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Carrying the weight: Organizational responsibility for the mental well-being of humanitarian workers

Published online by Cambridge University Press:  15 May 2026

Sarah T.D. Ellingham Open the ORCID record for Sarah T.D. Ellingham [Opens in a new window]
Sarah T.D. Ellingham*
Affiliation:
Forensic Specialist, International Committee of the Red Cross, Dnipro, Ukraine
*
Email: ellingham.sarah@gmail.com
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Abstract

Humanitarian and non-profit work places staff and volunteers in contexts of high moral responsibility and commitment to mission, which can simultaneously sustain and strain mental well-being. Drawing on literature from organizational psychology and studies of non-profit and voluntary organizations, this paper examines how workplace structure and dynamics shape psychological outcomes among humanitarian workers. It argues that distress is not solely a consequence of exposure to traumatic events but is significantly influenced by organizational factors, including hierarchical constraints, inequitable working conditions and limited autonomy in ethically complex environments. These conditions create a dual-edged experience: workers derive purpose and identity from their altruistic engagement, yet face structural and relational stressors that contribute to burn-out, moral distress and reduced well-being. By foregrounding organizational responsibility, this paper identifies key determinants of mental well-being and highlights the need for systemic approaches that move beyond individual resilience-focused interventions.

Keywords

humanitarian aid workoccupational mental healthburn-out and moral injuryresiliencealtruistic identity

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Type
Research Article
Information
International Review of the Red Cross , First View , pp. 1 - 24
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NC
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial licence (http://creativecommons.org/licenses/by-nc/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original article is properly cited. The written permission of Cambridge University Press or the rights holder(s) must be obtained prior to any commercial use.
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of International Committee of the Red Cross.

Introduction

Humanitarian aid workers operate in environments marked by acute crises, chronic instability and high operational demands, including active conflict, natural disasters, political insecurity and public health emergencies.Footnote 1 While research has historically focused on the psychological consequences of direct trauma exposure, such as post-traumatic stress disorder (PTSD), anxiety and depression, emerging evidence suggests that these individual-level outcomes represent only part of the picture. A substantial proportion of psychological distress in humanitarian personnel arises from organizational and structural factors, including workload, inequitable reward systems, role ambiguity, managerial practices and workplace culture.Footnote 2 These stressors are often chronic, cumulative and modifiable, highlighting the critical role of employers in shaping staff well-being.

Organizational structures influence both risk and resilience. Humanitarian workers face differential exposure to stressors based on contract type, role, deployment location and staff status (national versus international), while inequities in support, recognition and resources exacerbate vulnerability to burn-out and psychological distress.Footnote 3 At the same time, identity and meaning-making processes, such as altruistic and professional identities, mediate how workers experience and interpret stress, contributing to both resilience and vulnerability.Footnote 4 Persistent misalignment between personal values, organizational constraints and the ethical compromises that humanitarians must sometimes make can generate moral injury, further compromising mental health and engagement.Footnote 5

This paper draws on a narrative review of the literature on occupational mental health in international and national humanitarian aid workers, focusing on the organizational determinants of psychological distress and highlighting how structural inequalities, workplace culture and institutional practices contribute to harm. Relevant academic sources were identified through databases including PubMed, PsychINFO and Google Scholar; additional sources were identified though reference list screening and the author’s prior familiarity with the field. The research prioritized peer-reviewed empirical and theoretical contributions but is not intended to be exhaustive – rather, it aims to synthesize key themes and perspectives to inform the analysis presented.

Drawing on ideas such as the effort–reward imbalance model,Footnote 6 job demand–control frameworksFootnote 7 and conservation of resources theory,Footnote 8 alongside theories of identity and resilience, this paper argues that distress is rarely the result of individual fragility but instead reflects the interaction of personal, social and systemic factors, many of which are amenable to organizational intervention. By foregrounding employer responsibility, the review moves beyond individual resilience-focused narratives to identify structural determinants of mental well-being and their implications for practice. To do so, the article first examines the role of identity, meaning-making and resilience, before outlining key forms of occupational stress, including moral injury, burn-out and workplace mistreatment. It then introduces organizational frameworks for understanding psychosocial risk and integrates these perspectives to identify organizational leverage points. Finally, the article concludes with key operational implications for humanitarian organizations.

Humanitarian identity and mental well-being: A source of motivation and vulnerability

Humanitarian work is often underpinned by a strong moral identity, which plays a central role in shaping both motivation and vulnerability among aid workers. Many aid workers enter the field with a strong moral identity, grounded in altruistic motivations and a willingness to sacrifice aspects of their personal lives to alleviate the suffering of others.Footnote 9 Where personal identity is closely aligned with ethical commitments and the humanitarian mission, this has been described as altruistic identity.Footnote 10 While this alignment can be a strong source of meaning and engagement, it may also increase susceptibility to distress when individuals are unable to act in accordance with these values.Footnote 11

Individuals are deeply embedded in social and cultural contexts, shaped by group-based norms, perceptions and cognitions. Consequently, most people have a dual self-perception, as individuals and as members of groups.Footnote 12 Social identity theory (SIT) posits that people self-identify as belonging to various groups, such as professional affiliations or ethnic communities.Footnote 13 Personal identity and social identity are not always equally salient, a phenomenon further elaborated by self-categorization theory (SCT), which views identity salience as context-dependent and modifiable according to social comparative cues.Footnote 14

Drawing on SIT and SCT, research suggests that the humanitarian identity is highly salient during missions, reinforced by shared attitudes and norms within the “in-group” of fellow humanitarian workers.Footnote 15 Organizational membership often forms a central aspect of this social identity, providing a framework through which workers align with the organization’s values and decision-making processes.Footnote 16 Individuals manage identification frames by aligning personal values with those of their work environment, though different work contexts may evoke multiple and sometimes conflicting frames, with certain frames gaining salience at specific times. This is particularly relevant in humanitarian work, where frequent transitions between duty stations and agencies are common.Footnote 17

