1. Symptoms

2. Contributing factors

3. Prevention

A. Introduction ⁽¹⁾

1. HROs work and live under situations in which they are likely to experience stress, vicarious traumatization, counter-transference, exhaustion, and burnout. Taken together, psychologists have referred to these phenomena as "secondary trauma", which is quite common among those who work intensively with traumatised individuals.

2. HROs often deal with people who are suffering and who need help, but the ability of HROs to help is necessarily limited by their mandate, resources, the needs of others, and the constraints of time. HROs often feel as though they cannot afford to take a break or even to sleep, because their work requires their total commitment. In addition to their work conditions, HROs frequently need to live under less than ideal conditions of housing, food, climate, etc. The stress of work and living conditions is compounded by the vicarious traumatization HROs often feel from interviewing and working with individuals who are suffering or have suffered great loss. Hearing about the trauma suffered by others may also trigger painful memories from the officer's own past; psychologists have termed this common experience "counter-transference". In some circumstances, HROs may witness deaths, dead bodies, similar immediate evidence of violations, and other events, which may cause them to be directly traumatized.

3. If HROs do not cope well with the tremendous stress and secondary traumatization or if they have had to handle such conditions over a significant period of time, it is likely that they will suffer from burnout and diminished capacity to live and work effectively in the field. No one is immune from these effects and HROs should understand that such feelings are quite normal. There is a great need for HROs and others in the helping professions to acknowledge and be aware of the consequences of secondary trauma. Further, the HRO's susceptibility to secondary traumatization is shaped not only by the characteristics of the situation, but also the officer's own unique psychological make-up.

B. Secondary traumatization

1. Symptoms

4. Secondary traumatization often causes such symptoms as:

• Fatigue, sadness, depression;
• Cynicism, discouragement, loss of compassion;
• Hyper-arousal, sleep disturbances, intrusive nightmares related to trauma material;
• Somatic problems: head aches, joint pain, abdominal discomfort/diarrhea;
• Feelings of helplessness, denial and disbelief, anger and rage.

2. Contributing factors

5. Contributing factors to secondary traumatization include:

• Concern about the potential impact of the HRO's work upon the root causes of violence, war, suffering, and violations;
• Conflicted feelings and issues of trust are typical where survivors may be both

perpetrators and victims;

• Communication difficulty, both of language and of culture;
• Inadequate resources and equipment;
• Difficulties in sharing scarce equipment, e.g., an automobile;
• Lack of privacy for those HROs who work in one area;
• Feelings of responsibility for having an automobile accident and thus disabling transportation for other HROs in an area; etc.

3. Prevention

6. There are a number of measures and practices which can help to prevent and treat secondary traumatization, including:

• Mandatory intermittent work-free periods (e.g., one day per week)
• Mandatory rest and recreation outside of the country (e.g., one week

every six to eight weeks)

• Supportive relationships with family and friends;
• Professional support systems, including sharing with fellow officers

their reactions that are painful and disruptive;

• Relaxation techniques, such as meditation, deep-breathing exercises, and listening to music;
• Physical exercise;
• Feelings need to be openly acknowledged and resolved;
• Rotation through different types of work activity;
• Good nutrition and adequate sleep;
• Avoiding excessive use of stimulants, such as sugar and caffeine; and
• Psychological debriefing after crises in which the officer reviews the experience and deals with feelings of fear, frustration, and success that accompany the work.

7. Since work-free periods are the most important way of reducing stress, it should be noted that HROs must be provided with regular opportunities to relax, and to leave their immediate working region. They should make an effort to get to know other international and national workers in the region to which they are deployed. Access to books, newspapers, and music can also be ways of leaving work behind at the end of a day. As far as possible HROs should have a separate living and working space. During free weekends it is a good idea for HROs to be provided with the opportunity to leave the region/area office in which they are working and to travel to another part of the country -- to the central office or to visit the members of another area office, for example. Vacation time should, where possible, be spent outside of the country of operations, and at least outside the region to which a HRO is deployed.

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1. Adapted from UNHCR, Guidelines on the evaluation and care of victims of trauma and violence (1995) and Center for Victims of Torture, Vicarious Trauma and Burnout (1995).