Journal of Human Security | 2015 | Volume 11 | Issue 1 | Pages 19‒25
DOI: 10.12924/johs2015.11010019
ISSN: 1835-3800
Research Article
Human Security Workers Deployed in Austere Environments:
A Brief Guide to Self-Care, Sustainment, and Productivity
Thomas F. Ditzler
*, Patricia R. Hastings
and Abigail D. Hoeh
Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA;
E-Mail: [email protected] (ADH)
Joint Chiefs of Staff (JCS) Surgeon's Office, United States Department of Defense (DOD) , 1400 Defense
Pentagon, Washington, DC, USA; E-Mail: patricia.r[email protected]
* Corresponding Author: E-Mail: thomas.f.ditzler[email protected]; Tel.: +1 8084331246
Submitted: 15 September 2014 | In revised form: 24 December 2014 | Accepted: 15 January 2015 |
Published: 14 April 2015
Abstract: Since the early 1990s, the human security movement has sought to expand the
concept of security beyond the traditional military defense of national borders to focus on the
intra-state security needs of populations at the individual level. Specific initiatives frequently
address problems of population health, ethnic conflict, religious extremism, human rights,
environmental or natural disasters, and other critical issues. For expatriate human security
workers in the field, the environment may present meaningful challenges to their wellbeing and
productivity. This can be especially so for those who have relatively more experience in
academic, business, or administrative settings, and less in the field. The authors' goal is to
illuminate practices that have demonstrated their efficacy in enhancing wellness, sustainment,
and productivity for human security and other humanitarian and development workers deployed
to austere environments. The content represents a synoptic consensus of best general practices
and guidance from a range of resources comprising United Nations agencies and activities,
national and international non-governmental organizations (NGO's), private volunteer organ-
izations (PVO's), national military services, and international business concerns.
Keywords: humanitarian; human security; non-governmental organizations; population health;
private volunteer organizations
1. Introduction
From its beginnings in the early 1990's, the human
security movement has engaged a stunningly broad
constellation of challenges. Human security workers
may represent disciplines of anthropology, interna
© 2015 by the authors; licensee Librello, Switzerland. This open access article was published
under a Creative Commons Attribution License (
tional relations, environmental science, ethics, health,
engineering, economics, law, or other professional
fields. For those who engage in human security work
in the field, environments are often austere. Workers
may confront their mission in the context of civil strife,
limited or depleted natural resources, endemic disease,
meager or absent health care, unsafe transportation,
inadequate public health assets including water and
sanitation, and other critical infrastructure. Research on
psychological distress among such workers indicates
that chronic exposure to such environmental stressors,
including the suffering of others, is associated with
negative mental health outcomes, including depression,
anxiety, and "burnout" characterized by long-term ex-
haustion and diminished interest. These outcomes are,
in turn, associated with decreased work satisfaction
and productivity [1]. To effectively meet the challenges
of these environments, workers require strong support
from their sponsoring organizations; the best prepa-
ration emerges from a transparent and interactive
agency-worker partnership that embraces a shared re-
sponsibility for mission outcome. Specific agency-based
support should include pre-employment screening of
potential workers, provision of mission-specific edu-
cation, training, and ongoing worksite support in the
field. Whatever the specific activities of the agency,
planning for success should include thorough worker
preparation in self-care and sustainment. Specific skills
typically include healthy practices of personal hygiene,
diet, physical fitness, cultural adaptation, socialization,
and development of effective stress management strat-
egies. These skills are mission-essential for all deployed
workers. The advantage of healthy, self-sustaining work-
ers is reflected in greater mission success, improved
job satisfaction and increased worker longevity [1].
2. Pre-Deployment Issues
If being engaged a new organization, workers are ad-
vised to contact current or former workers familiar with
the organization to learn as much as possible about its
leadership style and general culture, to get a clear
understanding of screening, hiring, and field support
procedures as well as vacation or leave policies and
access to health care.
Many experienced workers make a "deployment
book" to leave at home with an appropriate person.
