RESEARCH ARTICLE
Post-traumatic Mental and Physical Consequences of Frontline Reporting in the MENA Region
Lakhdar Chadli1, *
Article Information
Identifiers and Pagination:
Year: 2022Volume: 15
E-location ID: e187494452212090
Publisher ID: e187494452212090
DOI: 10.2174/18749445-v15-e221209-2022-233
Article History:
Received Date: 29/4/2022Revision Received Date: 26/10/2022
Acceptance Date: 3/11/2022
Electronic publication date: 30/12/2022
Collection year: 2022
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background:
A current need in journalistic frontline work is to understand the potential psychological and physical traumatic consequences that may result from on-duty appointments. Journalists are active in frontline zones to report on conflicts, crises, and natural disasters. In the Middle East and North Africa (MENA) region, reporters are not equipped or trained mentally or emotionally to handle stressful events. Most journalists suffer from certain degrees of post-traumatic mental and physical disorders associated with their frontline duties.
Objective:
The objective of this exploratory study is to provide comprehensive insights into challenges faced by journalists reporting in conflict zones in the MENA region.
Methods:
This research study is based on a qualitative research approach where data was collected by directly interviewing eight journalists who have covered frontline conflicts and disasters in the MENA region. The collected qualitative data was analysed by conducting a thematic analysis to appreciate emerging categories. The ontology of critical realism was adopted to recognise the real feelings and experiences of the responding journalists.
Results:
This original study presents six themes emerging from the data and researcher triangulation. The health and social issues in MENA are found to be most critical for high-risk reporting.
Conclusion:
Amidst the psychological and physical problems, all journalists did not give up their jobs or ask for privileges. Media houses could consider a more robust training plan based on health and safety to prepare these journalists.
1. INTRODUCTION
The recent disorder in journalism has increased the physical and psychological risk for journalists in the Middle East region [1, 2]. Various types of risks for journalists, especially in conflict zones, emerge from socioeconomic and political transformations making their job most vulnerable to mental and physical consequences [3, 4]. Several dangers of reporting are recognised, especially in conflict regions, as reported by International News Safety Institute [5], at least 1000 journalists sacrificed their lives while reporting in the past decade.
The potential psychological and physical traumatic consequences resulting from journalistic frontline work are underreported and not registered [6]. The public and private media agencies in the Middle East and North Africa (MENA) region have been less concerned about the occupational health risk of their reporters to be prepared to face, manage, and handle conflict-based stress during the job [7-9]. Journalistic work in a time of crisis includes various tasks such as preparing footage at the office and live broadcast reporting. Most journalists, due to the sheer psychological and health-risk impact face, on a day-to-day basis, varying levels of distress provoking unintended mental and physical health consequences. A considerable lack of research is limited to findings by Finnish, British, American, and Canadian colleagues who have all consented to a correlating link between frontline journalism and various mental and physical consequences, including cardiovascular diseases, back pain, anxiety, stress, increased guilt, and post-traumatic stress disorders [10-12].
The purpose of this exploratory study is to provide comprehensive insights into occupational health and work-related challenges faced by journalists reporting in conflict zones in the MENA region. This paper presents qualitative research based on in-depth interviews with journalists who experienced the coverage of frontline conflicts and cities in the MENA region. The major reason for selecting the MENA region is the lack of studies on the health issues of journalists in this region and the gap in the literature on support factors for reporters in conflict zones [4, 13]. Furthermore, since the team of authors is working in the MENA region, an element of convenience in sampling and data collection also justified the area selection. Findings of this research were concluded by adapting thematic analysis. The team of four authors participated in direct interviews with each respondent and took their own notes. All transcripts, after approval from the respondent, were consolidated for investigator triangulation. Each researcher conducted a thematic analysis on all transcripts, which were triangulated to reach findings. The four authors working for the same university belong to different backgrounds with diverse expertise: media studies, healthcare, psychology, and market communications.
2. LITERATURE REVIEW
The research focuses on the exposure of journalists from the MENA region to Potentially Traumatic Events (PTE). The latest World Press Freedom Index compiled by Reporters Without Borders (RSF) indicates that countries considered safe for journalistic professions are decreasing in number [1]. The key reason is that authoritarian regimes are financing, managing, and controlling various media outlets and information processing [1]. The Index also determined that an intense climate of fear has been triggered that makes the job of journalists more stressful and demanding [14]. Journalists must be on the field during a conflict to report on the outcomes of the war, whether liked or not, by the audience, indicating military, political, economic, and social risks involved [2, 4]. This study attempts to highlight that among these factors, which is the highest risk area faced by reporters in dangerous zones of the MENA region.
With the goal to reach the specific research goals and objectives, this study presents a concise literature review discussing all related topics. The team of authors working on this paper researched past and current literature on media affairs, frontline reporting in conflict zones, health dimensions and related psychological consequences.
2.1. Media Affairs
The process of repeated exposure to trauma among journalists can lead to adverse and varied psychological reactions. These reactions may include modified global assumptions, substance abuse and symptoms of post-traumatic stress disorder and depression [4, 7]. Many organizational implications also make the issue of trauma exposure relevant to managers and organizations in the MENA region; for example, journalists who are personally exposed to physical danger are less likely to perceive their employer as supportive [2, 15].
