Safety and Security in Disasters and Conflicts

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Ewa Jaraczewska and Jess Bell      

Introduction[edit | edit source]

Safety is the freedom from risk or harm as a result of unintentional acts (accidents, natural phenomena, illness), while security is the freedom from risk or harm resulting from violence or other intentional acts. The aftermath of disasters and conflicts frequently results in insecurity, instability and rapidly changing environments, that often amplify pre-existing problems of social injustice and inequality resulting in heightened safety and security concerns. Health and rehabilitation professionals face many challenges working in these settings. They have to adapt standards of care to the resources available, deal with large influxes of patients requiring immediate life-saving attention, and work in environments with damaged and destroyed infrastructure and reduced health and security personnel.

Beyond these professional and personal challenges often lie grave dangers associated with the nature of their work, particularly in conflict situations where targeting of health and rehabilitation professionals and healthcare facilities continue despite the 2016 United Nations Security Council Resolution 2286 that condemns attacks and threats against the wounded and sick, humanitarian and medical staff providing healthcare and their equipment, transportation and facilities, including hospitals,[1] with 3,780 attacks reported by the International Committee of the Red Cross between 2016-2020.[2]As such, rehabilitation professionals choosing to work in disaster and conflict settings should be aware of the inherent safety risks of working in insecure environments. They should recognise that they have responsibility for their own safety and security and, as such, need to ensure they undertake adequate training to prepare themselves prior to working within these environments and only travel with organisations that provide adequate safety and security briefing prior to departure.[3][4]

Individual Responsibility[edit | edit source]

Rehabilitation professionals have to recognise that they have a responsibility for their own safety and security and have a duty to minimise the risks to themselves and their colleagues by developing their safety and security awareness. And they must put this into practice daily, within whatever context they work in.[5][6][7][4]

  • Be Prepared; Learn about the environment you are going to be working in, ensure you are aware of the risks and dangers that exist, and take precautions to minimise the risks. The more you understand the context in which you are working, the easier it will be to recognise any signs of danger before they develop into a threat.[7]
  • Be Responsible; You are accountable for your actions, both personal and professional. Be aware of how your actions or inactions can impact your safety i.e. not wearing a seat belt, driving at night when road infrastructure is damaged.
  • Follow Policies and Procedures; Organisation policy and procedures, particularly those around health, safety and security, are in place for your protection, know what they are and ensure you follow them i.e. curfews, travel or movement restrictions.
  • Act Appropriately; Cultural awareness is really important. Be respectful of the environment and culture that you are working in. When working in a cross-culture situation, show consideration for the religious beliefs, local customs and cultural practices of the communities and colleagues your work with.
  • Be Cautious; Do not take unnecessary risks.

Responding Internationally to Disasters: A Do’s and Don’ts Guide for Rehabilitation Professionals is a resource that provides guidance for all rehabilitation professionals considering responding internationally to a disaster and should be compulsory reading for all prior to deployment into the field.

Well-being and Self Care [edit | edit source]

Work in disaster and conflict settings can be very challenging, physically and mentally, as a result of a heavy workload, long and irregular hours, tough environmental conditions, insecurity, living under security constraints, lack of medical infrastructure, exposure to acute consequences of disasters and conflicts, exposure to ongoing suffering and trauma, and lack of communication with family and friends.[8] Stress is a word used to describe experiences that are challenging emotionally and physiologically, and is a common feature of working in disaster and conflict. Symptoms of stress include sleep disturbance, fatigue, lack of concentration, emotional distress, altered appetite, and behaviour changes including irritability, short temper, outburst, withdrawal, risk-taking and a wide range of physiological responses seen in Table 1.

Table.1 Fight or Flight - Physiological Responses [9]
Body System Physiological Effect Consequence
Heart Increased heart rate

Dilation of coronary blood vessels

Increase in blood flow

Increased availability of oxygen and energy to the heart

Circulation Dilation of blood vessels serving muscles

Constriction of blood vessels serving digestion

Increased availability of oxygen to skeletal muscles

Blood shunted to skeletal muscles and brain

Lungs Dilation of bronchi

Increased respiration rate

Increased availability of oxygen in the blood
Liver Increased conversion of glycogen to glucose Increased availability of glucose in skeletal muscle and brain cells
Skin Skin becomes pale or flushed as blood flow is reduced Increased blood flow to muscles and away from non-essential parts of the body such as the periphery
Eyes Dilation of the pupils Allows in more light so that visual acuity is improved to scan nearby surroundings

With reduced opportunities for self-care and increased stress, mental health issues such as depression, anxiety, ‘burn-out’ and compassion fatigue are commonly seen in rehabilitation professionals working in humanitarian settings, which can have a further adverse effect on an organisation’s ability to provide services to people directly affected by the emergency. Recognising stress within these environments is important as they can often be the first warning signs that you may need to prioritise self-care or other supports.

