Introduction
The mental health and psychosocial well-being of humanitarian workers in armed conflict contexts have garnered increasing attention in recent years, particularly as the scale and intensity of global crises continue to rise. In this context, the literature reflects a growing concern about the psychological toll of humanitarian work on staff and volunteers. Humanitarian workers face significant risks in conflict zones, including direct exposure to violence, trauma, chronic stress, and moral injury. Guisolan and colleagues highlight the health and security risks faced by aid workers during field missions, noting that mental health issues such as anxiety, depression and post-traumatic stress disorder (PTSD) are common due to prolonged exposure to trauma and high-pressure environments.Footnote 5
The psychological consequences of working in armed conflict contexts are well documented. Cameron et al. conducted a systematic review and meta-analysis of nine studies, revealing prevalence rates of psychological distress (6.5–52.8%), burn-out (8.5–32%), anxiety (3.8–38.5%), depression (10.4–39%) and PTSD (0–25%).Footnote 6 Hazardous alcohol use ranged from 16.2% to 50%. Key associated factors included trauma exposure, chronic stress, pre-existing mental health conditions, younger age, female gender, and poor living conditions. Another systematic review by Strohmeier and Scholte of trauma-related mental health problems among national humanitarian staff concluded that those staff experience similar or higher prevalence of depression, anxiety and PTSD compared to reference groups.Footnote 7 In another study, Foo et al. examined burn-out among humanitarian workers in Bangladesh during the COVID-19 pandemic, finding that workplace psychosocial stressors such as poor communication, lack of recognition and discrimination had a stronger impact on burn-out than exposure to adversity.Footnote 8 Negative emotion-focused coping (such as self-blame) was a key mediator between stressors and mental health outcomes;Footnote 9 sleeplessness and emotional exhaustion have also been highlighted by Williamson and Murphy as a consequence of living in armed conflict contexts.Footnote 10 Meanwhile, the Volunteering in Conflicts and Emergencies (ViCE) Initiative, led by the Swedish Red Cross in collaboration with academic partners, has explored the emotional impact of volunteering in conflict settings, emphasizing that volunteers often lack access to psychosocial support and counselling.Footnote 11
National humanitarian workers
Macpherson and Burkle argue that humanitarian aid workers are the “forgotten first responders”.Footnote 12 They highlight the dilemma of national staff, who often face greater risks but have fewer protections. Greenaway et al. have documented that national humanitarian workers face disproportionately high physical and emotional risks, including violence, disease and harassment, while also receiving lower pay and fewer social protections than their international counterparts;Footnote 13 for example, health-care workers in Gaza face extreme trauma exposure, resource scarcity, and ethical dilemmas.Footnote 14 Symptoms associated with PTSD persist for years after the conflict, and moral injury is common due to rationing of care and the witnessing of suffering. National humanitarian workers’ embeddedness in local communities further complicates their role: Elkahlout’s research in Arab conflict zones highlights how local staff navigate pressure from armed groups, suspicion from communities, and donor expectations.Footnote 15 This embeddedness enables access but also generates competing loyalties, accusations of bias, and reliance on personal networks and faith-based motivations to operate in high-risk environments.Footnote 16
National humanitarian staff experience exceptionally high levels of distress, and evidence shows that culturally adapted, low-cost group support can be effective. For example, De Fouchier and Kedia found that 96.4% of national staff in the Central African Republic had experienced at least one traumatic event,Footnote 17 and that a brief, culturally tailored group stress-management session significantly reduced symptoms of anxiety,Footnote 18 depression and PTSD, demonstrating the value of scalable interventions. Such interventions for low- and middle-income countries are urgently needed to address constant stress, sleeplessness and emotional exhaustion in volunteers and staff.Footnote 19
Despite the effectiveness of organizational support systems where they exist, they are often under-utilized. A study by Stevens et al. shows that although staff value support in principle, stigma, organizational culture and confidentiality concerns undermine trust.Footnote 20 Organizational culture plays a key role in well-being, with supportive environments correlating with better mental health outcomes.Footnote 21 However, humanitarian workers commonly prefer turning to colleagues rather than internal agency services,Footnote 22 which are often avoided due to doubts about privacy and neutrality. At the same time, structural inequities exacerbate the burden on national staff.