The Diagnostic and Statistical Manual of Mental Disorders 1 recognises that people may develop trauma reactions following direct exposure, attending PTE, or repeated exposure to a PTE. An understanding of personal exposure to PTEs among journalists in conjunction with work-related exposure is important because prior exposure to trauma leads to reduced resilience in the face of future adversity [16].
2.2. Reporting in Conflict Zones
The question arises: are journalists, like many who roam in conflict grounds, subject to post-traumatic syndromes? Addressing the issue of post-traumatic stress disorder [PTSD] among journalists returning from war zones or natural disaster is not an easy task. Jean-Paul Mari, a senior reporter and author of many books, emphasises that this is a taboo subject [17]. Post-traumatic stress disorder affects approximately one-third of journalists returning from conflict zones, subjected to individuals whose job is precisely to speak, write and express themselves [11].
War correspondents are reporters assigned to cover war-related stories that is considered journalism’s most dangerous as well as lucrative form [7]. Newspaper sales and television ratings dramatically increase during wartime, to the extent that news organizations are accused of militarism [16]. For first-hand observation of conflicts, correspondents sometimes become embedded in combat units and may be exposed to dangerous environments as they often accompany troops to the front lines [6].
War correspondents are affected by their job, due to obstacles they must endure to capture the ‘perfect’ photo [4]. The war-torn landscape is tragic and painful to watch; however, they continue in their profession in the quest for the truth [12]. Journalists are affected when returning home and continuous involvement in warzones increase the threat of social risk that leads to mental instability, depression, and anxiety [12]. Post-coverage, journalists tend to get mixed feelings of sadness, gratitude, and possibly fear [15]. A total of 1,290 journalists’ killing were reported between 1992 and 2018, of which the most died in 2009 [18]. 164 journalists on this list have been killed over the years committed to dangerous assignments, while 58 are still missing [8]. Social risk also relates to the lack of trust felt by journalists leading to stress and other mental health problems. The literature review raises the evident issue that statistics for journalists in the MENA Region are limited.
2.3. Health Dimensions of Reporting in Conflict Zones
Journalists who cover conflicts, crises, and natural disasters on a rotational-basis or semi-permanency are prone to develop psychological and health-related issues similar to other high-risk professions [11, 15, 16], who presented their study based on the examination of 906 U.S. daily newspaper journalists. Participants were exposed to 7.8 potential traumatic events (PTEs). Journalists found reporting the following kinds of stories to be the most stressful: injured and dead children, murder, and road accidents. Few researchers have examined the relationship between journalists’ work conditions and health issues. However, recent studies highlighted journalists were at risk of developing health issues such as stress [9, 4]. Others have found correlations between journalism and depression, anxiety, pain and postural problems and work-related musculoskeletal disorders, headache, insomnia and sleep disorders, hypertension, gastrointestinal problems, respiratory disorders, and allergies [11].
Health researchers also suggested that chronic stress, faced by many journalists, can lead to cardiovascular diseases [12]. Similarly, it was clarified that journalists covering trauma in poor working conditions have increased risks of stress, and adversely affect their health and quality of life. The frequent consumption of caffeine and energy drinks can also have adverse effects on mood states and lead to problems like insomnia, hypertension, lack of appetite, weight loss, and hallucinations [11].
Earlier reporting of traumatic events was correlated to the onset of PTSD. The relationship between past traumatic event reporting among 503 Finish journalists and PTSD was studied [11]. The study found a significant relationship between the two. Meanwhile, reporters in the MENA region are not equipped mentally or emotionally to cover stressful events. One possibility for this is the lack of awareness and preparation, with little to no credible research conducted to indicate the plight of journalists belonging to the region; hence, providing a key motivation for research conducted for this paper [19].
2.4. Psychological Aspects of Reporting in Conflict Zones
Journalism in high-risk scenarios such as war zones is often exposed to traumatic experiences. According to Cottle et al., journalists reported little to no Post-Traumatic Stress Disorder (PTSD) in the short-term exposure to refugee crisis coverage; however, they also reported high levels of moral injury and guilt [2]. On a similar note, Feinstein, Pavisian, and Storm maintained that the emotional distress from reporting in high-risk situations relies on the journalists’ morality judgments [10]. Furthermore, 90 journalists partaking in a survey-based study claimed high levels of PTSD, with emotional distress as the main consequence of coverage of high-intensity elections in Kenya [10]. Emotional difficulties, guilt and lack of long-term psychological support were the main complaints of Kenyan and international reporters covering the Kenyan elections of 2007 [10].
The nature of trauma responses is best understood in terms of a continuum based on individual differences, in which some people will face social risk and experience little or no symptoms, and others will have severe trauma reactions [6]. Generally, PTSD will not be present or consequential if observed immediately after a traumatic event. The empirical study of Browne et al. determined that journalists reported higher levels of guilt cognition (r=.29 – very significant). Interestingly, PTSD and guilt cognitions rose higher the more experienced a journalist (i.e., more experienced journalists incur greater psychological distress damage over a longer period) [12].
