Addressing occupational stress among health staff in non-government controlled Northern Syria: Supporting resilience in a dangerous workplace

  • Mahmood Othman University of New South Wales, Sydney, Australia
  • Zachary Steel University of New South Wales, Sydney, Australia
  • Catalina Lawsin Rush Medical Centre, Chicago, United State
  • Ruth Wells University of New South Wales, Sydney, Australia; University of Sydney, Sydney, Australia
Keywords: Torture, occupational stress, compassion fatigue, refugees, stress disorders, traumatic


Introduction: Syrian medical staff working in non-government controlled areas of Syria operate in situations that expose them to great personal danger, while they must often face the same challenges as the people they help. Supporting the wellbeing of these staff is crucial to the operation of health services for internally displaced Syrians given the large-scale destruction of healthcare infrastructure. Methods: Findings from a staffcare programme designed by a grassroots Syrian psychosocial organisation in Southern Turkey and implemented in a medical nongovernment organisation in Idlib in Northern Syria are presented. An iterative and collaborative process employed individual, team and organisational level consultation to identify occupational stresses within the workplace. A six-month programme involved group sessions across eight sites with 56 staff working in three primary health clinics, two mobile teams and one sexual and reproductive health clinic, serving eight internally displaced persons camps in Idlib. Results: Following the programme, staff reported significant reductions in role ambiguity, and improvements in the nature of their work, personal relationships with colleagues and superiors and physical conditions in the workplace. There were no significant differences in reported organisational structure or job satisfaction. Discussion: This evaluation of a grassroots programme, designed to address the expressed needs of displaced staff, suggests that reductions in daily living stresses can be achieved even in the context of ongoing crisis.


Abbara, A., Sahloul, Z., Fouad, F., Coutts, A., & Maziak, W. (2015). The Effect of the Conflict on Syria’s Health System and Human Resources for Health. World Health & Population, 16(1), 87-95.

ACU. (2016). Dynamo. Syria Dynamic Monitoring Report. . Retrieved from

Ager, A., Pasha, E., Yu, G., Duke, T., Eriksson, C., & Cardozo, B. L. (2012). Stress, mental health, and burnout in national humanitarian aid workers in Gulu, northern Uganda. J Trauma Stress, 25(6), 713-720. doi:10.1002/jts.21764

Al-Otaibi, M. b. N., & Jaber, O. H. (2011). (The relationship between occupational and personal stresses in a sample of administrators at the University of Najran). Journal of Arab Studies in Education and Psychology, 21, 1432.

Barber, B. K., Spellings, C., McNeely, C., Page, P. D., Giacaman, R., Arafat, C., . . . Mallouh, M. A. (2014). Politics drives human functioning, dignity, and quality of life. Soc Sci Med, 122, 90-102. doi:10.1016/j.socscimed.2014.09.055

Ben Taleb, Z., Bahelah, R., Fouad, F. M., Coutts, A., Wilcox, M., & Maziak, W. (2015). Syria: health in a country undergoing tragic transition. Int J Public Health, 60 Suppl 1, S63-72. doi:10.1007/s00038-014-0586-2

Brooks, S. K., Dunn, R., Sage, C. A., Amlot, R., Greenberg, N., & Rubin, G. J. (2015). Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster. J Ment Health, 24(6), 385-413. doi:10.3109/09638237.2015.1057334

Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals. Aust N Z J Psychiatry, 43(4), 373-385. doi:10.1080/00048670902721079

Drozdek, B. (2015). Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives. Eur J Psychotraumatol, 6, 24750. doi:10.3402/ejpt.v6.24750

Elamein, M., Bower, H., Valderrama, C., Zedan, D., Rihawi, H., Almilaji, K., . . . AbouZeid, A. (2017). Attacks against health care in Syria, 2015–16: results from a real-time reporting tool. The Lancet. doi:10.1016/s0140-6736(17)31328-4

Elbarazi, I., Loney, T., Yousef, S., & Elias, A. (2017). Prevalence of and factors associated with burnout among health care professionals in Arab countries: a systematic review. BMC Health Serv Res, 17(1), 491. doi:10.1186/s12913-017-2319-8

Eriksson, C. B., Lopes Cardozo, B., Ghitis, F., Sabin, M., Gotway Crawford, C., Zhu, J., . . . Kaiser, R. (2013). Factors Associated With Adverse Mental Health Outcomes in Locally Recruited Aid Workers Assisting Iraqi Refugees in Jordan. Journal of Aggression, Maltreatment & Trauma, 22(6), 660-680. doi:10.1080/10926771.2013.803506

Fie, S., Norman, I. J., & While, A. E. (2012). The relationship between physicians’ and nurses’ personal physical activity habits and their health-promotion practice: A systematic review. Health Education Journal, 72(1), 102-119.


