Best Paper Award
Stresses and Traumas Experienced by Humanitarian Aid Volunteers and How Yoga Can Help

My name is Jennifer Dany Aubé and I’m from Canada.  I work for an organization called Médecins Sans Frontières also know by its acronym MSF.  You might be more familiar with the English name Doctors Without Borders.  Seven French doctors created MSF in 1971, which explains why the official name of the organization is in French.  Since then MSF hasdeveloped into an international organization with offices in 18 countries.  It recruits more than 3000 international volunteers per year to work on projects in over 80 countries.  MSF is the world’s leading independent international medical relief organization.   They have been providing medical help to people caught in many kinds of catastrophes: armed conflicts, natural disasters, epidemics of disease, and famines.

MSF received the Nobel Peace prize in 1999, and since then has expanded its role to the Campaign for Access to Essential Medicines so that patients do not die from treatable diseases for lack of affordable medicines.  (explain importance India played in reducing prices for HIV/AIDS drugs)

I wish to briefly speak about the stresses and traumas experienced by humanitarian aid volunteers and how yoga can help them.

Being in the field has its stresses.  Actually the stress starts accumulating before their mission begins.  They need to sublet their apartment, or move and put their things into storage.  There’s deciding what to pack, which should be neither too much nor too little.  There’s organizing getting all their vaccinations and required paperwork done, like applying for visas, and for some countries that can be an arduous process.  There’s mentally preparing to leave familiar surroundings, family and friends, for the unknown. 

Then, while in the field, volunteers find themselves living in remote areas, where communicating with family and friends is sporadic at best.  In unfamiliar surroundings they have to adapt to a different culture, different language, different social structure, different food, different weather etc. Volunteers not only work together, but they also live together, which creates another level of stress.  What if they need to share a room with others, and they are used to having private space and being alone (give example of Darfur).   For a westerner this could be a big problem.  What if the person sleeping in the room or the bed next to them snores?  And they don’t get enough sleep?  What if there’s a person on their team that they really don’t get along with?  Personality clashes between volunteers can be a great source of stress, especially if there’s no way to get away from each other.

Volunteers must also abide by a strict code of conduct, and failure to do so might mean expulsion from the team.  In yogic terms we can equate this with the yamas and niyamas and we all know how difficult it is to follow the yamas and niyamas.  Being obligated to behave in a certain way can also be a source of stress. 

Finally, because of the situations MSF works in, there are often curfews that are imposed. These curfews challenge ideas about freedom and are stressful for most.  For some, freedom is doing what they want, when they want, however they want to do it.  For a yogi we see succumbing to one's desires as a form of bondage, for us freedom is moksha.  

I think that you would agree that humanitarian aid volunteers live in their own type of Ashram while in the field; a type of laboratory for transformation.

Clearly the layers of stress are accumulating and we haven't gotten to the most stressful part, which is the field mission itself.  I would say that the most traumatic thing a volunteer needs to deal with is bearing witness to the suffering of others.  How does one cope with seeing malnourished children?  Abject poverty?  Families forced to flee from their homes because of war?  Bearing witness to mass starvation caused by the military that purposely burn crops in order to gain control over a population?  Consistently hearing stories about rape, murder and hatred?

Now more specifically...

Imagine the stress of a water and sanitation engineer who is responsible for sustaining a clean and adequate water supply to 10,000 refugees in an arid climate?  We can go days without food but how long can we survive without water? 

Imagine the stress of a logistician who is responsible for the transport of a cold storage unit for a measles vaccination campaign.  If the vaccine isn't maintained at a certain temperature it becomes ineffective, and these prevention campaigns are usually widespread meaning thousands of people get vaccinated.  If not done properly then thousands become susceptible to the disease.

Imagine the stress of a doctor in the middle of a war zone and all he can do is stitch up wounds.  He is frustrated by the realization that doctors cannot stop hatred; doctors cannot stop war. (give example of Rwandan Genocide of 1994)

Imagine the stress of a lab technician who determines that 35% of blood samples tested are HIV positive? That every family in the area they are in is affected by the disease.  That during their three-month mission they see many young patients die including three of their co-workers.  Knowing that there are drugs that could prolong life so that people can work and support their families but that there is no program currently set up in the area?    

Imagine the frustration of a nurse after months of seeing people die from treatable infectious diseases simply because they cannot afford the medicines that could save their lives, and that by the time they come to the health clinic or hospital they are too sick to recover. 

Imagine the stress of international aid workers who are evacuated from their mission, usually because of violence or threats of violence in areas of conflict, and who must not only leave the local staff behind but also their patients? 