3. RESEARCH PROBLEM AND OBJECTIVES
This research makes a first-time attempt to discover health issues related to MENA-based journalists. The overarching research problem of this study is the lack of research conducted and published on mental and physical health risks and occurrences endured by journalists from the MENA Region reporting in conflict zones. The research problem and the literature review lead towards the specific research objectives or questions as given below:
1. What are the specific psychological and physical health issues faced by frontline journalists in the MENA Region?
2. What type of support mechanism is offered by media outlets for these journalists?
3. What is the impact of these work-related problems on the psychological and physical wellbeing of the journalist?
4. METHODOLOGY
Considering its lesser discussed position on the issue within the MENA region, an exploratory methodology had to be followed to reach credible findings [13, 20, 21]. Moreover, in-depth data and detailed discussions with respondents were required and hence qualitative research was conducted. In this qualitative research, direct interviews with the selected journalists and recognised experts in the MENA Region who have been reporting in conflict areas were the research instrument used [22]. In an effort to reach these special journalists, purposeful and convenient sampling were undertaken to effectively utilise the Delphi technique [23, 24]. The analysis of the qualitative data collected from interviews with the journalists was based on the ontology of critical realism since the authors had to take a critical position and realistically report the findings [20, 21, 23].
A questionnaire was constructed upon the literature review and methodology. The questionnaire was verified through a pilot study conducted with two senior and respected journalists in the region, respondents MR 1 and MR2, in this research. Their suggestions were inculcated in the final questionnaire for this research. All respondents were exclusively interviewed on the campus of researchers’ university as experts and journalists reporting in conflict zones were, presented in a list of respondents as given in Table 1. All journalists participating in this study were qualified if they were directly or indirectly involved in reporting, through any media channel in conflict zones that could be suffering due to climate disasters, war, famine, illegal occupation, terrorism, health hazards or other uncontrollable human crises.
| Respondent Code No. | Personal Description |
|---|---|
| MR 1 | This journalist is most affected by the occupational hazard of being a reporter in dangerous areas for nine years in Iraq, Kurdistan andIran. He nearly lost his life because of a kidnapping incident during media coverage of dramatic events happening in this MENA region. This journalist became disabled due to occupational injury and now passes his personal and professional life in a wheelchair. After a long journey in various hospitals, this journalist did not go down; after this attack, he still has the desire to work and exercise this dangerous job. Of course, he became a journalist and settled in the newsrooms because of his injuries and his mobility, but the topics remained the same, the hot zones and conflicts. His injury led him personally to challenge himself, he became a pilot and a journalist, and now he tries to see the beauty of the land from above, to forget the horrors of wars. |
| MR 2 | This journalist has been an excellent female war reporter for 12 years in Lebanon, Iraq, Syria, Kurdistan, Yemen, Libya, Mali, South Sudan, and Somalia. As a freelance journalist, she likes to work on exciting and hidden topics but in dangerous areas. Sometimes she risked too much despite the personal precautions she was advised. She claims to be a brave and open feminist working for the real and fair world. She was almost kidnapped twice, and despite that, she came back with unusual cover proposals. |
| MR 3 | This reporter has started her own company “Al Daraj”. During her professional life, she worked collaboratively with her team in the field of investigative journalism for 11 years in Turkey, Syria, Iraq, Lebanon, Jordan, Libya, South Sudan, Cyprus, and Europe, following refugees from MENA. She has great enthusiasm, a humanistic vision as a journalist, and as ‘a warrior of truth’, she calls herself. She is interested in the themes of refugees and intellectual refugees living in very harsh conditions. By itself, she is an open personality, something that comforts and opens a lot in her work of investigation in difficult areas. |
| MR 4 | This journalist reporter specialises in current affairs and investigative journalism for 18 years in Egypt, Lebanon, Jordan, Syria, Turkey, Iraq, Kurdistan, Yemen, Sumatra, West Bank, Gaza, Israel, Libya, Mali, Sudan, South Sudan, Somalia, Senegal, Madagascar, Congo, Rwanda, Afghanistan, Egypt, and Iran. His career reflects upon his personal journey. Coming from a region where a military conflict is still present, he militated in organizations that were engaged in the conflict. This man, before becoming a journeyman of dangerous zones in the MENA region, was imprisoned for years as a political detainee. He rubbed shoulders with the prisoners who were looking for him as he spoke loudly for their cause. He was released from prison as part of a political agreement between the belligerents. He went to Europe studying, despite his age, and joined a satellite TV channel in the MENA region, the first one to broadcast from Europe, this channel was looking for people who lived in Europe and could join the area of journalism. Through his work in dangerous areas, this journalist carried the label of the concept of evil and good, the Iliad and the Odyssey. This journalist was doing field coaching with his colleagues who were with him, and the experience has its say. |
| MR 5 | This lady prefers to be in front of the journalistic scene; she also had the desire to be in front of the camera, not in the studio but outside in the field. She wanted to be internationally renowned for taking risk and doing journalistic coverage in high-risk areas, working for 6 years in West Bank, Israel, Lebanon, Iraq, Mauritania, and Jerusalem. As her motivation, she helped and worked for CNN on the specialised coverage of the MENA region. This young journalist could possibly bear all the burden of the dangers she faced during her work. Perhaps her personal story influenced her career, she witnessed the murder of her own father during the civil war in a country in the MENA region. Also, her incurable illness left her in the belief that she must help people be their spokesperson. |
| MR 6 | She is characterised by her intelligence and her love for the research of information. The mission she chose herself was giving her voice to forgotten people and talking about their problems being their spokesperson. She has been working for 8 years in South Lebanon, Syria, Iraq, Libya, Chad, Mali, Algeria, Morocco, Darfur, Jordan, Kurdistan, and Iran. Regarding the question why you are going on the field while you are a popular presenter, she replied “I want to prove myself in extreme conditions.” The example of the great reporters in major international channels was also part of this choice to expose oneself to danger. In her reports, we feel the human side where she tries to shed light on the suffering of thousands of people who are victims of violence, war, and other man-made disasters. |
