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Series on Women and Children’s Health in Conflict – The Voice of Gender: Shedding Light on the Impact of Emergencies and Armed Conflicts on the Health and Safety of Women and Girls

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A Syrian refugee and her newborn baby at a clinic in Ramtha, Jordan. Photo Credit: UK DFID, licensed under Creative Commons

This article is part of the Strife Series on Women and Children’s Health in Conflict. Read the Series Introduction at this link.

After a crisis, women face abuse in many shades and colours. Such abuse includes intimate partner violence, which is occurring at a shockingly high rate in many countries. Moreover, some women and girls who rely on aid are exposed to sexual exploitation by aid workers who withhold support until sexual demands are met. It is important to highlight that the mentioned types of abuse, and many others concerning health and safety of women, do not only affect individuals. They also have a long lasting impact on societies as numerous studies have shown that children growing up with violence are more likely to being abused or becoming abusers themselves in the future. Categorically, sexual violence, child marriage, female genital mutilation, trafficking for sexual exploitation, female infanticide, and ‘honour’ crimes remain common in many societies.

Working as a medical referrals’ coordinator for refugees, I still recall being struck by the number of underaged girls leaving school and getting married. Often before the age of 18, they endured numerous preventable health complications as a result of giving birth to their first, second and sometimes third child before they reached adulthood. And this problem did not end there, one woman I met had had more than 9 pregnancies before reaching the age of 35. This was because, as she told me while laying on her hospital bed, “a woman in her culture cannot say no to her husband”, and that hers “does not approve of using contraceptives or any family planning method”, even though she has been continuously warned that further pregnancies may jeopardise her own life.

These are just snapshots of many life stories that women and girls experience when they are deprived of access to basic services such as sexual and reproductive health. The inability to access such essential services puts women at a greater risk of unplanned pregnancy, maternal mortality and morbidity, severe sexual and reproductive injuries, and contracting sexually transmitted infections. In addition, emergencies cause scarcity of basic feminine hygiene products, which causes girls to experience cultural shame. This, in turn, can negatively affect their mental health and exposes them to physical health risks as low menstrual hygiene has been linked to reproductive and urinary tract infections.

As the COVID-19 global pandemic further worsens the suffering of communities especially in the Eastern Mediterranean region, where many countries are already experiencing conflict or are undergoing post-conflict transitions, many organisations and  governments have reported a dramatic increase in GBV. This increase can largely be attributed to factors such as disruption of social and protective networks and decreased access to services.

The risk of GBV was exacerbated during the COVID-19 pandemic as many females were trapped in long lockdowns with their abusers. This put them at increased risk of various types of abuse, while isolating them from access to support systems. Simultaneously, governmental support was reduced as resources were diverted to the enforcement of Covid-19 measures and precautions. This has meant that law enforcement is stretched thin and is unable to address reports of GBV in a timely manner. For example, the World Health Organization (WHO) Eastern Mediterranean Region Office’s (EMRO) initial information from two countries in the Eastern Mediterranean Region, reported an increase of 50-60% in cases of violence against women, based on survivors’ calls for help to women’s organisations’ hotlines.

Even though many international and local organisations are working on issues related to women and girls, as one of the most vulnerable groups in post-conflict and emergency settings, I believe that there is still a very long road to go in order to achieve protection and meet women and girl’s needs. In order to alleviate suffering, UN organisations need to advocate for ending sexual violence against women and meeting the needs of women and girls, through raising awareness, increasing accessibility to healthcare including sexual and reproductive health services, and enforcing regulations that serve and protect females.

To support that, I believe that governmental and non-governmental organisations should prioritise including women in planning for and responding to emergencies, ensuring they are active participants in both formal and informal processes. The inclusion of women will shift the situation from women and girls being perceived solely as vulnerable or as victims, to being able to plan for and support their own needs. Many organizations supporting women’s involvement state that women are often strong influencers and dynamic leaders of change. Empowering women to participate in decision making ensures that women and girls’ issues are prioritised in any formal actions and, I believe, would be a major step towards better serving the needs of women and girls. As a woman who has studied and worked in emergency management, I believe that women in decision-making positions are able to give back a voice to those females who need it the most.