This value-based sense of self simultaneously supports and constrains involvement in the sector and remains highly vulnerable to disruption. In the morally complex environment of humanitarian operations, the aspiration to relieve suffering often collides with financial, organizational and policy constraints.Footnote 18 Confronted with conditions that prevent them from enacting their core values, aid workers may experience identity dissonance, manifesting as existential distress and undermining professional coherence.Footnote 19 This destabilization is further compounded by structural conditions such as long working hours, resource scarcity, and blurred boundaries between work and private life in high-pressure environments.Footnote 20 Such conditions not only expose workers to trauma but also erode clarity of professional roles and self-concept. Identity erosion among humanitarian workers is not simply a by-product of exposure to traumatic events but is also closely tied to institutional dysfunction and systemic constraints, which prevent workers from enacting their core values and sustaining a coherent professional identity.Footnote 21 This highlights a critical organizational leverage point: institutions play a central role in either sustaining or undermining staff’s ability to enact their core values. Organizational strategies that promote ethical clarity, reduce role ambiguity and support value alignment are therefore essential to preserving professional identity and preventing distress.

The process of returning from mission assignments can further disrupt self-concept, as re-entry into “normal” life may mark profound shifts and potentially the loss of the collective humanitarian identity. This transition often results in difficulties with social reintegration and a questioning of belonging.Footnote 22 McCormackFootnote 23 coined the term “altruistic identity disruption” to describe a post-deployment crisis characterized by isolation, doubt and self-blame. Many aid workers describe humanitarian work as a “bubble”, a socially cohesive and immersive environment in which they feel valued and connected. The loss of this environment can make leaving the sector difficult, with some seeking to return to fieldwork in order to regain identity coherence and peer support networks, which are critical for coping with isolation and emotional burden.Footnote 24 At the same time, this period of disruption may also present an opportunity for identity reconstruction, allowing individuals to re-evaluate and integrate their humanitarian experience with other pre-existing roles, relationships and personal values. Structured reintegration support, including post-deployment debriefing, transitional programming (such as that used in the armed forcesFootnote 25) and continued peer connection, represents an important but often under-developed organizational strategy to mitigate identity disruption and support long-term workforce sustainability.

Resilience in aid work: A double-edged sword

Resilience is a term frequently invoked when discussing what constitutes a “good humanitarian”, yet it is often misunderstood as a fixed personality trait or innate character feature. In reality, resilience is malleable, shaped by a complex interplay of internal capacities and external conditions.Footnote 26 Within emergency relief and humanitarian contexts, resilience operates both individually and collaboratively. It encompasses adaptive responses to disruption, trauma and loss, while being supported and facilitated by environmental factors, social networks and organizational structures.Footnote 27 From a communicative perspective, resilience is constructed through narratives, identities, emotions and social networks that allow workers to reintegrate or transform following exposure to challenging circumstances.Footnote 28 Environmental supports such as strong family connections, spiritual anchors and future-oriented goals can contribute to resilience, while organizations play a critical role by providing structural supports, clear norms, and resources that enable workers to navigate adversity and adapt creatively to evolving challenges.Footnote 29

Humanitarian work offers opportunities for those who work in the sector to address both personal vulnerabilities and broader societal inequities in the communities they support, shifting focus from passive receipt of aid to active engagement. Agarwal and BuzzanellFootnote 30 use the term “resilience labour” to describe the interplay of identity/identification networks which sustain aid workers’ involvement and resilience. Resilience labour is shaped by three overlapping identity and identification networks: family networks, ideological networks and destruction–renewal networks. Family networks sustain resilience through self-directed and other-directed efforts to maintain strong emotional bonds with colleagues, peers and the broader community.Footnote 31 These networks, which workers frequently describe as being akin to family, provide essential emotional support, reduce stress and promote long-term engagement, even in voluntary or temporary roles.Footnote 32 Identification with these networks enables aid workers to maintain personal growth, adapt effectively to changing circumstances, and find meaning and satisfaction in their work.

Ideological networks similarly support resilience by aligning the personal values of aid workers with the broader organizational ideologies of humanitarian, egalitarian and secular principles. This alignment reinforces pride, recognition and meaning in one’s work and provides a buffer against reputational, ethical or operational challenges.Footnote 33 Workers embedded within these ideological networks report greater capacity to sustain motivation, even when faced with bureaucratic, political or logistical constraints.Footnote 34

Destruction–renewal networks capture the cyclical and high-intensity identification with the disaster response process, spanning from witnessing destruction to engaging in urgent response, participating in long-term rebuilding, and preparing for subsequent crises. Emotional labour and compassion are central within these cycles, producing both immediate satisfaction and a sense of spiritual significance, which in turn supports resilience and engagement in aid work.Footnote 35

Through the interplay of these family, ideology and destruction–renewal networks, aid workers construct resilience labour that integrates functional dimensions (task-related competence), relational dimensions (emotional and interpersonal connections) and internal dimensions (meaning-making and community identity). This process operates at two interconnected levels: it supports the individual aid worker’s sense of purpose and psychological endurance, while also reinforcing the collective identity and recovery process of the community they serve.Footnote 36 Critically, this implies that resilience is not an individual asset to be relied upon but an organizational outcome that must be actively designed and supported through institutional practices, leadership approaches and resource allocation.Footnote 37