The content typically includes relevant personal infor-
mation that someone else would need to contact the
worker. At the very minimum this should include names
and contact information of key deployment agency per-
sonnel at both the home office and in the area of
operation (AO), copies of the ID page of the worker's
passport with several other recent pictures of him or
her, and a letter of instruction on what to do if the
worker is ill, detained, or missing. A more substantive
document might include copies of required author-
izations and permissions necessary to permit another
to carry out legal, business, financial or other personal
responsibilities on the worker's behalf, such as a power
of attorney.
In addition, it is important for the worker to con-
duct a thorough background study of the AO. There is
no single best way to organize the effort, but areas of
focus often include the region's history, geography,
social organization, political institutions, spiritual sys-
tem(s), health care, transportation, important social
customs and traditions, and language. Learning some
of the local language is an obvious advantage in any
environment. In situations with one principal language,
workers can pursue pre-deployment study. There are
many government, academic, and commercial sources
available in a range of media.
Unfortunately, many of the languages of the field
environments human security workers engage are
not commonly spoken, or the number of languages or
dialects commonly spoken precludes the acquisition of
meaningful skills. This is especially so in settings in
host communities with a large number of refugees or
internally displaced persons. A properly vetted local
translator is a necessity, and can also serve as a
cultural informant to provide useful information on a
range of issues related to important customs, tra-
ditions, and social conventions. For workers attached
to organizations already in the AO, translation and
related language issues are usually managed by the
sponsoring agency. In the absence of a translator, the
pre-deployment language practice mentioned above
can go a long way in facilitating productive social ex-
changes. It is a truism that workers' level of wellness,
comfort, security and productivity can be largely
predicted by their working knowledge of the culture
around them.
3. Health Preparation
Health authorities recommend that basic preparation
include a comprehensive pre-deployment medical ex-
am, a review of routine personal medications, and
consultation on medications indicated for potential
medical threats in the AO [2]. A dental exam is also
considered good planning. It is worth noting that even
in otherwise sophisticated military organizations, dental
problems are a common cause of evacuation from the
field. Hormonal changes may predispose females to
gingivitis, making a dental exam more important than
many may realize [3]. For routine maintenance medi-
cation, seasoned workers often take a supply that
extends two months beyond the scheduled deploy-
ment. In preparation for work in arduous environ-
ments, the basics of nutrition would advise keeping a
healthy weight with a BMI of 19‒25, and eating a
balanced diet including grains, fruits, vegetables,
milks, and meats/proteins. Women need more iron,
calcium and folic acid. If unable to secure these nu-
trients on a reliable basis, it is best to discuss possible
supplements with a health care provider.
4. Equipment
Proper fit and comfort of personal gear is an important,
but easily neglected aspect of self-care. Most military
and camping equipment items are sized for males and
may need to be modified for females. Injuries to the
lower back and legs of female soldiers are twice those
of men [4]. Jumping from relatively low heights can
cause knee and hip injuries. Women are more prone to
stress fractures of the hip and leg. Females involved in
extreme athletic endeavors can have similar problems
due to low body fat, loss of menstruation, and hor-
monal changes which can weaken bones and pre-
dispose to stress fractures [5]. One of the factors con-
tributing to these types of injuries may be equipment,
which is not typically designed for females. [6]. A
female may have difficulty carrying the same load in
the same way as a male, often because she has a
shorter back. The best backpack for females is often
one that has adjustable shoulder straps, a chest strap,
and a waist belt to place some of the bag's weight on
the hips. Because a female's shoulders may not be as
broad as a male's it is often beneficial for a greater
amount of weight to be placed on the hips.
Ankle injuries are also more common in women
than in men. If at all possible, women should select
boots made for the female feet. Females have higher
arched and semi-curved feet. In contrast, the male
heel and ankle is typically wider due to the pull of the
calf muscles and musculature [7]. Before deploying,
women should ensure that foot-gear is well broken in.
