Interns’ Mental Health, Workplace Bullying in Africa, and Strategies for Change

Abstract

This paper provides a comprehensive analysis of workplace bullying and harassment as a critical occupational health hazard, with a specific focus on the heightened vulnerability of interns within the African corporate and institutional landscape. Synthesizing data from longitudinal studies, meta-analyses, and regional reports, this analysis establishes a definitive link between prolonged exposure to workplace mistreatment and severe, long-term mental health sequelae, including clinical anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal ideation. The paper meticulously examines the prevalence, manifestations, and unique socio-economic drivers of this phenomenon across Africa, highlighting how factors such as high youth unemployment, hierarchical power structures, and systemic gender inequality create a fertile ground for exploitation. Case studies, particularly from South Africa’s medical sector, reveal a systemic crisis demanding urgent attention. In response, this paper proposes a robust, dual-pronged strategic framework for intervention. For interns, it outlines evidence-based strategies for personal resilience, meticulous incident documentation, and safe reporting. For organizations, it details a comprehensive corporate wellness model encompassing zero-tolerance policies, accountable leadership, confidential reporting systems, and culturally-attuned mental health support. It is concluded that addressing the bullying of interns is not merely a human resources issue but a strategic imperative for sustainable economic development and public health across the African continent.

1.0 Introduction: A Silent Epidemic in the Global Workforce

1.1 Defining the Scope of the Problem

Workplace bullying represents a pervasive and insidious form of psychological violence that constitutes a significant, yet frequently underestimated, threat to corporate wellness and public health.¹ It is defined as the systematic and repetitive engagement in interpersonally abusive behaviors that negatively affect the targeted individual and, by extension, the work organization.¹ Core to its definition is the presence of a real or perceived power imbalance between the perpetrator and the target, which escalates over time to a point where the target finds it increasingly difficult to defend themselves.⁴ This systematic mistreatment is distinct from isolated incidents of workplace conflict; it is a prolonged process of harassment, social exclusion, humiliation, and intimidation designed to undermine a person’s professional standing and personal dignity.² The behaviors can be overt, such as verbal abuse and threats, or subtle, such as social exclusion, the spreading of rumors, or the assignment of unmanageable workloads.¹ Regardless of its form, workplace bullying is a severe psychosocial stressor with demonstrable, health-harming consequences.⁸

1.2 The Unique Vulnerability of Interns

While workplace bullying can affect any employee, this paper focuses on interns, a demographic that is structurally and psychologically predisposed to a heightened risk of mistreatment. Interns occupy a precarious position within organizational hierarchies, characterized by their temporary status, dependency on supervisors for performance evaluations and future career prospects, and a general lack of institutional power.⁵ This inherent power differential is a key component of the bullying dynamic, creating an environment ripe for exploitation.¹ Often young and at the nascent stages of their careers, interns may lack the experience to recognize subtle forms of abuse or the confidence to challenge inappropriate behavior from senior colleagues.¹² Their primary goal is to gain experience and secure a permanent position, a dependency that perpetrators can leverage to enforce compliance and silence. Consequently, interns represent a critically vulnerable, yet historically under-researched, population in the study of workplace harassment and its long-term health impacts.

1.3 The African Context: A Confluence of Risk Factors

The challenge of intern harassment assumes a particularly acute dimension within the African context, where a confluence of profound socio-economic and cultural factors amplifies the structural vulnerabilities faced by young professionals. Deeply embedded hierarchical power structures, a legacy of colonial and post-colonial administrative systems, often foster organizational cultures where challenging authority is discouraged, thereby enabling abusive conduct by those in senior positions.¹⁴ This is compounded by pervasive gender inequality, which manifests in high rates of sexual harassment and creates additional barriers for female interns navigating male-dominated industries.¹⁵

Perhaps the most significant accelerant of this crisis is the continent’s staggering youth unemployment rate. In nations like Uganda and Kenya, economic desperation forces young people to accept precarious and often exploitative internship conditions, drastically tilting the power balance in favor of the employer.¹⁶ This economic precarity is a potent tool of control; the threat is not merely a negative reference but the loss of a vital, and perhaps singular, economic opportunity. This transforms the intern-supervisor relationship into one of extreme dependency, a primary enabling condition for bullying. The result is a silent epidemic of mistreatment, evidenced by alarming data across the continent. Studies from West Africa reveal lifetime prevalence rates of work-related violence and harassment as high as 65% in Senegal and 58% in Côte d’Ivoire.¹⁸ In South Africa, the medical community has been described as facing a “silent epidemic” of bullying against junior doctors and interns, with one study finding that virtually all participating interns in KwaZulu-Natal had been targets of bullying.¹⁰ These figures underscore the urgency of addressing this phenomenon not just as a corporate policy failure, but as a critical public health and economic development issue for the continent.

