Sexual and gender-based violence during COVID-19: lessons from Ebola
The COVID-19 pandemic is a disaster that has severely disrupted the normal functioning of populations around the world and continues to proliferate indiscriminately.
Disease outbreaks like COVID-19 threaten the health of all. But women and girls are disproportionately affected . During epidemics, the very measures taken to protect populations and keep health systems afloat leave women and girls especially vulnerable to violence.
Sexual and gender-based violence is a hidden consequence of the COVID-19 pandemic. As communities around the world are forced to stay at home, women and girls are at a heightened risk of domestic violence , intimate partner violence , child abuse , and other forms of sexual and gender-based violence.
Because disasters exacerbate pre-existing gender inequities and power hierarchies, violence in the home may worsen as prolonged quarantine and economic stressors increase tension in the household . Women and girls are isolated from the people and resources that can help them, and they have few opportunities to distance themselves from their abusers.
During epidemics, it's harder for sexual and reproductive health workers to appropriately screen for sexual and gender-based violence. And referral pathways to care are disrupted.
Our research shows that an increase in sexual and gender-based violence was observed during the 2013-2015 Ebola outbreak in West Africa. During that outbreak, response efforts focused on containing the disease.
This focus was important, but protocols were never established to protect girls and women from violence during the outbreak. Quarantines and school closures were put in place to contain the spread of disease. This left women and adolescent girls vulnerable to coercion, exploitation and sexual abuse.
There is already concern that COVID-19 is leading to an increase of sexual and gender-based violence.
Rising levels of violence
Sexual and gender-based violence does not begin with disasters like COVID-19. But the chaos and instability they cause leave women and girls more vulnerable .
The United Nations secretary-general, António Guterres, has sounded an alarm on a “ horrifying global surge ” of domestic violence.
In Kenya, cases of sexual, gender-based and domestic violence have increased significantly since the country began its response to the virus. In China , domestic violence reports nearly doubled after cities were put under lockdown, with 90% related to the epidemic.
Helpline calls have increased in Malaysia, Lebanon , France, Argentina, Cyprus and Singapore . A sharp drop in calls in Italy suggests that the lockdown also prevented many women from seeking help.
According to the World Health Organisation, 35% of women around the world have already experienced some form of sexual and gender-based violence in their lifetime. In some crisis settings, this number skyrocketed to more than 70% .
Increases in sexual and gender-based violence were observed during the 2013-2015 Ebola outbreak in West Africa. Estimates concerning the scope are difficult to obtain and vastly under-reported. Survivors of violence were ignored as health workers counted the number of Ebola cases.
According to some reports, Guinea reported a 4.5% increase in sexual and gender-based violence and twice as many rapes. More often than not, this violence was evident only by its devastating consequences for women and girls.
In the aftermath of Ebola, both Sierra Leone and Liberia saw an upswing in teenage pregnancy rates.
The parallels between the response to Ebola and COVID-19 are striking. Public health infrastructure during Ebola came to a grinding halt. In a desperate attempt to control the virus, governments employed many of the current social distancing strategies. These included school closures, curfews, and quarantines .
As Ebola spread throughout West Africa, heavily burdened relief efforts failed to account for particularly vulnerable populations. The needs of women and girls, especially concerning sexual and gender-based violence, were largely ignored in response and recovery planning.
Many organisations waited until Ebola was under control before addressing these needs. By then it was too late.
One of the key lessons learned from the Ebola outbreak was that epidemics leave women and girls especially vulnerable to violence. Mistakes made during the Ebola epidemic are valuable lessons in the COVID-19 response.
Governments must ensure the protection of women and girls right from the beginning of an epidemic. However, a top-down approach is not enough. Prevention and mitigation initiatives need to be integrated across sectors.
Research has found independent women's groups to be the single most important factor in addressing violence against women and girls. In light of this, women and girls should be involved in the development and delivery of services during COVID-19. And comprehensive data on the gendered impact of COVID-19 should be collected.
All protective services for women and girls must be classified as “essential” during any disaster. Domestic violence hotlines, safe spaces, sexual and reproductive health services, referral pathways, and justice mechanisms are necessary in pre-pandemic times, and even more important in crisis.
Governments should identify organisations already focused on sexual and gender-based violence and give them the tools and resources to continue supporting women and girls during the pandemic. Since social distancing limits screening opportunities, these organisations should explore alternate entry ways for women to access care , especially in places like supermarkets and pharmacies .
As hospitals and clinics deal with infected patients, the health sector should collaborate with gender-violence organisations to deliver services creatively and strengthen referral pathways in accordance with virus mitigation measures.
High-quality clinical care for survivors should be accessible at all times. Community gatekeepers including religious, traditional, women, and youth leaders should play a key role in both virus and violence mitigation initiatives. They can also serve as early warning and alert groups within the community.
Frontline workers should be trained to recognise and safely refer cases of sexual and gender-based violence. And women should be aware of the increased risk during times of crisis, and where to access help.
The consequences of sexual and gender-based violence do not end when medical crises are contained. The impact of COVID-19 will be wide scale, longstanding, and likely generational. Response and recovery planning must ensure that those most impacted by COVID-19 are not forgotten.
Additional research was done by Alexandra Regan, a Master of Public Health candidate at Boston University School of Public Health
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
By Monica Adhiambo Onyango, Clinical Associate Professor, Global Health, Boston University
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