Why investing in health is critical for addressing gender-based violence in fragile settings

Globally, over one-third of women report having experienced some form of physical or sexual violence. Many cases of violence, such as domestic abuse and rape, are underreported, so the true incidence of gender-based violence (GBV) is actually much higher.  

This risk is amplified in fragility and conflict affected situations where there is a breakdown of law and order and institutions that protect the vulnerable. Based on the limited data available, it is clear that GBV is a pervasive issue for displaced and refugee populations. One of the most comprehensive surveys of South Sudanese refugees, for example, found that 65 percent of women and girls had experienced some form of physical or sexual violence. 

Addressing GBV in fragile and conflict affected situations requires a strong understanding of the added complexities of people on the move or in transient camps that may end up becoming long-term living situations. The challenges, and consequently solutions, in different situations are obviously varied, but the health sector plays a pivotal role in managing and preventing GBV across all settings.  

For example, first aid and emergency health workers are among the first points of contact for victims of violence in most cases. These personnel should be aware of the signs of gender-based violence (including sexual and domestic violence); and are equipped to provide support to these people. In more settled camps, community-level interventions may be adapted to reach large groups of populations that have been exposed to violence. In the Democratic Republic of Congo, for instance, community-based health services have had success in reaching victims of violence in South Kivu, where access to health and social services has otherwise been limited.  

Investing in health and social services that address GBV is therefore critical to improving the health and well-being of refugee and displaced populations. This not only helps to restore and maintain people’s basic human rights, but, as a public health measure, it reduces the risk of unnecessary deaths and morbidity and can help improve social conditions and economic opportunities among displaced populations. This is critical to bolster their emotional health and improve their rehabilitation experiences. 

But where should we focus our investments in health? What are some critical areas for strengthening the health sector’s response to GBV? GBV interventions in fragile and conflict affected settings should be able to respond to short- and long-term needs. Some essential interventions include:  

• Training health personnel and emergency responders to recognize signs of GBV and its treatment.  
• Provision of reproductive and maternal health services as well as “dignity kits” to women and girls. Dignity kits are care packages targeted to women and girls and include items such as menstrual pads, clean underwear, and soap.  
• Provision of GBV-related health services to victims including emergency contraception, post-exposure prophylaxis for HIV, administration of rape kits, emergency counselling, and referrals for more comprehensive mental and physical health services. 

When devising these GBV interventions, there are some key things to consider. According to the Inter-Agency Standing Committee’s (IASC) updated guidelines, it is important to:  

• Develop and/or standardize protocols and policies for GBV-related programming.  
• Engage all stakeholders, especially victims/survivors, in designing policies and programs.  
• Enable inter- and intra-agency information-sharing on GBV incidents and take a multi-sector, cross-cutting approach.  
• Ensure confidentiality, compassion and quality of care for survivors of GBV, and referral pathways for multi-sectoral support.  
• Implement monitoring and evaluation throughout the project cycle. 

There has been a growing acknowledgement of and attention to GBV in fragile and conflict affected settings in recent years, and with it growing questions. There are several excellent sources of information available to practitioners. Among these resources is a recent World Bank Group brief that answers key questions for the health sector and highlights the best practices in designing, implementing and evaluating a project involving addressing GBV in conflict and fragile situations. The brief is intended to provide an overview of the main issues and identifies knowledge resources to help the field practitioner.