Despite the importance of organizational facilitation, the institutional role in promoting resilience and well-being is frequently overlooked. Responsibility is often placed solely on the aid worker to “be resilient”, creating external and internalized expectations of toughness and heroic altruism.Footnote 38 These expectations can obscure signs of distress and prevent workers from seeking support when needed. Aid workers commonly fear that expressing vulnerability or accessing psychological support may be perceived as weakness or jeopardize future deployment opportunities.Footnote 39 Moreover, many minimize their own suffering, believing their needs to be trivial compared to those of the beneficiaries they serve.Footnote 40

This dynamic can produce a “conspiracy of silence” in which workers refrain from sharing experiences because they perceive that no one outside their immediate context can truly understand them, further internalizing emotional distress.Footnote 41 In this sense, resilience functions as a double-edged sword: it can serve as a coping narrative that enables continued functioning under extreme conditions, yet it may also mask cumulative harm, encourage overwork, normalize prolonged exposure to danger and allow organizations to valorize “toughness” rather than addressing systemic sources of distress.Footnote 42 Recognizing this complexity is essential, as resilience in humanitarian settings is not merely a personal attribute but a socially and institutionally mediated process. It is shaped by organizational norms, expectations and support structures that influence how aid workers interpret and respond to prolonged stress. Without adequate recognition and support, resilience may reinforce harmful patterns such as overwork and emotional suppression; conversely, when appropriately supported, it can contribute to sustained engagement, psychological well-being and effective humanitarian response.Footnote 43

Addressing this requires organizations to shift from valorizing individual toughness to actively monitoring workload, normalizing help-seeking, and embedding psychological support within routine operations. Without such structural changes, resilience narratives risk perpetuating harmful working conditions.

Occupational stress in humanitarian work

Ethical dilemmas and moral injury

Building on the dual-edged nature of resilience, humanitarian work also exposes personnel to profound ethical tensions that can have lasting psychological consequences. Aid workers operate in environments where ethically appropriate action is often constrained, ambiguous or unattainable, generating persistent moral tension and psychological distress.Footnote 44 These dilemmas arise not only from the immediate exigencies of crisis contexts but also from the structural and organizational conditions of aid delivery.

At the operational level, resource scarcity constitutes a central ethical challenge. Humanitarian professionals frequently confront distributive justice dilemmas, deciding how to allocate care and assistance under conditions of profound insufficiency, often with the awareness that alternative outcomes would be possible under different political or structural arrangements.Footnote 45 Organizational policies and donor-driven agendas intensify these tensions, as mandates restricting eligibility for care or prioritizing specific outcomes frequently conflict with practitioners’ moral and professional commitments.Footnote 46

This dissonance between humanitarian ideals and everyday practice has been conceptualized as “moral labour”: the psychological effort required to continue working within systems perceived as being ethically compromised.Footnote 47 Organizational cultures often reinforce this strain through heroic narratives of sacrifice and resilience, morally policing motivation and framing ambivalence, exhaustion or distress as ethical failure.Footnote 48 In such contexts, resilience can function less as a protective factor and more as a mechanism of institutional compliance, normalizing excessive workloads and discouraging ethical dissent.Footnote 49

Recent work increasingly frames these experiences through the lens of moral injury, defined as psychological harm arising from exposure to events that violate deeply held moral beliefs and cannot be reconciled within existing ethical frameworks.Footnote 50 Humanitarian workers report moral injury when perceiving themselves as complicit in inequitable or discriminatory systems, particularly when they recognize their capacity to act differently but feel powerless to challenge entrenched organizational practices.Footnote 51 Structural inequalities, especially between international and national staff in decision-making authority, remuneration, security and risk exposure, constitute recurring moral stressors, generating guilt, shame, anger and erosion of professional identity.Footnote 52

When these moral violations remain unacknowledged or structurally embedded, the psychological consequences can be severe. Moral injury has been linked to loss of meaning, reduced compassion, burn-out, disengagement, and withdrawal from one’s profession.Footnote 53 Attrition from the sector is frequently reported in response to sustained moral distress and organizational inflexibility.Footnote 54 Framing these outcomes as failures of individual resilience obscures the collective and institutional responsibility for creating morally injurious working conditions, underscoring that such experiences are not simply personal vulnerabilities but are embedded within the operational and ethical landscape of humanitarian work. Organizational strategies must therefore include mechanisms for ethical reflection and inclusive decision-making as well as safe channels for challenging policies that generate moral distress, ensuring that staff are not left to individually absorb structurally produced ethical tensions.

Burn-out and psychological distress

Alongside moral injury, humanitarian aid workers frequently experience burn-out, a consistently identified occupational outcome arising from chronic psychosocial hazards. Burnout has significant implications for mental health, job satisfaction, and workforce sustainability.Footnote 55 Defined by the World Health Organization’s (WHO) International Classification of Diseases 11th Revision as resulting from chronic workplace stress that has not been successfully managed, burn-out is operationalized across three dimensions: emotional exhaustion, reflecting emotional and physical depletion; depersonalization, capturing relational disengagement and cynicism towards service recipients; and reduced personal achievement, denoting feelings of inefficacy and diminished accomplishment.Footnote 56 Across studies of humanitarian aid workers, burn-out is typically measured using the Maslach Burnout Inventory – Human Services Survey,Footnote 57 which enables comparative prevalence estimates across different settings. Consistently high rates of burn-out have been reported, particularly among international aid workers. Cross-sectional studies indicate that approximately 40% of expatriate humanitarian aid workers exhibit symptoms in at least one of the three dimensions of emotional exhaustion (24–45%), depersonalization (9–24%) and reduced personal achievement (10–43%).Footnote 58

Non-specific psychological distress is another common outcome, encompassing a constellation of psychological and somatic symptoms observed across several mental health disorders.Footnote 59 Longitudinal studies demonstrate that staff of international non-governmental organizations (INGOs) experience higher levels of depression and emotional exhaustion following deployments compared to pre-deployment, with symptoms persisting for up to six months post-return.Footnote 60 Anxiety and depersonalization similarly increase after deployment, although these appear to resolve over time.Footnote 61 These psychological outcomes also have significant organizational consequences, including increased accident and illness rates, reduced productivity, disengagement, and attrition from the humanitarian workforce.Footnote 62 Collectively, these findings indicate that burn-out and psychological distress undermine both the sustainability and the ethical integrity of humanitarian operations. They point to the need for organizational interventions that address workload, job design and resource allocation at a systemic level, rather than relying solely on individual coping strategies.

