ACHAIKI IATRIKI | 2024; 43(2):67-73
Original Research Article
Anna-Koralia Sakaretsanou1, Maria Bakola1, Stefanos Reppas1, Konstantina-Soultana Kitsou1, Konstantina Mavridou1, Mohamed E.G Elsayed2,3, Apostolos Veizis4, Eleni Jelastopulu1
1Department of Public Health, Medical School, University of Patras, Patras, Greece
2Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg, Ulm, Germany
3Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
4Intersos Hellas, Thessaloniki, Greece
Received: 15 Dec 2023; Accepted: 07 Mar 2024
Corresponding author:
Dr. med Eleni Jelastopulu, Public Health – Social Medicine Physician, Professor of Public Health, Head of the Department of Public Health School of Medicine, University of Patras, 1 Asklipiou St., 26500, Rio, Patras, Greece
Key words: Greece, humanitarian aid workers, Covid-19, difficulties, suggestions, thematic analysis
Abstract
Background and Aim: The COVID-19 pandemic has been an unprecedented global experience, with multiple consequences affecting various aspects of modern life. This study focuses on exploring the challenges faced by humanitarian aid workers operating in Greece during the pandemic and, subsequently, offering feasible solutions to mitigate these challenges.
Methods: We conducted a cross-sectional study in August and September 2022 to explore this topic. Data were collected through a comprehensive electronic questionnaire distributed via email to humanitarian organizations in Greece and disseminated through various social media platforms, such as Facebook and closed groups for humanitarian workers. The questionnaire included 73 questions, three of which were open-ended. The open-ended questions were evaluated using thematic analysis.
Results: A total of 153 participants took part in the study, 115 (75.2%) of whom were women. The thematic analysis revealed five main categories of challenges: i) communication, ii) accessibility, iii) funding, iv) education, and v) mental health. To address these challenges, participants suggested various actions, including continuing education, seeking support from various organizations, increasing resources and donations, establishing additional structures for psychological empowerment structures, and encouraging collaborations with researchers who can influence government policy through the dissemination of research findings. Most participants reported emotional exhaustion, a condition that was exacerbated during the pandemic.
Conclusions: Our study has shed light on the considerable emotional exhaustion experienced by a significant number of humanitarian workers, exacerbated by the far-reaching impacts of the coronavirus. These challenges include economic hardships, communication barriers, and strained interpersonal relationships. To gain a deeper understanding of this complex issue, further research using qualitative methods, such as in-depth interviews, is warranted.
INTRODUCTION
Humanitarian Aid Organizations provide assistance and support to people affected by human-made disasters, wars, natural disasters, or other crises. The services they provide include food, water, medical care, shelter, psychological support, education, and access to basic infrastructure. They aim to help people overcome difficulties and regain their dignity after crises and disasters. During COVID-19, these humanitarian organizations focused on providing medical supplies, and healthcare services, and disseminating information to help contain the spread of the virus.
Greece, like many other countries, faced unique challenges in coping with the COVID-19 pandemic and the lockdown policy which had a psychological impact on the population [1,2]. Migrants and refugees living in Greece, as in other countries, are particularly vulnerable to COVID-19 infection, with both clinical and socioeconomic consequences [3,4].
The vital importance of integrating refugees into pandemic readiness strategies is emphasized, considering their crowded living environments that can promote virus transmission. To address the challenges faced by refugees, conducting “site-specific epidemiological risk assessments” is proposed to gauge the potential for outbreaks within vulnerable communities [5,6]. Migrant workers also encounter significant difficulties, as many live near other migrants. The suspension or cessation of manual labor and informal jobs due to COVID-19 poses serious economic concerns for them. Furthermore, decisions regarding their legal status in host countries are currently pending [5,6].
Lockdown measures in countries with large migrant and refugee populations have significantly impacted volunteer community services. For instance, the lack of linguistically accessible information about COVID-19 has led to confusion among migrants and refugees, hindering their understanding of the virus and appropriate safety measures. Refugees often face discrimination and may hesitate to seek medical assistance or disclose information, posing increased risks not only to themselves and other migrants but also to host communities [5,6].
Numerous humanitarian workers have sacrificed their lives to assist and safeguard the communities they serve, which include millions of the world’s most vulnerable women, children, and adolescents. The challenges confronting humanitarian workers are compounded by the unequal distribution of COVID-19 vaccines and the inherent difficulties in delivering health services in humanitarian contexts [7].
The following research questions guided our investigation: 1. Which difficulties did workers in humanitarian aid organizations encounter in Greece during the COVID-19 pandemic? 2. In their perspective, how can these challenges be effectively addressed? 3. In what manner can researchers contribute to alleviating these challenges? By delving into these inquiries, our study endeavors to contribute valuable insights that can inform strategies to enhance the resilience and efficacy of humanitarian aid efforts during public health crises. Thus, our study aimed to identify the difficulties faced by employees in humanitarian aid organizations in Greece during the COVID-19 pandemic. Employing a qualitative approach, we sought to identify these challenges and explore proposed solutions.
