Gender-based Sexual

Violence in Complex

Emergencies

• Dr. Ayesha Ahmad

• Lecturer in Global Health, St Georges University of London; Honorary Lecturer Institute for Global Health, University College London

• Email: aahmad@sgul.ac.uk/ a.ahmad@ucl.ac.uk

• Twitter: @AcademicAyesha

Introduction

• Examine role of gender in societies experiencing humanitarian crises & nature of sexual violence

• Explore cross-cultural aspects of gender based violence

• Critically analyze humanitarian responses to gender based violence

Objectives

• Describe why considering violence matters for global health

• Understand contextual factors that shape sexual violence

• Ability to critique multi-sectorial approaches in responding to sexual violence in humanitarian contexts

• Understand mental health aspects of sexual violence

• Critically evaluate cross-cultural psychological interventions of humanitarianism

Sexual Violence in

Conflict

• “Sexual violence in conflict represents a great moral issue of our time… casts a long shadow over our collective humanity”

Special Representative of the Secretary-General on Sexual Violence in Conflict

Positive changes: “a normative foundation has been laid and deeper knowledge, analysis, and information led to strategic interventions” … more resources for interventions and accountability.

Violence—definition

• “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation”

[World Health Organization]

Violence and Global Health

• Violence - declared a major public health issue since 1996 [World Health Assembly]

• ‘Cultural’ forms of violence; acts that fall under the category of violence but are accepted as societal norms such as Female Genital Mutilation [FGM]

• Mass and collective forms of violence such as conflict, humanitarian crises, the recent revolutions as well as individual acts

• Trans-generational trauma- beyond the violence, issues in migration- traumatized exiles, asylum seekers, racism

Effects of Violence

• Globally, violence claims 1.6 million lives annually

• 50% due to suicide

• Causes significant mental health consequences such as depression and anxiety

• Affects safety and security of communities and society

• Violence and trauma refer to experiences; rather than inherent pathological processes, which can cause psychiatric disorders such as Post Traumatic Stress Disorder [PTSD]

• Subject to cultural differences

• Bridge humanitarian and medical institutions

• PTSD – humanitarian - interventions are a vital aspect of responses to all forms of violence

Cultures of Violence

• Symbols, ideas, images [Juergensmeyer; 2003]

• Stigma and Shame – basis of honor-based violence

• Violence is understood through narrative – a distinctly ‘cultural’ process’ [J.C. Wood, Violence and Crime in Nineteenth-Century England: The Shadow of Our Refinement” (London: Routledge, 2004).

Prevention of Violence

• Key focus for health organizations, policy-makers, academics

• Root causes of violence are predominantly social and cultural factors

• Prevention efforts need to begin at a young age

• Changing social norms

• For example, in sexual violence, focus is on developing strategies to promote gender equality

Definition: Gender-based violence

• Gender:—

• Refers to the ‘socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women’ [World Health Organization]

• UN Declaration on the Elimination of Violence against Women: “is a manifestation of historically unequal power relations between men and women…”…”a crucial social mechanism”...

• Ozgecan Aslan, 20 year old, Southern Turkey

• “No child is born a murderer, a thief, or a terrorist. Everyone is born an angel. There are many things behind what has turned him into this” [Naciye Tan, the mother of Ozgecan’s murderer – 26 year old Ahmet Supho Altindoken].

Gender in Humanitarian Crises

• Disasters are: social phenomenon, rooted in social structure [Quarantelli, 1994]

• Social processes more visible in times of disaster: compressed into very dramatic and short time span [Fritz, 1961]

• Humanitarian settings are not gender neutral

• Gender is an organizing principle of societal roles and perceptions

• Humanitarian action is representative of the society in ‘peace’ times

• Humanitarian guidelines must account for the values within society – difficult within a framework of neutrality and pluralism

• Gender is under-recognized in terms of its impact

• Triage and disaster recovery may be at risk of minimizing the importance of gender

Case Scenario

• In the recent Darfur crisis, women and young girls were confronted with the difficult task to ensure access to sufficient food for their families. This led to them leaving the camp regularly in order to fetch firewood and grass for handicrafts. Leaving the camp meant that they exposed themselves to being harassed, looted, raped or killed by the surrounding rebel groups (gunmen). Humanitarian aid organizations were aware of the risks women exposed themselves to when leaving the camp and thought of distributing fuel efficient stoves. This however did not protect them from harm as women continued to leave the camp to collect grass in order to do their handicrafts to be sold at the local market in order to generate some income.