Vulnerability to burn-out is further shaped by demographic and career-stage factors. Younger humanitarian aid workers demonstrate higher risk for both emotional exhaustionFootnote 63 and depersonalization,Footnote 64 while first-time deployees are more likely to develop mental health problems compared to those with repeated field experience.Footnote 65 These patterns are interpreted as reflecting survivorship and adaptation effects, whereby older and more experienced workers are those who have committed to humanitarian work as a long-term career and have developed more effective coping strategies for occupational stressors.Footnote 66 Gender differences also emerge, with female staff consistently being identified as more vulnerable to burn-out across multiple studies.Footnote 67

Predictors of burn-out extend beyond individual characteristics to include structurally specific features of humanitarian work. Region of deployment, organizational location, contract type, and role within the organization all influence burn-out risk.Footnote 68 A survey by the Office of the United Nations High Commissioner for Refugees (UNHCR) found elevated emotional exhaustion among Europe-based staff and increased depersonalization in the Middle East and North Africa region, while headquarters-based employees in Geneva showed the greatest risk for both emotional exhaustion and depersonalization.Footnote 69 Psychological stress at HQ level was attributed to high pressure, limited job resources, low job control and constrained decision-making autonomy.Footnote 70 These findings challenge assumptions that institutionalized organizations necessarily offer protective working conditions, and highlight cultural and structural differences within organizations as salient stressors. Socio-cultural norms regarding work pace, bureaucratic processes and work–life balance also shape burn-out risk.Footnote 71

Differences between national and international staff further highlight the organizational dimension of burn-out. International staff in South Sudan have been found to report higher – although not statistically significant – levels of emotional exhaustion and depersonalization compared to national staff.Footnote 72 National staff, however, carry a greater cumulative burden of psychosocial stressors overall.Footnote 73 Paradoxically, national staff may benefit from stronger social support networks, a protective factor consistently identified across multiple studies.Footnote 74 This dynamic underscores the importance of considering how organizational positioning interacts with the availability of protective resources.

Inequities between national and international staff are a particularly salient source of stress. National staff, who now constitute over 90% of humanitarian field personnel, are increasingly exposed to operational risks under localization agendas, as international organizations reduce their presence in high-risk settings or residentialize positions under budget constraints, transferring disproportionate risk onto local staff.Footnote 75 These pressures are compounded by financial insecurity, limited recognition, restricted decision-making power and inequitable treatment, contributing to elevated anxiety and emotional exhaustion. National staff also often experience the same emergencies personally that they are tasked with responding to within their communities.Footnote 76

Distinct stress profiles further highlight differences across staff groups. National staff commonly identify financial insecurity and limited career progression as primary stressors, whereas international staff more frequently report social isolation, cultural adjustment difficulties, and challenges maintaining work–life balance due to prolonged separation from family and support networks.Footnote 77 These findings reinforce the inadequacy of uniform interventions focused on individual resilience and emphasize the need for organizational strategies that address structurally produced inequalities rather than placing the onus solely on individual workers. Organizational responses must therefore be differentiated and equity-focused, addressing the distinct risk profiles, resource access and structural vulnerabilities of national and international staff.

Despite explicit commitments to staff well-being articulated at the World Humanitarian SummitFootnote 78 and increasing numbers of organizational guidelines addressing staff welfare,Footnote 79 implementation remains inconsistent and fragmented.Footnote 80 Structural inequalities within the humanitarian workforce further exacerbate psychosocial risks. Employment insecurity is widespread due to short-term, donor-dependent contracts, particularly in smaller non-governmental organizations (NGOs).Footnote 81 Organizational affiliation also matters, with staff working for INGOs reporting higher levels of depression and anxiety compared to those employed by UN-affiliated agencies.Footnote 82 These disparities likely reflect differences in institutional capacity to provide formalized staff support and welfare mechanisms, but may also relate to variations in roles and working conditions across organizations. For instance, UN personnel are often based in capital or coordination hubs, whereas NGO staff may be more frequently deployed in front-line or “deep field” settings, potentially increasing exposure to operational stressors. However, such distinctions are not uniform and remain under-explored in the literature. This suggests that strengthening institutional capacity for staff support, particularly in under-resourced organizations, should be a strategic priority in the sector.

Bullying, harassment and discrimination

Burn-out and psychological distress in humanitarian aid workers are closely intertwined with workplace cultures and organizational practices, including exposure to bullying, harassment and discrimination. Humanitarian staff frequently report experiencing abusive supervision and negative interpersonal behaviours, which in studies conducted in other care professions has been found to exacerbate emotional exhaustion, depersonalization and reduced personal accomplishment, and can contribute to long-term psychological harm.Footnote 83 Continual exposure to hostile management practices is linked to diminished self-esteem, heightened stress and physical health consequences, while also generating organizational harms such as lower job satisfaction, higher turnover and reduced performance.Footnote 84

