The Syrian civil war has dragged on for four years now. Hundreds of thousands of Syrians have died and more than 3 million have been displaced.

The refugee crisis there has attracted humanitarian aid workers hoping to make a difference. Kayla Mueller was one of them. The 26-year-old Arizona native was captured by the self-proclaimed Islamic State in August of 2013. She was killed last month.

Despite the danger, her family said she was drawn to the work she was doing.

It's not just geopolitical conflicts that make humanitarian work hard and dangerous. As the need for refugee assistance has exploded, so too has the need medical workers to fight the Ebola crisis in West Africa.

Those deployments come with their own serious consequences.

In this For The Record: Humanitarian Aid Work, The Risks And Rewards, we speak to three people working in this world. Two are still very much on the front lines. Jeffrey Dow is education coordinator for the International Rescue Committee in Lebanon; Seema Manohar is the health director of Save The Children in Liberia; and Jessica Alexander is a United Nations contractor and author of Chasing Chaos: My Decade In and Out of Humanitarian Aid.


Three Takeaways From The Conversation

- They're honest about their motivations for going into the field. They want to find work that matters, that makes a difference to people who need help, but they're not without ego. They are definitely motivated by the adrenaline and a sense of adventure.

- Some aid workers are far more concerned about dying in a car accident while working in the field than they are of being caught in a brazen attack.

- Current conflicts are making it harder for international aid organizations to do their work. Security risks in places like Syria and Iraq are just too high, and NGOs often have to operate remotely. That means the UN and other groups rely heavily on local humanitarian organizations to operate in conflict zones. The local aid workers are often the ones most at risk — not the Americans and Europeans who tend to capture the headlines when something goes wrong on a particular aid mission.

Check out this graph, which breaks down a decade's worth of attacks on aid workers.

We learned a lot from our For the Record segment this week. As always, the voices make this story come alive, so click the audio link above to get the full experience.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

RACHEL MARTIN, HOST:

This is WEEKEND EDITION from NPR News. I'm Rachel Martin. And this is For The Record. The Syrian civil war has dragged on for four years now. Hundreds of thousands of Syrians have died. More than 3 million have been displaced. The refugee crisis there has attracted humanitarian aid workers hoping to make a difference. Kayla Mueller was one of them. The 26-year-old Arizona native was captured by the self-proclaimed Islamic State in August of 2013. She was killed last month. Despite the danger, her family said she was drawn to the work she was doing. Here's her brother speaking on NBC. (SOUNDBITE OF TV SHOW, "TODAY")

ERIC MUELLER: It was her passion, and there wasn't anybody that was going to stop it - whether it was us, her friends, her close friends. It didn't matter.

MARTIN: It's not just geopolitical conflicts that make this work hard and dangerous. As the need for refugee assistance has exploded, so too has the need for medical workers to fight the Ebola crisis in West Africa. And those deployments have their own serious consequences.

(SOUNDBITE OF NEWS REPORTS)

UNIDENTIFIED REPORTER #1: Two Americans working in Africa have tested positive for the Ebola virus.

UNIDENTIFIED REPORTER #2: Another American has tested positive for Ebola. This patient was apparently infected while volunteering in Sierra Leone.

MARTIN: For The Record today - humanitarian aid work, the risks and rewards. We're going to introduce you to three people working in this world. Two are still very much on the frontlines.

SEEMA MANOHAR: My name is Seema Manohar. I am currently the health director with Save The Children in Liberia working on the Ebola emergency.

JEFFREY DOW: My name is Jeffrey Dow. I work for the International Rescue Committee, which is a humanitarian organization. And I'm based in Beirut, Lebanon.

MARTIN: And one aid worker we spoke to has turned the page.

JESSICA ALEXANDER: My name is Jessica Alexander. I am a humanitarian aid worker. I've been working in this field for over 10 years. And I live in Geneva now.

MARTIN: They each had similar reasons for going into this line of work - to help other people, to see the world. But sometimes reality doesn't measure up to expectation.

ALEXANDER: You see suffering on TV and from the comforts of your home and think that, wow, I'm going to really go in and be able to make a huge difference.

MARTIN: Jessica Alexander has stopped doing long-term field deployments. She looks back at why she started this work with a skeptical eye.

ALEXANDER: You get there, and you see that the needs are overwhelming. And you're playing a very small role in an industry that is working to alleviate some of these issues but is really, you know, only one vehicle to help people at times when they need it most.

MARTIN: Each of them has learned how to measure the difference they're making on a case-by-case basis. Jeffrey Dow is currently running education programs for Syrian refugee children in Lebanon.

DOW: Specific challenges are, obviously, you're dealing with a very heterogeneous student population. All of the kids have been out of school for years, a lot of the kids have never been to school. And there's certainly specific safety and security concerns for the kids in the communities as well.

MARTIN: He left his job as a teacher in the Bronx to become a humanitarian aid worker. But he hasn't given up the classroom.

DOW: Education is a very tangible, very visual thing to witness the impact. So when you see kids who otherwise would be doing nothing or would be working in the fields or just getting no education in schools with books, with backpacks, with learning materials engaging in lessons, it's very immediate.

MARTIN: Seema Manohar is working in Liberia on the Ebola crisis. And even though they are getting a grip on the epidemic in that country, resources are still an issue.

MANOHAR: We bring in simple things like gloves and syringes, aspirin and oral rehydration salts. And then they take a while to get here. And then it's stuck in warehouses. And sometimes the resources to get all of those medical supplies exist. But whether they make it to the people at the right time at the right place, you know, is not always the case.

