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Living in crisis locations – a mental and physical hardship

When people think of the challenges and hardships faced by expatriates the focus tends to be on physical threats to wellbeing – whether from natural disasters, air pollution, crime, disease or war. However, it is not just the physical risk that we need to consider – there is also a significant threat to mental wellbeing from a posting in a difficult and stressful environment.

In ECA’s recent Location Ratings Survey, expatriates in a number of difficult locations reported the extreme anxiety and mental strain they experienced. In recent times we have seen a much greater recognition of mental health issues, in the fields of sport, entertainment, politics and elsewhere. This has also been noticeable in responses to the Location Ratings Survey, with an increasing willingness from expatriates to discuss the impact of conditions in their host location on their mental health.

ECA recognises the importance of the issue too and this is reflected in higher health scores in locations where the mental risk is significant. This is evident in the recently published location ratings. All Chinese cities saw a score increase, largely because expatriates there are living with increased anxiety and stress owing to the country’s harsh Zero-Covid policy. While the rest of the world had largely removed or drastically reduced any remaining pandemic restrictions by late 2022, China has steadfastly maintained its stance, despite the futility of such an approach once the highly contagious Omicron variant had emerged in late 2021.

Under Zero-Covid expatriates in China have been confronted with the ever-present threat of draconian lockdown conditions, and even the potential for being separated from their families. The Chinese authorities have used the pandemic as an opportunity to expand their already widespread monitoring of the population, while also shutting down dissent and restricting freedom of movement (resulting in elevated socio-political tensions scores for China). Living with such threats is naturally very stressful and health scores have gone up as a result.

At the time of writing there has been a slight easing of the policy following public protests across several major cities. It remains to be seen if this easing marks an end to the hard-line policy, or if harsh restrictions will be reintroduced if there is a large spike in cases. Hopefully by the time the next set of results are published Zero-Covid will be just a memory and a posting to China will be a less challenging one for mental wellbeing.

Mental challenges in warzones

Naturally, postings in countries afflicted by war are also extremely stressful. It is, therefore, unsurprising that the health scoring for Kyiv in Ukraine increased this year following Russia’s invasion in February and the subsequent war that has ravaged parts of the country. Of course, it is not just the health scoring impacted. Kyiv also saw score increases in many other aspects of its assessment including goods and services (with shortages of certain items due to disrupted supply lines), utilities (Russian forces have targeted the country’s energy infrastructure), external isolation (there is a lack of civilian international flights) and socio-political tensions. These changes have resulted in Kyiv moving up to the next location allowance band on all home bases under ECA’s standard recommendations.

Russian cities have also seen significant score increases owing to the conflict. This may initially seem strange given that the military action is taking place in Ukraine, not Russia. As it stands, there is little threat to expatriates in Moscow from bombs and missiles. However, we must again take into account the mental impact of living in a very difficult location – and Russia has certainly become that for the dwindling number of expatriates, leading to an increase in health scoring. Immediately after the first tanks rolled into Ukraine governments around the world imposed major sanctions on Russia, which steadily increased as the war continued. This has naturally led to shortages of goods and services, even to the extent that spare parts for aeroplanes have been unavailable, compromising the safety of domestic flights (the internal isolation scoring has increased as a result). Banking services have also been severely impacted. Russian authorities have blamed economic woes on other countries and this has left expatriates in a vulnerable position. Many assignees have reported hostility from the local population and now try to keep a low profile, even trying not to speak out loud in public in case their foreign accent is detected.

Living with this constant anxiety places a great strain on mental wellbeing. This is exacerbated in Russia by oppressive levels of surveillance (taken into account in the News and Media scoring) and official harassment and propaganda – already issues in Russia before the war, but now even more severe. Freedoms have been reduced even further as the state has cracked down on those expressing opposition to the war, as well as further suppression of the LGBT community. The Culture scoring has gone up as a result and Russian cities have seen location allowances increase in many cases.

Declining democracy in East Asia

Assignees in Hong Kong have also experienced worsening conditions this year. The democratic situation has particularly deteriorated in recent times, with political rights and freedom of expression severely diminished. Hong Kong has become more and more aligned with mainland China, further evidenced by the appointment of a staunchly pro-Beijing figure to the post of Chief Executive. An aggressive approach towards dissent is now taken by the authorities, and political opposition has largely been banned. The Culture scoring for Hong Kong has increased as a consequence.

Hong Kong’s News and Media score has also gone up, given elevated levels of censorship and surveillance. Newspapers have been closed down and others censored, while journalists and editors have been arrested for alleged breaches of the National Security Law. Censorship has even been extended to social media and entertainment streaming services. In one instance, a reference to the Tiananmen Square massacre was removed from an episode of The Simpsons on the Disney+ channel.

Economic issues affecting expatriates

Sri Lanka was another flashpoint this year with major protests taking place against the government’s perceived mismanagement of the economy. The price of goods and services had skyrocketed, leading to major shortages of even basic items, including petrol and medical supplies (Colombo’s health and goods and services scores have increased accordingly). This culminated in violent protests and political turmoil as the country’s economy crumbled, with angry crowds even storming the presidential and prime ministerial residences.

Cuba has also suffered from acute shortages of goods owing to a deteriorating economic situation. Havana’s Goods and Services score has gradually worsened in recent years, and this continued in 2022 as expatriates struggled to obtain the items they needed. The damage caused by Hurricane Ian also contributed to a higher location ratings score this year for Havana.

Elsewhere in the Caribbean, troubled Haiti saw violence spiralling again as warfare between rival gangs impacted on the availability of goods and the safety of assignees. In Africa, Burkina Faso witnessed two coups in a year – with the group who toppled the government back in January being ousted themselves in September. Such undemocratic transfers of power raise the governance aspect of the Culture scoring.

ECA’s location ratings also take into account disasters which are not man-made. Earlier in the year the Pacific nation of Tonga experienced the world’s largest volcanic event of the 21st century when the Hunga volcano erupted, causing a number of fatalities as well as significant damage and disruption. This included the severing of the underwater cable which provides Tonga’s internet connection. Tonga’s natural hazards scoring increased, along with other aspects of the assessment. Elsewhere, cities such as Durban in South Africa experienced significant flooding which led to score increases.

What can we expect in 2023? The last three years have been tumultuous with a global pandemic and war erupting in Europe, the fallout from each impacting much of the world. Economic woes are being experienced globally, shortages exacerbated by disrupted supply lines as a result of the war in Ukraine and China’s pandemic policy. It is possible we will see the scenes in Sri Lanka repeated elsewhere by angry populations. Whatever happens, ECA’s location ratings team will continue to monitor all events closely, taking into account the threats to both the physical and mental wellbeing of international assignees.


ECA's Location Ratings are delivered through ECA's Location Allowance Calculator which offers a transparent and detailed system for calculating location allowances for expatriates relocating to a new country.

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