Abusive supervision, defined as subordinates’ perception of sustained hostile verbal or non-verbal behaviours by managers, constitutes a key source of workplace bullying.Footnote 85 It can manifest as public humiliation, coercion, withholding information and/or general hostility.Footnote 86 Staff may respond with counterproductive work behaviours, including withdrawal or sabotage, and reduce engagement in organizational citizenship behaviours, consistent with social exchange and power dependence theories.Footnote 87 Negative emotions arising from bullying, such as persistent anger, frustration and disengagement, further exacerbate harm to both individuals and organizations.Footnote 88 Inadequate organizational responses can undermine morale, perpetuate stress and reinforce destructive behaviours.Footnote 89

In humanitarian and non-profit contexts, these dynamics are amplified by structural and contextual factors. Bullying and harassment occur at similar or higher levels than in other sectors, with approximately 15% of employees reporting such experiences, and organizational responses are often poor.Footnote 90 Sexual harassment, particularly affecting local aid workers and female staff, is a major concern.Footnote 91 Features such as hierarchical structures, volunteer involvement, donor dependence and “heroic” leadership styles facilitate bullying while limiting recognition, reporting and intervention.Footnote 92 Staff members’ commitment to organizational missions may lead them to tolerate abuse, and management may shield high-performing leaders, creating a self-perpetuating cycle of harm.Footnote 93 These effects are intensified in hardship duty stations, where work and private life are often inseparable and staff may share living quarters with perpetrators.

Pathological power dynamics stabilize bullying, intensifying psychological distress, reinforcing inequitable hierarchies and disproportionately affecting marginalized staff, including women and volunteers.Footnote 94 The resulting organizational “shadow” preserves the myth of virtue while silencing those experiencing mistreatment,Footnote 95 and organizational inaction is often more damaging than the bullying itself.Footnote 96 Effective organizational strategies must therefore prioritize prevention, including leadership accountability, independent reporting mechanisms and enforcement of zero-tolerance policies rather than reactive or symbolic responses. Exposure to harassment and discrimination interacts with structural inequalities, including employment insecurity, unequal access to resources, and hierarchical divisions between national and international staff, creating cumulative stress burdens.Footnote 97 National staff, disproportionately exposed to operational risks under localization policies, may simultaneously face harassment or discrimination that limits their voice in decision-making processes. International staff, while sometimes shielded from certain operational risks, remain vulnerable to cross-cultural misunderstandings, isolation, and organizational power imbalances that can exacerbate harassment experiences.Footnote 98

Experiences of burn-out, harassment and moral injury illustrate that psychological distress in humanitarian work is rarely an individual failing but is instead deeply embedded in organizational structures, operational policies and culturally mediated expectations. These psychosocial risks are shaped by the interplay of workload, reward systems, managerial practices and social hierarchies. To systematically understand how these organizational conditions influence stress, well-being and resilience, there are four occupational and organizational models that offer conceptual tools for identifying both risk factors and protective mechanisms, and crucially, for informing the design of targeted organizational strategies that can mitigate harm and promote sustainable workforce resilience. These are the effort–reward imbalance, job demand–control, conservation of resources, and perceived organizational support models.

Organizational frameworks for understanding psychosocial risk

The effort–reward imbalance model

The effort–reward imbalance (ERI) model provides one of the most robust explanatory frameworks for understanding burn-out and psychological distress among humanitarian aid workers. The model conceptualizes distress as arising when sustained high effort is not met with commensurate rewards (whether financial, social or professional), resulting in emotional strain and adverse health outcomes.Footnote 99 In humanitarian contexts, where workloads are intense and recognition, job security and career progression are often limited, ERI offers a particularly salient lens through which to understand both burn-out and moral injury, as unmet expectations of fairness and reciprocity may erode professional identity and ethical meaning.

Across multiple studies, ERI, which is measured though a self-report questionnaire,Footnote 100 has consistently outperformed trauma exposure as a predictor of burn-out and mental health outcomes among aid workers.Footnote 101 In a large UNHCR sample, ERI prevalence reached 72%, exceeding rates of any specific mental health outcome. Each unit increase in ERI score was associated with a 4.62-fold increase in the risk of emotional exhaustion, a 2.32-fold increase in depersonalization, and a 1.45-fold increase in reduced personal accomplishment.Footnote 102 Importantly, these associations remained robust even after adjusting for PTSD and secondary traumatic stress, reinforcing the primacy of organizational stressors over exposure-related explanations.Footnote 103

Associations between depersonalization and high effort, as well as between depersonalization and over-commitment, were reported among female aid workers, with ERI also being linked to increased heavy alcohol use in this group.Footnote 104 These findings suggest that organizational expectations and gendered role norms may interact to amplify burn-out and maladaptive coping in already marginalized groups. However, these patterns are only sporadically documented, and gendered dynamics are not a major focus of the present review.

From an organizational perspective, these findings point to the need for transparent and equitable reward systems, including fair compensation, recognition, and career progression pathways, as well as attention to how gendered expectations shape both effort and reward within humanitarian roles.

The job demand–control model

While ERI emphasizes reciprocity and reward, the job demand–control (JDC) model complements this perspective by focusing on how work design itself shapes psychological risk. The JDC model conceptualizes negative work-related outcomes as a function of the interaction between job demands and job control.Footnote 105 Job demands are most commonly defined as quantitative workload and time pressure,Footnote 106 but also include role conflict and physical and emotional demands.Footnote 107 Job control, or decision latitude, refers to the degree to which individuals can influence their work and is typically conceptualized through skill discretion and decision authority.Footnote 108

According to the JDC model, jobs characterized by high demands and low control (“high-strain jobs”) carry the greatest risk for psychological and physical ill-health, whereas low demands combined with high control (“low-strain jobs”) are associated with more favourable outcomes.Footnote 109 Two mechanisms explain this relationship: the strain hypothesis posits that high demands and low control independently or interactively increase the likelihood of ill-health,Footnote 110 while the buffer hypothesis proposes that job control mitigates the negative effects of high demands on well-being.Footnote 111

In humanitarian settings, where operational demands are high and decision-making autonomy may be constrained by security protocols, donor requirements or hierarchical management structures, the JDC model provides a valuable framework for understanding how loss of control contributes to burn-out, disengagement and moral distress. Empirical support for this structural explanation is strengthened by work integrating the JDC and ERI models. In a 2019 study, Jachens, Houdmont and ThomasFootnote 112 demonstrated that a combined ERI–JDC model provided superior prediction of psychological distress compared to either framework alone, highlighting how excessive demands, insufficient rewards and constrained autonomy interact to produce adverse mental health outcomes. This highlights the importance of organizational strategies that increase staff autonomy and decision-making latitude, even within constrained operational environments, for example though participatory management approaches, clearer role definitions, and decentralized decision-making where feasible.