| MR 7 | This journalist has written a book about his experience and work that has taken him to different dangerous areas around the world. This reporter was among the first in the MENA region and with a MENA news organization took the risk to share live information from dangerous areas, allowing MENA audiences to know the MENA version of different conflicts and not from western media chains that have major logistic and human resources.He is a journalist who always volunteer for dangerous missions for 25 years in Afghanistan, Bosnia, Chechnya, Yemen, Sudan, Kenya, Libya, Chad, Mali, Egypt, Turkey, Rwanda, Angola, Jordan, Russia, Pakistan, Somalia, Djibouti, and Nigeria. In the writing room, he is the soldier-reporter side of him. On a personal level, his distance from his family and home affects him greatly, and it can be said that there have been repercussions on his personal life. But this guy is always ready to go where he is needed to report and record events. |
| MR 8 | This respondent was torn between two roles, being the head of reporters and himself working in danger and conflict zones. He worked for 5 years inBosnia, North Africa, Sudan, Lebanon, Bosnia, and Kurdistan. His role as director of reporters, therefore, made him responsible for the fate of many journalists and reporters. He was also responsible as the head of the desk for the chain, which disseminates the information. This journalist was affected by his role and his direct contact with the reporters who reflected their anguish, fear and the hidden evil of conflicts, and their anxiety. If a bad thing happened to the reporters, he was the first to know it, and by that, he was the mirror of their feelings. |
Questionnaire for reporters working in conflict zones based in the MENA region
1. Please explain how and why did you become a conflict zone reporter?
2. Do you think it is possible for a journalist covering a conflict to remain objective and neutral, please explain why?
4. What were your expected negative health outcomes of being a conflict zone reporter?
5. How do you rate your health condition before and after your official visit to the front lines or conflict areas?
6. Please specify the physical and mental problems you faced after coming back, for example: sleeping disorders, back pain, chest pain or food intolerance.
7. How do you immerse yourself into ‘normal life’ back home, are you able to remove yourself from the mind-set of being in a war zone, how?
8. Is there a health support procedure for journalists reporting in conflict zones? Did you ask for any special help, relief, or compensation for your high-risk reporting assignments? What could have helped you to be better prepared by your company before traveling to conflict zones?
The aim of this study was the depth of discussions with journalists, and hence the quantity in data was not sought. The sample size was not pre-determined or calculated since the rule of data saturation was adopted: the collected information seemed to be repetitive after achieving an understanding of diverse experiences related to the relevant topics [24]. Various journalists were approached, where five of them refused due to a lack of time available for interviews. The sample size was finalised when the knowledge provided by journalists and media experts was a duplication of previous ones and no new themes could be recognised by the team of researchers [23]. The final sample of this study had eight journalists and media experts. The description of each respondent is needed to validate findings of this research and is given in Table 1, but the personal identity is concealed.
The sampling criteria adopted for this paper were specific and the four researchers were clear about the identity and position of the people to be interviewed, hence judgmental and convenience sampling was used [20, 25, 26]. Although 20 appointments were made for the face-to-face interviews, only eight interviews could be finalised, yet, the theoretical saturation, or the qualitative isomorph, was achieved with this sample [20, 21, 25].
The in-depth interviews with respected journalists and media managers were conducted by all authors of this paper. Due to the sensitivity of the topic, interviews were not tape-recorded and all authors took notes during the face-to-face discussions with each respondent. To adopt the data triangulation, written notes were triangulated with the available literature and media reports to validate post-interview findings. The final transcript of each interview was presented to the respondent and was requested to confirm his or her statement and understanding of the shared knowledge. The first author consolidated the written notes after each interview; and the remaining authors finalised transcripts of all interviews after triangulating with their written notes and discussions. To adopt the researcher triangulation, the data analysis from all researchers were compared and matched to agree and reach the final sub-themes and themes.
Research questions were used as a guideline for probing respondents during interviews. These questions were derived from the research goals set for this study and extracted from the relevant literature review. Interviews ranged from 30 to 70 minutes and the authors confirmed key statements immediately after the interview with each respondent to ensure accuracy. All transcripts were read many times by each author for the thematic analysis to find ideas of respondents relevant to the aim and scope of this paper [17].
The data collected had to be analysed from various sources by data coding that is an integral part of qualitative data analysis. Codes have been explained as “tags or labels for assigning units of meaning to the descriptive or inferential information compiled during study” [25]. Coding is guided by research questions and directs the researcher towards new questions to arrive at the research objectives, while codes can be applied to words, phrases, sentences, or a paragraph [5, 28]. After conducting some interviews and writing all transcripts verbatim, the process for open coding began that was facilitated by the question-answer format [20, 24, 29]. Since respondents were journalists who were recognised experts in the field, some suggestions were received from them during interviews that were inculcated in the questions and response management.
In the process of open coding, each interview transcript was analysed to seek patterns of meanings, including assumptions or judgments made by respondents. Firstly, the open coding specified and color-coded indicators emerging from interviews. Further examination of all color-coded indicators led to the appearance of explicit thematic labels. These labels were then linked to the related color-coded sections to which they were applied in each transcript. The open coding thematic labels were drawn from the repeated and underlined ideas of each journalist that were painted and categorised on the original transcript of all interviews. Secondly, axial coding identified any relationships between all codes specified during the open coding process, where more focus was on various codes rather than the data [29].