1.4 Thesis Statement and Report Structure

Workplace bullying against interns in Africa is a systemic crisis fueled by structural vulnerabilities and socio-cultural norms, resulting in severe, long-term psychopathology that undermines both individual well-being and national human capital development. This crisis necessitates a holistic, integrated framework of individual empowerment and organizational accountability. This paper will substantiate this thesis through a multi-faceted analysis. Section 2.0 will review the extensive medical literature establishing the neuropsychiatric and somatic consequences of prolonged workplace mistreatment. Section 3.0 will provide a detailed profile of the structural vulnerabilities specific to interns, drawing on industry-specific case studies. Section 4.0 will present a comprehensive overview of the prevalence, drivers, and manifestations of workplace harassment within the African landscape. Section 5.0 will transition from analysis to action, proposing a dual-pronged strategic framework of interventions for both interns and organizations. Finally, Section 6.0 will offer concluding remarks and an agenda for future research.

2.0 The Neuropsychiatric Sequelae of Prolonged Workplace Mistreatment: A Review of the Evidence

The negative effects of workplace bullying are not merely subjective feelings of stress or unhappiness; they are quantifiable, clinically significant health outcomes rooted in well-understood physiological and psychological mechanisms. The persistent nature of bullying acts as a chronic and severe psychosocial stressor, triggering a cascade of biological and emotional responses that, over time, can lead to debilitating long-term illness. Framing bullying as a clinical and public health issue, rather than a simple managerial problem, is essential for appreciating the true cost of inaction and for designing effective, health-focused interventions. The damage inflicted is a form of sustained psychological injury, with a clear psychopathological profile and a predictable trajectory of long-term morbidity comparable to other recognized occupational hazards.

2.1 The Stress-Response Mechanism

Exposure to systematic and prolonged aggressive behaviors initiates a sustained stress response that is detrimental to long-term health.²² According to stress theory, this exposure is a major source of distress that leads to a state of cognitive activation, wherein the targeted individual repeatedly evaluates and re-evaluates the threatening social environment.¹⁰ This constant mental effort to cope with the situation exhausts the individual’s cognitive and emotional resources.⁴

This cognitive activation triggers a corresponding and prolonged physiological activation of the body’s primary stress-response systems: the autonomic nervous system and the Hypothalamic-Pituitary-Adrenocortical (HPA) axis.¹⁰ The sustained activation of these systems leads to enhanced neuroendocrine responses, including increased levels of cortisol, an elevated heart rate, and other physiological changes designed for short-term “fight or flight” scenarios.⁶ However, when the stressor is chronic, as in the case of workplace bullying, these systems become dysregulated. HPA-axis dysregulation, in particular, has been directly associated with a range of adverse health consequences, including depression, anxiety disorders, sleep disturbances, and burnout.⁶ This biological pathway explains how the psychological experience of being bullied translates into tangible, long-term physical and mental health impairment.

2.2 Long-Term Mental Health Outcomes

The link between workplace bullying and adverse mental health outcomes is one of the most robustly documented findings in occupational health research. A vast body of evidence from cross-sectional studies, longitudinal research, and large-scale meta-analyses confirms that exposure to bullying is a significant predictor of severe and lasting psychological distress.

2.2.1 Depression and Anxiety

A strong, positive correlation between workplace bullying and symptoms of depression and anxiety is consistently reported in the literature.¹ A major meta-analysis involving over 115,000 participants in cross-sectional studies found a mean correlation (

r) of 0.28 between bullying and depressive symptoms, and a correlation of 0.34 with anxiety symptoms.²⁵ These associations are not merely correlational. Longitudinal studies, which track individuals over time, provide powerful evidence of causality. A five-year prospective study showed that baseline exposure to workplace bullying was a significant predictor of mental health problems five years later, even after controlling for pre-existing mental health status.¹⁰ Other studies with two- to ten-year follow-up periods have consistently demonstrated that prior exposure to bullying or harassment is associated with elevated depressive symptoms and psychological distress years after the initial exposure.²³

2.2.2 Post-Traumatic Stress Disorder (PTSD)

The repetitive, systematic, and uncontrollable nature of workplace bullying can constitute a traumatic experience, leading to symptoms consistent with Post-Traumatic Stress Disorder (PTSD).²² The constant threat, humiliation, and social exclusion can be as psychologically damaging as a single, acute traumatic event. Research has claimed that the symptomatology found among bullied individuals closely resembles that of PTSD.²⁸ A meta-analysis of 29 studies established a strong positive correlation (

r=0.42) between being a target of bullying and reporting an overall symptom score for PTSD.²⁸ Another meta-analysis found a significantly stronger association between bullying and PTSD symptoms (

r=0.46) compared to general anxiety (r=0.28), underscoring the traumatic impact of these experiences.²⁵ Victims often experience intrusive thoughts, avoidance behaviors related to work, and hypervigilance, all of which are hallmark symptoms of PTSD.²⁷

2.2.3 Burnout, Suicidal Ideation, and Substance Misuse

The psychological toll of bullying extends to other severe outcomes. Burnout, a state of emotional, physical, and mental exhaustion caused by prolonged stress, is a common consequence.²² The constant need to manage the emotional and cognitive demands of a hostile environment depletes an individual’s resources, leading to burnout.⁴