Taken together, findings from the ERI and JDC models consolidate burn-out and psychological distress among humanitarian aid workers as phenomena rooted less in individual vulnerability and more in organizational design, reward systems, and cultural expectations of endurance and self-sacrifice, all of which represent modifiable targets for organizational intervention.

Conservation of resources theory

Conservation of resources (COR) theory provides a complementary framework for understanding burn-out and psychological distress among humanitarian aid workers by conceptualizing stress as the result of actual or threatened loss of valued resources, or insufficient return on resource investment.Footnote 113 Resources extend beyond material assets to include emotional energy, social relationships, professional identity and meaning.Footnote 114 Humanitarian work is characterized by chronic exposure to conditions that systematically erode these resources, including sustained high workload, insecurity, moral compromise, social isolation and organizational instability. COR theory emphasizes that resource loss is more salient than resource gain and that initial depletion increases vulnerability to further loss, creating loss spirals that progressively undermine well-being and functioning.Footnote 115

Although COR has rarely been applied explicitly to humanitarian aid workers, its core propositions closely align with empirical findings in the sector. Organizational stressors such as poor managerial support, role ambiguity, inequitable treatment, employment insecurity and exposure to harassment and discrimination have been shown to predict burn-out and psychological distress more strongly than trauma exposure alone.Footnote 116 From a COR perspective, these conditions represent cumulative resource losses across the emotional, relational and professional domains. Structural inequalities between national and international staff further intensify these loss processes, as unequal access to security, remuneration, decision-making power and career progression constrains opportunities for resource replenishment.Footnote 117 Organizationally, this underscores the need to actively protect and replenish staff resources through adequate rest policies, supportive supervision, equitable access to opportunities, and mechanisms that prevent cumulative resource depletion, particularly among structurally disadvantaged staff groups.

COR theory is particularly useful in integrating burn-out, bullying and moral injury within a single explanatory framework. Harassment and abusive supervision function as mechanisms of resource depletion, undermining self-esteem, social standing and perceived organizational support, while moral injury reflects the erosion of moral identity and meaning in ethically compromising contexts.Footnote 118 Organizational narratives that emphasize individual resilience without addressing structural drivers of resource loss risk perpetuating these loss spirals.Footnote 119 COR theory therefore reinforces the need for organizational interventions that prioritize resource protection and restoration, including equitable reward structures, psychosocial safety, supportive leadership and explicit recognition of moral and relational harm. Without such interventions, organizations risk perpetuating resource loss cycles that undermine both staff well-being and operational sustainability.

Perceived organizational support

While the ERI, JDC and COR models primarily identify structural sources of psychological risk, they offer more limited insight into why similar organizational conditions result in different psychological outcomes across individuals or teams. Organizational support theory provides a complimentary perspective by highlighting the role of perceived organizational support (POS) as a key moderating factor.Footnote 120 From this perspective, POS shapes how employees interpret and respond to high demands, resource loss, and effort–reward imbalances, and has emerged as a critical buffer against occupational stress.Footnote 121

Higher POS has been consistently associated with lower perceived stress and better mental well-being among humanitarian volunteers, middle managers and field staff across multiple contexts.Footnote 122 Longitudinal evidence further indicates that low POS predicts greater psychopathology well beyond the deployment period,Footnote 123 underscoring the enduring psychological impact of organizational climate. Interpersonal dynamics within teams play a central role in shaping POS and function as both risk and protective factors, and higher team cohesion has been associated with better mental health outcomes.Footnote 124 These findings reinforce the importance of relational work environments in sustaining meaning, engagement and ethical integrity under stressful working conditions. Strengthening POS therefore requires deliberate organizational investment in leadership development and team functioning, as well as communication practices that visibly demonstrate care, fairness and recognition.

Critically, the relevance of POS becomes most apparent where it is lacking. Bullying, harassment and discriminatory practices reflect not only interpersonal harm but also institutional failure, signalling to staff that well-being is subordinate to performance or hierarchy.Footnote 125 Organizational tolerance of mistreatment undermines perceptions of care, fairness and ethical consistency, thereby exacerbating burn-out and psychological distress. In humanitarian contexts, where work is explicitly value-driven, such failures may carry additional moral weight, intensifying dissonance between organizational ideals and everyday practice.Footnote 126 Addressing these gaps necessitates not only policy-level commitments but also consistent enforcement and accountability mechanisms which ensure that organizational values are reflected in everyday practice.

Together, the ERI model, the JDC framework, COR theory and the POS concept highlight organizational structures as key determinants of psychological distress among humanitarian aid workers. These frameworks show that burn-out, moral injury and identity disruption arise less from traumatic exposure alone than from sustained high demands, constrained autonomy, inequitable rewards, resource loss and insufficient organizational support. Integrating POS demonstrates that recognition, fairness and supportive relationships can buffer these harms, while their absence compounds distress.Footnote 127 This provides a foundation for shifting the discussion from individual vulnerability to institutional accountability, demonstrating that these frameworks can be directly applied to the design of organizational strategies aimed at reducing harm, strengthening support systems and promoting sustainable workforce well-being in humanitarian settings.