MARTIN: Another obstacle, Jeffrey Dow points out, organizations like his can't just go into a country and set up a humanitarian aid program. They have to get buy-in and support from the local governments. And that can slow things down.

DOW: Working alone we could have reached kids immediately. But because we really need to work with the government, you know, it's been delayed. And the kids that could have been in school five or six months ago aren't in school right now. So it's kind of a delicate balance and that does get frustrating.

MARTIN: For Jessica Alexander, there is one case she can't shake. She was working in a refugee camp in Darfur. And she could see clearly what it would take a help one person - a child in this case. But the aid industry wasn't equipped to provide it.

ALEXANDER: There was this one family whose daughter was very sick. And I was really determined to try to get her out to Khartoum. And despite, you know, all of the humanitarian organizations that were there, it wasn't in anyone's mandate necessarily to have - charter a flight for her and her family to go to Khartoum. It was my first real experience understanding this industry where we can't always work on an individual basis.

MARTIN: Eventually that young girl did get the help she needed. But Jessica Alexander says that's the exception. These are the kinds of moral dilemmas aid workers can face. But increasingly they're forced to think more and more about their own security. In 2013 Seema Manohar was in Turkey along the Syrian border. Another aid worker, Peter Kassig, was in the area too. He was the American Army Ranger turned aid worker who was abducted and killed by ISIS.

MANOHAR: I remember that day when he was kidnapped because we were all waiting at the same border crossing. And after that day, after he was kidnapped we couldn't cross the borders anymore.

MARTIN: Two years later she was in Liberia when she learned that Peter Kassig had been executed.

MANOHAR: I think it was just in passing in a hotel lobby that was showing CNN. I saw it, and I thought, wow, that was the man. That was that incident two years ago. It sent shivers down my spine. And then two minutes later I said, oh, well, but I have to go for a meeting. And, you know, we're in the middle of an Ebola crisis. I can't really let myself get into this right now. You know? And I don't think I ever really processed that, but it does come back every now and then, like, that could have been me.

MARTIN: Before he moved Lebanon, Jeffrey Dow was working in Afghanistan. He was in Kabul in 2013 when insurgents opened fire on a UN guesthouse.

DOW: So this happened maybe 100 meters from my own home. And we had quite extensive damage to our house. And all our windows were blown out, and there was kind of prolonged gun battle that happened also. You know, it kind of creates an environment that you're very much on edge a lot of the time. And people like that, and it burns people out also. So it's quite a complicated emotional environment as well.

MARTIN: For you does that make the work more or less attractive?

DOW: For me, personally, it makes it more attractive. I like the elevated state that kind of risk brings, not for prolonged periods of time because it could really burn you out and become exhausting. But I guess, personally, for me it's something that does attract me to the work.

MARTIN: I asked Seema Manohar the same thing.

MANOHAR: We are meant to be fearless and the humanitarian who can go out there in the worst security conditions and be able to do their work is a true humanitarian. That's sort of the sense that we all kind of drive on.

MARTIN: So it sounds like there is a little bit of ego in this.

MANOHAR: Oh, totally, there's ego. (Laughter) There's a huge sense of ego wrapped into all of this, for sure. I mean, I think we would like to stay humble and say, yes, I'm, you know, I'm just a humanitarian worker. But there can be all of these different crises going on in the world, but, you know, once a new emergency hits, everyone wants to be on the first flight out there.

MARTIN: Jessica Alexander says the extreme nature of the work can be alluring. And, yes, there are cases where aid workers are caught in the crossfire or even targeted directly. But more often than not, she says, the biggest physical threats are more mundane.

ALEXANDER: When I think about when I'm going to the field, like, what I'm most afraid of or when I've felt most threatened, it's really on the road. You know, and in a really terrible car on a really bad road, and you only have one headlight. And you can't see at night. I mean, that's the real threat to take humanitarians out there.

MARTIN: Even so, she says, the killing of Kayla Mueller and other aid workers in recent years has put humanitarian workers on edge and for good reason. According to the aid worker security database, there were 63 attacks against aid workers in the year 2003. In 2013, there were 264.

ALEXANDER: Today we're really being targeted more as individuals, it feels. And we're being perceived as having been on a certain side. And we're probably being seen more and more as part of the Western tools. And I think that's the difference. And that's what makes it a bit more scary.

MARTIN: And if it's more dangerous, international organizations are less likely to send in their own people.

ALEXANDER: As humanitarian action becomes more and more risky, we rely on local staff and local organizations to implement programs that we are managing by remote control.

MARTIN: So she says, it ends up being local aid workers who take the greatest risks, not the Westerners who capture headlines when something goes wrong. All three of the aid workers we spoke with said despite the risks and frustrations the work is worth it. Although when I asked Jessica Alexander if there's anything about the system, the industry of humanitarian aid that needs to change, she said yes.

ALEXANDER: We're not accountable to affected people enough. We're accountable to our donors. We're accountable to headquarters, and we are accountable to our peers. But really the people who are at the receiving end of aid, we're not accountable to them in a way that we should be. And, you know, there is is they're not paying for it. It's really a take it or leave the relationship. So I think there is a huge movement to be more accountable to affected people, to people that we aim to serve. But I think we still have a long way to go to really fulfilling that commitment.

MARTIN: That was Jessica Alexander, author of "Chasing Chaos: My Decade In And Out Of Humanitarian Aid." We also heard from Seema Manohar in Liberia and Jeffrey Dow based in Lebanon. Transcript provided by NPR, Copyright NPR.

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