The syndemic of COVID-19 and gender-based violence in humanitarian settings: leveraging lessons from Ebola in the Democratic Republic of Congo

Type Journal Article Author Lindsay Stark Author Melissa Meinhart Author Luissa Vahedi Author Simone E. Carter Author Elisabeth Roesch Author Isabel Scott Moncrieff Author Philomene Mwanze Palaku Author Flore Rossi Author Catherine Poulton URL https://gh.bmj.com/content/5/11/e004194 Rights © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Volume 5 Issue 11 Pages e004194 Publication BMJ Global Health ISSN 2059-7908 Date 18/11/2020 Extra Publisher: BMJ Specialist Journals Section: Commentary PMID: 33208316 DOI 10.1136/bmjgh-2020-004194 Accessed 2020-11-27 17:08:12 Library Catalog gh.bmj.com Language en Abstract As the gendered dimensions of COVID-19 are increasingly recognised, efforts to situate gender-based violence (GBV) within the pandemic remain inadequate. It is critical to first acknowledge that the drivers and impacts of COVID-19 and GBV do not occur in isolation; rather, they present as a syndemic—each is made more destructive by the presence of the other.1 Thus, it is not the infection of COVID-19 that increases the risk of GBV but rather the gender-insensitive systems and policies that magnify the risk.2 Based on the knowledge that the public health crises of violence and infectious disease are intersecting, we use a syndemic perspective to examine their shared influence in humanitarian settings. This brief leverages learnings from the 2018–2020 Ebola outbreak in the Democratic Republic of the Congo (DRC) to inform and strengthen ongoing responses related to GBV and COVID-19 within humanitarian settings. Existing knowledge of GBV in emergencies GBV encompasses a variety of damaging acts perpetrated against someone based on socially ascribed gender differences.3 Systemic inequalities and differences based on patriarchal norms are the root of GBV perpetration and its dire consequences for individuals and society at large. The hegemonic systems that are rooted in gender most often manifest as violence perpetrated by men against women and girls; the adverse influence of these systems increases in humanitarian settings as entrenched norms and inequities are magnified and proliferate during times of crises.4 GBV is most often perpetrated inside of the home, as the prevalence of intimate partner violence exceeds other forms of GBV.5 Given that humanitarian crises are associated with periods of extreme chronic stress, loss of health and social service infrastructure, and a strained social support network, consequences of all forms of GBV are aggravated, thereby increasing risks such as revictimisation and adverse intergenerational impacts. These risks are also evident during infectious disease outbreaks, leading researchers to identify how women are more affected by men economically, socially and in regard to violence victimisation during pandemics.6 While emerging evidence links COVID-19 and GBV, less is known in humanitarian settings. GBV and COVID-19: a syndemic perspective A syndemic requires that multiple epidemics be inextricably linked and mutually deleterious. GBV and COVID-19 synergistically reinforce the impacts that would otherwise arise if either epidemic occurred in isolation. For example, shelter in place policies may exacerbate domestic violence where women and girls are isolated and living with an abuser. Simultaneously, reduced economic opportunities may drive women and girls to transactional and survival sex, possibly increasing the transmission of COVID-19. Syndemics are also entrenched in the geographical or temporal setting in which they are immersed1; humanitarian settings create conditions that are ripe for syndemics given the fundamental breakdown of economic, political and social systems. Thus, managing syndemics, such as GBV and COVID-19, requires not only addressing each but also the context: conflict, displacement, norms and inequities. We must also be cognisant of the intersectionalities that magnify the deleterious impact of the syndemic among certain groups of women and girls in humanitarian settings. This is not the first time we have seen these intersections; we can distil useful lessons from the 2018–2020 Ebola outbreak in the DRC to inform our current syndemic.7 Short Title The syndemic of COVID-19 and gender-based violence in humanitarian settings