-19, where perceived social support plays a vital role in promoting mental health and wellbeing. For humanitarian workers, including national and international staff, social support is not always available in the challenging contexts where they live and work. Perceived social support significantly contributes to emotional wellbeing and personal accomplishment. Evidence shows that support from family members and colleagues is important for coping with stresses in the life of humanitarian workers (Procidano & Heller, 1983). During COVID-19, maintaining social distance, quarantine and isolation brought major changes to existing social support systems and negatively contributed to mental health status (Xin et al., 2020).

The primary objective of this study was to determine the mental health status and perceived social support of the humanitarian community in Cox’s Bazar, Bangladesh. Specifically, we aimed to assess symptoms associated with mental health problems experienced by humanitarian workers and their perceived social support during the early period of COVID-19. We were specifically interested in exploring the differences between national and international staff.


  Methods Top


Context

During the period of COVID-19, a team of seven peer advisors in the United Nations High Commissioner for Refugees (UNHCR) office in Cox’s Bazar actively supported their colleagues in coping with the distress of the pandemic. These peer advisors were trained in 2019 as part of UNHCR’s global Peer Advisor Network (PAN) which has over 400 members. From April to June 2020, the peer advisors in Cox’s Bazar organised six online sessions on self-care for humanitarian workers. This self-care module was developed by the PAN and was shared with the peer advisors to support their colleagues during the COVID-19 period. Three sessions for the staff of the UN refugee agency, one session for ActionAid Bangladesh (AAB) and two sessions for the members of the Gender in Humanitarian Action (GiHA) group were organised by the Gender Hub. More than 150 participants attended these sessions. The findings of these online sessions, mentioned below in the Discussion section, prompted this rapid quantitative assessment initiated by the first author, a psychologist with over 10 years’ experience in humanitarian work.

Participants

Initially, the study was planned for the staff of UNHCR, but in coordination with the Mental Health and Psychosocial Support Working Group (MHPSS WG) in Cox’s Bazar, this study opened up to all humanitarian workers in the 160 projects in Cox’s Bazar in 2020 (Inter Sector Coordination Group, 2020). All national and international humanitarian staff working in the Cox’s Bazar operation, either in person or remotely from other locations, were eligible to participate in the study.

Procedures

All humanitarian workers were invited to complete an online, self-reported questionnaire using the KoBo Toolbox for online data collection in humanitarian settings (www.kobotoolbox.org). The survey was open for 3 weeks, from the last week of July to mid-August 2020. The assessment link was shared through different coordination platforms, including the Protection Working Group, Gender in Humanitarian Action (GiHA), Gender-Based Violence Sub Sector, Communication with Communities (CwC) Working Group, and technical working groups, including mental health and psychosocial support (MHPSS), health, site management and water, sanitation and hygiene (WASH). Additionally, the link was circulated to all staff from different agencies, including the United Nations High Commissioner for Refugees (UNHCR), Bangladesh Rural Advancement Committee (BRAC), Humanity and Inclusion (HI) and Action Aid Bangladesh (AAB) via email. The total time to complete the assessment was estimated to be between 5 and 10 minutes. These invitations were managed by a small group formed under the research and assessment subgroup of the MHPSS WG to facilitate the study. Reminder emails were sent to the MHPSS WG and UNHCR staff contact list after 2 weeks of the survey. The other identified channels mentioned above were sent reminder emails at different times but we could not track these. This made it difficult to estimate the number of participants who received a reminder email. The survey instructions and measures were presented in English and Bengali.

Measures

Outcomes assessed included mental health symptoms, perceived social support and some additional questions such as whether respondents felt that they required external support such as peer advisors or mental health professionals to manage the stress during the period of COVID-19.

Demographic Information

Gender, age, educational qualification, relationship status, type of humanitarian worker, working modality, type of humanitarian programme and affiliated organisation were included. As this study was an initiative of a peer advisor of UNHCR, a secondary aim was to disaggregate UNHCR data to design and advocate for required support for them.

