In war zones around the world, aid workers trying to help local populations now face a relentless cycle of violence and personal risk.
“It is kidnapping, it is direct targeting, bombing, it is threats by collateral stuff that can just be wrong place at the wrong time, where an IED happens to be on the road that goes off," said Amaury Cooper, cofounder of International NGO Safety and Security Association.
Aid workers can also be used as "political pawns, where they are being kidnapped to make a message or kidnapped for ransom,” added Cooper.
Increased threats of kidnappings and death from Islamic State militants have made Syria a no-go zone for expatriate aid workers, despite the desperation of civilians caught in the crossfire.
American aid worker Kayla Mueller died in 2015 while being held hostage in Syria by Islamic State militants. Just months before, the same group beheaded British aid worker David Haines, also kidnapped in Syria.
Ten years ago, aid and humanitarian workers were seen as separate from the conflicts in which they were trying to operate. Things have changed, said Jim LeBlanc, vice president of the global risk management company Unity Resources Group.
“In the past if someone was harmed or injured, it might have been a criminal activity, it might have been a road accident of some type, or collateral damage," he said. "Now, they're targeted.”
Much depends on the place. There are large parts of the world where humanitarian workers are accepted.
Joel Charny, vice president of Interaction, an alliance of U.S.-based relief and development agencies, said in areas controlled by extremist groups like Islamic State, the risk is even higher.
“In those particular places, the NGO label or the humanitarian label carries with it very little protection," he said. "Indeed our community can be seen as a soft target.”
According to Humanitarian Outcomes, violent acts against aid workers around the world have increased in the past decade, with kidnappings seeing the steepest rise. In 2012, Afghanistan, Pakistan, South Sudan and Somalia ranked as the most violent.
Charny said lately, the biggest impact has been inside Syria, where there is an almost complete inability to use expatriate workers in cross-border operations to help civilians stranded there.
Now, it is virtually unthinkable for any large aid agency not to have dedicated security personnel, said LeBlanc. And most aid organizations have become much more sophisticated in how they approach security and their duty of care obligations, which means the "reasonable steps" they are obligated to do "to mitigate the risk of something bad happening to one of their staff."
Because many aid groups don’t want to alienate the local communities they work in, they rarely hire private security firms to protect them. When danger levels are considered too severe, expatriate staff often are evacuated, leaving local staff to continue the aid work. Charny said such pullouts raise a number of ethical questions, as well as demands by local staff for death compensation and trauma counseling.
The question is then how to continue to work side-by-side with the community in places like Syria or Afghanistan, Charny said.
With the spread of threats by Islamic State and its supporters in Egypt, Libya, Turkey and Jordan, Charny said aid groups are taking security seriously.
Cooper said donors and aid organizations have to invest more in security planning, and aid workers need to make sure those plans are in place.
“Aid workers, when they are looking for jobs and applying for jobs, should ask, ‘What security measures are in place for us? What is being done?" he asked. "Do you have a crisis management plan? Do you have a way to medevac, medical evacuation or security evacuation in place?’”
Cooper added that many aid groups plan for security, although it continues to be seen as an external factor, a check box that needs to get filled rather than an integral part of the project.
“If an aid organization cannot honestly say, 'yes, no matter what happens we can continue operating,' they should not go in,” he advised.
And those who stand to lose the most are the civilians left behind, caught in the crossfire with no one to turn to.