Williamson and Murphy discuss moral injury, a state of psychological, social and spiritual distress resulting from perceived violations of moral values, as a significant consequence of armed conflict, affecting aid workers and civilians alike (largely tested in Western contexts).Footnote 23 Alah has reported that the cumulative effect of repeated wars in the Occupied Palestinian Territories has created a mental health crisis, with an urgent need for tailored interventions.Footnote 24 These pressures contribute to persistent moral tension, especially where humanitarian principles are difficult to apply in practice. The International Committee of the Red Cross (ICRC) has emphasized that principles such as neutrality and independence, while operationally essential, are often challenging to uphold, can hinder access if applied rigidly, and provoke ongoing ethical dilemmas.Footnote 25 The ICRC therefore advocates for adaptive strategies, cultural sensitivity and clear communication to maintain trust.Footnote 26 Taken together, this evidence shows that interventions for national humanitarian staff must extend far beyond individual coping strategies. Effective support must address trust, organizational fairness, contextual pressures and operational realities, ensuring that well-being approaches are grounded in the lived experiences and structural conditions shaping national staff’s work.
The role of organizational support
Organizational support plays a critical role in mitigating mental health risks. Cameron et al. have found that organizational support is linked to lower burn-out and depression,Footnote 27 while Strohmeier and Scholte have found that organizational support is a key determinant of mental health.Footnote 28 However, the perception of support being available is also an important element in volunteer and staff support. A study by Aldamman et al. found that perceived organizational support was positively associated with mental well-being and negatively associated with adverse mental health outcomes among Sudanese Red Crescent volunteers.Footnote 29 This is an important consideration, as the Humanitarian Horizons report emphasizes that the organizational environment is the primary stressor affecting the well-being of national humanitarian workers.Footnote 30 For these workers, psychosocial support is often limited, poorly tailored, and inaccessible due to stigma, confidentiality concerns and practical barriers such as language.Footnote 31 Despite its key role in supporting staff and volunteer well-being, organizational support is often insufficient, with gaps before, during and after missions and emergency responses, leaving workers to rely on informal coping mechanisms and peer support due to limited professional resources.Footnote 32
Research on national staff and volunteers remains scarce, despite indications that their psychological burden may be equal to or greater than that of international humanitarian workers. National volunteers and staff face distinct challenges, including continuous exposure to trauma within their own communities and systemic inequities in organizational support. For example, Strohmeier et al. found that national staff in South Sudan exhibited significantly higher rates of PTSD and anxiety than international staff, underscoring their heightened vulnerability and the need for targeted research and support strategies.
The present study
The aim of this study is to explore and document the mental health and psychosocial experiences of national Red Cross Red Crescent (RCRC) volunteers and staff working in communities affected by armed conflict. This is particularly pertinent considering the limited focus on the mental health and psychosocial well-being of volunteers and national staff in academic literature and in the humanitarian sector. This article contributes to the existing understanding of the mental health and psychosocial experiences of humanitarian workers by centring the first-hand experiences and voices of RCRC volunteers and staff. While prior research on the mental health of humanitarian workers has often focused on international staff, this study explores the specific risks, coping strategies and psychosocial realities faced by local RCRC staff and volunteers, who are embedded in the communities they serve.
This study used the grounded theory method to gather experiences of RCRC volunteers and staff through semi-structured interviews focused on their work and lives in communities affected by armed conflict.Footnote 33 Interviews with volunteers and staff explored their reflections related to the mental health and psychosocial impacts and rewards of their work, the well-being implications of upholding humanitarian principles, and the mental health and psychosocial support (MHPSS) services available to them. The paper presents an analysis of themes gathered from RCRC volunteers and staff and documents the different types of support referred to by participants, along with their reflections on these activities.
This study is informed by two key conceptual frameworks: the trauma-informed approach and the theory of moral injury. The trauma-informed approach emphasizes understanding the pervasive impact of trauma, recognizing its signs, and integrating this awareness into organizational practices to promote safety and avoid re-traumatization.Footnote 34 Moral injury refers to the profound psychological, social and spiritual distress that arises when individuals witness, perpetrate or fail to prevent actions that violate their deeply held moral beliefs.Footnote 35 These frameworks provide a lens for examining how humanitarian workers experience and interpret adversity, shaping both their psychological outcomes and their sense of meaning and purpose.
As staff of the RCRC Movement MHPSS Hub, the study team were particularly interested in the experiences of people working in the RCRC Movement. Therefore, the research question guiding this study was: how do RCRC volunteers and staff working in armed conflict contexts experience and respond to psychosocial and mental health impacts?
Methodology
Research design
The focus of this study was to elevate the experiences of RCRC national staff and volunteers working in armed conflict settings by documenting and exploring their experiences and the impacts of this work on their mental health. For this reason, the study team chose a qualitative study design using the grounded theory method. Data were collected through semi-structured interviews, analyzed using thematic analysis to identify themes, and linked to relevant theories.Footnote 36 Interviews and thematic analysis allowed the research team to hear directly from staff and volunteers, document their experiences and explore themes that emerged from these experiences. The scope of the study was limited to national staff and volunteers working in armed conflict or post-conflict contexts.