The axial coding exercise included all codes as tags, labels or memos that were noted during the open coding phase. Codes were further deliberated and compared with each other to make sense of the collective response of all respondents. The axial coding instituted a cross-case analysis of the collected data by all researchers to objectively discover themes and sub-themes within coded themes. As a regulation for exploratory research, no attempt was made to force or fit any responses into any themes or sub-themes [25]. Any origins of any theme and sub-theme were not predetermined by any researcher preceding the data collection or from the literature but from an accumulation and conceptualization of the collected knowledge. All answers from interviewees for a specific question were typed or copied and pasted into an individual document. Each document narrated the respondent’s perceptions of physical and psychological health issues related to occupational hazards. Eventually, the cross-transcript readings and exploration of various topics from the questionnaire were considered during the axial coding process to finalise the themes and sub-themes. The mapping of the sub-themes and the major themes is presented in Table 2.
| Themes | Sub-Themes |
|---|---|
| 1. Motive for reporting in conflict zones | • My goal in life• Ambition• Serving humanity and for truth• To prove myself and never give up• To give voice to the voiceless |
| 2. Guilt based stress | • Unable to help people in trouble• Could not give monetary help• Disallowed to raise the issue with governments• Unable to go to court of law |
| 3. Physical and mental stress | • Pain in my back and bones• Indigestion problems• Lack of sleep and restlessness• Getting used to alcohol and smoking• Became short tempered and sensitive |
| 4. Official Support | • Training before the reporting trip• Medical advice and services on trip• Physical training provided• Safety measures introduced and forced |
| 5. Recovery from reporting stress | • Family and friends’ support• Fitness exercises• Office support system |
| 6. Lack of Management link | • No link with problems and threats• No idea about the real picture• Less attention to safety issues by management |
5. RESULTS AND DISCUSSION
The thematic analysis of the data collected from interviews and triangulated among the authors concluded six major themes that were constructed upon the sub-themes directly emerging from the interview analysis. These stem from direct and distinguishing statements from the respondents as given in Table 2. Subsequently, each of the major themes will be explained with its construction on the sub-themes and their respective quotes.
5.1. Motive for Reporting in Conflict Zones
Since this job is considered a high risk and sensitive job [14, 18], the respondents, when answering the early questions, reflected upon the reason for joining this profession. The dangers of reporting in conflict zones are not hidden [8, 14]. Respondents indicated that they became a journalist as a life goal [8, 14], career and ambition [2] and serving humanity [14, 2]. The risks taken by war journalists are regularly debated. The very usefulness of the practice is called into question, but public opinion is not the only one to wonder [4]. The journalists concerned question their personal motivations to document conflicts and to go to the front in the MENA region.
After several reports from the field, journalists/war reporters in the MENA region are questioning the usefulness and impact of their work. Like an international observer or a soldier, the risks taken are enormous and have been debated at length in recent years. The deaths and kidnappings in the Middle East – in Syria and Iraq especially – raise reflections on the real usefulness of journalists, ready to put themselves in danger to lift the veil on distant conflicts [2]. Far from the public debate, many of them wondered about the usefulness of war reporting and the reasons that led them to go to conflict zones in the MENA region.
Journalism became their culture, some of them said it gave them a personality that built them to be journalists/reporters. Beyond their intimate perception of the profession, their Gulf War celebrities also saw themselves as public figures, ready to challenge official government discourse about the Gulf War and the MENA region [7]. By traveling to dangerous regions, they proved that the usefulness of war journalism was not limited to observing a single aspect of a conflict, but to denouncing the horrors of war by observing both sides.
Thus, they showed a motivation for the denunciation of conflicts and humanitarian disasters, and they call it the perils against information. But there are also personal motivations. War journalism should not be restricted to the mission of informing testimonies. It is, therefore, necessary to observe war journalism from another side. That of the visceral need to know what is going on, to be at the forefront of an event, however dangerous it may be.
More specifically, motivations that push them to leave include two types of motives: intrinsic motives (passion, sense of duty and social status) and extrinsic motives (autonomy, adrenaline, collegiality, or fame).
The study respondents embraced dangers while reporting as they were motivated by the above factors rather than by financial benefits. This major theme indicating the motive behind joining this dangerous profession is illustrated in more detail as shown below quotes:
5.1.1. My Goal in Life
I always wanted to be part of coverage of war stories (MR3).
My dedication to war reporting has been my ultimate goal in life. (MR6)
Being confined to wheelchair forever cannot stop me from my life’s mission (of reporting in conflict zones) (MR1).
5.1.2. Ambition
My lifetime ambition was to be in media about MENA region (MR2).
I feel like having a special mission to draw public opinion towards danger of war (MR4).
This job (reporter) was always my personal and professional ambition (MR5).
5.1.3. Serving Humanity and for Truth
As Iraqi, I have seen many wars and want to help my people and spread the truth, without any protection for myself (MR1).
An opportunity to highlight the suffering of civilians, mainly children, and the terrible devastation caused by war (MR4).
Few reporters share the truth and I wish to be one of them (MR 7).
5.1.4. To Prove Myself and Never Give up
My PhD was political science and my passion is media so I can be someone one day, hence I never demanded any special treatment (MR 2).