Also, a supportive sports bra can make long treks much
more comfortable and decrease back and shoulder
pains. Most females with field experience would advise
a pull over the head sports bra to lengthen its use, as
harsh washing can break or rip the eyelets used to
fasten a regular bra.
5. Safety and Security
Among seasoned humanitarian workers there is a com-
mon saying: "if you don't have security, you don't have
anything". This aphorism is especially true for emer-
gency workers responding to large-scale natural or tech-
nologic humanitarian disasters, or those who are work-
ing in areas of armed conflict or other general social
strife. Clearly, workers deployed to these areas are in
exceptional circumstances, and security measures are
unique to each environment. Typically, security practices
involve responses reflecting the collaborative efforts of
the supporting humanitarian agencies/organizations,
the host government, and in some instances, military
personnel or civilian police (see Appendix A for more
information about physical security in high risk areas).
In stable environments, unavoidable hazards, threats,
and vulnerabilities require a clear and consistent risk
management strategy. The most effective security
plans start with detailed background knowledge of the
AO; there is no substitute for situational awareness of
the environment and culture. Below are a number of
principles, precepts, and practices that have demon-
strated their utility in maximizing collective security
and wellness for program leadership and workers.
Safety and security is everyone's concern at both
the organizational and personal level. A useful aph-
orism is: "have the plan, know the plan, carry out the
Safety plans and rules must be communicated to
all; acceptable and unacceptable risks must be clearly
defined along with procedures for exceptional cir-
cumstances ( at night, traveling alone, etc.)
Ensure that safety and security issues are an
integrated part of administrative and supervisory
meetings. This will reify the expectation of shared
security vigilance among colleagues
Have clear contingency plans for special threat
situations including severe weather, important infra-
structure failure, civil disruption, or other security
Communication practices are critical and should
include standardized training for communication
equipment, procedures and terminology.
Know relevant local laws and customs, especially
about what to do in cases of a vehicular collision,
pedestrian accident, or inadvertent property dam-
age. Especially in rural tribal settings or areas em-
bracing transitional justice, the customary response
may be harsh.
Do not defer routine vehicle maintenance, and
ensure that all vehicles have up-to-date maps on
board along with serviceable mobile communications
If possible, have secure vehicle parking and main-
tain an environmentally appropriate medical kit on
Personal wellness is a large part of safety. In
addition to physical fitness, adequate sleep and ap-
propriate nutrition, workers can increase safety for
themselves and others by abstaining from recre-
ational drug use, and moderating alcohol.
For those concerned about the need for emergent
medical care or the possibility of rapidly deteriorating
security conditions, consider rescue and evacuation
insurance (see Appendix B for more information on
several well-known firms).
6. General Hygiene in the Field
The routine conveniences of daily hygiene materials
and practices may be much less available in the field.
Important hygiene practices to maintain are: dental
care, regular bathing, hydration maintenance, avoid-
ance of simple sugars, and abstaining from alcohol
and tobacco products. Fluoride toothpaste is advised
in most cases. In the absence of toothpaste, table salt
or baking soda may work well, or use a cloth and
water to wipe over each tooth surface to help avoid
debris build-up.
Ideally, all workers should have access to a way to
wash every day to avoid disease, parasites and skin
infections. Showers are preferred to baths to avoid
urinary tract infections (UTIs). Minimal requirements
for bathing are: a secure environment, at least one
quart of water, soap, and proper drainage. If no
shower facilities are available and water use is restricted,
commercially available wet-wipes can ensure a minimum
level of hygiene until a shower is available. Wet-wipes
may also be used as toilet paper if this comfort is not
A common hygiene problem for workers (and for
women in particular) is difficulty urinating in environ-
ments with less than optimal privacy or in situations in
which it could be dangerous to disrobe. In responding
to this, workers may sometimes resort to strategies
that are sub-optimal for peak performance and health.