Ethical considerations
The research study design was centred on the principles of trauma-informed practice. Foundational to such an approach is the understanding of the impact of trauma exposure on individuals, avoiding re-traumatization, and promoting a sense of safety and control for people participating in research or engaging with services.Footnote 37 These principles guided the recruitment process, the selection criteria, the design of the interview schedule, and the approach to planning, conducting and following up on the interviews.
Participation in the study was voluntary. To support informed consent, a participant information sheet was developed to provide potential participants with key information about the study, the data handling, and what involvement would include. An online registration form was shared with potential participants to indicate their interest in being involved in the study and their consent to engage in the study. At the beginning of the interview, key information shared in the participant information sheet was repeated and discussed with participants to ensure understanding. This included information on data collection and storage, the possibility of withdrawing from the study at any time during or after the interview, and post-interview procedures. Post-interview, a check-in with participants was offered and proactively conducted via email or phone with some participants. Consent was confirmed verbally and on the interview transcript.
Participants
Sixteen participants were recruited for the study from Afghanistan (2), Armenia, Colombia (2), the Democratic Republic of the Congo, Lebanon, Niger, Nigeria (2), the Philippines, Sudan, Syria, Ukraine (2) and Yemen. There were nine female and seven male participants. All participants represented National Red Cross and Red Crescent Societies (National Societies); eight are National Society staff, six are volunteers, and two are staff but also volunteer with their National Society in additional roles. Participants represented a range of operational focus areas, including MHPSS (5), disaster management (4), mine action (2), Restoring Family Links (1), volunteer engagement (1), community engagement (1), protection, gender and inclusion (1), and branch management (1).
Selection criteria were developed to guide the recruitment of participants for the study. The selection criteria included that participants must:
• be staff or volunteer of a National Society, the International Federation of Red Cross and Red Crescent Societies (IFRC) or the ICRC;
• be a national staff member or volunteer of the country in which they work;
• have a minimum of one year of volunteering or work experience;
• have been working in countries affected by armed conflict in the last five years; and
• be working in a role that requires working and interacting with the community.
Purposeful sampling was used to recruit participants. The study team utilized existing RCRC networks, guided by a geographic focus, to ensure that study participants represented a diverse and global range of experiences. The experience of the study team and consultation with colleagues from the RCRC Movement MHPSS Hub, IFRC, ICRC and National Societies supported the identification of potential countries in which to focus on recruitment. Further demographic diversity factors were considered during recruitment; these included ensuring a balance of genders, staff and volunteers, geographic regions, roles and responsibilities, and duration of service.
Data collection
Semi-structured interviews with participants explored the experiences of RCRC national staff and volunteers working in armed conflict or post-conflict contexts. The interviews were conducted by all four study team members online via MS Teams and were recorded and transcribed by the MS Teams transcription function to support data analysis. Interviews were conducted in Arabic (4), English (6), French (2), Spanish (2) and Ukrainian (2).
The study team drafted an interview schedule informed by the Adult Attachment Interview (AAI)Footnote 38 approach to interviewing. The AAI is a structured method used to explore how individuals mentally represent and emotionally process their attachment experiences through narrative reflection. In this adaptation, the AAI framework was used to structure and organize the questions. In addition, the Professional Quality of Life Scale (ProQOL) was used to guide the development of interview questions.Footnote 39 As a widely recognized tool, the ProQOL captures key dimensions of the emotional impact of caregiving professions, namely compassion satisfaction, burn-out and secondary traumatic stress.
Trauma and moral injury theories guided the development of the interview structure to foster both reflection and emotional expression in a safe and caring setting. Interviews began with a brief introduction, followed by a reflective question prompting participants to consider their past experiences. Participants were then asked to summarize their experience using a single word, encouraging them to distil their emotional and cognitive responses. This word served as a thematic anchor, which they were invited to support with concrete examples and facts. This approach not only facilitated deeper introspection but also allowed participants to articulate the emotional resonance of their work in a structured and meaningful way.
The interview schedule was drafted with fourteen questions and tested in English with three individuals outside the study team who had limited familiarity with MHPSS approaches. Based on feedback, the questions were refined and subsequently tested in Arabic, English, French, Spanish and Ukrainian, ensuring linguistic and cultural relevance. The final version of the interview schedule was prepared in all five languages.