Assessment of Mental Health Symptoms

Serious mental health symptoms were measured using Part-A (the individual version) of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) (WHO-UNHCR, 2012). The scale is not meant to provide an adequate prevalence of diagnosable mental disorders but to provide a quick overview of the number of people suffering from severe psychological symptoms. The WASSS Part-A examines common but serious mental health symptoms, including excessive fear, anger, lack of interest, hopelessness, avoidance and lack of ability to carry out essential activities. Each item is scored on a five-point Likert-type scale ranging from “none of the time” (0) to “all of the time”’ (4). Each item is analysed separately. One question was adapted: question number 5 in the original WASSS is “You may have experienced one or more events that have been intensely upsetting to you, such as the recent emergency, disaster or war. During the last 2 weeks, how often did you feel so severely upset about the emergency, disaster, war or another event in your life that you tried to avoid places, people, conversations or activities that reminded you of such event?” This was adapted for the COVID-19 context as “During the last two weeks, about how often did you feel so severely upset about the emergency/COVID-19 crisis or another event in your life, that you tried to avoid places, people, conversations or activities that reminded you of such event?” This scale has been widely used in needs assessments in humanitarian settings, including in Southeast Asia, such as among earthquake affect populations in Nepal (Kane et al., 2018) and among Rohingya refugees in Malaysia (Welton-Mitchell et al., 2019) and Bangladesh (Riley et al., 2017). As far as we know, this is the first time it has been used with humanitarian staff.

The Perceived Social Support Questionnaire

The perceived social support of humanitarian workers was assessed using the brief form of the Perceived Social Support Questionnaire (F-SozU; Kliem et al., 2015). The F-SozU is a reliable and valid instrument to assess perceived social support in various cultural contexts (Lin et al., 2019). It consists of six items with three-point options (“yes”, “no” and “do not know”) to measure whether, during the past week, participants had “experienced a lot of understanding and support from others”, “a very close person whose help [they] can always count on”, “people with whom [they] can spend time and do things together”, “if [they] get sick, [they] have friends and family who will take care of [them]”, “if [they] feel down, [they] have people [they] can talk to without hesitation” and whether they could “if necessary, [they] can easily borrow something [they] need from neighbours or friends”. The total score of the questionnaire indicates the level of perceived social support, where higher scores indicate higher social support and lower scores indicate lower social support.

Help-seeking Behaviour Questions

To assess whether people had actually sought help for managing stress and mental health symptoms, we asked two additional questions: 1) “Have you sought any external support such as peer advisors or mental health professionals during this COVID-19 period to manage stresses?” and 2) “Do you feel that you will need external support such as peer advisors or mental health professionals to manage the stress?”

Ethical Considerations

Data were collected within a humanitarian emergency to inform programming. During the assessment, the COVID-19 pandemic and associated measures hit Bangladesh hard, and it was not feasible to submit to the usual ethical review boards, whose procedures take several months, and their functioning was affected by the lockdowns. The research team made all possible efforts to adhere to ethical principles for medical research involving human subjects (World Medical Association, 2013). The assessment was discussed and approved by the MHPSS WG in Cox’s Bazar. The Bangladesh Peer Advisor Network of UNHCR contributed to this study, as the members of the network actively provided psychosocial support to the staff during the initial period of COVID-19 and facilitated support to conduct the assessment. Participants provided informed consent at the beginning of the questionnaire to continue the assessment. This assessment was endorsed by the senior management of UNHCR and ethically approved by the Psychosocial Wellbeing Section of UNHCR’s head office.

Answering the questionnaire was anonymous. Participants were advised to contact professional psychological support if answering the questionnaire made them feel distressed. The preamble of the assessment form provided information and contact details on resources for participants in need of additional support. These resources were all freely accessible and were provided by mental health professionals in Bangladesh. Peer advisors and regional staff counsellors were available for the UNHCR staff. The local resources could receive and provide basic support in English for international staff and to refer them if required.

Data Analysis

Descriptive statistics were used to assess the prevalence of mental health symptoms and perceived social support. To test whether the type of humanitarian worker, national and international, predicted the risk of experiencing mental health symptoms and perceived social support, logistic regression was performed with α = 0.05 as the criterion for significance. For this analysis, the scoring was coded in a binary method such as for mental health symptoms, “none of the time” was coded “0”, “a little of the time to most of the time” was coded “1” and “all of the time” was systematically excluded in the analysis process. The Pearson correlation was used to analyse the association between variables including location, work modality, experience, organisation and mental health symptoms. The strength of the correlation was interpreted where r = <0.10 was evidence of little or no correlation, 0.10–0.30 was a weak correlation, 0.30–0.50 was moderate and ≥0.50 was a strong correlation. Microsoft Excel and SPSS-25 (IBM Corp, 2017) were used to perform the analyses.