In the most extreme cases, workplace harassment is linked to suicidal ideation and even completed suicide.¹¹ A study of internship students in Malaysia found that workplace bullying was a significant predictor of suicidal ideation.¹¹ More starkly, a national prospective study of Swedish workers with a 13-year follow-up period found significant associations between exposure to sexual harassment and subsequent suicide attempts and completed suicides for both men and women.²³ Furthermore, chronic exposure to both generalized and sexual harassment has been directly linked to increased alcohol misuse as a coping mechanism.²³

2.3 Somatic and Psychosomatic Consequences

The sustained physiological activation caused by bullying-induced stress inevitably manifests in physical health problems. These somatic and psychosomatic symptoms are not merely incidental but are direct bi-products of a dysregulated stress-response system. Among the most commonly reported physical consequences are severe sleep disturbances and insomnia, which are often a primary indicator of psychological distress.¹ Chronic lethargy and fatigue are also highly prevalent, with one study of medical interns reporting a rate of 79.3% among bullied individuals.¹

Other frequently cited physical complaints include recurrent headaches, neck pain, and generalized musculoskeletal pain.¹ Gastrointestinal issues, such as colitis and stomach problems, are also common psychosomatic responses to chronic stress.¹⁹ In the longer term, sustained activation of the cardiovascular system can contribute to more serious conditions, with some studies linking workplace bullying to cardiovascular symptoms.¹ These physical ailments compound the psychological burden on the victim, creating a debilitating cycle of mental and physical ill-health.

Table 1: Documented Long-Term Health Consequences of Workplace Bullying

Health Consequence Category	Specific Condition/Symptom	Key Supporting Evidence
Mood Disorders	Depression	1
Anxiety Disorders	Generalized Anxiety, Panic Attacks	10
Trauma- & Stressor-Related	Post-Traumatic Stress Disorder (PTSD)	22
	Burnout	22
Behavioral Outcomes	Suicidal Ideation & Suicide Attempts	11
	Alcohol & Substance Misuse	12
	Increased Absenteeism / Sick Leave	1
	Intention to Leave / Turnover	10
Somatic Symptoms	Sleep Disturbances / Insomnia	1
	Chronic Lethargy / Fatigue	1
	Headaches & Migraines	19
	Musculoskeletal & Neck Pain	1
	Gastrointestinal (GI) Disorders	19
	Cardiovascular Symptoms	1

2.4 The Bi-Directional Relationship

While the evidence overwhelmingly supports bullying as a causal factor for deteriorating mental health, a more nuanced understanding reveals a bi-directional relationship. Several longitudinal studies have found that individuals with pre-existing mental health problems are at a higher risk of becoming targets of bullying in the future.¹⁰ One five-year study, for instance, found that while baseline levels of depression did not predict future bullying, symptoms of anxiety did, particularly in men.¹⁰ This suggests the existence of a pernicious cycle: an individual’s pre-existing vulnerability, such as anxiety, may make them a more likely target for perpetrators, who often prey on those perceived as less able to defend themselves. The subsequent bullying then exacerbates the underlying mental health condition, further increasing the individual’s vulnerability and potentially prolonging the cycle of abuse. This dynamic complicates prevention and intervention efforts, as it highlights the need to address not only the abusive behavior itself but also the underlying vulnerabilities within the workforce.

3.0 The Intern’s Predicament: A Profile of Structural Vulnerability

The mistreatment of interns is not an unfortunate series of random, isolated events. It is a predictable and systemic outcome of a tripartite failure: the failure of the employing organization to establish and enforce a culture of safety and respect; the failure of the educational institution to adequately prepare, monitor, and protect its students; and the failure of the broader labor market and its regulatory frameworks to shield this vulnerable population from exploitation. This “triad of vulnerability” creates a high-risk environment where interns are often trapped, silenced, and left to endure abuse that can have lasting consequences on their health and career trajectories. The power imbalance is not merely a feature of the intern-supervisor relationship; it is the very foundation upon which it is often built, particularly in high-stress, hierarchical, or economically precarious settings.

3.1 The Power Imbalance Amplified

The defining characteristic of workplace bullying is a power imbalance that renders the target unable to defend themselves.¹ For interns, this imbalance is structurally amplified to an extreme degree. Their position is inherently transient and subordinate. Their primary objective is often not remuneration but the acquisition of experience, academic credit, a positive reference, or a potential full-time job offer. This dependency creates a powerful coercive dynamic; perpetrators understand that interns are highly unlikely to report mistreatment for fear of jeopardizing these crucial career-building outcomes.² The threat of a negative evaluation or the withdrawal of a potential job offer is a potent tool for enforcing silence and compliance. This dynamic is further intensified by the intern’s typical lack of familiarity with corporate policies, reporting procedures, and their own labor rights, leaving them isolated and without clear avenues for recourse.

3.2 Industry-Specific Case Studies

The manifestation of intern vulnerability varies across industries, shaped by the specific cultural norms, hierarchies, and pressures of each sector. Analysis of specific cases reveals common patterns of exploitation.