Data analysis
Interview transcripts were evaluated using thematic analysis. Interview transcripts were first analyzed in the original language of each interview by the member of the study team who conducted the interview. This included listening to audio recordings of the interviews and reading interview transcripts; where necessary, corrections were made to the automated transcript for accuracy. Key interview excerpts and quotes were translated into English by the study team member who had conducted the interview and copied to an Excel spreadsheet for coding. Coding involved assigning interview excerpts and quotes a relevant high-level theme along with a secondary theme in English; high-level and secondary themes were assigned considering the topic expressed by each participant. Initial coding was followed by secondary analysis by the study team in English to analyze shared themes across the data. The secondary analysis phase included two workshops involving all study team members during which themes and coding were discussed. In the first workshop, coding was standardized across the dataset; this involved the study team reviewing all interview excerpts and quotes and agreeing on the relevant codes for each quote or excerpt. The second workshop involved further refinement of the high-level themes and determining the frequency of occurrence of themes across the dataset.
Reflexivity
The research team was composed of four MHPSS advisers from the RCRC Movement’s MHPSS Hub, each with more than ten years of experience working across diverse humanitarian settings. Their professional backgrounds include clinical MHPSS practice, community-based programming, emergency response and organizational well-being, and they brought varied cultural and linguistic perspectives to the study. Several team members have lived or worked in conflict-affected or crisis contexts, which informs their awareness, through a trauma-informed and moral injury lens, of the psychosocial realities faced by RCRC staff and volunteers. Their long-standing engagement in the RCRC Movement shapes their understanding of the organizational culture and influences how they interpret participants’ experiences.
The team acknowledges, however, that while these professional identities and organizational affiliations provide valuable insight, they may also introduce assumptions. Throughout the research process, the team therefore engaged in ongoing reflective discussions to critically examine how their perspectives shaped data interpretation.
Findings
Five main themes emerged from the analysis of the interview transcripts. The key underpinning theme of “life in armed conflict” sets the context in which participants live and work and is a thread throughout all the other themes. The further four themes, presented in order of frequency from most to least expressed, are commitment and belonging to the RCRC Movement, exposure to harm (death, injury, kidnapping and suffering), mental health and psychosocial impacts of humanitarian work, and the different types of support available to staff and volunteers.
Life in armed conflict
The context of armed conflict presents profound challenges for those engaged in humanitarian work. Participants reflected on the absence of basic physical safety and the realities of living under an ongoing threat to life: “It is not safe anywhere. Not even in your house or your own bed.”Footnote 40
Beyond the immediate danger, movement within some communities is often restricted due to mine contamination, a long-term consequence of armed conflict that continues to shape daily life:
Whenever the people have to travel and work in that particular camp, it’s very difficult due to our roads not being safe. You have to just keep moving without knowing whether you will step on a landmine.Footnote 41
Another long-lasting effect is the inability to have a perspective on the future: “So what I encounter today might be different, different from tomorrow or even worse than tomorrow.”Footnote 42 Daily uncertainty makes planning almost impossible: “I try to plan, and the plan is needed, but maybe I also fear to plan because I don’t know what can be next.”Footnote 43 Also, the perception of time changes, with a feeling of time being scarce due to the constant risk of life. As one participant reflected:
Values have changed, the price of life too. Before there was understanding that there is a lot of time, but now no one can guarantee that. No one can guarantee that there will be a next day. We all live in some kind of box which seems to be safe, but it is not, and everything can change in a moment.Footnote 44
Living under constant threat, such as from shelling and drone attacks, influenced participants at the individual and interpersonal levels. They reported the erosion of the social fabric and the impairment of social connectivity, cohesion and basic interpersonal trust. Loss of agency was also reported, with participants expressing frustration with the disengagement of community members in efforts to improve living conditions, reflecting a growing sense of helplessness and disbelief in their own capacity to make change – for example, there was no support for initiatives involving “planting trees and repairing playgrounds”.Footnote 45 Some participants noted an increase in protection risks for children, because of community and family social disengagement:
I wish more children could come to the activities. We only see the ones who can come by themselves. Parents do not bring them, because they [the parents] are in a bad condition. And social services are not functioning.Footnote 46