It takes a special person to do the work of a humanitarian aid volunteer.  The ones who go back again and again clearly have opened their hearts to the suffering of others - they have that spirit of service - they are true karma yogis.  They might not know anything about yoga philosophy or asanas or pranayama but they are yogic-minded.  We need to be grateful that there are people out there willing and able to do this type of work – because it isn’t easy

work – and someone has to do it.  Due to recent events (the tsunami), I think that we can all appreciate this more.

Here are a few yogic concepts that would help humanitarian aid workers effectively deal with stress while on mission.

When thinking about this, the first thing that came to my mind was the concept of Vairagya or non-attachment. One must do their dharma – perform their duties to the best of their ability and detach themselves from the results.  One must realize that it is not possible to help or save everyone.  However being detached does not mean that one stops caring.  (give example of Rwandan genocide and importance of temoignage) True Karma Yoga is done from the heart, from a place of deep compassion, caring and concern, but it also means not being attached to the fruits of their labors.  However having done their best, it doesn’t mean that tasks were done faultlessly.  Mistakes might have been made; conflict and tension might have been created within the team.  Therefore swadyaya, or the ability to step back, to analyze their thoughts, behaviour, feelings, motivations, actions etc. is important.  This allows them to learn from their mistakes, to adjust (explain yogic concept of Samradhya)themselves so as to improve the quality of their work and to improve their relationships with others.  Ultimately, this laboratory of transformation which is field work, helps them to grow spiritually, to develop into a better human being.  The people who go to the field are pretty amazing people to begin with, but despite this they return from their missions transformed.  It is impossible for them to return exactly the same as when they left, and it has been my privilege to bear witness to their transformations.

Then there are practical tools like deep yogic breathing and relaxation techniques.  The physical response to stress is that the sympathetic nervous system is stimulated.  To counteract stress, a relaxation response needs to be there to stimulate the parasympathetic nervous system for balance.  However when stressful factors are continually present, and the body and mind never relax, then the body is permanently in the sympathetic nervous system.  If left unchecked, this will lead to a lowered immune system and leave one more susceptible to illness and bad moods.  One is agitated and anxious all the time and unable to make proper decisions, which is dangerous when peoples’ lives are at stake.  And if the stress continues to accumulate for a long period of time, then the inevitable result is burnout.  Simply, when the body and mind have had enough they crash.  (give example of computer) Unfortunately, I’ve known people who have suffered from burnout, and it takes a long time to recover from it.  It would be much wiser to learn and practice simple techniques like Marmanasthanam kriya, vibhaga pranayama or the hathenas.  Or in the very least, to simply allow themselves to stop for a few minutes to consciously breathe deeply when everything around them seems unbearably chaotic.  Even this simple conscious act would be helpful. 

But sharing the knowledge of these practical concepts to humanitarian aid volunteers is challenging for many reasons.


  1. 1.The people who are attracted to high stress environments are type A personalities.  They can’t sit still; they always need to be doing something.  Stress stimulates them to do more and more.  They are only happy when they are doing something.

  1. 2.They are unconscious of their need to relax.  And worse they don’t know what relaxation is.  I’m realizing that most westerners don’t know what relaxation is.  Relaxation is simply the ability to completely let go: let go of physical and mental tension as well as emotional traumas.  But in order to let them go you must first be aware that they are there, and again this brings us back to this concept of swadyaya that was mentioned earlier.  The truth is that it becomes harder to let go of something the longer you’ve held onto it.  So it is best to practice relaxation techniques regularly to let go of tension as it manifests and not to let it accumulate.  However this is easier said than done.  People confuse relaxation with pleasant activities like spending the day at the beach, shopping or reading a book. Although these activities are a pleasant distraction to a stressful environment, they in no way mimic the deep relaxation afforded by yogic relaxation techniques.

  1. 3.The culture of the humanitarian aid sector is that the focus is on the health of the populations in danger and not on the health of the humanitarian aid volunteers.  This is a slippery slope because if the volunteer’s health is compromised then they aren’t able to do their work, which in turn negatively affects the population they are serving.

In conclusion, being yogic minded myself, and having the privilege to meet with MSF field volunteers before and after their mission to listen to their stories, how do I cope with seeing good people suffer from both physical and mental stresses and the emotional traumas that fieldwork affords them?  I must take my own advice and practice vairagya – detachment.    In the end all I can do is be strong in my own practice and provide support to those who are ready and willing to learn – one person at a time. And in this small way – I too will have helped the populations MSF serves.

Jennifer Dany Aubé

January 2005

I presented this paper at the 2nd International Seminar on Integral Yoga Psychology in Pondicherry in January 2005.  The event brought together scholars and practitioners from across the globe with a common aim to discuss a variety of issues relating to the relevance and application of Eastern and Western psychological and spiritual approaches in meeting the challenges facing humanity.

I was presented with the best paper award and a prize of Rs.500, which is about $15 canadian.