The many years of conflict in northern Uganda between government forces and the Lord’s Resistance Army took a heavy toll on the civilian population. The LRA carried out killings, rapes, looting, mutilations and abductions. But new research shows that Ugandan humanitarian workers were also deeply affected by the chronic and traumatic stress during those years.

The Lord’s Resistance Army began its attacks in the late 1980s. It’s estimated that by 2006, tens of thousands of civilians had been killed, tens of thousands of children abducted and nearly two million people displaced. Those living in the many camps in the north often had few basic services and were ravaged by disease.

The government and the LRA signed a truce in 2006, which led to on-again, off-again peace talks and internal power struggles within the rebel group, as well as multi-national military offensives. In the end the rebels left Uganda.

However, for years, small bands of the rebels have terrorized parts of the DRC, Central African Republic and South Sudan. But while the LRA may be gone from northern Uganda, research shows the effects of the conflict remain very much present among aid workers.

Researchers focused on the Gulu area, which was at the heart of the conflict. The study chose 21 agencies and 376 Ugandans.

Professor Alastair Ager said that studies had been done on the effects of conflict on expatriate workers. But that was a relatively small number compared to native-born aid workers.

“This was only telling part of the story and that the experience of those who lived and worked in the country of their birth was an important part of the story. So we did studies in northern Uganda, but we have also done them in Jordan, particularly working with the Iraqi refugee crisis, and also people working in Sri Lanka,” he said.

Ager is a professor of Clinical Population and Family Health at Columbia University’s Mailman School of Public Health.

He said, “Broadly we saw this common pattern of really quite significant levels of mental health symptoms associated with people who are really finding it pretty tough. And in a sense that’s not surprising. These are difficult situations and it’s difficult work. But it was one of the first times to really document the mental health and burnout issues that many people in this key sector are facing.”

These include high levels of depression, anxiety disorders and post-traumatic stress disorder. They’ve built up over time due to a gradual erosion of the workers’ resilience to conflict conditions. And the symptoms were worse in the Ugandan-born workers than in the ex-pats.

“Certain organizations seemed to be doing a better job in helping their staff cope with difficult situations than others. A major source of stress was the differences between the experience of expatriate workers and national staff – the inequities, if you like, in conditions of service, in the treatment and the privileges available to people who have an expatriate status or a national status. And that was an awkward thing to talk about, but clearly was a major source of contention in terms of people feeling that they’re getting the short end of the stick in the terms of the way that they’re dealt with and the way that facilities are made available to them,” he said.

Aid workers with U.N. organizations reported “the fewest overall symptoms.” However, Ager said Ugandans employed by international NGOs “reported significantly more signs of depression.”

“The bigger organization has resources and capacities to be able to deploy staff, give appropriate leave, give appropriate management and so on. So, if you’re a small organization, you might feel, well, ok, we just can’t do the sort of things that those bigger agencies can do. One of the key predictors of difficulty was a lack of team cohesion – a sense of the work group that you’re working with being one where there’s conflict and difficulty. And that’s an area clearly where any organization can put some investment into,” he said.

The study says women were found to be much more vulnerable to mental health issues. But it’s not clear whether men were being completely forthcoming in the survey about how they felt.

The study recommends that aid workers find ways to ensure they have rest and recreation and somehow disconnect from the conflict situation for a time. However, Professor Ager says the bulk of the recommendations are aimed at organizations.

“To get the best out of your staff, there’s real value in some fairly simple and straightforward investment in good management practice in terms of people having clear job descriptions in terms of knowing what they’re doing. Regular form of feedback so that people can be encouraged that they’re being successful and if they are finding things difficult. And generally an acknowledgment that teams can get tense with each other. There can be problems and issues there. And these very practical management things promise significant impact in terms of the well-being of workers,” he said.

The recommendations also include providing better access to the phone or Internet for personal communications and discouraging “excessive hours at work.” The study appears in the Journal of Traumatic Stress.