I became a conflict zone reporter through my work with BBC World Service and took the challenge to prove myself and never quit (MR4).
I did not give up and am struggling in the media world to build my name even if my life passes on wheelchair (MR 1).
5.1.5. To Give Voice to the Voiceless
My Iraqi people have no voice, so I decided to be that voice for the world (MR1).
Started by joining the Olive Tree Campaign to support farmers suffering from Israeli policies of uprooting olive trees and illegally confiscating the land. I figured that I could help them by covering their stories in the media and ignored my own necessities (MR3).
The only way I could help the suffering civilians, especially children, helpless in the middle of dead bodies and wounded people, was to bring to the world their suffering and frustrations, for me that is to give a voice to the voiceless (MR4).
I was brought up around a lot of silence, so I decided to give voice to voiceless and entered this dangerous reporting in conflict areas (MR 6).
5.2. Professional and Personal Guilt
The professional guilt expressed by respondents is related to being too professional sometimes, and not being able to help or interfere while reporting. Most respondents discussed their helplessness during their conflict zones’ reporting [2, 17]. They discussed the difficulty of not being able to help people in need and who are suffering. Respondents indicated the need to be emotionally detached from what is being reported (reference). The respondent journalists felt professional guilt in not being able to raise the human or environmental issues on the right forums or in appropriate ways. Likewise, personal guilt was felt due to the incapability to give a hand to the vulnerable people suffering in conflict areas [17]. The feeling of guilt could also invite stress and other psychological diseases for journalists [17, 18].
5.2.1. Unable to Help People in Trouble
Hard to help people and work among armed groups that adopt radical ideologies (MR1).
Sometimes it is painful to be helpless and [also] useless, so I never demanded anything from my agency (MR6).
When see people suffering, house destroyed, land being taken, the human instincts kick in and I feel obliged to sympathise with them (MR3).
The biggest challenge for a journalist is not to become part of the story. He needs to keep a distance from events he’s covering and be truthful, accurate and balanced in the coverage (MR4).
5.2.2. Could not give Monetary Help
I saw poor people but can’t afford to help as a reporter (MR2).
I wish there was financial support for people suffering in conflict zones (MR5).
Earlier I used to give money to help the poor people, then I was told that it was not allowed to give money to the respondents, how frustrating (MR6).
5.2.3. Disallowed to Raise the issue with Governments
The more you cover armed conflicts, the better you understand the reality of the world we live in, which is marked by foreign interferences, economic interest of external powers and inactivity of your own governments (MR1).
The problems we face during our reporting trips are considered confidential by the agency and can’t even tell the government or ask for my own help, that is frustrating (MR6).
Even if we complain to the government about the reporting problems, they don’t want to hear from us (MR4).
5.3. Psychological and Physical Issues from the Occupational Hazard
The physical and mental stress theme was the most outstanding theme as respondents spoke out about such issues, which were not always disclosed by them. Respondents reported physical injury, which caused a lifelong disability, intense physical pain, back pain [4, 9], indigestion problems and lack of sleep. Psychological stress resulting from being away from family contributed to chronic depression among respondents [11, 15, 16]. Other health behaviour issues resulting from exposure to traumatic events were reported by respondents, such as being short tempered health related issues, smoking and drinking.
5.3.1. Pain in my Back and Bones
While covering war, I suffered a spinal injury that made my life in the wheelchair, but never asked for privileges (MR1).
The physical pain in my body is bearable, but I can’t bear the pain of being away from my family due to work (MR7).
I have a regular back pain problem, the tireless and restless work from reporting and managing reporters (MR8).
Reporting in conflict zones can have serious life-changing injuries on a journalist. The above response concurs with other reported cases of a journalist being killed or seriously injured while reporting in conflict zones [8].
5.3.2. Indigestion Problems
I had food intolerance, some places I had lack of hygiene and got poisoned (MR2) (MR1) (MR3) (MR4).
Food eating and handling is the basic problem I faced in the start of this job (MR6).
I have worked with refugees in very hard places, the first problem of quality of water and bad water damages me seriously (MR3).
5.3.3. Lack of Sleep and Restlessness
Even today, after several years since my injury, I have no sleep for all nights (MR1).
I experienced sleeping problems due to the extensive interrogation I went through at the checkpoints, and when they [Israeli security] confiscated our cameras and stopped us for hours (MR3).
In some cases, I would find myself so much affected by the sad scenes I witnessed, that I lost sleep for the night. On those nights, I would resort to sleeping pills to be able to cope in the next day (MR4).
5.3.4. Getting used to Alcohol and Smoking
Not addicted, just a social smoker and drinker (MR3).
Sometimes a few drinks at the end of a long working day can help release the pressure and recharge the batteries for the next day (MR4).
Smoking and drinking is normal among us [conflict reporters] (MR1).
Many people in my field smoke and drink to kill the stress (MR4).
Reverting to drinking and excessive smoking are habits that are mostly associated with serious health impacts such as developing chronic diseases [30].
5.3.5. Became Short Tempered and Sensitive, Emotionally Drained
I become short-tempered and sensitive to loud noise after working in armed conflict areas and feel psychological and emotionally drained (MR7).
I love my job, but it emotionally drains me out, but I never asked for professional help from my company (MR5).
Dealing with reporters and my own tasks makes me short tempered and super sensitive (MR8).
