Moral injury in humanitarian aid workers: exploring the perspectives and experiences of mental health professionals

Humanitarian aid workers are frequently exposed to ‘potentially morally injurious events’ (PMIEs) and are at risk of moral injury. While research on PMIEs and moral injury in other occupational groups is burgeoning, studies exploring how humanitarian aid workers are affected remain limited. This qualitative study aimed to better understand how moral injury occurs in, and affects, humanitarian aid workers, through exploring the perspectives and experiences of 9 mental health professionals. Semi-structured interviews were conducted and findings analysed using reflexive thematic analysis. The study found that the concept of moral injury was considered a helpful introduction to the mental health lexicon for both participants and their clients, helping to validate the client’s experience. Participants reported that the types of PMIEs causing distress in their humanitarian clients primarily related to acts of omission, and betrayals by organisations, governments, and wider society. Notably, the current humanitarian context, characterised by funding cuts and erosion of humanitarian law, was thought to be exacerbating exposure to, and severity of, PMIEs, thereby increasing moral injury risk. Reported impacts spanned psychological, spiritual, behavioural, and social domains, echoing findings in studies of other groups. Perceived risk factors and barriers to support encompassed both individual and organisational factors, with mitigation approaches seen to lie in improved organisational leadership and duty of care, training and awareness-raising of PMIEs and moral injury, and appropriate support provision. The study provides valuable insights into an under-researched area and has important implications for research, advocacy for improved care, and for organisations, particularly relating to policy, provision of support, insurance, awareness raising and pre-deployment training.