3.2.1 Medicine: A Culture of Pervasive Mistreatment

The field of medicine, with its rigid hierarchy, high-stakes environment, and tradition of intense training, has been identified as a sector with alarmingly high rates of bullying, particularly directed at junior staff.¹⁹ A study of medical interns in KwaZulu-Natal, South Africa, described the situation as a “silent epidemic,” where bullying by senior medical and nursing staff is pervasive.¹⁹ The abuse is often psychological and intellectual, taking the form of public belittling and humiliation, threats, insults, and the deliberate prevention of access to training opportunities—a particularly damaging form of sabotage for a trainee.¹⁹ This culture is not unique to South Africa; a systematic review of psychiatric trainees globally found substantial levels of bullying, with perpetrators frequently being senior consultants and managers.⁵ In these environments, mistreatment is often normalized as a rite of passage or a necessary component of a rigorous training process, creating a culture where reporting is seen as a sign of weakness and is systematically discouraged.

3.2.2 Hospitality and Media: The Specter of Sexual Harassment

In other sectors, the vulnerability of interns manifests predominantly as sexual harassment. A qualitative study of hospitality interns in Ghana found that their youth, attractiveness, and even their required uniforms were cited as “causes” of sexual harassment by perpetrators.³² This victim-blaming narrative highlights a deeply problematic organizational culture. Critically, the study revealed that the interns experienced various forms of sexual harassment but refused to report any of the cases, and they had not been given any orientation on sexual harassment policies prior to their internship.³²

A similar pattern emerges in the Kenyan media industry. An investigation revealed that newsrooms are a dangerous entry point for young professionals, with 42% of women journalists who had been harassed stating they first experienced it as an intern.¹³ Perpetrators, often well-known senior journalists, exploit the interns’ admiration and their eagerness to secure a foothold in a competitive industry. Incidents ranged from lewd verbal comments and unwanted sexual advances to physical groping.¹³ Victims who confided in colleagues were often told the perpetrator was “known for that,” indicating a culture of impunity where such behavior was an open secret, yet tolerated by the organization.

3.2.3 Construction: Masculinity and Targeting the Vulnerable

While located outside Africa, a study of construction apprentices in Australia offers a valuable comparative lens, particularly for male-dominated industries. The research identified a “masculine” industry culture where bullying is common, particularly directed toward apprentices and those new to the industry.¹² Younger, smaller, or perceived weaker workers frequently become targets, linking the experience of bullying directly to increased substance use, poorer mental health, and suicidal ideation.¹² This case demonstrates how cultural norms around masculinity and toughness can create a hostile environment where seeking help is stigmatized, and bullying is used to enforce social hierarchies.

3.3 The Role of Educational Institutions

Universities and vocational colleges, as the bodies responsible for placing interns, bear a significant and often neglected duty of care. The research indicates a systemic failure on the part of many educational institutions to adequately prepare their students for the potential psychosocial risks of the workplace.³⁵ The aforementioned study of Ghanaian hospitality interns found a complete absence of pre-placement training on sexual harassment, leaving them unaware of their rights or the company’s policies.³² This is not an isolated issue. Educational institutions frequently prioritize the logistical aspects of internships—securing placements and ensuring academic requirements are met—while overlooking the critical need for training on workplace rights, conflict resolution, and identifying and responding to harassment.

Furthermore, these institutions often lack robust systems for monitoring the well-being of their students during internships or for receiving and acting upon confidential complaints. Without a clear, supportive, and proactive link back to the university, interns are left to navigate hostile environments alone. A successful transition to the world of work requires more than just technical skills; it demands resilience and an understanding of workplace dynamics. By failing to provide this preparation and ongoing support, educational institutions become passive contributors to the system of intern exploitation.

4.0 The African Landscape of Workplace Harassment: Prevalence, Drivers, and Manifestations

Workplace harassment and bullying are not fringe issues in Africa; they are widespread phenomena with alarmingly high prevalence rates across multiple regions and sectors. The data reveals a continental challenge driven by a complex interplay of cultural norms, economic pressures, and institutional weaknesses. A particularly troubling pattern that emerges from the data is the existence of a profound “reporting gap” and a subsequent “justice gap.” While the experience of harassment is common, formal reporting is rare. This reluctance stems from a deep-seated lack of trust in existing systems, a justifiable fear of retaliation, and a pervasive belief that reporting is futile. This cycle of silence is the greatest single barrier to progress. Victims do not report because they believe nothing will be done, and because incidents are not officially recorded, organizations can maintain a veneer of functionality, failing to invest in the robust systems necessary to create genuine psychological safety. Breaking this cycle requires a fundamental shift from mere policy creation to active trust-building and demonstrating through transparent action that reporting is safe, confidential, and, most importantly, effective.

4.1 A Quantitative Overview of a Continental Challenge

While comprehensive, continent-wide data remains a challenge, a growing body of research paints a stark picture of the scale of workplace mistreatment.