For example, some may decide to voluntarily minimize
fluid intake to avoid urination, which could increase
the likelihood of UTIs. If one will be away from any
medical facilities it may be practical to have an
antibiotic prescribed for use if needed. In addition to
increasing the likelihood of a UTI, water restriction
can cause dehydration. Voluntary water restriction
may not be subjectively perceived as dangerous to
the individual owing to the belief that the sensation of
thirst will automatically cue them when it is time to
hydrate. In reality, anyone with a clear sensation of
thirst is already dehydrated. Controlled studies
indicate that among women, even mild dehydration is
associated with headache, lowering of mood, in-
creased fatigue, increased perception of task difficulty,
and impaired concentration [8‒10]. More severe
restriction can also lead to heat injury including heat
exhaustion or heat stroke, which can be fatal. The risk
of heat injury may be increased in very dry environ-
ments in which the sensation of perspiration may not
provide a clue for fluid loss [11]. Urine retention also
increases the likelihood of bladder injury in the in-
stance of blunt impact or deceleration injury (e.g. fall,
or vehicular mishap) as the pelvis or abdomen can
more easily traumatize the distended bladder. Fluid
intake is critical to peak performance and, though this
may be considered in hot environments, it can be
problematic in cold regions where women can face
the danger of cold exposure because of the need to
disrobe more fully to urinate.
It is not unusual to have some change in menstrual
period length or flow in a physically or emotionally
stressful environment. Women are encouraged to have
enough sanitary supplies for at least 30 days if resupply
is predictable and longer if resupply is not assured.
Some external irritation may occur in hot environments,
but cornstarch or a thin layer of petroleum jelly may
improve comfort. Pads can also be used if stress incon-
tinence may be an issue. For women who use tam-
pons, cardboard applicators are usually a better choice
than plastic because plastic applicators can cause
micro-abrasions in the vaginal mucosa and are not bio-
degradable. Both tampons and pads can do double
duty when used as dressing or to occlude bleeding
7. Climate Issues
It has long been known that a high level of physical
fitness is a key element in worker safety and produc-
tivity. As a practical matter, physically fit workers are
less likely to get sick or injured; and they recover more
quickly when illness or injury occurs. In addition, active
physical conditioning helps workers to acclimatize to
the environment. This is especially important in envi-
ronments of extreme heat or cold including desert en-
vironments, where daily cycles of extreme temper-
atures are common. Caution is advised when exercising
in very hot or cold weather as chance of injury tends to
increase with temperature extremes. In general, wom-
en do not tend to perspire as quickly or easily as males
[12]. The way the female body adapts to heat relies on
the principal of a smaller total body mass combined
with the larger surface area to body mass ratio. This
explains why women will often do better than men in
hot topical (wet) environments, but not as well initially
in hot desert (dry) locations where perspiring can make
a difference in acclimatization (US Army Public Health
Command, 2010). Also, women typically have lower
finger temperatures and higher rates of peripheral vas-
cular disorders that could make them more susceptible
to peripheral cold injury.
8. Social Acculturation and Gender Roles
The process of adaptation to a new and sometimes
jarringly different social environment has traditionally
been referred to as "culture shock". Hopefully workers
will have availed themselves of basic background in-
formation about the work environment and the proc-
ess of cultural adjustment. In many areas, traditional
gender role expectations may place meaningful con-
straints on working women, even if they are expats in
a humanitarian role. Expat female and male col-
leagues in these areas are well advised to have a
clear understanding of culturally acceptable inter-
action in a shared space.
Customary dress is often conservative for both men
and women. This may involve covering the limbs, (i.e.
long pants for males and long sleeves and long pants
or long skirts for females), and often includes covering
the hair for females. These modes of dress can make
one's job more difficult physically and emotionally. For
example, if acceptable clothing comprises a full-length,
dark colored robe, heat may become a meaningful
problem. Likewise, covering the ears can decrease the
ability to hear the spoken word or localize other
sounds. Full facial coverage can also impair peripheral
vision and the ability to see what is near ones feet. In
some areas, women wear tight fitting shorts under
their skirts to ensure if there is an inadvertent move-
ment of the skirt that their upper legs will not be seen.
