Protecting humanitarians’ mental health: what we can learn from the U.S. Marines, McDonald’s and marathons

Robert Macpherson has been a writer, aid worker, and career infantry officer in the U.S. Marines with service in Vietnam, Iraq, and Somalia. After retiring from the Marines, he joined the humanitarian organisation CARE, where he spent 15 years directing global risk mitigation for staff and vulnerable populations and led humanitarian response missions worldwide.

He’s published a book, Stewards of Humanity: Lighting the Darkness in Humanitarian Crises, telling the stories of the people who have courageously confronted evil and injustice from Somalia to Bosnia, Rwanda, Iraq and Afghanistan. Hit the Iron Bell asked Robert about these remarkable human beings, his calls for more support for the mental health of humanitarians and his thoughts on the future of aid work (Part 2 below).

Question: To anyone who reads your book, you’re a hero who has lived an extraordinary life driven by a belief that a better world is possible – a ‘life that mattered’, as you call it. But, as you also share in the book, the reality of living that life is complicated. There have been many dark moments, and it’s come at enormous personal cost. Reflecting back, if you were speaking now to someone fresh out of school or even mid-career who was thinking about working as a humanitarian, would you say it was all worth it? And what would be three pieces of advice you’d give them? 

Bob Macpherson: The first piece of advice is to take responsibility for your own wellbeing – and this is where we all break down as aid workers. It’s simple but, regardless of gender, we all let our egos get involved in this.

My PTSD was certainly cumulative. In other words, in a way, I began to address it by just staying in the field, because I began to feel much more comfortable in those environments than out of those environments.

But it’s bigger than that. It’s also having the courage…to hold your organizations responsible for the support that they owe you. I’m going to…digress here because this is important to everybody who reads this. In 2011, there was a game changer paper that was published by two European guys called, ‘Can you get sued? Legal liability of international humanitarian aid organisations towards their staff’. I looked at that title and I thought, that’s all we need, somebody talking about lawsuits now in the aid world. Until I read it.

These guys had done a marvelous job of looking at the laws on the books of most Western nations about what their organizations owe with duty of care to their staff. And it was shocking because what they found is that when it came to corporations – think General Motors or something – everyone expected them to have an element of this duty of care. But when it came to humanitarians, there’s this sense that they were good people doing good things and they didn’t have to worry about it.

[A]id workers walking into these places have a right to know that everything behind them is there to support them. Whether it’s their safety and security, whether it’s their health. And…if it’s not, then it’s time to take a walk.

That paper first came out to talk about issues of staff safety and security. And all of a sudden humanitarian organizations began to look at staff safety and security and also litigation, and that got their attention.

Well, I’m saying that now with mental health issues, it’s the same thing. And it’s harder, certainly. I mean, somebody shooting at you is pretty obvious when it comes to staff safety and security. This business of mental health is different.

And here’s the point: you’re now almost competing against the aid worker themselves, because they love their work and they’re up to their neck working with people and doing what they’re there to do. And they’re really reluctant to step back and say, ‘Hey, I think I have a problem.’ So, taking care of yourself is more than just making sure you brush your teeth. This is a marathon and not a sprint. And if you look at it as a sprint, you’re going to burn out really quick.

Another piece of advice is that women bring so much more to the table when they’re involved with aid work. First of all, they leave the testosterone at the door. I’ve had to lead these groups and trust me, just that fact alone would have kept half my hair brown rather than white in dealing with some of these things. I think that because of the pressures that are on women that aren’t on men, if I were a woman going into this work, I’d make sure that I really understood the difference between management and leadership and now stewardship – and I mean that in a secular sense, not in a religious sense. Because they’ve got more demands on them.

It’s a gender thing: there’s a lot of people who bristle at women being in charge, right? We’d like to say that’s not true, but it is. But I think for women, it really makes a difference when they understand persuasive leadership, inspirational leadership. And when you combine that with how steady women are through most things, I think that’s something that’s important.

The next piece of advice is bigger than most people think. When they come back from these events, it’s almost like going to war. You come back, and there aren’t lot of people you can talk to. I’m not talking about counseling, I’m just talking about relating to other people.

I actually lived in Hawaii for most of the time that I was really involved in this. But say you came from Melbourne [in Australia] or I came from Charlotte [in the United States] and you come back from a genocide in Rwanda and you just want to quietly turn on the TV and somebody is advertising a Big Mac at McDonald’s – that is a real shock. Or, for instance, you came back from Somalia where there were starving people. And you say, ‘Wow, talk about Alice in Wonderland, stepping back-and-forth through the looking glass.’ And I think the more you do it, you don’t become immune to it, but you’re able to adjust better. That’s something to look out for and to think about.

And finally, particularly for women – and this has got to be tough – to be prepared for the cultural biases you’ll encounter in your work. I don’t know how I would feel if I were up to my neck in a humanitarian response in a place like Bosnia during the war, when there was a gender balance there of sorts, but all of a sudden she finds herself trying to be involved in humanitarian work where the local men won’t even talk to her. When I was in Afghanistan with CARE, the Country Director was a woman. She’s trying to deliver aid, she’s trying to work with locals and they wouldn’t talk to her. You had to have a man who might be two or three levels junior to her, who’s actually doing that kind of discussion and she’s expected to sit in the back of the room with her hands folded. I mean, I can’t relate to that obviously, but that’s got to be a hard one.