National staff and volunteers often bear the weight of community expectations while navigating scarce resources and fractured or absent social care systems. One participant reflected on the limitations of their programme: “The programme couldn’t meet the needs of the people. … [W]e even tried to do some referrals, but I couldn’t find any other structures.”Footnote 47 The commitment to service delivery often pushes teams into dangerous terrain, with one participant recounting a moment of tension between safety protocols and humanitarian urgency:
One night, me and my team and also our other colleagues and staff, we went to an area that was a very difficult place, a very dangerous place. Some of the team members said that safety and security were very important for us, but me and the other half of the staff said, “That’s why you have to come here – we have to deliver services.” It was first aid, medical first aid for the people. So, I think there’s a conflict, and we break the rules, because that area and that place were not safe for us, but we went there and we delivered the first aid for the affected people.Footnote 48
Participants are not only responding to humanitarian needs because of armed conflict, but are also personally impacted by the conflict themselves. Stories of loss, separation and emotional strain were common, with one participant recalling: “I was separated from my family due to the armed conflict. I’m in one place, they’re in another. It’s emotionally difficult not knowing their situation.”Footnote 49
This constant uncertainty is compounded by worry for loved ones, which adds to chronic stress caused by the lack of basic safety. As one participant noted: “It is difficult enough just to hear what has happened. Of course, I am stressing out until I know that all my relatives and friends are OK after a shelling. I become more stressed if I don’t hear from them.”Footnote 50
The psychological impacts of the protracted armed conflict on communities were also expressed by participants as having a transgenerational nature:
[The conflict] has been going on for more than thirty years, and many, many people, thousands of people have died, have become victims of this conflict. Many people have become disabled, and many people are missing, which is really very, very hard, very difficult, and working in such a situation in partnering with the families of the people who were really affected is not an easy task. Living here, I am part of this larger community. Here is my home, my family, my friends, my relatives, my parents, and I am one of them.Footnote 51
If anything happens to you, you cannot do the things that you have a passion to do. If anything happens to you, you cannot take care of yourself and your family and also do the work that you are doing. I could give examples of my colleagues who have been victims of [an] incident. Some of them got injured, and now they cannot move like before, which makes it very difficult for them to function like before and do the things they used to do or respond to humanitarian needs.Footnote 52
For many participants, the choice to join the RCRC Movement was driven by an individual need for their coping to be productive, giving them a sense of perceived control in a volatile situation of constant uncertainty: “I am the kind of person for whom it is difficult to stand aside. It is more difficult for me emotionally just to observe. So, it is better for me to take part [in the response]”.Footnote 53
Commitment and belonging to the Red Cross Red Crescent Movement
All participants described a deep sense of commitment and belonging to the RCRC Movement. These feelings were evident in their direct statements during interviews and, for some, in their long-standing service with their respective National Societies, which ranged from two to twenty years. One participant reflected on this experience, stating:
I started about nine years ago. In December it will be nine years since I joined the Movement. I started at a very, very young age, at 13. So, I went through a whole process in the youth group I belong to. I was involved with the children, then I moved to the youth group.Footnote 54
Participant motivations for initial engagement with the RCRC Movement were varied, from being a beneficiary of Red Cross support to youth engagement or for professional reasons. One participant expressed: “I started volunteering with the Red Cross because the Red Cross had helped me once.”Footnote 55
This trajectory was common among participants. Many began their involvement as volunteers before transitioning into paid roles, and some continue to volunteer alongside their professional responsibilities. Such long-term engagement illustrates how commitment to the RCRC Movement often becomes deeply integrated into personal identity. This dedication was also reflected in the way participants spoke about their work, not merely as a job but as a meaningful part of their lives. “I don’t feel that I’m a staff”, one participant noted. “I feel that I’m a volunteer and I do voluntary services right now that I’m here as a staff.”Footnote 56
Participants described how their work with the RCRC Movement extends beyond their professional roles, influencing and shaping their personal lives. One participant reflected: “Working with the Red Crescent changed me. I became more committed to humanitarian values, and it shaped my personal life deeply.”Footnote 57 Another participant shared:
I am happy that the Red Cross exists in my life and gives me a more meaningful life and an understanding that help is needed. From the start of the armed conflict I had a question: “How I can help?” You understand why you do what you do – you do it to help.Footnote 58
Exposure to harm (death, injury, kidnapping and suffering)