5.3.6. Sense of Loss and Psychological Problems
I always feel that I lost everything, when I was put on the wheelchair, the physical and psychological wound remains deep (MR1).
I get anxiety from reporting in conflict areas that is something threatening happen to me (MR3).
During my reporting jobs I was almost kidnapped two times, it damaged my overall psychology and I still have nightmares about it (MR2).
My psychological pain from what I have seen at work is worse than my body pain (MR5).
War correspondent job can affect your health in terms of psychological trauma and stress. Post-Traumatic Stress Disorder (PTSD) is no stranger to many war correspondents who experience tragedies and traumatic events. When I came back from my assignments, I used to experience sadness, fright and a sense of irreparable loss, but never complained for lack of proper compensation (MR4).
5.4. Official Support for Journalists
One major theme that was recognised was the lack of support for frontline journalists [2, 8, 13]. The support indicates any type of pre or post reporting training, coverage or payments made by media houses to such reporters. Most respondents were dissatisfied with the support for such difficult assignments. It has been discussed that journalists from developed countries received proper training before their reporting trips to conflict zones [1, 4, 13]. Likewise, they were provided complete assistance in settling-in after their return. Respondents indicated that they received training before the reporting trip to the conflict zone. However, media reporters based in the MENA region do not receive any such support or training before and after their trips [8, 18].
5.4.1. No Training before the Reporting Trip, Nor in Newsroom
Self-preparation is the way, having full experience and knowledge [unbiased, she clarified] (MR3).
In this job the support is limited. (MR2)
I used to complain about official support for reporters. Now I am managing reporters so I realise that support is almost impossible in our environment, it frustrates the newcomers (MR8).
5.4.2. No Medical Advice and Services on Trip
Medical support is there, but with areas of conflict are often isolated with possibility of communication very difficult (MR1) (MR8) (MR7) (MR2).
The medical advice is very outdated [laughs] and we never care about extra compensation (MR2).
In my book on war reporting, I have raised the issue that medical training is a must for reporters (MR7).
Reporting from Europe was different with updated medical tips, I do not see that level of support here [in MENA] (MR4).
5.5. Recovery from Reporting Related Health Issues
Psychological and physical problems could not be solved easily. Moreover, the solutions to such problems are beyond the scope of this study. However, while discussing with respondents, the topic of their personal approach to recovery arose where they mentioned not asking or receiving any special treatment or compensation. Thus, the theme of personal recovery measures emerged and was recognised. This theme could be further utilised in a future study focusing on solutions for problems faced by frontline journalists.
5.5.1. Family and Friends’ Support
When back to family, I feel memories of war and tell my children to feel good (MR1).
By talking my experience and share stories with colleagues and friends reduce the psychological effects (MR2).
I would not have survived this job if my family was not fully behind me (MR7).
5.5.2. Personal Fitness and Soul Searching
I tried to understand the reasons and causes of the particular conflict and calmed down, never demanding extra care (MR2).
As far as I am concerned, I used to rely on my inner strength to overcome the trauma and pressure related to coverage of conflicts (MR4).
I usually make sure that I am in good shape on the eve of my travel to conflict zones, with no expectations (MR3).
5.5.3. Counselling and Mentoring
Thanks to counselling and physical exercise I could get over my PTSD (MR4).
I personally counsel and mentor all new reporters so they are safe and focused on their assignments (MR8).
With the media growth and industrializing, the mentoring is getting lesser and it scares me (MR3).
5.5.4. Office Support System
By keeping instant contact with my company made me feel secured with tips how to behave if something went wrong (MR2).
Support was there from office, more training and extra compensation with real [istic] approach will help (MR3).
Before traveling to war zones, the media institutions where I worked, would provide me with some hostile environment coaching, security training courses and travel safety tips (MR4).
5.6. Lack of Communication with Management
The final theme recognised in this study was the issue of lack of communication between the management and the journalists. Media houses are usually notorious for not being closely in touch with reporters and treating them as sales agents rather than messengers of truth [6, 8]. This paper further extends the grievances of journalists that even when endangering their lives for the media house, they still feel that there is a communication gap with the management. Respondents indicated deep concern, expressing grave concern, also at the growing threat to the safety of journalists posed by non-state actors, including terrorist groups and criminal organisations [13]
5.6.1. No Link with Problems and Threats
Media houses are business making machines only (MR3).
I have always seen that media reporters and management are working in different planets (MR1).
Managing reporters taught me that bridges could be built between journalist and the company (MR8).
5.6.2. No Idea about the Real Picture
Media business is reporting only not helping people or care about reality (MR1).
It depresses me that history keeps repeating itself, normal people always suffer, and media bosses are unaware of the pressure on reporters (MR2).
I have clearly mentioned in my book that reporters seek the truth, not the media (MR7).
I worked for CNN and here, all media companies want to sell exciting news not reality (MR5).
5.6.3. Less Attention to Safety Issues by Management
Physical safety may be, but no clear about the psychological safety of reporters (MR1).
Safety for journalist is much better in European countries (MR4).
We have safety issues but all sides are less serious about applying (MR8).
I always took risks and even escaped kidnapping, media companies need better safety measures and even insurance for journalists like me (MR2).
As summary, all journalists interviewed in MENA suffered from emotional, physical, and psychological health problems due to their reporting in conflict zones [4, 9, 11, 14]. However, they never asked for any special support, benefits, or extra compensation. Moreover, none of them ever gave up, or requested early retirement, or even relocation. It can be implied from the study that occupational health risks and social issues are most critical for journalists working and sacrificing in the MENA region [7, 17].