It is therefore important to prioritise self-care and stress management where possible for all rehabilitation professionals within humanitarian contexts.[1] Self-care is any activity that we do deliberately, in order to take care of our own mental, emotional and physical health. It is “something that refuels us, rather than takes from us”.[10] It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (physical activities, leisure etc), environmental factors (living conditions, social habits, etc) socio-economic factors (income level, cultural beliefs, etc), psychosocial factors (relationships, connection) and self-medication[11] and should be incorporated within your personal safety plan to manage health and well-being while working within disaster and conflict settings.[12][13]

Why Self-Care is Important[edit | edit source]

  • Working in disaster and conflict settings can be emotionally difficult for individuals working in this field. 
  • Embedding self-care activities within your daily routine helps in identifying, managing, and reducing stress and anxiety. It helps maintain and enhance short- and longer-term health and well-being.
  • It can help prevent negative reactions such as secondary trauma, compassion fatigue or burnout.[12][13]
  • It helps improve quality of life and supports achieving a healthy balance between life and work.
  • Taking care of yourself will allow you to continue providing care to those you support in your work and at home. 

ABC's of Self-Care[edit | edit source]

Understanding how to create self-care is based upon three main principles.[14]

Awareness[edit | edit source]

Awareness is an essential first step in figuring out your responses to what is happening in your work and life (the potential risk factors and your own warning signs) and what you can do to take care of yourself in those times. It is important to check in with yourself on regular bases:

  1. How you are feeling (emotionally, physically and spiritually)? 
    • Spend some time reflecting on how you are feeling (physically, emotionally, and spiritually)
    • Ask yourself how did you feel when you woke up this morning? How do you feel now?
  2. Identify the sources of your stress and how you are responding to them?
    • Identify what sort of problems or people you find it especially easy to empathise with.
    • Identify some of the ways that caring about people who have been hurt affects you.
    • Identify sources of stress in your life, and which areas of your life need improvement.
    • A helpful tool here is the Wheel of Strife or the Wheel of Life
  3. Stay connected and present
    • When you are working in disaster and conflict settings, it is important to stay connected and present. This will help you observe your body and mind, and be more aware of your actions and reactions. 
    • List any signs or symptoms that you are experiencing in the physical, psychological, behaviour and relationships, and worldview or frame of reference (spirituality, identity, and beliefs) areas.
    • Think back over the last couple of years. What are your early warning signs? (i.e. the first signals that warn you that you are struggling in this area)
  4. Recognise early the need to make the needed adjustments to your work and personal life
    • Do you know what you are doing in your work, and why? (Knowing that your work is making a difference in other people’s lives, will remind you that your work has a purpose, a meaning, and a positive impact on people's lives)
    • How do you measure success in your work? (For example; Do you need to accomplish everything on your to-do list to feel the success? Or do you feel success when you do your best at any task?)
    • What can you control in your work? Can you make a choice about your work schedule? Structure? Knowing what can you control and what you cannot, will prevent you from putting up energy and focusing on things you cannot change, a helpful tool here is the Circle of Influence.
    • What are the costs and rewards of this work, and how are you personally changing? When you work in a humanitarian setting, it is inevitable that the work will change you. What is rewarding about the work you do? What are the risks? Think about why did you choose to work in this field? Highlight the differences between then and now.
    • List the ways that you have changed over time because of your work?

Balance[edit | edit source]

It is important to balance your personal needs with the demands of your work; making sure that each workday includes some breaks for meals and physical activity, and that you are taking some time away from work for rest and relaxation, for friends and family, for spiritual renewal. It is also important that you find a balance between caring for others and being cared for. You also need to find a balance within work that will allow you to work in a sustainable way.

List the things that you do to cope with these symptoms? In the Physical, Mental and Emotional, Behaviour and Relationship areas and at work. What are the activities you do regularly or enjoy doing that can help you cope? Which do you find most helpful to you? And which strategies do you wish you used more regularly? A helpful tool here is the Self-Care Wheel.