The Arms Trade Treaty & Gender-Based Violence: Challenges Require Data & Willpower

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by Hannah Papachristidis,

‘Non-Violence’ also known as ‘The Knotted Gun’, bronze sculpture by Carl Fredrik Reuterswärd, 1985. (Source: https://untappedcities.com/2020/05/15/art-while-you-walk-in-the-sculpture-gardens-in-nyc/10/ )

The Arms Trade Treaty (ATT) is the first global arms control instrument to acknowledge, and create obligations around, the connection between international arms transfers and gender-based violence (GBV). The treaty’s adoption in 2013 followed over a decade of campaign work led by Oxfam, Amnesty International and the International Action Network on Small Arms (IANSA), which galvanised international popular support for the instrument as well as political engagement. Within this international campaign was a focus on the inclusion of references to the link between GBV and the arms trade by a group of civil society organisations, including Reaching Critical Will (the disarmament programme of the Women’s International League for Peace and Freedom), IANSA and Amnesty International.

The ATT is the first arms control agreement that centres around humanitarian concerns and is notable for introducing the notion of responsibility on the part of exporting states. It obliges states to assess whether there is an overriding risk that the export of arms to another country will be used for, or to commit, violations of international humanitarian law or of the Geneva Convention. With regards to GBV, the treaty obliges state parties to assess whether items exported would contribute to or facilitate acts of GBV. It is the only human rights infringement which is addressed through a standalone article.

Acts of GBV take place in both conflict and non-conflict contexts, in both domestic and public spaces. Conventional weapons can, and are regularly, used to inflict discriminatory violence based on a person’s gender. Moreover, the trade, possession and use of arms have specific gender and power dimensions. The link between the arms trade and gender-based violence, therefore, is one which interrogates power relations and social norms. Article 7 of the treaty addresses the obligations of party states with regards to permitted exports and within this article, part (4) states:

The exporting State Party, in making this assessment, shall take into account the risk of the conventional arms covered under Article 2 (1) or of the items covered under Article 3 or Article 4 being used to commit or facilitate serious acts of gender-based violence or serious acts of violence against women and children.

States are therefore mandated to undertake a gender-sensitive risk assessment of all potential exports. In order to produce an effective risk assessment, states need a comprehensive understanding of gender relations in the importing country and the implications for the risk of GBV, as well as data on the occurrences of GBV by the end-user.

It is widely recognised that data on violence against women and gender-based violence is significantly underreported and likely to be unreliable. Levels of reporting are impacted by stigmas surrounding this type of violence and power imbalances in society that create barriers to reporting. According to UN Women, less than forty per cent of women who experience violence seek help of any sort and, of those seeking help, less than ten per cent appealed to the police. Where data relating to gender-based violence is collected, it is further complicated by the issue that there is no universally accepted definition of GBV, meaning that countries collect different data on aspects of the violence. The lack of standardisation in data collection, therefore, means comparisons and global trends are hard to infer. Finally, data relating to how different categories and types of arms and arms users facilitate GBV are even more rare.

The challenges surrounding assessing the risk of GBV for arms exports are widely recognised by the international community. A paper presented by Ireland to the 2017 Conference of State Parties to the Arms Trade Treaty (CSP), lambasted Article 7(4) for being ‘overly broad, unenforceable and unverifiable’. In 2019, the theme of the CSP5 was gender and arms-related gender-based violence. The CSP5 President’s working paper outlined issues around implementing GBV risk assessments including the vague language in Article 7(4) and the importance of sharing national practices with regards to undertaking this risk assessment. The ATT Monitor report reflecting on CSP5 emphasised again the “uneven understanding among States Parties of what constitutes or facilitates an act of GBV, the ways in which the ATT addresses GBV and how GBV can be incorporated into Articles 6 and 7 risk assessment obligations”. Whilst the ATT may have been groundbreaking for its references to GBV, it is clear now that this obligation should have been more specifically defined such to allow for uniform implementation.