• West Africa: A series of pilot surveys conducted by the International Labour Organization (ILO) revealed extremely high lifetime prevalence rates of work-related violence and harassment. In Senegal, approximately 65% of workers reported such experiences, with the figure at 58% in Côte d’Ivoire and a still-significant 43% in Burkina Faso.¹⁸ Psychological violence, including verbal abuse and humiliating behaviors, was the most common form reported in all three countries, affecting a majority of male workers and a large proportion of female workers.¹⁸
• Southern Africa: Data from the region confirms a similar trend. A Lloyd’s Register Foundation report found that 22% of men and 11% of women in South Africa, and 28% of men and 20% of women in Namibia, had experienced workplace violence or harassment.³⁷ A separate study focusing specifically on workplace bullying in South Africa found a prevalence rate of 31.1%.⁹
• Healthcare Sector: The healthcare industry appears to be a particularly high-risk environment. A systematic review and meta-analysis focusing on workplace violence against nurses in Africa found a pooled prevalence of 62.3%.³⁸ Within this, bullying was reported by 22.9% of nurses, verbal abuse by 51.2%, and sexual harassment by 10.3%.³⁸ These figures highlight the extreme vulnerability of frontline health workers across the continent.

Table 2: Prevalence and Nature of Workplace Harassment in Select African Nations

Country/Region	Study Focus/Population	Prevalence Rate (%)	Primary Perpetrators Identified	Key Source Evidence
South Africa	Medical Interns (KZN)	Bullying: 100% (of NAQ respondents)	Senior Medical Officers (83.2%), Nurses (67.6%)	19
	General Workforce	Bullying: 31.1%	Not specified	9
	General Workforce	Violence/Harassment: Men 22%, Women 11%	Not specified	37
Kenya	Newsroom Staff	Sexual Harassment: 42% of women first harassed as interns	Senior Colleagues, Editors	13
	General Workforce	Harassment: Women 36%, Men 19%	Not specified	40
Nigeria	Healthcare Workers	Workplace Violence: 88.1%	Patients/Relatives (primary), Senior Colleagues (bullying)	41
Ghana	Hospitality Interns	Sexual Harassment: Experienced but not reported	Male Managers, Coworkers, Customers	32
West Africa	General Workforce	Lifetime Violence/Harassment: Senegal 65%, Côte d’Ivoire 58%, Burkina Faso 43%	Clients/Customers, Supervisors, Colleagues	18
Pan-Africa	Nurses	Workplace Violence (Pooled): 62.3% (Bullying: 22.9%, Verbal Abuse: 51.2%)	Not specified	38

4.2 The Socio-Cultural and Economic Context

The high prevalence rates of workplace harassment in Africa are not arbitrary but are deeply rooted in a specific set of socio-cultural and economic drivers that create an enabling environment for abuse.

• Hierarchical Power Structures and Culture: Many African societies and, by extension, their workplaces are characterized by a high degree of “power distance,” a cultural dimension describing the extent to which less powerful members of an organization accept and expect that power is distributed unequally.⁴² This can foster authoritarian leadership styles and create a culture where subordinates are reluctant to question or challenge their superiors, even in the face of mistreatment.¹⁴ In such environments, bullying by managers and senior staff is more likely to be tolerated and less likely to be reported, as it is perceived as a legitimate exercise of authority.⁴²
• Gender Inequality: Deeply entrenched patriarchal norms and systemic gender inequality are a major driver of workplace harassment, particularly sexual harassment against women.¹⁵ Women in many parts of sub-Saharan Africa are more likely to be in low-paid, insecure jobs and face significant structural and cultural barriers to leadership and advancement.¹⁵ This economic and social disempowerment makes them more vulnerable to abuse and less able to report it.⁴⁴ The ILO data from West Africa confirms this, showing that while men experience more psychological and physical violence overall, women are consistently more likely to be victims of sexual violence and harassment.¹⁸
• Youth Unemployment and Exploitation: As established previously, the crisis of youth unemployment across the continent creates a large pool of desperate job-seekers, including prospective interns. This desperation is actively exploited. In Uganda, for example, high youth unemployment is directly linked to the trafficking of young women to the Middle East under the false pretense of legitimate jobs.¹⁶ In Nigeria, children and youth are subjected to the worst forms of child labor, including forced labor and commercial sexual exploitation, driven by poverty and lack of opportunity.⁴⁶ This broader context of economic vulnerability means that interns often enter the workplace with minimal power, making them easy targets for exploitation and abuse.
• Legacies of Discrimination: The historical context of the continent cannot be ignored. The legacies of colonialism and, in countries like South Africa, apartheid, have entrenched patterns of discrimination based on race, ethnicity, and social class.⁴⁹ These historical power imbalances can persist in modern workplaces, contributing to a culture where discrimination and harassment against marginalized groups are more likely to occur and be tolerated.⁹

4.3 Case Focus: The Medical Internship Crisis in KwaZulu-Natal, South Africa

The situation facing medical interns in KwaZulu-Natal (KZN), South Africa, serves as a stark and comprehensive case study of how these systemic factors converge to create a crisis. A 2023 cross-sectional study of interns in the province revealed a situation of extreme and universal mistreatment.¹⁰