MATERIAL AND METHODS
Participants
A total of 153 individuals, comprising 115 (75.2%) women and 38 (24.8%) men employed in humanitarian aid organizations in Greece, answered an online survey between August to September 2022. The mean age was 39.3 years old (SD=10.6), 43.8 % (n=67) had one-five years’ experience in the humanitarian sector, 49.6% (n=76) had more than six years of experience, and 87.6% (n=134) had direct contact with the beneficiaries.
Participants were recruited from International Federation of Red Cross (IFRC) societies and various International and National non-Governmental Organizations (NGOs) in Greece, such as Solidarity Now, Greek Council for Refugees, AMURTEL (Amanda Marga Universal Relief Team Ladies) Greece, Lesvos Solidarity, KAST (Khora Asylum Support Team), INTERSOS Hellas, Médecins Sans Frontières and other.
We used both convenience and snowball sampling methods. All participants provided informed consent at the beginning of the questionnaire, with explicit emphasis on anonymity and secure data handling, and the research conformed to the ethical guidelines of the Helsinki Declaration.
Data Collection
Data collection was carried out by means of a comprehensive electronic questionnaire that was distributed by email to humanitarian organizations in Greece. Additionally, the survey was advertised via various social media platforms aimed exclusively at humanitarian aid workers. The questionnaire included 73 questions, three of which were open-ended. The answers to the open-ended questions were analyzed thematically.
Data Analysis
Following the collection of data, the necessary preparations for the analysis were initiated. Specifically, the researcher transferred the files from Google Forms and assigned a unique number from 1 (for the first participant) to 153 (for the last participant) to each recording. The researcher then highlighted the most important elements, followed by systematic grouping to allow a comprehensive analysis and interpretation of participant responses. The process of data analysis consisted of three phases: data analysis, data display, and conclusion drawing, which allowed for a robust examination of patterns and themes that emerged from the participants’ contributions.
RESULTS
Difficulties faced by humanitarian workers
The responses of humanitarian aid workers revealed several salient themes that provided a nuanced understanding of the challenges faced during the COVID-19 pandemic. These themes encompass a range of difficulties in different dimensions and mainly relate to communication, accessibility, funding, education, and mental health (Table 1).
In particular, cultural differences, perceptions and language barriers proved to be significant barriers to effective communication, which can lead to disputes and social inequalities. One participant recounted his experience: “When carrying out different activities, I often had difficulties communicating with beneficiaries due to cultural differences and different perceptions” (P.3/male/age 36).
The switch to remote working during the pandemic brought logistical and interpersonal challenges. Some employees commented on the difficulties arising from the lack of face-to-face contact with beneficiaries and colleagues: “I could not have any interpersonal contact with my beneficiaries and colleagues” (P.83/female/age 30), “Because we were working remotely, we had a lot of difficulties because the families in care did not have the necessary technical equipment and the internet” (P.129/female/age 35) or “Working remotely cannot meet people’s needs” (P.137/female/age 30). Additionally, remote working hindered support efforts and made accessing services a complex task as it was not possible to physically visit beneficiaries.
In terms of funding, the respondents highlighted a shortage of materials, infrastructure, donations and staff, as well as minimal government support: “…Lack of funding from the state, fear of anything different, sloppiness and lack of planning in dealing with humanitarian issues” (P.22/male/age 69) or “The uncertainty about the continuation of the programs due to a lack of stable funding” (P.23/male/age 42).
The lack of knowledge and training, unclear responsibilities and lack of supervision were also prevalent, as one participant said: “…There is a terrible ignorance of public health issues and health protocols…” (P.97/female/age 39).
Mental health issues were a dominant theme among respondents, as feelings of insecurity, frustration and uncertainty seem to be prevalent in their working environment: “Facing the fear of others, but also your own fear of the coronavirus” (P.12/male/age 70), “To what extent can I give my beneficiaries the feeling of safety and security they need when I don’t feel that way myself” (P.55/female/age 22) or “Burnout from colleagues, trauma and existential needs that cannot be met” (P.93/female/age 35). Others also stated that there was “a lot of pressure, little reward, a lot of uncertainty” (P.119/female/age 29), or “…emotional exhaustion” (P.124/female/age 38), and “… the feeling of futility, that you cannot change the situation for the better” (P.144/female/age 26).
Notably, some respondents reported no difficulties at all in their work, while one person even expressed optimism: “So far everything is manageable” (P.109/female/age 41).
These identified themes underscore the multifaceted nature of challenges faced by humanitarian aid workers during the pandemic, shedding light on the complexities inherent in their work environment.
Proposals of employees
In response to the challenges identified, humanitarian workers have made concrete proposals to address the complex problems they face. These suggestions include a range of strategies, such as continuing education and skills development, training strategies, psychological support, collaboration with local institutions, organizations and governmental agencies, and more donations, resources, materials and funds (Table 2).
In particular, many workers emphasized the need for continuous training and development under supervision and with a clear mandate. Furthermore, seminars, conferences, and organized programs would improve communication and technical skills: “continuing education” (P.5/male/age 41), and “development of communication and technical skills (wherever/whoever needed)” (P.48/female/age 32).
