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coping mechanisms. The physical symptoms can be overtiredness, diarrhea, constipation and head-
aches. Some emotional results are anxiety, frustration, guilt, depression, and creeping cynicism. Co-
gnitive impacts can affect one’s job performance: forgetfulness or poor concentration. The results in
personal relationships may be feeling isolated, resentful or intolerant of others. One common but
serious result of incapacitating, cumulative stress is ‘burnout’, evidenced by severe emotional distress
and behavioral dysfunction.

Unhealthy behavioral changes include increased intake of alcohol, caffeine, drugs, tobacco and addic-
tions, as we have frequently observed. Some aid workers, for example, may drink coffee throughout
the day and follow this with an extended “happy hour” into the night. This is typically “socially-accep-
table” yet it is a warning of unacknowledged and mismanaged cumulative stress.

Stress can look different in everyone, and it is helpful to identify what circumstances in life can con-
tribute to stress. How each individual responds to stress depends on his/her background, values, ex-
periences and current level of perceived support. A large majority of those who work in humanitarian
settings are able to eventually cope after violent traumatic events. At times it is the sense of betrayal
from those that are meant to support and protect that leads to symptoms of ongoing emotional and
mental distress.

One of the authors, working with victims of terrorist attacks, heard that after the shock had worn off,
clients struggled with lingering feelings of resentment, hopelessness, apathy and anger. Oftentimes,
these were caused not by the brutal attack but by the failure of their organizations and superiors to
provide adequate support and follow-through.

2. Traumatic Stress: Managing Responses to Conflicts and Calamities

“I had been a reporter for nearly a dozen years when I met Sarajevo. Nothing could prepare me, really,
for its deadly game of chance….no one ever spoke much about the personal armor needed to weather
a war...the emotional risks writing about war…There was no time or place to tell the private battles
waged to capture the trauma on paper.” Spolar (2002, pp. 301-302)

‘Traumatic stress’ is caused by events that are shocking and emotionally overwhelming: the constant
snipers targeting civilians in Sarajevo during the Bosnian war, the deliberate shelling of crowded mar-
ket places in Somalia by rival combatants, managing nuclear catastrophe in Fukushima, or dealing
with trapped earthquake victims in Haiti or Mexico. These stressors can and often do lead to more
serious psychological difficulties. Some of these emerge relatively promptly; but delayed expression
can also appear years later.

For some, their responses to major stressors can be mild and manageable, as was the case of a team
that two of the authors helped debrief who were held captive for weeks by a terrorist group. For others
the impact can be extremely strong, even disabling. In one incident, a major international humanita-
rian organization in West Africa had to pull out an entire team because of severe psychological stress
and secondary trauma brought about by dealing non-stop with brutally savaged victims of violence,
including women who had been repeatedly raped.

Single Incident Trauma or Critical Incident Trauma
People can often have strong reactions following a single traumatic event. These reactions are usually
temporary. Some of the common reactions during the first hours after an event may be:
--Shock, disbelief, feeling of being overwhelmed
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