Discussion: Integrating evidence into organizational strategies

Humanitarian organizations have a pivotal role in shaping the mental health and well-being of their workforce, with evidence indicating that organizational and psychosocial factors contribute more substantially to distress than trauma exposure alone.Footnote 128 While these organizational mechanisms are not unique to the humanitarian sector, they are intensified by its distinct features, including value-driven work, exposure to moral dilemmas, inequities between national and international staff, and expectations of personal sacrifice, which together amplify both the risks and consequences of organizational failure. Structural interventions, such as organizational-level changes to work design, reward systems, leadership practice and resource allocation, offer a viable pathway to mitigating burn-out, moral injury and harassment, while fostering resilience and engagement. The preceding sections have highlighted how organizational structures shape psychological risk; building on this, the following section synthesizes these findings into key areas of organizational intervention.

One of the most direct avenues for organizational influence is through the design of work and reward systems. The ERI framework demonstrates that sustained high effort without adequate reward (be it financial, social or professional) predicts emotional exhaustion, depersonalization and reduced personal accomplishment.Footnote 129 In humanitarian contexts, where workloads are intense and recognition and job security are often limited, these imbalances are particularly pronounced, especially among national staff.Footnote 130 Complementing this, the JDC model highlights the importance of decision-making latitude, demonstrating how constrained autonomy under high-demand conditions contributes to moral distress and burn-out.Footnote 131 Together, these frameworks emphasize that organizational design, rather than individual vulnerability, is central to understanding distress.

COR theory further underscores the cumulative nature of psychological risk. By conceptualizing stress as the result of actual or threatened resource loss, COR highlights how harassment, inequitable treatment and moral injury progressively erode emotional, relational and professional resources.Footnote 132 In humanitarian settings, where such stressors are often chronic, these processes may generate loss spirals that undermine both well-being and function over time. Structural inequalities between national and international staff further intensify these dynamics by constraining access to resource replenishment.Footnote 133

POS provides a complementary lens by identifying protective organizational mechanisms. When staff perceive that their organization values their contributions and prioritizes their well-being, they demonstrate lower stress and better psychological outcomes.Footnote 134 Conversely, organizational tolerance of mistreatment, lack of transparency, or inconsistent support erodes trust, exacerbates moral injury and reinforces existing inequities.Footnote 135 In value-driven humanitarian contexts, such discrepancies between organizational ideals and lived experience may carry particular psychological weight.

Beyond structural and relational factors, the findings of this review also highlight the importance of identity and meaning-making processes. Humanitarian work is sustained not only by material conditions but by relational, ideological and cyclical forms of engagement that shape how individuals interpret and endure adversity. Where organizational environments support alignment between personal and institutional values, facilitate peer connection and acknowledge the emotional and ethical dimension of work, these processes can sustain engagement and mitigate distress. Conversely, where such alignment is absent, the risk of identity disruption and disengagement increases.Footnote 136

Finally, sustainability and accountability emerge as critical considerations. The persistence of psychological risk despite existing policy commitments suggests that organizational responses remain inconsistent and often superficial. Without systematic integration into operational priorities, interventions remain fragmented and insufficient to address structurally embedded stressors.Footnote 137 These findings collectively point towards the need for coherent, organization-wide approaches that move beyond ad hoc well-being initiatives.

Operational implications for humanitarian organizations

Building on the evidence presented, this review has identified a set of organizational leverage points through which humanitarian organizations can meaningfully reduce psychological distress and strengthen workforce sustainability for their staff. While many of the mechanisms identified (such as workload, reward and leadership) are not unique to the humanitarian sector, their effects are intensified by the specific conditions of humanitarian work, including exposure to moral dilemmas, strong value-based identities, and structural inequities between national and international staff. As such, addressing psychosocial risk in this context requires not only general organizational good practice, but also targeted strategies that account for the ethical, relational and operational complexities of humanitarian environments. The following priority areas emerge as particularly salient for organizational action:

  • • Redesign work and reward systems to address sustained effort–reward imbalances, including equitable and transparent compensation, recognition of contributions (including emotional and ethical labour), and the reduction of chronic workload and employment insecurity.

  • • Increase staff autonomy and ethical agency by expanding decision-making latitude, reducing role ambiguity and establishing safe mechanisms for ethical reflection, dissent and escalation in contexts of moral constraint.

  • • Protect and replenish staff resources through structured rest and recovery policies, embedded psychosocial support and equitable access to training and career development, with particular attention to preventing cumulative resource depletion over time.

  • • Strengthen leadership and perceived organizational support by investing in supportive and accountable management practices, transparent communication and confidential, trusted systems for reporting harassment, discrimination and ethical concerns.

  • • Address structural inequities within the workforce, particularly disparities between national and international staff in remuneration, security, decision-making power and access to opportunities, recognizing how these inequalities shape differential exposure to risk and distress.

  • • Support identity, meaning-making and reintegration, including facilitating peer support networks, reflective practice and structured post-deployment transitions to mitigate identity disruption and sustain long-term engagement.

  • • Embed accountability and sustainability mechanisms, integrating staff well-being into core operational priorities through dedicated resources, longitudinal monitoring, and leadership accountability for psychosocial outcomes.

These recommendations align with existing guidance on workplace mental health, including the WHO Guidelines on Mental Health at Work,Footnote 138 which emphasize the importance of organization-level interventions addressing psychosocial risk factors. They further extend these frameworks by specifying contextually grounded strategies tailored to the structural, ethical and relational demands of humanitarian settings.