6. CONTRIBUTION OF RESEARCH
The exclusive findings of this ground-breaking study on psychological and physical issues faced by journalists in conflict zones contribute to the theory of health and media studies with realities regarding media operations in the MENA region. The study confirms the high level of health and mental risks that journalists experience while reporting in conflict zones reported in the MENA region [11]. The health related psychological and physical problems faced by reporters are generally expressed in movies and not disclosed in research publications. This paper explicitly presents the health loss of journalists reporting in conflict zones as part of research conducted exclusively with such selected respondents, which is not common.
The study reports that journalists are facing lifelong physical and mental disabilities while reporting in conflict zones. The study also reports a lack of mental and emotional training to prepare journalists to undergo coverage in conflict zones.
The guilt that reporters must live with of only reporting and not helping is observed as a major theme and contribution of this study. Most reporters are generally silent about any professional guilt of neutrally reporting without interference. However, during interviews for this paper, some reporters admitted the guilty feeling of the robotic approach of just doing the job and not being humanistic to physically support the people suffering in conflict zones.
The lack of communication with management is not a new phenomenon in the media industry. However, it may be assumed that there is a different case for journalists who risk their lives to report in conflict zones. Based on discussions with respondents, this paper contributes knowledge on media management and occupational health risk, by exposing the experiences of such journalists that they feel left alone by their management.
CONCLUSION AND FUTURE RESEARCH
This qualitative study adopted direct and in-depth interviews with relevant journalists to discuss the psychological and physical consequences of frontline reporting. Six journalists indicated that they suffered from food indigestion problems, three reported a lack of sleep and restlessness, and four leaned to substance abuse such as smoking and drinking to cope with the post stress they were experiencing from reporting in conflict zones. The study indicated that reporting in conflict zones can have serious physical and health impacts on journalists [2, 8]. A journalist reported a spinal injury which caused him losing the ability to walk and spending the rest of his life in a wheelchair Back pain and unspecific pain were also reported by many journalists. Negative emotional health can have an impact on overall health status [12]. Most journalists reported a low level of emotional health and claimed to be emotionally drained. One journalist reported a loss of purpose and meaning in life [4, 6]. Other journalists reported a high level of chronic anxiety and one of the journalists indicated recurrent nightmares [15]. On the contrary, none of the respondents gave up their jobs, retired early, or even asked to be transferred to different positions or locations.
This study concludes that the social risk for journalists reporting in a conflict zone is significantly based on the discourse of denial that existed within journalism boosted by social infrastructure built and maintained in various regions [4, 31]. Managing social issues could further progress towards economic and political issues [17, 18]. The research outcomes suggest that social risk for journalists can be contained by training, educating, protecting, and motivating them with proper compensation. There is an increased awareness of the violence suffered by reporters who are members of reporting teams working in conflict zones. Evidence of the impact of this violence - on the safety and security of journalists and reporters - has been documented by a range of organizations and, in turn, has been the subject of national, regional, and global advocacy [17]. Countries in the Middle East and North Africa (MENA) are no exception. In recent years, a series of extreme situations in the MENA region have highlighted the hostility of environments and rights violations affecting the safety of journalists-reporters and their teams [13, 18].
This study concludes that safety and security issues can lead to negative repercussions in all aspects. However, more systematic investment and governmental support are needed to strengthen safety and security to protect journalist-reporters covering conflict zones in the region. The study describes the contextual factors that shape safety and security challenges in the MENA region for journalist-reporters. The social risk must be managed carefully, otherwise, the society will bear the burden of treating, rehabilitating, and supporting the journalists [1, 14].
The data and researcher triangulation concluded with six major themes: motive for reporting in conflict zones, professional guilt, psychological and physical stress from occupational hazards, official support, recovery from occupational stress, and lack of communication with management. The themes were constructed upon the sub-themes that emerged and were coded from transcripts prepared after direct interviews. The major limitation of the study was the fact that most journalists were hesitant to be interviewed and to disclose their expressions about sensitive topics in the MENA region.
All major themes indicated that respondents were directly or indirectly suffering from psychological and physical consequences due to the nature of their jobs and related assignments. Most respondents were observed to be dissatisfied with the management of the media companies regarding these consequences. A future study on solutions for the psychological and physical issues disclosed in this paper is a palpable research direction. Professional journalists, psychological experts, and media managers could be sampled for a qualitative study based on interviews to examine whether any specific post-traumatic debriefs and health therapies could be applied to the problems highlighted in this paper.
LIST OF ABBREVIATIONS
| MENA | = Middle East and North Africa |
| PTSD | = Post-Traumatic Stress Disorder |
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
The protocol for the study was approved by the Ethical Committee of the Canadian University Dubai, UAE.
HUMAN AND ANIMAL RIGHTS
No animals were used for studies that are the basis of this research. All the humans were used in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013 (http://ethics.iit.edu/ecodes/node/3931).
CONSENT FOR PUBLICATION
The written informed consent form was taken from the patients and volunteers.
STANDARDS OF REPORTING
COREQ guidelines were followed.
AVAILABILITY OF DATA AND MATERIALS
The data that support the findings of this study are available within the article.
FUNDING
None.
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or otherwise.
ACKNOWLEDGEMENTS
Declared none.
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