Suggestions also included establishing more psychological seeding, as psychological support plays an important role in providing help, resilience building and decompression/relaxation after challenging incidents: “support, resilience building” (P.12/male/age 70), “… Decompression/relaxation measures …” (P.23/male/age 42) or “… believe more in ourselves and our abilities” (P.118/female/age 28). One participant state more specifically that: “… it would be good if the service provided a psychologist at least twice a month to get rid of the pressure and negative thoughts and doubts after a difficult incident” (P.49/female/age 32).
Collaboration and support were also highlighted, with staff suggesting collaboration with local agencies and organizations, and asking for support from state agencies. They also acknowledged the interdependence of these suggestions with the need for adequate funding through more donations, resources, materials and money
Finally, one participant brought up a holistic perspective that encompasses everything mentioned by most: “Approaches need to be holistic, mind, spirit and body… Services need to be people-centered… In this way, the outcome for professionals will be affirming and rewarding. The information and the conferences where it was held are now much more important than how we can apply this knowledge in practice” (P.64/female/age 56).
These proposals underscore once more the multifaceted nature of the challenges faced by humanitarian aid workers. Their proposals provide a comprehensive framework for addressing and overcoming the difficulties. Emphasis should be given on skill development, collaboration, resource enhancement, and well-being, in order to reflect a holistic approach in creating a more supportive and effective working environment for those engaged in humanitarian aid efforts.
Proposals of employees for researchers
The third open-ended question related to employees’ views on how researchers can contribute to overcoming the identified challenges. In their response to this question, humanitarian aid workers expressed different perspectives on the potential role of researchers in mitigating the problems identified. They emphasized the crucial role of researchers in conducting meaningful studies and disseminating their findings, but also their role in providing practical advice through seminars, training programs and the development of crisis management handbooks (Table 3).
The publication of survey results was seen as an effective tool for communicating the challenges to the relevant authorities, as they can help to: “…put pressure on the state apparatuses to make improvements” (P.23/male/age 42), “… Highlight the problems faced by employees” (P.25/male/age 30) or “… raise awareness in society and put pressure on the state” (P.98/female/age 59).
Researchers were also seen as valuable contributors in the workplace providing practical advice through seminars, training programs and the development of a crisis management manual/guide. Therefore, collaboration between researchers and staff was seen as essential to encourage open discussions, identify deficiencies, and implement solutions through counseling programs. One participant stated: “…it would be useful if some of your colleagues had experience in humanitarian organizations” (P.12/male/age 70).
Mental health issues continue to be a recurring problem as mentioned by most participants, who even suggested the introduction of a mental health officer. This person could offer support in the form of experiential seminars and help staff manage stress and other related risks: “… knowing the attitude and psychological state of colleagues through research data certainly offers us the opportunity to observe and perhaps offer more for ourselves...” (P.55/female/age 22).
However, two participants acknowledged certain limitations, recognizing that some challenges may be beyond the direct control of researchers and attributing them to the responsibility of the state: “…this is purely a state issue” (P.18/male/age 40) and “… I don’t think anything can be done …” (P.31/male/age 44).
These various perspectives highlight the multifaceted ways in which researchers can contribute to addressing the challenges faced by humanitarian aid workers. However, the employees recognize the inherent complexities and limitations in certain aspects of these challenges.
DISCUSSION
Our study aimed to explore the challenges faced by humanitarian aid workers in Greece during the COVID-19 pandemic and to propose solutions to address these issues. The data for the present study came from 153 humanitarian aid workers in Greece. The results showed a high prevalence of emotional exhaustion linked to the communication, accessibility, funding, education and mental health challenges amplified by the coronavirus.
Similar findings have been identified in a pre-pandemic study, which highlighted the influence of socio-cultural factors, language barriers and problems related to access and funding [8]. Above all, the state itself plays an important role, failing to invest in workforce, resources, and the accurate dissemination of information. A prevailing sense of uncertainty and skepticism among Greeks regarding the effectiveness of existing political institutions further complicates the process of restructuring [9].
It is emphasized that the improvement of living conditions in these facilities is an immediate priority and that free, comprehensive and universal access to care without any discrimination must be guaranteed [3]. Addressing these fundamental aspects is crucial to mitigate the challenges faced by humanitarian workers and promote a more resilient support system. To delve deeper into these complexities, future studies could utilize more comprehensive research methods, such as questionnaires or interviews. This would allow for a more comprehensive analysis of the complicated dynamics surrounding the experiences of humanitarian aid workers in the context of the pandemic.
Acknowledgements
The authors would like to express their gratitude to all humanitarian aid workers, who participated in this study.
Conflict of interest disclosure
None to declare
Declaration of funding sources
None to declare
Author contributions: Anna-Koralia Sakaretsanou and Maria Bakola were responsible for the analysis and interpretation of the data and drafting of the article. Stefanos Reppas, Konstantina-Soultana Kitsou, Apostolos Veizis and Konstantina Mavridou were responsible for data collection. Mohamed E.G Elsayed was responsible for conception and design. Eleni Jelastopulu was responsible for the critical revision of the article for important intellectual content. All authors read and approved the final manuscript.
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