Participants reported frequent and intense exposure to serious harms, including death, injury, kidnapping and profound human suffering. These experiences encompassed tasks such as handling the remains of people killed in armed conflict, retrieving the bodies of colleagues, managing bodies of the dead, listening to accounts of sexual violence, murder and abuse, and witnessing the aftermath of disasters. “Bodies are often horribly mutilated. So, we, the Red Cross, come in, we manage the situation. … [W]e wrap the body so it can be buried in a way that doesn’t cause epidemics in the village.”Footnote 59
One participant described the harrowing reality of these situations:
There are some situations where you cannot even separate a mother from her baby. She was breastfeeding when the explosion happened. You will see a very black dead body, with burns. You cannot even separate them. So, at that incident, we put many, many, many women with their children into body bags.Footnote 60
In addition to witnessing suffering, participants themselves experienced harm. Several reported both physical and psychological injuries during their humanitarian work, including being victims of kidnapping, and providing support to colleagues and community members injured in attacks. One participant recounted: “In 2017, during intense conflict, I was in the field constantly. I was kidnapped and detained twelve times. These experiences caused psychological trauma and changed my life completely.”Footnote 61 Exposure was not limited to physical scenes of violence; participants also described the psychological toll of hearing traumatic narratives. They spoke of listening to accounts of sexual violence, torture and profound loss, which often resulted in vicarious trauma. As one participant explained:
I was exposed to many kinds of … vicarious trauma stories [sexual violence] from the victims, how they experience traumatic events. Which was very different from the context where I was before. … [T]hey used to describe how the impact of events touched their lives.Footnote 62
This psychological burden was compounded by collective tragedies, such as in response to a critical incident where one participant recalled: “In that incident … we lost many of our colleagues; six of our colleagues were killed and seventeen or eighteen were badly injured. The six who were killed, they were all from one branch.”Footnote 63
The emotional impact of repeated exposure was evident in participants’ reflections on how these experiences lingered beyond the immediate moment. One participant shared:
I hear a lot of sorrow from the women; I hear a lot about their problems. Sometimes when I sit alone, I hear some of their thoughts, some of their words, some of their crying. I cry myself sometimes.Footnote 64
Mental health and psychosocial impacts of humanitarian work
Participants described significant mental health and psychosocial challenges associated with their roles, reporting a range of distress reactions such as sleep disturbances, anxiety, depressive symptoms, and emotional withdrawal from family, friends and social relationships. One participant reflected: “The work affected me psychologically and physically. It had a very negative impact on my mental health and family life. I became more withdrawn, irritable, and emotionally exhausted.”Footnote 65
Many participants noted that over time they experienced profound changes in their emotional responses and sense of self. One shared: “I used to be sensitive and emotional. Now I handle corpses and body parts without flinching. People ask how I became so detached. I don’t recognize myself anymore.”Footnote 66 Several participants expressed the desire to “unsee” traumatic experiences, describing intrusive memories and emotional strain:
Sometimes I come across a situation that touches me, and when I come back home, I recall what I saw. I also have those feelings that I wish I had a way out of seeing this thing that I saw. So sometimes it really affects me.Footnote 67
The impact extended to personal relationships and social functioning. Emotional disconnection, isolation and withdrawal were common themes. One participant explained: “My work sometimes … used to disconnect me from my colleagues, and especially my friends in the community and my family.”Footnote 68 Another shared the emotional toll of the work and its effects on their life, saying: “I feel emotionally disconnected. I’m a social person, and when I can’t connect with my family or community, I feel mentally unwell.”Footnote 69
Continuous exposure to suffering amplified these effects. Participants spoke of deep emotional reactions to witnessing loss and grief:
Sometimes I really cry about the people because when I see their situation, especially the children, it hurts my soul. And when someone has lost their loved ones, it’s very painful. So yeah, sometimes I feel bad for them, and sometimes I get emotional about the situation.Footnote 70
This psychological burden was compounded by the persistent sense of danger and uncertainty inherent in conflict settings: “There’s always stress, especially when many people are on the ground. You never know if you’ll return. Every moment carries danger and uncertainty.”Footnote 71 Finally, participants highlighted how these experiences disrupted healthy routines, such as sleep, due to overwhelming empathy and concern: “It kept me up all night thinking how they [the affected people] were spending that night.”Footnote 72
Different types of support for staff and volunteers
Participant narratives illustrate a recurrent thematic pattern in which individuals predominantly drew on personal, faith-based and peer-based resources to sustain their well-being, while emphasizing the limited availability of formal organizational psychosocial support mechanisms.