• Prevalence and Perpetrators: The study’s findings were staggering: all 135 interns who completed the Negative Acts Questionnaire (NAQ) were classified as having been bullied in the past six months.¹⁹ The abuse was not random but came from those in positions of power within the rigid medical hierarchy. The most frequently identified perpetrators were senior medical officers (cited by 83.2% of victims) and nurses (67.6%), confirming that the abuse is a top-down phenomenon.¹⁹ The most common forms of abuse were psychological (91.3%) and intellectual (88.2%), including humiliation and being blocked from training opportunities.¹⁹
• Health Impact: The consequences for the interns’ mental and physical health were severe and widespread. A significant majority, 61.8%, screened positive for symptoms of clinical anxiety and/or depression.¹⁹ The somatic and work-related impacts were equally devastating, with interns reporting chronic lethargy (79.3%), sleep disturbances (67.8%), loss of interest in their work (81.0%), recurrent headaches (42.5%), gastrointestinal illnesses (42.7%), and high rates of absenteeism (43.5%).¹⁹ This constellation of symptoms points to a cohort of young professionals suffering from profound burnout and psychological distress at the very beginning of their careers.
• Systemic Failure: The study powerfully illustrates the “reporting gap” and “justice gap.” Despite the universal experience of bullying, a majority of the interns (61.2%) did not report it to senior staff.¹⁹ This silence is a rational response to a broken system. Of the minority who did report, an overwhelming 91.2% were dissatisfied with the outcome of the investigation.¹⁹ This finding demonstrates a near-total failure of the internal grievance and accountability mechanisms within these healthcare institutions. The system does not protect the victims; it protects the status quo and, by extension, the perpetrators.

5.0 A Dual-Pronged Strategic Framework for Intervention

Addressing the systemic crisis of intern bullying requires a paradigm shift away from viewing it as an interpersonal issue and toward treating it as a critical failure of organizational health and safety. The evidence clearly indicates that policies on paper are insufficient; many African organizations have them, but they are rendered ineffective by a lack of awareness, a deficit of trust, and an absence of committed leadership.¹⁹ The true metrics of success are not the existence of a policy document but the degree of employee awareness, trust in the reporting system, and the perceived fairness and decisiveness of the organizational response. Therefore, an effective intervention must be dual-pronged, simultaneously empowering the individual intern to navigate and respond to hostility while fundamentally reforming the organizational culture and systems that enable it.

5.1 Empowering the Intern: Individual Strategies for Resilience and Response

While the ultimate responsibility for preventing bullying lies with the organization, interns can adopt strategies to mitigate psychological harm, protect themselves, and build a case for intervention.

5.1.1 Proactive Resilience and Self-Care

Building personal resilience is a crucial first line of defense against the psychological toll of a hostile environment. This involves actively engaging in stress-management techniques that can help regulate the body’s physiological stress response. Practices such as mindfulness, meditation, and deep-breathing exercises can improve self-awareness and provide tools for managing acute anxiety.⁵¹ Regular physical exercise is also a powerful tool, proven to boost mood and provide a healthy outlet for stress.⁵¹ Interns should be encouraged to cultivate positive self-talk and use self-affirmations to counteract the erosion of self-esteem that often accompanies bullying.⁵¹ Perhaps most importantly, interns must actively combat the isolation that bullying creates by seeking social support. Connecting with trusted friends, family members, and fellow interns can provide emotional validation and reduce feelings of loneliness.⁴

5.1.2 The Critical Importance of Documentation

Meticulous and contemporaneous documentation is the single most powerful tool an intern possesses when facing harassment. A detailed, factual record transforms subjective experiences into objective evidence that can be used in formal complaints or legal proceedings. This documentation must be kept privately and securely—on a personal device or in a physical notebook, never on a company computer or network.⁵⁴

Each entry should be made as soon as possible after an incident, ideally within 24 hours, to ensure accuracy.⁵⁴ The record must be factual and specific, avoiding emotional language or interpretations of motive.⁵⁵ Essential details to include for each incident are:

• Date, time, and specific location of the event.⁵⁵
• Names of all individuals involved, including the perpetrator(s) and any witnesses.⁵⁵
• A detailed, objective description of what happened, using direct quotes wherever possible.⁵⁴
• The intern’s response during and after the incident.⁵⁵
• The names of any witnesses and their immediate reactions.⁵⁴
• The impact of the incident on the intern’s ability to work, their emotional state, and their physical health.⁵⁴

All forms of digital or physical evidence, such as emails, text messages, screenshots of chats, or handwritten notes, must be saved and securely backed up.⁵⁴ This systematic approach to documentation builds a chronological timeline that demonstrates a pattern of behavior, which is crucial for substantiating a claim of bullying.⁵⁴

5.1.3 Navigating Reporting Channels

Deciding to report harassment is a difficult step, fraught with legitimate fears of retaliation and disbelief.¹³ A strategic, tiered approach can help manage this risk.