  Results Top


In total, 307 participants (mean age: 33.7 years, SD = 8.82) completed the questionnaire out of 315 with partial responses only. The estimated number of humanitarian workers reached through the various email lists, working groups and agencies was approximately 3,500. Therefore, the approximate response rate of the assessment was almost 9%. The majority of respondents (79%) were national staff, and a half (50%) of the sample were frontline workers, defined as those who visited the refugee camps at least once per week; 37% of respondents were female, 92% of participants were working in Cox’s Bazar district including Ukhiya and Teknaf during the assessment period and 67% of them worked for NGOs and INGOs (see [Table 1]).
Table 1 Demographic Characteristics of the Sample (n = 307)

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Mental Health Symptoms

Findings on the prevalence of serious mental health symptoms are presented in [Table 2].
Table 2 Symptoms associated with Mental Health

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Three in five participants (61%) reported anxiety, and 30% had severe levels of anxiety. Roughly one in three (33%) felt so angry that they felt out of control some or most of the time. Around 42% of the respondents felt so severely upset most of the time about the emergency/COVID-19 or another event in their life that they tried to avoid places and people. These symptoms had substantial effects on their ability to carry out essential activities for daily living. One in three (33%) indicated that performing essential activities was difficult due to feelings of fear, anger, disinterest, hopelessness or being upset for some or most of the time in the previous 2 weeks.

There were significant differences between national and international staff. The odds of national staff endorsing the items relating to fear, anger and hopelessness and ability to carry out essential activities were 3.7 (95% CI: 2.0–6.7, P < 0.001), 2.1 (95% CI: 1.2–3.8, P < 0.01), 3.8 (95% CI: 1.9–7.6, P < 0.001) and 2.3 (95% CI: 1.3–4.1, P < 0.05) times greater than for international staff. No significant differences between national and international staff were found for the other two items of feeling uninterested and avoidant due to COVID-19.

Perceived Social Support

Approximately three in 10 respondents (30%) indicated that they experienced a lack of social support in aspects of “I receive lots understanding and security from others”, “There is someone very close to me whose help I can always count on”, “If I need to, I can borrow something from friends or neighbours without any problems”, “When I am sick, I can ask friends/relatives to handle important things for me without hesitation” and “If I am very depressed, I know whom I can turn to”. No significant differences between national and international staff were found except for the item, “When I am sick, I can ask friends/relatives to handle important things without hesitation”. The odds of national staff endorsing this item were 2.2 times greater than the international staff (95% CI: 1.2–3.8, P < 0.01) (see [Table 3]).
Table 3 Perceived Social Support of Humanitarian Workers

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The relationship between mental health symptoms and other variables, such as location, experience, working modality and organisation, was also explored. No significant correlations were found. Symptoms associated with mental health were internally correlated. A poor correlation was found between location and type of humanitarian worker, between working modality and the organisation the humanitarian staff working with. The type of humanitarian worker, organisations of the humanitarian staff working with and working modality was negatively correlated (see [Table 4]).
Table 4 Correlation between Variables and Symptoms associated with Mental Health

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Help-seeking Behaviour

From the items “Have you sought any external support such as peer advisors or mental health professionals within this COVID-19 period to manage the stresses?” and “Do you feel that you will need external support such as peer advisors or mental health professionals to manage the stress?”, the results showed that less than one in five humanitarian staff sought professional support and the percentage was very similar for national (18%) and international (17%) staff, despite approximately 50% of the respondents indicating they wanted to receive mental health support.


  Discussion Top


To the best of our knowledge, this was the first study investigating the mental health of staff providing humanitarian assistance, including those working remotely or in supportive functions in Cox’s Bazar, Bangladesh, during the COVID-19 pandemic. We found high levels of distress, with roughly 30% of participants experiencing symptoms indicating significant mental health issues. Overall, national staff reported more mental health symptoms than international staff during the COVID-19 outbreak between July and August 2020.

COVID-19 may have placed additional stress on humanitarian staff working in an already stressful environment, with evidence of a potentially greater impact on national staff (International Committee of the Red Cross & International Federation of Red Cross and Red Crescent Societies, 2020; United Nations High Commissioner for Refugees, 2016). Much of the literature on mental health in humanitarian workers focusses on expatriate workers, with only limited research being done on the needs of national staff despite substantial differences between national and international staff (Kasztura & Duroch, 2020; Strohmeier & Scholte, 2015; United Nations, 2020a). The entitlements and rights of the staff from the organisation by contract, benefits and services vary drastically between national and international staff, which may negatively contribute to wellbeing (Foo et al., 2021).

Interestingly, there was no statistically significant difference between national and international humanitarian workers in levels of perceived social support except for one item. This was where national staff mentioned that they could ask friends or relatives to handle important things on their behalf without any hesitation when they are sick, which can be explained according to the context, given that national staff are likely to have family and friends in the country. This is in contrast to international staff, most of whom were living alone in the duty station. Many international staff could not utilise their dedicated rest and recuperation break during this period due to restrictions on international flights. Others were stuck in their home country and were unable to return to their duty station. Our assumption that international staff would report significantly less perceived social support was not confirmed.