Faith and spirituality were identified as key sources of strength: “My family’s prayers and God give me strength. Every day I pray, “I hope I’m OK.” That spiritual support is very important.”Footnote 73 In contrast, organizational formal support systems were described as largely absent. Many participants expressed frustration at the lack of MHPSS services provided for staff and volunteers: “Unfortunately, mental health services are not available. We need psychological support, but the organization lacks the capacity. We are expected to give what we don’t receive ourselves.”Footnote 74
All the participants identified team and peer support as the primary source of emotional support in their work. In most cases, this was the first and most accessible form of help. One participant captured this sentiment “First of all, [my primary source of support] is my team. The thing is that we have a very good team, team structure and people. What I am saying is that I am very happy that I have my team with me now; we are supporting each other.”Footnote 75
Informal support among colleagues was consistently perceived as the most valuable and readily available: “Even when afraid, we stayed close to each other, supported one another, and planned escape routes. We felt like one unit.”Footnote 76 Alongside peer support, participants mentioned individual coping strategies such as maintaining contact with family and friends:
In this situation, maybe at first, we see the affected people as more important than anything else, but every time I call my family – especially my parents – to say that I’m safe and fine, that gives me energy to work for the people.Footnote 77
Finally, belonging to the RCRC Movement was seen as a protective factor, offering connection, commitment and meaning through shared experiences and relationships: “I turn to a friend, a friend from here, from the Red Cross, who also upholds the principles and to whom I can talk and with whom I can maintain professional ethics.”Footnote 78
Discussion
This qualitative study draws on sixteen in-depth interviews with RCRC volunteers and national staff working in conflict-affected settings. It focuses on their experiences of the psychosocial and mental health impacts of conflict and how they respond to those impacts. Participants’ narratives reinforce previous research and reveal profound and persistent challenges associated with living and working in armed conflict contexts, including constant threats to physical safety, exposure to severe physical and psychological harm, and the emotional weight of witnessing human suffering.Footnote 79 RCRC staff and volunteers in this study reported exposure to violence, abuse, kidnapping, death and immense suffering while also facing additional challenges such as systemic inequities and limited access to professional and local support. Participants commonly reported mental health consequences, including sleep disturbances, anxiety, depressive symptoms and feelings of social disconnection, consistent with patterns documented in previous research on humanitarian personnel in high-risk environments.Footnote 80
Unlike international humanitarian staff, national staff and volunteers cannot disengage from conflict environments after missions.Footnote 81 Participants reported their exposure as continuous and deeply personal. This finding resonates with those of the ViCE Initiative, which documented embodied trauma and long-term psychological distress among volunteers in conflict settings.Footnote 82 Such embeddedness blurs the boundary between professional and personal spheres, and this can intensify emotional strain and complicate recovery. At the same time, participants emphasized that their strong commitment to RCRC principles provided a profound sense of meaning and belonging, reinforcing engagement despite adversity.
The strong sense of commitment and belonging to the RCRC Movement expressed by participants was often rooted in personal values and the RCRC principles. The extent to which staff and volunteers deeply embraced the Movement’s principles was evident in participants’ stories. This moral and social anchoring acted as a coping resource, enabling individuals to reframe distress through purposeful action and team solidarity. This study has revealed the powerful role that working or volunteering with the RCRC Movement plays in supporting the well-being of humanitarian workers through providing community, belonging and social connectedness in times of crisis.
Participants in this study perceived the organizational support available to them as limited, despite the importance placed on such support in the literature.Footnote 83 Patterns observed in this study align with previous findings that organizational factors such as poor communication, lack of recognition and inadequate psychosocial resources exacerbate mental health risks.Footnote 84 Instead, participants reported relying primarily on peer support. This reliance on informal coping mechanisms reflects both structural limitations and cultural dynamics. While peer support offers immediate emotional relief, it cannot substitute for professional or organizational support, particularly in cases of severe psychological distress. The persistence of stigma and confidentiality concerns further limits the uptake of formal services, reinforcing the need for culturally sensitive and trust-based approaches amid a context that is highly volatile and violent.
The concept of trauma-informed care, widely advocated in the health and social service sectors, remains under-utilized in humanitarian organizations. A trauma-informed approach emphasizes safety, agency and cultural sensitivity,Footnote 85 and these principles could mitigate the cumulative mental health impacts of trauma exposure among RCRC personnel. Integrating these principles into organizational policies would represent a significant advancement over current models, which often rely on reactive, top-down interventions. Such integration would not only address psychological distress but also reinforce the sense of belonging and purpose that volunteers and staff identify as central to their engagement. Linking these strategies to a value-based approach grounded in the RCRC Movement principles could further strengthen resilience – simple, engaging, structured activities, led by RCRC national teams, that encourage staff and volunteers to reflect on and discuss these principles offer a creative and culturally sensitive way to integrate humanitarian values into daily practice. Such approaches may help individuals navigate the moral and operational complexities of armed conflict, make sense of their experiences, and transform distress into adaptive coping through shared meaning and collective identity.
Reflections from participants in this study underscore the dual reality of humanitarian work in conflict contexts, with deep personal and professional commitment amid significant psychosocial harm and vulnerability. They highlight the urgent need for tailored, value-based and trauma-informed approaches to address the mental health and psychosocial impacts of this work.
Strengths and limitations
Internet connectivity and audio quality were an issue for some interviews; challenges with connection disrupted the flow of some interviews and may have affected the interviewers’ understanding of some aspects of the interviewees’ responses. In addition, poor connectivity affected the quality of transcripts for a minority of interviews. The study team worked to resolve these issues during the interviews and in the initial data analysis phase by listening to audio recordings while conducting analysis.
