How do international humanitarian aid workers stay healthy in the face of adversity?

Background International humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health. Methods and findings The stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional. Conclusion In addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.