MSF observed this in Dunkirk: working with migrants in France exposes them to real trauma. And the teams are less prepared there than abroad.
Médecins Sans Frontières intervenes in Gaza, Ukraine and Sudan. We know it. What is less known is that MSF also intervenes in Dunkirk. And it was there, on French territory, that the organization noticed something unexpected: its healthcare and social support teams were facing trauma of an intensity comparable to those observed on international grounds.
This observation deserves attention. Not to dramatize. To understand what working in local humanitarian work really requires — and what the organizations that recruit these professionals still too often struggle to integrate into their operations.
I. The dissonance that no one anticipates
We arrive in this sector with a reassuring representation: in France, the rule of law protects. The social system covers. Fundamental rights are guaranteed. We find ourselves facing a different reality.
People sleep in tents a few kilometers from a shopping center. Files are blocked for administrative reasons which have nothing to do with the human situations they are supposed to reflect. Theoretical rights remain inaccessible for practical reasons that no one has planned to resolve. Industry professionals have a name for this: institutional violence. It’s not a metaphor. It is the name of a precise, documented mechanism that we observe when a system produces suffering without the intention of doing so and without a mechanism to avoid it.
For an executive who joins this sector from a company or an administration, this gap between the ideal and the real can produce what psychologists call cognitive dissonance: the uncomfortable coexistence of two contradictory representations. It’s not a personal frailty. It is a normal reaction to a reality that does not correspond to what we have been taught to believe.
We don’t anticipate this shock. We don’t prepare for it. And this is precisely where the difficulty begins.
II. Four mechanisms that we don’t see coming
What the MSF teams in Dunkirk went through was a set of psychological dynamics that fueled each other.
The first mechanism is that of dissonance itself: discovering that the country in which we live produces situations that we associate with other geographies. This discovery does not happen in a day. It builds up, week after week, until it becomes hard to ignore.
The second mechanism is more subtle, and often the most destabilizing: the contrast between the week and the weekend. International humanitarian workers go on missions. They live in an environment consistent with what they do. Local workers return home in the evening. They do their shopping on Saturday morning. They have family lunch on Sunday. And something resists. The psychological adjustment required by this passage from one world to another, several times a week, represents a real effort that cannot be measured from the outside.
The third mechanism arises from the second: a feeling of guilt. Guilt for experiencing normal things on the weekends while witnessing misery during the week. This feeling is irrational. It is no less real, and it uses.
The fourth mechanism is perhaps the most important for understanding why geographic proximity does not protect: the surprise effect. A professional sent to Gaza or Ukraine has been prepared. He was briefed on the risks. He signed documents. He participated in training. He knows, before leaving, that what he sees will leave an impression on him. The local worker has often not benefited from this preparation. The intensity of the shock surprises him. And the surprise amplifies the trauma.
This mechanism also has a name: secondary trauma. It refers to the psychological impact that repeated exposure to the stories and traumatic realities of others can cause. It affects therapists, social workers, caregivers. It also affects, increasingly documented, local humanitarian professionals. And it doesn’t disappear because we work twenty minutes from home.
III. What organizations do; and what they struggle to finance
The response to these risks exists. She is not mysterious. But it’s expensive, and that’s where things get complicated.
The first essential measure is preparation in advance. Inform teams, before taking up their duties, of the psychological reality of the position they are about to occupy. Name the risks. Describe the mechanisms. This preparation does not eliminate the shock, but it reduces the effect of surprise — and therefore the impact. When trouble arrives, we recognize it. We avoid denial. We know we can talk about it.
The second measure concerns debriefings and psychological support for teams. This support must be integrated into working time, not relegated to volunteering or personal time. It must be part of the organization’s project, not a fragile side program. This requires teams dedicated to supporting caregivers and social workers — professionals whose role is to care for those who care for others.
And this is where the question arises that few organizations like to formulate clearly: it costs money. Structured psychological support, hours of collective supervision, specific training – none of this is directly “productive” in the sense that funders understand. This is not an hour spent accompanying a refugee to accommodation. This is not a medical consultation. It is an investment in the sustainability of teams, the return of which is real but deferred. And in a sector where budgets are already constrained, it is often this type of position that is sacrificed first.
This paradox is one of the sector’s blind spots: we ask professionals to deal with difficult realities, we recognize that this affects them, and we struggle to allocate the necessary resources to support them.
Conclusion
Working in local humanitarian work means accepting daily confrontation with realities that society would prefer not to see. This is not a job for which good will is enough. Nor is it a work which, because it takes place here, requires less solidity than that which takes place elsewhere.
The psychological risk is not proportional to the distance traveled. It is proportional to the intensity of what one sees, the frequency with which one is exposed to it, and the degree to which one has been prepared to experience it.
The organizations that recruit these professionals have a clear responsibility: to tell them, before they start, what awaits them. And give ourselves the means to support them once they are there.
It’s not a soul supplement. It is a working condition.