• Initial Consultation: Before initiating a formal complaint, it can be beneficial for the intern to seek confidential advice from a trusted source outside the direct line of command. This could be a designated mentor within the organization, a career services advisor at their university, or a family member.³⁵ This step allows the intern to discuss the situation and strategize without immediately triggering a formal process.
• Formal Internal Reporting: If the intern decides to proceed, the next step is to utilize the organization’s formal channels, typically the Human Resources (HR) department or a designated manager.⁵⁹ Before doing so, the intern should request and review the company’s anti-harassment policy to understand the official procedure. The complaint should be submitted in writing, referencing the detailed documentation log.
• External and Legal Recourse: If internal channels fail to provide a satisfactory resolution—a common occurrence as shown in the KZN study ¹⁹—the intern must be aware of their external options. In countries like South Africa, this includes filing a dispute with the Commission for Conciliation, Mediation and Arbitration (CCMA) or seeking legal aid for employment claims.⁶¹ Interns should also be made aware of national mental health and crisis support hotlines, such as those provided by the South African Depression and Anxiety Group (SADAG) ⁶³ or various NGOs and crisis lines in Kenya ⁶⁴, which can provide immediate psychological support.

5.2 Reforming the Workplace: Organizational Strategies for Prevention and Support

The burden of addressing workplace bullying cannot rest on the shoulders of its most vulnerable targets. Organizations have a legal and ethical duty to create a safe work environment. This requires a comprehensive, top-down approach that integrates policy, leadership, and support systems into a cohesive corporate wellness strategy.

5.2.1 Policy and Governance: The Zero-Tolerance Framework

A robust anti-bullying and anti-harassment policy is the foundational document for a safe workplace. This policy must be more than a legal formality; it must be a clear, accessible, and actively enforced statement of the organization’s values.⁶⁰ Best practice policies, aligned with local legal frameworks like South Africa’s Employment Equity Act ⁶⁶ and international standards like ILO Convention 190 ⁶⁸, should include:

• A clear and broad definition of prohibited conduct, explicitly including bullying, psychological harassment, verbal abuse, intimidation, and social exclusion, in addition to discriminatory harassment.⁶⁶
• A statement of zero tolerance, communicating that such behavior will not be permitted from any employee, regardless of seniority.⁶⁰
• A detailed, multi-channel reporting procedure that outlines clear steps for lodging a complaint, ensuring confidentiality for the complainant.⁶⁶
• An unequivocal anti-retaliation clause, stating that any negative action taken against an individual for reporting harassment in good faith will result in severe disciplinary action.⁵⁵
• A clear outline of the investigation process and the range of potential disciplinary consequences for perpetrators, up to and including termination of employment.⁶⁰

5.2.2 Leadership and Accountability

A policy is meaningless without the visible and unwavering commitment of senior leadership.⁷⁰ The organizational culture is set at the top. Leaders must not only endorse the zero-tolerance policy but also model respectful and inclusive behavior in all their interactions.⁶⁰ Accountability must be embedded throughout the management structure. Managers and supervisors are the first line of defense; they must be trained to recognize the early signs of bullying and required to intervene promptly and effectively.⁶⁰ Their performance evaluations should include metrics related to team psychological safety and their effectiveness in fostering a positive work environment. A culture of accountability means that managers who tolerate or ignore bullying are held just as responsible as those who perpetrate it.⁶⁰

5.2.3 Systems for Safe Reporting and Support

To bridge the trust deficit and break the cycle of silence, organizations must implement systems that make reporting safe and provide tangible support to victims.

• Confidential and Anonymous Reporting Channels: Recognizing the fear of retaliation, organizations must provide multiple reporting options beyond a direct report to a supervisor or HR. These should include confidential whistleblower hotlines or third-party digital platforms that allow for anonymous reporting.⁵⁹ These systems empower employees to raise concerns safely and are a critical tool for uncovering problems in teams where a manager may be the perpetrator.
• Comprehensive and Continuous Training: Mandatory, interactive training on anti-harassment and anti-bullying is essential for all employees, from interns to the CEO.⁷⁰ This training should be culturally sensitive and tailored to the local context, as demonstrated by initiatives in Ghana.⁶⁸ It should go beyond legal definitions to include scenario-based learning on identifying subtle harassment, understanding its impact, and developing the skills for safe bystander intervention (“upstander” training).⁷¹
• Integrated and Accessible Mental Health Support: A core component of any corporate wellness program must be robust mental health support. Organizations should offer a confidential Employee Assistance Program (EAP) that provides free access to counseling and psychological services.⁷⁴ To ensure cultural relevance and effectiveness in the African context, companies should consider partnering with local mental health organizations, such as Idimma in Nigeria ⁷⁶ or Basic Needs Kenya ⁷⁷, which have deep expertise in providing culturally sensitive support. This demonstrates a genuine commitment to employee well-being beyond mere legal compliance.

