Displaced or refugee women are at increased risk of violence. What can WHO do?
23 November 2018 - The estimate that 1 in 3 women around the world have experienced either physical and/or sexual violence, mostly by an intimate partner is one that is widely cited today. Whilst this is a worldwide figure, there is variation in the prevalence of violence seen within and between communities, countries and regions. Even though data are scarce, we know that in humanitarian and emergency settings, linked to an increase in armed actors and a decrease in security as a result of broken social and protective networks, the risk to women of different forms of violence are even greater. For example a recent study in South Sudan found that abuse by husbands or partners was the most common form of violence reported, with more than half of the women who ever had an intimate partner reporting physical and/or sexual domestic violence. Up to one-third of the women interviewed reported sexual violence by a non-partner, with many incidents related to a raid, displacement or abduction.The variation in prevalence across settings highlights that violence against women is not inevitable and that it can be prevented.
The short and long-term consequences of such violence on the health and well-being of women are many and significant. In addition to the immediate trauma and injuries, women may have to face other health issues including unintended pregnancy, mental health problems, sexually transmitted infections, and, in some regions, HIV. In many settings the health services to respond to survivors of violence are non-existent or, at best, limited. In addition, many survivors may not seek care and thus suffer even more health consequences. Women often also face subsequent stigma and rejection from their families or communities and, in a vicious cycle, are vulnerable to further violence.
Bearing in mind that health services, even when they are available, are often limited, the World Health Organization (WHO) is continuing to strengthen the health systems’ response to violence against women including in humanitarian and emergency settings. Consistent with WHO’s commitment to keep countries at the centre of its work, WHO supports countries in implementing the actions in the WHO global plan of action on strengthening health systems response to violence, in particular against women and girls and against children.
WHO has been working in all six of its regions to support countries to develop or update their national guidelines and protocols on responding to violence against women in line with WHO clinical and policy guidelines and to implement these through health care provider trainings. For example, in October of 2018, the regional offices for the eastern-Mediterranean and Africa convened an inter-regional workshop with 12 countries from both regions to exchange lessons and learn about WHO tools and guidelines for strengthening health systems response to violence against women.
WHO is also strengthening responses to violence against women in humanitarian and emergency settings including Afghanistan, Cox’s Bazaar (Bangladesh), Democratic Republic of Congo, Iraq, northern Nigeria and Syria. For example, in Syria, WHO has begun activities to work with health providers and health organizations, holding in October a sub-national workshop in Aleppo which brought together participants from the Aleppo Directorate of Public Health, nongovernmental organizations and UN agencies. Discussions focused on the consequences of violence on women’s health; health system minimum requirements to facilitate care for women subjected to violence; WHO tools to provide survivor-centred support; women's protection needs; and inter-sectoral coordination.
Equipping health care providers with the skills and knowledge to better support the management of gender-based violence will be critical and to this end, a training of trainers is scheduled for early 2019.
Mental health response in Bangladesh
In Bangladesh Dr. Boris Budosan, psychiatrist and WHO mental health consultant in Cox’s Bazar (a refugee camp housing many of the Rohingya refugees), is working to increase the understanding of the impacts of violence against women and to ensure that a mental health response to violence against women is integrated in the training of health care providers. Health care providers working in Cox’s Bazar are also being trained on how to identify and provide clinical care to women survivors of violence. The clinical care training includes providing first-line support including empathetic listening, a non-judgemental response and addressing the practical needs of the survivor as well as treatment for health consequences of violence.