The organisations which campaigned for the inclusion of GBV obligations in the ATT have moved to take on an active role monitoring the implementation of these obligations. In particular, many of these organisations have reflected on these challenges and  have produced resources and guidelines on best practice for implementation. Reaching Critical Will, for example, has published a range of resources on the effective implementation of GBV obligations. Many of these have a strong focus on the need for more comprehensive data collection and sharing practices. Their 2016 report revealed that no country explicitly includes GBV in their end-user documentation and most countries rely on human rights reports rather than specific assessments of GBV. As such, there is often little evidence of the link between arms transfers and GBV because the data used does not interrogate the occurrence of systemic gender-based violence by the end-user. The report provides guidelines for export officials, including examples of how arms facilitate GBV and indicators of GBV that could be used for a risk assessment.

A similar ‘practical guidance’ report was published by Control Arms, which outlines a four-stage approach to incorporating GBV into export assessments. Their report also outlines an extensive library of information sources and datasets corresponding to indicators relating to the prevalence of GBV and state commitments. As with the RCW report, this report is written to provide export officials “with a framework within which to systematically consider GBV in export assessments”. These two reports provide foundational knowledge for states which do not have existing expertise on GBV risk assessments and go some way to cement understanding on the link between GBV and arms transfers.

A recent report by Greenpeace focused specifically on Germany’s arms exports and gender-based violence. The report emphasises the importance of gender-sensitive human rights assessments rather than a general human rights focus and the need for the German government to include a specific criterion relating to the risk of GBV in its risk assessment as well as to improve internal training on the relation of GBV to arms transfers. Greenpeace draws upon research by both RCW and Control Arms to present cases of ‘best practice’, which include Latvia’s questionnaire on the prevalence of GBV in the recipient country and the UK’s updated licensing criteria legislation which includes reference to the risk of GBV.

As Control Arms, Greenpeace and RCW highlight in their publications, gender-based violence is systematically under-reported. In terms of data collection, it is a hidden violence. Consequently, it is not enough to rely on a gender-neutral human rights assessment to assess the risk of GBV within the export of arms. That GBV is the only human rights concern to be addressed with a standalone article in the ATT, highlights the need for governments to specifically focus on overcoming tendencies to overlook GBV. Despite elevation within the treaty however, this need is hindered by the vague language of Article 7(4) and the lack of an agreed definition of GBV weakens systematic global monitoring.

For civil society and advocates of the treaty, the ATT has been disappointing. The UK’s continued exports of weapons to Saudi Arabia for use in the Yemen war, in the face of clear evidence that the Saudi-led coalition continues to target civilians and violates international humanitarian law, has been a significant failure for the ATT’s progress. With implementation of the most basic export assessments failing as in the case of the UK, it can be easy to disregard the importance of other components of the treaty. Perhaps, however, if there was a more comprehensive evidence base and a strong practice of collecting gender-disaggregated data, the clear evidence of the importance of GBV to arms transfers would be more difficult to ignore.

The international civil society has created a wealth of resources addressing the implementation of obligations around gender-based violence in arms transfers. Although the challenges are significant and will take time to surmount, it is critical that states step up, heed the guidance presented to them, invest in gender-specific expertise, and take their responsibilities seriously.

Hannah Papachristidis is a project officer at Transparency International Defence & Security, where she manages research outputs for the 2020 Government Defence Integrity Index. She holds an MA in International Affairs from Columbia University and is an Emerging Expert at Forum on the Arms Trade.

The Forgotten Casualties: The Indirect Gendered Consequences of Explosive Violence on Civilian Populations

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by Miles Cameron Hunter

9 July 2019

One of thousands of Syria’s widows; Hanaa’s husband went missing before their son was even born. She now struggles to support him on her own. (Image credit: 2014 UNRWA Photo by Taghrid Mohammad)

Explosive violence is a feature of most contemporary armed conflicts. It comes in many forms: from mortars and airstrikes, to landmines and suicide bombings. Tragically, it is civilians who face the brunt. There is little sign of this trend abating: the casualty monitor run by Action on Armed Violence observed a 165% increase in civilian deaths as a result of explosive violence between 2011 and 2017.