The study team was able to conduct interviews in five languages, but for some participants these were not their first language. Mental health and well-being concepts and expressions are highly cultural and often difficult to translate, and this is likely to have affected the ability of some participants to fully express themselves.
While the study team made a conscious effort to ensure a diverse participant sample, gender was not treated as a specific analytical variable in this study. The study team members who conducted the interviews are trained to navigate gender dynamics sensitively, ensuring participants’ comfort regardless of gender, but the data were not analyzed from a gender perspective – a factor which could offer additional insights in future research.
Implications
While hope and the RCRC principles sustain the capacities and engagement of national staff and volunteers working in armed conflict contexts, as clearly stated by participants, these findings also underscore an urgent need to institutionalize support through clear standards and regulations. Given participants’ reliance on peers, structured frameworks should strengthen helping skills among volunteers and staff while safeguarding their well-being through a robust organizational support system. Moving beyond ad hoc practices and toward formalized guidance is essential to ensure ethical, sustainable engagement in high-risk humanitarian contexts. This can be done through supporting evidence collection and research to more clearly understand specificities such as age, gender and culture of national staff and volunteers, while ensuring that the universality of the RCRC principles remains central, providing a common foundation for care and protection across diverse contexts.
From a practice perspective, key messages from participants highlight several priorities related to differentiated support, organizational reform and peer support integration. Regarding differentiated support, participants emphasized the need for tailored interventions that account for continuous exposure, cultural norms and resource constraints. Scalable, community-based approaches such as group stress management sessions have shown promise in reducing symptoms of anxiety, depression and PTSD.Footnote 86 Moreover, organizational support must extend beyond physical safety to include proactive mental health strategies. This involves strengthening role- and task-specific training, promoting psychosocial support and systematizing follow-ups, with particular attention to confidentiality and stigma reduction.
Study participants highlighted the importance of support from their supervisors and managers. It is essential to develop the skills of RCRC Movement leaders and managers in trauma-informed approaches in order to reinforce value-based and supportive leadership skills. Leadership has a role to play in modelling behaviour that embodies the RCRC principles. Furthermore, the findings highlight the need to have consistent integration of the RCRC principles within organizational processes and work culture, such as through onboarding, supervision and creating a psychologically safe and trustworthy work environment that encourages open discussion, adheres to confidentiality and actively responds to psychological vulnerability and the need for support. Finally, while informal networks are valuable and indeed were the most reliable support system identified by participants in the study, they should be complemented by structured peer support programmes and facilitated access to professional services.
At the policy level, humanitarian organizations and donors must recognize mental health and psychosocial well-being as integral to operational effectiveness and the protection of humanitarian workers. Investment in trauma-informed systems and culturally adapted interventions should be prioritized alongside security measures. At the global level, the ICRC and the wider RCRC Movement must continue to defend and advocate for international humanitarian law (IHL), emphasizing its implications for the protection of humanitarian staff and volunteers. This includes sustained engagement with international bodies to ensure that the legal frameworks safeguarding humanitarian actors continue to be respected, such as through the Global IHL Initiative.Footnote 87
At the national level, each National Society should actively advocate with its respective State to guarantee the protection of its staff and volunteers under both national law and international obligations. This requires building strong partnerships with government authorities, promoting awareness of IHL, and ensuring that protective measures are embedded in national policies and emergency response frameworks.
Conclusion
This study has sought to bring focus to how RCRC volunteers and national staff experience and respond to the mental health and psychosocial challenges of living and working in armed conflict contexts. By highlighting the disproportionate burden on national staff and volunteers, the study has identified a critical evidence gap and has set the stage for future research. Participants shared their realities, struggles and hopes, and the profound impacts of their experiences on their roles and personal lives. Constant exposure to harm and suffering, amid violent contexts, places them at risk of significant mental health and psychosocial harm, including a range of distress reactions and strained social relationships. The findings of this study identify the unique experiences and vulnerabilities faced by national staff and volunteers working and living in armed conflict contexts.
The study has also revealed the vital role that the RCRC Movement plays in fostering belonging, connectedness and community among humanitarian workers. Participants reported the pivotal role that their colleagues play in providing emotional support and enabling them to continue their work. Integrating trauma-informed and moral injury frameworks into humanitarian practice offers a pathway to reinforce this culture of peer support with more comprehensive and context-sensitive support systems. The voices from the front lines presented here underscore that safeguarding the mental health of national humanitarian workers is not only a matter of individual well-being but a cornerstone of effective and ethical humanitarian action.
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