Anecdotal evidence from the six online sessions on self-care for humanitarian workers in Cox’s Bazar (see Methods) provides a potential explanation for our findings. For example, national staff who continue to deliver essential humanitarian services in camps may have been worried about exposing their family members, especially older relatives. Many frontline humanitarian staff mentioned that the working relations with the refugee community became strained because some refugees perceived the humanitarian staff as a source of bringing COVID-19 into the camps. National staff also mentioned the challenges of balancing a personal and professional life in a period where many staff was in constant emergency mode (Visser et al., 2016). The adapted working modalities in response to COVID-19 affected working hours, with frequent online meetings after working hours. The boundaries between professional and personal space became blurred. Other stress factors mentioned in the online support sessions included the increased burden of unpaid care work (especially for female staff), job insecurity and worry about whether people would get medical support from the office if they caught COVID-19. These factors have been described in the literature (Dutta, 2019; Hellgren et al., 1999; Power, 2020).

Foo et al. (2021) explored the unique stressors faced by national and international staff, including that national staff may be less protected by evacuation plans, have less comprehensive health insurance and have less access to adequate psychological support. The researchers also found that national staff cited greater job insecurity concerns and inequality in treatment between national and international staff. In contrast, international staff perceived more difficulties with work–life balance and issues associated with separation from family and lack of social support. These different areas of concern between national and international staff may contribute to our findings, as some of the factors mentioned by these authors were similar to the findings of staff consultations, even if the research by Foo et al. (2021) was not specific to the COVID-19 context.

While half of the participants in the current study expressed the need for psychosocial support during the COVID-19 period, only 18% of the participants had actively sought this support from existing systems present from the pre-COVID-19 period. Many humanitarian organisations in Cox’s Bazar have internal mechanisms for psychosocial support of staff, such as peer advisors and buddy systems. Additional initiatives were taken in the context of COVID-19, such as hotline numbers that offer staff support. However, our findings indicate that there are gaps between the need for mental health support and actively seeking support from existing support systems. This is in line with similar findings on staff wellbeing and mental health in a previous UNHCR report (United Nations High Commissioner for Refugees, 2016), which found that 48.8% of respondents indicated that they needed to consult with mental health services, yet only 26.4% of respondents had sought help. Among national and international humanitarian staff in South Sudan, the most widely endorsed action to improve staff wellbeing was to improve their access to psychosocial support services (Strohmeier et al., 2019). Future research should explore help-seeking behaviour among humanitarian workers and elaborate on what organisations can do to overcome barriers and support facilitators in seeking care. The role of the organisation is likely to be critical: perceived organisational support contributes to reducing symptoms of distress and improving staff mental health and wellbeing (Aldamman et al., 2019; Pathak, 2012). It also mediates the adverse effects of a challenging working environment and improves engagement with the organisation (Rasool et al., 2021). Good practices such as organisational staff counsellors and peer helper programmes can strengthen the effective provision of psychosocial support to humanitarians (Curling & Simmons, 2010).

The study has several limitations. First, all data are based on brief self-report instruments and are not corroborated by observational data or clinical interviews. The original tool, WASSS Part-A, was designed to be administered by interviewers. In this assessment, we used it as a self-reporting questionnaire which may have impacted the results. Additionally, we adapted the WASSS question regarding avoidance for the COVID-19 context. This revised question may also have captured “adaptive avoidance” in the context of pandemics, and positive responses cannot always be considered pathological. Second, we do not know to what extent the sample is representative of all humanitarian workers in Cox’s Bazar. Our sample may be skewed towards individuals who perceive more problems and therefore may have been more likely to participate. Third, this study was cross-sectional. Data on the situation of the humanitarian workers in this specific context pre-COVID-19 are not available and therefore we cannot reach any conclusion about changes in mental health and wellbeing. Fourth, as the assessment was done online, many staff may have faced technical challenges due to poor Internet connectivity to complete the survey.


  Conclusion Top


This study in Cox’s Bazar, Bangladesh, presents mental health-related symptoms among humanitarian workers and their need for psychosocial services in the context of COVID-19. The data show a significant gap between the expressed need for mental health services and the help-seeking behaviour of humanitarian staff in Cox’s Bazar, Bangladesh. Future studies should explore barriers for humanitarian workers to accessing mental health support and identify strategies to improve the wellbeing of humanitarian workers, especially national staff.

Humanitarian agencies need to proactively provide psychosocial support to their staff, including promoting self-care and facilitating a healthy work–life balance to mitigate the stress of working in a public health crisis that compounds an already stressful humanitarian context. Such efforts should ensure the wellbeing of all humanitarian workers, with targeted consideration towards the national staff.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.







 
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