But I would say on a very personal level, aid workers walking into these places have a right to know that everything behind them is there to support them. Whether it’s their safety and security, whether it’s their health. And I have to say, if it’s not, then it’s time to take a walk.

And I also know how hard that is because aid workers – and I’ll say this again and again – it’s not a job, it’s a calling. That aid worker is giving up an awful lot to be there. So, there’s something inside of that person that makes them different and they don’t want to walk away. They really don’t. But on the other hand, I can tell you, having once been wounded in Afghanistan and again with PTSD, that’s tough to get over. I mean, it hurts you. You’re hurt and it takes time to mend.

Question: After everything you’ve seen, do you still believe in multilateralism?

Bob Macpherson: Oh yes. I think the example of the international campaign to ban landmines was probably the greatest multilateral event I was ever involved in. And that’s because there were several nations on this planet – my own being one of them – that refused to ratify or involve themselves in that Treaty. But for the 164 countries that ratified it, it was a no brainer when we went to Ottawa to put that thing together. And I’ll tell you, behind the scenes, there were times it was just a fist fight. That’s what you have to expect. it’s not all ‘Kumbaya’ with everybody holding hands and singing songs. But again, the objective was so apparent: not to blow up people and not to blow up kids. That’s not too hard to figure out.

So yes, I believe in multilateralism. In fact, I’m probably a proponent of multilateralism. But nothing’s easy. The problem is, how do we create a multilateralism that is balanced, where all parties feel like they have an equal say? I remember, for the Treaty, the United Kingdom had as much say as Uruguay.

But I think if anything’s going to get done on this planet, particularly for things like global warming…that’s the only way this is going to be accomplished. I mean, certainly, the more industrialized nations can do a lot more to cut carbon, but still, it has to be across the planet.

Question:  Building on that, to put it bluntly, is there value in international aid workers getting involved at all in responding to local crises or conflicts? And if so, how?

Bob Macpherson: Oh yes, absolutely. It takes a composite, doesn’t it? It takes all these people coming from all over the planet to come together. Because when you’re in harm’s way, when everything is in extremis – I go back to the Rwanda genocide or snipers in Sarajevo or…Afghanistan and Iraq, where it’s just going nuts – Western aid workers, national aid workers, it’s not about ‘decolonization’ or anything else. It’s about what’s in front of you and how do we solve this problem? And this is one of the few things in the world – that you and I do for a living – that is: how do we save lives?

Question: In your book you had many great observations about the effectiveness of different humanitarian responses and highlighted the need for national staff to play a leading role in that work. What are the most important changes we need to see in the aid sector to ensure it genuinely makes a difference to the lives of people in need?

Bob Macpherson: Along the way we’ve passed through different terms with this, but one was ‘national staff empowerment’. A lot of times – and this is only my opinion – I thought there was a definite link between that terminology and when aid work for Westerners became more and more dangerous.

From the time I was involved with the UN community, they never batted an eye about having security around the compounds. But as you probably know, NGOs wrestled, and still wrestle, with the idea of having armed guards, particularly in places like Somalia, which is still almost a no-go place since I wrote about it, going back to 1992. So, as Western aid workers started confronting more danger, I felt like I started hearing more about national staff empowerment, which in essence meant that we’re going to start having national staff…but in the background, the NGOs still maintained absolute control over budgeting, human resources and all these different things.

Look, that whole picture of Westerners in there, ‘helping the people in Africa’ – we’re all getting uncomfortable with that, aren’t we?

We’ve now evolved to another term that I started seeing more and more and I’ve thought about a whole lot: ‘decolonization’. The genesis of that is not bad in that if the Western aid agencies…want to step back and ‘fully empower’ national staff, they’re going to have the trust them. They’re going to have to say, ‘Okay, we want you to [run programs]. Are you willing to do [that]?’ ‘Yes, we are.’ ‘Okay. Here’s the money to go do these things.’ [But then] at some point we need all these different donors – multilateral, unilateral – to get involved. Well, they have a right and they have a desire to make sure that where their funding is going is also being monitored.

So the donor, through an aid agency, may fund 20 different projects there with 20 different NGOs…Well, all it takes is in one of those, somebody pops up and says, ‘Hey, that money is going to…a terrorist group.’ Or, ‘It’s all going into the pocket of the NGO manager.’ It only takes that one to discount the other 99. At the end of the day, you have this conflict, don’t you?

Before I became an aid worker, I was a US Marine for 30 years and there’s a high standard that I think the world associates with that armed force. But you learn very quickly that it’s a bell curve. Granted, that bell curve might be a little more to the good side than normal…society, but it’s still a bell curve. So you have good Marines and bad Marines. You’ve got people who assault, people who rape, people who murder. I mean, that is a reality. And the country accepts that. They don’t like it, but they say, okay, you’re bound have a few bad Marines.