Grandesso, F., Sanderson, F., Kruijt, J., Koene, T., & Brown, V. (2005). Mortality and malnutrition among populations living in South Darfur, Sudan: results of 3 surveys, September 2004. JAMA, 293(12), 1490-1494. jama.293.12.1490

Hamdan, M., & Hamra, A. A. (2017). Burnout among workers in emergency Departments in Palestinian hospitals: prevalence and associated factors. BMC Health Serv Res, 17(1), 407. doi:10.1186/s12913-017-2356-3

Hearns, A., & Deeny, P. (2007). The value of support for aid workers in complex emergencies: a phenomenological study. Disaster Manag Response, 5(2), 28-35. doi:10.1016/j.dmr.2007.03.003

Higson-Smith, C. (2013). Counseling torture survivors in contexts of ongoing threat: Narratives from sub-Saharan Africa. Peace and Conflict: Journal of Peace Psychology, 19(2), 164-179. doi:10.1037/a0032531

IASC. (2007). Interacgency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

Lambert, J. E., & Alhassoon, O. M. (2015). Traumafocused therapy for refugees: meta-analytic findings. J Couns Psychol, 62(1), 28-37. doi:10.1037/cou0000048

Lopes Cardozo, B., Gotway Crawford, C., Eriksson, C., Zhu, J., Sabin, M., Ager, A., . . . Simon, W. (2012). Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PLoS One, 7(9), e44948. doi:10.1371/journal.pone.0044948

Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52(1), 397-422. psych.52.1.397

Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med, 70(1), 7-16. doi:10.1016/j.socscimed.2009.09.029

Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev, 31(3), 399-417. doi:10.1016/j.cpr.2010.10.004

Nordahl, S. (2016). Mental health in and psychosocial support for humanitarian field workers. A Literature Review. (Masters), University of Oslo.

Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Physical activity in the treatment of Post-traumatic stress disorder: A systematic review and meta-analysis. Psychiatry Res, 230(2), 130-136. doi:10.1016/j. psychres.2015.10.017

Silove, D. (1998). Is Posttraumatic Stress Disorder an Overlearned Survival Response? An Evolutionary-Learning Hypothesis. Psychiatry, 61(2), 181- 190. doi:10.1080/00332747.1998.11024830

Steel, Z., Chey, T., Marnane, C., Bryant, R. A., & Ommeren, M. V. (2009). Association of Torture and Other Potentially Traumatic Event with Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement. A Systematic Review and Meta-analysis. Journal of the American Medical Association, 302(5), 537–549.

Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry, 188(1), 58-64.

Strohmeier, H., & Scholte, W. F. (2015). Traumarelated mental health problems among national humanitarian staff: a systematic review of the literature. Eur J Psychotraumatol, 6, 28541. doi:10.3402/ejpt.v6.28541

Van Dam, N. (2011). The struggle for power in Syria: politics and society under Asad and the Ba’th Party: IB Tauris.

Van Griensven, F., Chakkraband, M. S., Thienkrua, W., Pengjuntr, W., Cardozo, B. L., Tantipiwatanaskul, P., . . . Gotway, C. (2006). Mental health problems among adults in tsunami-affected areas in southern Thailand. JAMA, 296(5), 537-548.

Veronese, G., Pepe, A., & Afana, A. (2016). Conceptualizing the well-being of helpers living and working in war-like conditions: A mixed-method approach. International Social Work, 59(6), 938- 952. doi:10.1177/0020872814537855

Weine, S., Danieli, Y., Silove, D., Ommeren, M. V., Fairbank, J. A., & Saul, J. (2002). Guidelines for international training in mental health and psychosocial interventions for trauma exposed populations in clinical and community settings. Psychiatry: Interpersonal and Biological Processes, 65(2), 156-164. psyc.

Wells, R., Steel, Z., Abo-Hilal, M., Hassan, A. H., & Lawsin, C. (2016). Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments. Br J Psychiatry, 209(2), 99-106. doi:10.1192/bjp. bp.115.165084

Wells, R., Wells, D., Steel, Z., Hunt, C., Alachkar, M., & Lawsin, C. (2016). A Qualitative Study of Explanations of and Attitudes to Mental Health Concerns among Syrian Refugees Living in Jordan. In S. J. V. Bayardo (Ed.), Global Challenges and Cultural Psychiatry (Proceedings of the Puerto Vallarta World Congress) (pp. 165- 176). Zapopan, Jalisco, México:Universidad de Guadalajara; Centro Universitario de Ciencias de la Salud; World Association of cultural Psychiatry and Grupo Latinoamericano de Estudios Transculturales: World Association of Cultural Psychiatry.

WHO. (2010). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP).

Yassin-Kassab, R., & Al-Shami, L. (2016). Burning Country: Syrians in Revolution and War: Pluto Press. London.

How to Cite
Othman, M., Steel, Z., Lawsin, C., & Wells, R. (2018). Addressing occupational stress among health staff in non-government controlled Northern Syria: Supporting resilience in a dangerous workplace. Torture Journal, 28(3), 104-123.