Connection[edit | edit source]

It is important to maintain a connection with other people whom you like and care about as much as possible. It is also important to connect with the community, and with a group of people who know each other, share experiences and values, and to reach out to one another in good times or in times of need or distress. It is advisable to connect with different communities, for they often provide different types of support.

Self-Care Strategies[edit | edit source]

Table.5 Self Care Strategies
  • Reflection: Journaling, Writing, Meditating
  • Ongoing support group
  • Counselling 
  • Expressive therapies
  • Drawing 
  • Movies, books, music
  • Regular physical activity
  • Healthy eating 
  • Drinking water 
  • Limiting consumption of alcohol
  • Relaxation techniques
  • Repetitive activities such as walking, drawing and cooking.
  • Getting enough sleep 
  • Regular contact with friends and family
  • Healthy boundaries 
  • Use of humour 
  • Building and maintaining positive relationships 
  • Take some time off 
  • Knowing your values: Where do you tend to find meaning in your life?
  • Participating in a community of meaning and purpose
  • Regular time of prayer, reading, meditation 
  • Spiritually meaningful conversations 
  • Listening to spiritual music
  • Contact with Religious / Spiritual Leaders 

Summary[edit | edit source]

Disasters and conflicts cause health and rehabilitation services to be overwhelmed, which creates multiple challenges for the delivery of safe and effective rehabilitation care. Understanding the inherent risks that come with working in disaster and conflict settings are vital for all rehabilitation professionals in order to ensure their personal safety. They must recognise the need to continually analyse the context, associated security risks and understand the importance of following all safety and security procedures at all times. All rehabilitation professionals should access specific humanitarian and clinical training and pre-register with international emergency medical teams or international non-governmental organisations (INGOs) prior to getting involved in any disaster or conflict rehabilitation response. Self-care is a practical, person-centred set of activities that all rehabilitation professionals can undertake when working in disaster and conflict settings to maintain their health, wellness and wellbeing and to have a positive approach to their capacity to work in these stressful environments.

Resources[edit | edit source]

Organisations[edit | edit source]

Online Learning[edit | edit source]

  • Disaster Ready
    • DisasterReady is a free online learning platform built to better prepare humanitarian and development professionals for critical work in humanitarian contexts. DisasterReady is provided in English, Arabic, French and Spanish.
  • Health Care In Danger
    • Health Care In Danger is a free E-learning tool developed by the International of the Red Cross for Healthcare Professionals on the rights and responsibilities of healthcare personnel working in armed conflicts and other emergencies.

References [edit | edit source]

  1. 1.0 1.1 Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. Handicap International: London, UK. 2020.
  2. International Committee of the Red Cross. Health-care providers, patients suffer thousands of attacks on healthcare services over the past five years, ICRC Data Show. Available from: (accessed 2 March 2022).
  3. Skelton P, Foo W. Responding Internationally to Disasters: A Do's and Don'ts Guide for Rehabilitation Professionals. London, United Kingdom: Handicap International. 2016.
  4. 4.0 4.1 International Committee of the Red Cross. Health Care in Danger: The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies. International Committee of the Red Cross; 2012.
  5. Roberts DL, Roberts DL. Staying alive: safety and security guidelines for humanitarian volunteers in conflict areas. Geneva: International Committee of the Red Cross; 2005.
  6. Bickley S. Safety first revised: A safety and security handbook for aid workers. Save the Children UK; 2010.
  7. 7.0 7.1 Bickley S. Care International Personal Safety and Security Handbook. Care International USA; 2014.
  8. Antares Foundation. Managing stress in humanitarian workers: guidelines for good practice. 2005.
  9. Psychology Tools. Fight or Flights Response. Available from: [Accessed 30 September 2020]
  10. PsychCentral. What Self Care Is and What It Isn't. Available from: [Accessed 30 September 2020]
  11. World Health Organisation. The role of the pharmacists in self-care and self-medication: report of the 4th WHO consultative group on the role of the pharmacist. Geneva, 1998.
  12. 12.0 12.1 Ehrenreich JH, Elliot TL. Managing stress in humanitarian aid workers: A survey of humanitarian aid agencies' psychosocial training and support of staff. Peace and Conflict. 2004 Mar 1;10(1):53-66.
  13. 13.0 13.1 International Committee of the Red Cross. Managing Stress in the Field. Geneva 2009. Available from: [Accessed 12 March 2022]
  14. ASCENT. Good Practice Briefing; Self-Care and Professional Resilience. Available from: [Accessed 30 September 2020]