The impact of explosive violence is far-reaching, triggering numerous indirect consequences beyond an initial blast; this affects everything from the provision of effective healthcare, to education and sanitation. However, this piece focuses on a less-discussed impact of explosive violence: the series of indirect gender-related consequences. Patriarchal societal norms and values in many war-torn regions often result in women being immensely disadvantaged. Meanwhile, the traditional impression that men are the chief actors in war is still overstated, frequently leading to the impact on women going unseen. These views persist even as explosive violence in modern war harms a growing number of women and children. Women regularly find themselves widowed in societies that repress their independence, raising families alone in poverty while often enduring limited access to health and after care services. Greater awareness regarding these gender-based issues is overdue.

For men, the consequences are often more self-evident. As a result, they tend to overshadow the subtler, but no less important, impact on women. The raw statistics suggest that men and boys are more likely to be harmed in an explosive incident than women, especially when looking at landmines or explosive remnants of war (ERWs). According to data from 2015, 86% of explosive incidents where the gender was known involved men. A main reason for this is societal norms and traditional gender roles that are often present in affected areas.

In many of the worst hit regions, such as Syria and Zimbabwe, it is commonplace for men to be the chief breadwinners for the family, while afflicted regions also tend to be more economically disadvantaged. As a result, occupations such as farming and scrap salvaging are notably at risk, with labourers (usually men) forced to work dangerous land to provide for their families.

But there are more indirect gendered-consequences. In societies where it is the norm for a man to provide, a maimed father has a knock-on effect on the family. Often, it is children, generally boys, who are pulled out of school to work instead, facing the same dangers from explosive ordnance. Women also suffer the cost.

Despite being more likely to suffer direct consequences of blasts, men are also in a more advantageous position to cope by receiving treatment and/or finding alternate employment. This is largely due to gender-based bias in many affected societies. Dr Sherry Wren, in association with Doctors Without Borders, has expressed concerns that medical treatment in conflict zones, such as those in Sub-Sharan Africa and the Middle East, is far less accessible to women. Data suggests that sixty-nine percent of surgeries between 2008 and 2014 were on men, leading to fears that women are under-represented in hospitals due to their second-class societal status. It is true that for direct violent trauma, such as gunshot wounds and explosive injuries, seventy percent of surgeries were performed on men. This is not surprising. However, the alarming figure is that even for indirect trauma, such as illness and disease, seventy-three percent of surgeries were performed on men. This is a stark inequality.

The key finding of this report is that women endure many long-term, and often overlooked, indirect consequences of explosive violence. In general, there is already an issue with long-term trauma in post-war states being neglected. However, for women this is exacerbated due to a second-class status in the patriarchal societies that make up the majority of modern conflict zones. Injured women are less likely to have access to aftercare services and generally face more stigma and marginalisation than men if disfigured; according to  UN research into gender-based perceptions of war survivors. There are also health complications unique to women. For instance, a blast can damage the female placenta, leading to direct or indirect complications in childbirth in future: indeed, this is one of the biggest killers of young women according to the WHO.

Women in Non-Western patriarchal societies also suffer from many indirect socio-economic consequences of explosive violence. Those widowed, or who have a husband incapacitated, face a plethora of struggles. They find themselves in a position where they must be chief breadwinner in cultures that frequently militate against women working, while also retaining the responsibility of raising children.

In Syria and Lebanon, fifty percent of families with a female head face food insecurity and are twice as likely to live in deprived informal settlements. Many women struggle to find work due to gender-based stigma. As a result, they risk being dragged into poverty and/or forced into exploitative means of income such as sex work or seeking early marriage for young girls. All of this can cause intense psychological scarring, which although not as immediately evident as physical injury, can be equally debilitating.

Even when women struggling in the aftermath of explosive violence do find conventional work there are harsh inequalities. In Lebanon, it is reported that women often work longer hours than men for just seventy-seven percent of what their male counterparts earn, while also having demanding maternal duties.

There are many more hardships facing women than those documented in this report. But its findings are demonstrative of clear gender-based issues persisting in civilian populations affected by explosive violence. The notion that men are the primary actors in war still prevails despite the ever-greater toll on women and children. Consequently, the plight of thousands of women affected by explosive incidence often goes unnoticed.  As awareness for their predicament grows, traditional assumptions need to evolve along with the changing nature of war.

Miles Hunter graduated from King’s College London with a BA in War Studies and an MA in Terrorism, Security and Society. He is currently a researcher with the charitable NGO Action on Armed Violence.