Norms for behavior may not allow male or female
workers to talk to the opposite gender. Females may
not be allowed to be in the company of males who are
not a relative; in some instances, a male aid worker
may put a local female at risk by speaking with her or
being in her company. Age can also be a difficulty with
regard to the youth of a country adapting to foreign
languages more quickly than adults and change the
dynamics of a family or clan if the younger children or
adolescents are acting as interpreters.
Body language can be a powerful force for good or
ill. In many circumstances, there are subtleties that
must be briefed to those going into an area. It is espe-
cially important to be aware of norms about physical
touching, and in many cultures there a certain gestures
that are best avoided. Other normative communication
issues might concern gaze behavior. In many western
cultures, looking another person in the eyes is often
considered a sign of sincerity; in many other settings it
may be considered rude or aggressive. Also, the social
expectations of gaze behavior may be different de-
pending on the gender of the speakers. Similarly, ask-
ing about another's spouse or family may be viewed as
friendly or intrusive. It is worth noting that many cul-
tures also have strong customs, traditions, and social
rules governing the processes of gift giving; once
again, a little cultural homework can go a long way.
This is especially so if the host country is also accom-
modating refugees or internally displaced persons,
where multiple standards may apply.
9. Emotional Self Care
This skill set has been variously referred to as stress
management, resiliency, personal wellness, mental
health, emotional well-being, psychological hardiness,
and other terms. Research confirms that humanitarian
workers, especially those responding to large scale
disasters, have high rates of subsequent psychological
distress. These frequently include a range of mood dis-
orders, anxiety disorders, and in some instances spir-
itual or philosophical problems, sometimes involving
loss of hope or purpose [1,13,14].
Although the field work of human security workers
may not routinely engage the magnitude and com-
plexity of career disaster responders, the cumulative ef-
fects of their work can still be emotionally challenging.
Whatever the specific mission, it is clear that evidence
from a number of studies reveals the most common
source of psychological distress is the persistent ex-
posure to the suffering or deprivation of others (An-
tares Foundation, 2012; Brunette, 2011). An important
but less striking source of strain may include separation
from family and friends, physically demanding work,
different language and working through translators,
unusual foods, crowding and lack of privacy, different
social customs (especially concerning gender roles),
harsh climate, or a lack of accustomed comforts. Over
time the otherwise fairly ordinary inconveniences can
produce an emotionally corrosive effect sufficient to
compromise general wellness and productivity.
Based on a review of the literature, Blanchetiere
[14] proposed that causes of stress may be thought
of under four general headings: 1) situational factors,
including personal security, health risks, and demands
of the population; 2) job related factors, comprising
living conditions, cultural change; workload, colleague
relations, and job security; 3) organizational climate,
involving program roles and expectations, manage-
ment style and worker support; 4) personal risk fac-
tors, incorporating poor self-care, psychological vul-
nerabilities, unrealistic expectations and motivation,
and lack of experience. The sources of stress, there-
fore, are complex, interrelated, persistent, and idio-
syncratic. The key to management lies in having in
place an individualized self-care program focused on
health maintenance and increased comfort. The plan
embodies the worker's aggregate knowledge, skills,
experience, beliefs, behaviors, plans, and attitudes that
contribute to the maintenance of well-being. Effective
plans begin in the pre-deployment phase, during which
the worker reflects on the personal values, goals and
expectations they attach to their efforts. These insights
can help to identify the substance of their motivation
and facilitate the earnest assessment of their particular
strengths and limitations that shape specific self-care
plans. Below are some self-care ideas that have proved
useful for many.
Monitor your mood, and establish mutual support
relationships; share your thoughts and feelings with
trusted coworkers at appropriate times.
Make a point of planning an exercise schedule
and stick to it. Because the operational tempo may
be high, it is important to block out specific time to
ensure you maximize the advantages of a regular
physical care regimen.
Real time electronic communication (social media,
FaceTime, Skype, etc.) can facilitate a sense of con-
nectedness with home.