Table 3: A Strategic Framework for Combating Workplace Bullying of Interns

Individual-Level Strategies (For Interns)	Organizational-Level Strategies (For the Workplace)
Resilience & Self-Care	Policy & Governance
– Practice stress-management (e.g., mindfulness)	– Implement a clear, comprehensive zero-tolerance policy
– Engage in regular physical exercise	– Define all forms of prohibited conduct, including bullying
– Cultivate positive self-talk and affirmations	– Ensure alignment with local laws and international standards
– Actively seek social support from peers, family, and friends	– Establish clear, unequivocal disciplinary consequences
– Prioritize sleep and nutrition to mitigate physical effects	– Include a strong, enforceable anti-retaliation clause
Documentation	Leadership & Culture
– Keep a detailed, contemporaneous log of all incidents	– Secure visible, unwavering commitment from senior executives
– Record date, time, location, witnesses, and specific actions/words	– Hold managers directly accountable for their team’s climate
– Be factual and objective; avoid emotional language	– Integrate psychological safety into manager performance metrics
– Save all digital evidence (emails, texts) securely and privately	– Leaders must model respectful and inclusive behavior
– Note the impact on work, mental, and physical health	– Acknowledge and reward kindness and positive teamwork
Reporting & Recourse	Systems & Support
– Understand company policy and internal reporting procedures	– Provide multiple reporting channels, including anonymous hotlines
– Seek confidential advice from a trusted mentor or university advisor	– Conduct mandatory, interactive anti-bullying training for all staff
– If reporting internally, submit a formal, written complaint	– Offer a confidential Employee Assistance Program (EAP)
– Know your external rights (e.g., labor tribunals, legal aid)	– Partner with local, culturally-sensitive mental health providers
– Utilize national mental health and crisis support hotlines	– Establish a formal partnership with interns’ educational institutions

6.0 Conclusion and Future Directions

6.1 Synthesizing the Crisis

The evidence synthesized in this paper demonstrates unequivocally that the bullying and harassment of interns, particularly within the African context, is not a peripheral HR issue but a systemic and critical public health crisis. It is a phenomenon driven by a toxic confluence of structural power imbalances, profound economic precarity fueled by youth unemployment, and socio-cultural norms that can perpetuate hierarchical abuse and gender inequality. The consequences are severe, leading to a well-documented spectrum of long-term neuropsychiatric and somatic disorders, including clinical depression, anxiety, PTSD, and suicidal ideation. This sustained psychological assault at the very outset of a professional’s career has the potential to inflict lasting damage, derailing career trajectories, eroding self-confidence, and imposing a significant long-term burden on individuals and the healthcare systems that must support them. The failure to protect this vulnerable population represents a significant loss of human capital and a threat to the sustainable development of a healthy, productive professional workforce across the continent.

6.2 A Call to Action

The multifaceted nature of this crisis demands a coordinated and multi-stakeholder response. A passive approach is no longer tenable. Therefore, a strong call to action is issued to the following key actors:

• To Corporations and Employers: The primary responsibility lies with organizations to move beyond performative, compliance-driven policies and invest in the cultivation of genuine cultures of psychological safety. This requires visible leadership commitment, the establishment of trusted and anonymous reporting systems, mandatory and continuous training for all staff, and holding all employees, especially managers, accountable for fostering a respectful environment. Investing in robust, culturally-attuned mental health support through EAPs is not a perk but a fundamental component of occupational health and safety.
• To Educational Institutions: Universities and vocational colleges must formally recognize and accept their duty of care for students during internships. This involves implementing mandatory pre-placement training on workplace rights, harassment recognition, and reporting procedures. It requires establishing clear, confidential channels for students to report mistreatment and creating formal partnerships with employers that include explicit standards for intern welfare and supervision. The safety and well-being of interns should be a key criterion in the selection and evaluation of placement partners.
• To Policymakers and Governments: National and regional governing bodies must act to strengthen the legal safety net for interns. This includes amending labor laws to provide explicit protections regarding working conditions, stipends, and termination for interns, who often fall into a legal grey area. Governments must also ensure that existing anti-harassment and anti-discrimination laws, such as South Africa’s Employment Equity Act, are vigorously enforced. Finally, public investment in accessible mental health infrastructure is crucial to support all citizens, including the young professionals who are the future of their economies.

6.3 Agenda for Future Research

While this paper has synthesized a substantial body of existing evidence, it has also highlighted critical gaps in the literature that must be addressed to inform more effective, evidence-based interventions in the African context. A dedicated agenda for future research should prioritize the following:

• Longitudinal Studies in Africa: There is an urgent need for more prospective, longitudinal studies based in diverse African countries. Such studies are essential to track the long-term health, well-being, and career trajectories of interns who have experienced bullying, providing definitive data on the lasting impact within specific cultural and economic contexts.
• Sectoral Diversity: Much of the existing Africa-focused research on interns concentrates on high-risk sectors like medicine and hospitality. Future research should expand to investigate the experiences of interns in other rapidly growing sectors on the continent, such as technology, finance, law, and the non-profit sector, to identify unique risk factors and protective measures.
• Interventional Research: There is a scarcity of research evaluating the efficacy of specific anti-bullying interventions within African workplaces. Studies are needed to assess the impact of different models of training, reporting systems, and corporate wellness programs on the prevalence of bullying and the psychological safety of employees, particularly interns.
• Qualitative and Narrative Research: While quantitative data is crucial for establishing prevalence, qualitative studies are essential for capturing the nuanced, lived experiences of interns. In-depth interviews and narrative research can provide a deeper understanding of the cultural dynamics of bullying, the barriers to reporting, and the coping mechanisms employed by targets, giving a powerful voice to those at the heart of this crisis.

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