How MSF supports health workers

Every day on the job, humanitarian workers come face-to-face with the traumatic stories of people in crises: families and friends lost, homes left behind, futures disappearing in a moment. Doctors Without Borders/Médecins Sans Frontières (MSF) integrates psychosocial care for patients into its medical humanitarian projects worldwide. But these experiences can also be traumatic for MSF teams.

MSF’s Psychosocial Care Unit (PSCU) provides mental health support for our humanitarian staff. Rahma Borgi is a staff psychologist with the PSCU’s Middle East and North Africa unit, which operates out of Amman, Jordan, and provides both remote and in-person support for staff in MSF projects throughout the region. Here, she explains why this care is essential — not only for the well-being of staff, but for MSF to fulfill its humanitarian mission.

How did MSF identify the need for mental health support for staff?

Rahma Borgi: People working in the humanitarian field are at high risk because they work with highly affected people and face traumatic stories, and sometimes they are also affected themselves. There is secondary trauma, which means that you hear a traumatic story and it traumatizes you; you cannot get it out of your mind. There is also compassion fatigue, when you hear so many traumatic stories that you no longer respond emotionally to what you are hearing.

How do staff continue to function while experiencing trauma on the job?

RB: Their commitment to the work is extraordinary, but at the same time, it’s very costly. Underneath that functioning there is often exhaustion.

In the long term, if there is no space to process what they are going through, if there is no support and it accumulates, staff can experience burnout or anxiety, depression, or trauma symptoms. Sometimes the real crash doesn’t happen during the crisis — it happens when things slow down and the body finally feels safe enough to react.

What kinds of experiences cause staff to reach out for support?

RB: Staff tend to reach out for support when both accessibility and clarity of the support pathway are well established, meaning they know where to go, who to contact, and feel that the space is safe and confidential.

However, in high-risk or extreme contexts, this process can initially be challenging. When basic needs such as safety, food, and access to potable water are under threat, psychological support is often not the immediate priority. Despite this, the need for psychosocial support remains significant and often emerges progressively.

Staff seek support for a wide range of reasons, including: exposure to traumatic events; ongoing stress and operational pressure; personal or family-related difficulties; feelings of helplessness, particularly when they are unable to meet the needs of their loved ones; and emotional exhaustion linked to prolonged crisis exposure.

There is also an important cultural and professional dynamic, where many staff feel the need to maintain an image of strength and resilience: “I can manage, I am strong enough.” This can delay help-seeking behaviors.

But when individuals are offered a safe, confidential, and non-judgmental space, such as a session with a psychologist, there is often a shift. They begin to recognize that experiencing emotional reactions is normal, and that seeking support is not a sign of weakness, but rather an adaptive and healthy response.

How does the PSCU ensure staff feel comfortable sharing?

RB: Confidentiality is our main slogan. It’s the first thing that we talk about. When a person talks to any other colleague from the same organization, they might feel that their speech is going to be evaluated or judged. But from the beginning, we highlight that yes, we are MSF, but we are an independent unit within MSF, and we are here only for your well-being. Why is psychosocial care so vital to MSF’s mission?

You cannot provide dignified medical care if the caregiver is emotionally depleted. When staff are psychologically supported, they make clearer decisions, communicate better, and maintain compassion, even under pressure.  

The PSCU is not just an additional service that we are providing. It’s a part of MSF’s operational sustainability. If we want to continue serving the most vulnerable people, we must protect those who show up every day to care for them. So supporting staff mental health is not secondary. It’s foundational to MSF.