Keep a log (diary) of thoughts, feelings and ac-
tivities; this often helps in processing your activities
and may later provide an instructive source of re-
flection on your experiences.
Sharing humor can provide welcome relief from
the stress, but it is important to keep things positive.
If the tone turns negative or angry, it can com-
promise trust and erode the collaborative spirit.
Personalize your living quarters with photos, sig-
nificant keepsakes, and other reminders of home; it
helps maintain a sense of continuity and attachment
When possible, seek recreation away from the
work area.
Even if you will not be on site for an extended
period, it is generally a good idea to unpack your
bags to lend an element of order and predictability
to your personal environment.
Be careful about the use of alcohol; the pressures
of field work can potentially lead to an unhealthy in-
crease in consumption. Recreational drug use is
clearly contraindicated.
10. Coming Home
As the mission winds down, workers are often invig-
orated by thoughts of returning home to their family,
friends and customary lifestyle. They may reflect on
their endeavors, and the relationships they have
developed with colleagues and those they sought to
help. Workers often look forward to having time to
consider what they have learned and accomplished,
and to sharing their experiences with others. Indeed,
being part of a team with a shared goal in service to
others can be a great source of healthy pride. How-
ever, there is often sadness about departing.
Sometimes the feelings can be surprisingly intense.
Departing workers and those they served all benefit
from making adequate time to get closure, and saying
goodbye or making plans to stay connected. In some
circumstances this may involve a communal activity or
formal event; in others, it may be more personal.
Whatever form it takes, the departure process reifies
the value of what has been done and acknowledges
the contributions of all.
On returning home, workers embrace the challenges
of reconnecting with their previous world. Especially for
those who have less experience in foreign placements,
or who have been away for a longer time, the process
can be surprisingly disquieting. Although formal re-
search is scarce, comments of field workers from
diverse missions reveal a number of common themes
that may emerge for returnees. Below are some of the
most frequent of these with some advice from human-
itarian mission leaders [13].
As a returnee, understand that the homecoming
may be less eventful and rewarding than you had
Once home, get lots of rest. Jet lag only lasts a
few days, but returning to the pace and activities of
home may require some adaptation. Give yourself
time to adjust; don't try to do too much too fast.
This is especially important if you are returning to
Family and friends can be problematic if their
need for your attention inadvertently overburdens
you. It may be necessary to diplomatically explain
your need for some undisturbed time.
You may want to talk a lot about your expe-
rience and find that others are simply disinterested,
or that they don't seem to connect with the mag-
nitude of what you have experienced. They may be
much more interested in telling you what has hap-
pened for them during your absence.
In other cases, you may find the questions of
others to be intrusive. You may experience anger or
frustration with those who seem insensitive or un-
sympathetic to what may have been a life changing
experience for you.
These contradictory feelings, while troublesome,
are part of the readjustment process; as a general
rule, try to be at least as understanding of yourself
as you would be of someone else in your position.
11. Conclusions
A large and expanding body of research clearly
validates the critical role of individual worker wellness
in the success of human security field missions. From
pre-deployment planning, through mission responsi-
bilities in the AO, to the return home, both workers
and agencies clearly benefit from a thoughtful plan for
self-care. The rewards of worker self-sustainment can
be measured in terms of both mission success on the
ground and long term worker wellness. Hopefully the
authors' efforts will provide some useful guidance on
how to approach the process.
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Appendix A: Security Planning Resources
Rogers, C., & Sytsma, B. (1999). World Vision Security
Van Brabant, K. (2000). Operational security
management in violent environments. Overseas
Development Institute.
Adventist Development and Relief Agency. Guidelines
for Developing a Security Plan. Retrieved from
Appendix B: Rescue and Evacuation Resources
Rescue and evacuation insurance through Global
Rescue (
International Medical Group (
Adventure Sports Insurance
International SOS (
Appendix C: Aid Worker Training Resources
All resources accessed on 23 December 2014