On July 11, 2016, South Sudanese soldiers went on a four-hour rampage through Terrain, a residential compound in the city of Juba that's popular with expats. They beat and raped several women, ransacked buildings and executed a local journalist. As part of an ongoing civil war, the attack was one of the most brutal and most targeted against international aid workers.

When news of the atrocities reached Megan Nobert, she was horrified. Not only was the 30-year-old Canadian devastated for her fellow aid workers, it also dredged up heart-wrenching memories of her own assault just one year prior.

“It was hard to read and it brought up a lot of reminders of what happened to me in South Sudan,” recalls Nobert, who’s now based in Geneva, Switzerland.

In the summer of 2015, Nobert arrived in the small town of Bentiu to work with local communities in combatting sexual violence and providing support for survivors. Never could she have imagined that she’d be the one who would end up seeking help.

Shortly after arriving, Nobert was drugged and raped by a local contractor working for the UN. After receiving initial medical attention from MSF (Doctors Without Borders), she left South Sudan to clear her head. After only three weeks, she returned to work. 

“I went back because I needed to prove to myself that I could mentally do it,” Nobert explains. “As humanitarian workers, we like to think we’re invincible and that nothing affects us—and more importantly, that what affects us isn’t nearly as bad as what affects the local population.”

It’s this mentality that has caused so many aid workers to suffer from PTSD (post traumatic stress disorder), depression and anxiety. In South Sudan and around the world, humanitarian workers are at a high risk of experiencing burnout. In a 2015 survey conducted by the Global Development Professionals Network, 79 per cent of aid workers reported that they had experienced mental health issues.

“As humanitarian workers, we like to think that nothing affects us—and more importantly, that what affects us isn’t nearly as bad as what affects the local population.”

This has been attributed to several factors: aid workers feeling like they don’t have the right to complain; not wanting to leave a project; trying to avoid disrepute in the aid sector by reporting attacks and assaults; and needing the work for financial stability.

“It makes humanitarian work look bad when employees are being attacked, raped, burned, etc.,” says Nobert, explaining why so many aid workers withhold information of experiences on the ground.

In Nobert's case, although she admits that she “wasn’t okay” when she returned to work, she didn’t want to abandon the project—nor could she financially afford to. However, a month after returning to South Sudan, reality set in. Nobert realized her limits, leaving both her job and the country.

“All my knowledge and training went out the window. I shut down—I turtled and went inside,” she says.

Learning to seek help

According to research conducted by the Antares Foundation, an organization focused on improving the quality of humanitarian assistance, aid workers are more likely to develop anxiety and depression after being deployed for fieldwork. For some, like Nobert, the trigger may be one incredibly traumatic incident, but for others, the intrinsic nature of the work starts to tear them down.

“The threatening and unpredictable environment is, in itself, a constant challenge to the nervous system,” says Lynn Keane, psychotherapist and safeguarding coordinator for InterHealth. Based in London, InterHealth specializes in providing healthcare services—including visits to psychologists—to people in the humanitarian field.

Keane says that development work—especially in conflict zones or while working with vulnerable populations—can greatly affect people. It may become difficult to sleep or eat well, exercise, or to have a rewarding life outside of work, all of which takes its toll. And if tensions on the ground escalate and become unstable, the risk of succumbing to fatigue and stress increases. To combat this, aid workers need to seek help straight away when emergencies occur.

When fighting erupted in Juba in July 2016, Keane says more than 200 aid workers visited their neighbouring Nairobi clinic in just two weeks, seeking psychological care. She says this is consistent with a rising trend in people’s willingness to disclose difficulties.

Safe space for survivors

However, a stigma still exists when it comes to mental health. Although Nobert says that while agencies like InterHealth are filling an important void, more should be done to cater to the well-being of aid workers.

Following her rape, she said that her organization didn't know how to deal with it.

“They gave me a bit of money to pay for a couple sessions of therapy,” she explains, acknowledging that she was probably suffering from PTSD and didn’t even realize it. Nobert believes that although some organizations are really great at providing care in the field and after, some still have a ways to go.

Today, Nobert is the Founder and Director of Report the Abuse, an NGO based in Geneva that works on issues of sexual violence within the humanitarian and development community. Based on Nobert’s research, she estimates 86 per cent of humanitarians know a colleague who has experienced sexual violence while working in the field. Norbert’s goal is to create a safe space for survivors, so that they feel like they have someone on their side.

“What we see and what we do [as aid workers] has an impact on us,” she says. It's critical for humanitarian organizations and aid workers to acknowledge that the people doing the work of caring for the vulnerable, also require care.

Six steps to self-care

Whether you’ve been working in humanitarian aid for years or are simply participating in a short-term volunteer opportunity, working with vulnerable populations and in unfamiliar circumstances can take its toll on your mental and physical health.

InterHealth, an organization “committed to the health and wellbeing of those making the world a better, fairer and healthier place” offers six strategies that can help you to cope:

1. Have a strong support network in place. If somebody’s already prone to difficulties such as depression, anxiety, self-harming and obsessive-compulsive tendencies (amongst others), these can be enhanced when working abroad in often isolating situations. Be sure to have a strong network of friends and family in place, as it’s one of the greatest predictors of resilience.

2. Reflect on your usual reactions to stressful events. If you have serious vulnerabilities, be sure to consult a medical professional before travelling for a significant period of time. 

3. Take objects of comfort with you. This can help to ease anxiety in new environments.

4. Ensure you have a healthy work-life balance. Curfews can create monotony and isolation. Be sure to add variation to your day and spend time outdoors.

5. Make sure you know who is responsible for volunteer health. Know who the leaders are within the organization (and find one you trust and feel comfortable with) and identify where the health clinics are and how to get there.

6. Avoid putting yourself at risk. Don’t travel alone or with people you don’t know. 

This article originally appeared in the Winter 2017 issue of Verge.