Taken together, these strategies underscore that staff well-being is not an ancillary concern but a core component of effective and ethical humanitarian action. Humanitarian organizations can substantially influence employee well-being by addressing structural inequalities, implementing fair and supportive work systems, protecting key resources, fostering perceived organizational support, and supporting identity, meaning-making and integration.

This requires a shift away from resilience-focused narratives centred around individual endurance and towards integrated organizational approaches in which staff mental health is embedded as a core operational priority within leadership, resource allocation and accountability structures. Such a shift is essential not only to safeguard the well-being of both national and international staff, but also to maintain the effectiveness and ethical integrity of humanitarian response.

Footnotes

The advice, opinions and statements contained in this article are those of the author/s and do not necessarily reflect the views of the ICRC. The ICRC does not necessarily represent or endorse the accuracy or reliability of any advice, opinion, statement or other information provided in this article.

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34 Ibid.

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36 V. Agarwal and P. M. Buzzanell, above note 30.

37 Ibid.

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39 Ibid.

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48 G. Houldey, above note 44.

49 Ibid.

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51 M. L. K. Khera, C. Welton-Mitchell and G. V. Mitchell, above note 5.

52 Ibid.

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54 M. L. K. Khera, C. Welton-Mitchell and G. V. Mitchell, above note 5.

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59 L. Jachens, J. Houdmont and R. Thomas, above note 1.

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61 Ibid.

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63 C. B. Eriksson et al., above note 58.

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66 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

67 UNHCR, above note 55.

68 C. Y. S. Foo, Helen Verdeli and Alvin Kuowei Tay, above note 3.

69 UNHCR, above note 55.

70 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

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73 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

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81 ALNAP, above note 75.

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88 L.-C. Chu, above note 83.

89 P. E. Spector and S. Fox, above note 87.

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97 A. Ager et al., above note 71; ALNAP, above note 75.

98 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

99 J. Siegrist, above note 6.

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102 UNHCR, above note 55.

103 L. Jachens, J. Houdmont and R. Thomas, above note 1.

104 Ibid.

105 R. A. Karasek, above note 7.

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107 Robert Karasek and Töres Theorell, Healthy Work: Stress, Productivity, and the Reconstruction of Working Life, Basic Books, New York, 1990.

108 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

109 R. A. Karasek, above note 7.

110 Natasja Van Vegchel, Jan De Jonge and Paul A. Landsbergis, “Occupational Stress in (Inter)action: The Interplay between Job Demands and Job Resources”, Journal of Organizational Behavior, Vol. 26, No. 5, 2005.

111 M. Van Der Doef and S. Maes, above note 106.

112 L. Jachens, J. Houdmont and R. Thomas, above note 1.

113 Stevan E. Hobfoll, Jonathon Halbesleben, Jean-Pierre Neveu and Mina Westman, “Conservation of Resources in the Organizational Context: The Reality of Resources and Their Consequences”, Annual Review of Organizational Psychology and Organizational Behavior, Vol. 5, No. 1, 2018.

114 Mina Westman, Stevan E. Hobfoll, Shoshi Chen, Oranit B. Davidson and Shavit Laski, “Organizational Stress through the Lens of Conservation of Resources (COR) Theory”, in Pamela L. Perrewe and Daniel C. Ganster (eds), Research in Occupational Stress and Well-Being: Exploring Interpersonal Dynamics, Emerald, Bingley, 2004.

115 S. E. Hobfoll et al., above note 113.

116 A. Ager et al., above note 71; C. B. Eriksson et al., above note 58.

117 ALNAP, above note 75.

118 S. E. Hobfoll et al., above note 113; M. L. K. Khera, C. Welton-Mitchell and G. V. Mitchell, above note 5.

119 M. Westman et al., above note 114.

120 Robert Eisenberger and Florence Stinglhamber, “Perceived Organizational Support”, in Robert Eisenberger and Florence Stinglhamber, Perceived Organizational Support: Fostering Enthusiastic and Productive Employees, American Psychological Association, Washington, DC, 2011; James N. Kurtessis et al., “Perceived Organizational Support: A Meta-Analytic Evaluation of Organizational Support Theory”, Journal of Management, Vol. 43, No. 6, 2017.

121 R. Eisenberger and F. Stinglhamber, above note 120.

122 K. Aldamman et al., above note 2; H. Strohmeier, W. F. Scholte and A. Ager, above note 3.

123 Sigridur Bjork Thormar et al., “Organizational Factors and Mental Health in Community Volunteers: The Role of Exposure, Preparation, Training, Tasks Assigned, and Support”, Anxiety, Stress and Coping, Vol. 26, No. 6, 2013.

124 A. Ager et al., above note 71; H. Strohmeier, W. F. Scholte and A. Ager, above note 3.

125 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

126 H. Strohmeier, W. F. Scholte and A. Ager, above note 3.

127 K. Aldamman et al., above note 2; C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

128 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3; L. Jachens, J. Houdmont and R. Thomas, above note 20.

129 J. Siegrist, above note 6.

130 L. Jachens, J. Houdmont and R. Thomas, above note 101; H. Strohmeier and W. F. Scholte, above note 1.

131 R. A. Karasek, above note 7; L. Jachens, J. Houdmont and R. Thomas, above note 101.

132 S. E. Hobfoll et al., above note 113; S. E. Hobfoll, above note 8.

133 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3; K. Aldamman et al., above note 2; ALNAP, above note 75.

134 R. Eisenberger and F. Stinglhamber, above note 120.

135 C. Y. S. Foo, H. Verdeli and A. Kuowei Tay, above note 3.

136 V. Agarwal and P. M. Buzzanell, above note 30; J. E. C. Lee, K. A. Sudom and M. A. Zamorski, above note 28.

137 H. Strohmeier and W. F. Scholte, above note 1.

138 WHO, above note 77.