Sexual Violence in Conflict

• Nature of conflict increasingly characterized by use of sexual violence as a ‘weapon of war’

• e.g. Rwanda, Bosnia, D.R.C, Syria

• Understanding of the type of trauma is important for mental health support and humanitarian initiatives

• Role of testimony is vital

Sexual Violence as a ‘Weapon of War’: Milestones• The Security Council (UN) adopted Resolution 1325 (2000) following recognition

of the need to protect women and girls during armed conflict

• Result of study of armed conflict led to Women, Peace, and Security report (2002)

• Resolution 1820 (2008) further updated the need to address impunity during and after conflict (Resolution 1620, (2013)) and to further address sexual and gender-based violence during and after armed conflict

Jean-Pierre Bemba

• “The ICC trial of former Congolese vice-president and militia leader Jean-Pierre Bemba concerned command responsibility for crimes committed by Bemba’s militia the Mouvement pour la Libération du Congo (MLC) against civilians during the 2002-3 internal armed conflict in the Central African Republic (CAR). The trial opened in November 2010, with Trial Chamber III convicting Bemba of murder, rape, and pillaging as war crimes and murder and rape as crimes against humanity in March 2016. Bemba was sentenced to 18 years’ imprisonment in June 2016. Victims reparations are pending”.

• http://www.coalitionfortheicc.org/cases/jeanpierre-bemba-bemba-i

‘War-rape’: Multiple ontologies

• Definition of rape that is too narrowly confined to the violation of the body is a dangerous reduction

• Penetration of the body represents the penetration of the enemy

• Body is lining of the social situation

• ‘War-rape’ is complete annihilation of all boundaries constituting our human condition

Beyond boundaries

• Rape is a “deliberate strategy to undermine community bonds and weaken resistance to aggression”

• “Since rape in war affects not only the individual but also the family and community to which the survivor belongs, the restoration of social and community bonds is central to the process of healing and must be addressed within the specific cultural setting”

[Swiss and Giller; 1993]

Finding stories

• The majority of the research is conducted in conflict areas

• Societies predominantly Islamic, and/or have strong stigmas and sensitivities regarding sexual violence

• War and/or trauma from sexual violence are a chapter from an entire life history

• Western psychiatric perspectives magnify trauma

• Oral story-telling contexts – virtue of story is to ‘pass it on’ – affects sense of privacy/secrets/confidentiality

Humanitarian Contexts

• “It is now more dangerous to be a woman than a soldier in modern conflict”—Major General Patrick Cammaert, former UN Peacekeeping Commander

• Humanitarian action: Cross cultural interventions crossing boundaries of values —shapes priorities, needs, and determines risk following a disaster

Trauma

• Trauma – a deeply distressing and emotionally painful experience

• “Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary adaptations to life” [Judith Herman, Trauma and Recovery]

• Post Traumatic Stress Disorder = a mental health condition that is triggered by a terrifying event – either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncomfortable thoughts about the event

Post Traumatic Stress Disorder: Global context

• 2 basic groups of potentially traumatic events: intentional or interpersonal including war, abuse and violence, and accidental including natural disasters

• PTSD studies in Europe suggest presence of long-term emotional and psychological impacts of the Second World War even among second and third generations [Burri and Maercker, 2014]

• Bearing witness to trauma is also a source of PTSD—high exposure to violence

• “A person is as weak or as strong as his or hers society assumes them to be” [Derek Summerfield]

Disclosure of sexual violence among refugees in humanitarian settings• Disclosure of trauma is considered to be an essential component of the therapeutic

recovery process from Post-traumatic Stress Disorder (PTSD). However, the status of disclosure offers different symbolisms depending on societal contexts.

• PTSD is a normative prescription classifying suffering.

• Disasters, conflict, humanitarian crises typically occur in non-Western settings, yet involve humanitarian action including psychological interventions from clinical frameworks dominated by a Western scientific medicine paradigm, which then forms the basis of informing assessment criteria, diagnosis and treatment.

Suffering in Silence?

Syria- Who is silent?

“Direct accounts of sexual violence continue to be sought from victims and eyewitnesses. It remains immensely difficult to collect first-hand accounts due to a culture of silence that prevents reporting”

International Independent Commission of Inquiry on the Syrian Arab Republic [March, 2013]

Sexual Violence in Syria

• 2013: psychological aid and support in aftermath of sexual violence by UN humanitarian agencies provided to 38,000 people

• Post-rape treatment to 17 hospitals and primary health care centers in Lebanon- home to largest number of Syrian refugees

• On average, 75 people who experienced SV during the conflict access UN services every month in the Za’atari refugee camp, Jordan

• Fear of SV driving force for refugee exodus

• SV victims also victims, consequently, of ‘honor killings’

Non-disclosure

• “it happened to my sister/aunt/neighbor/friend”

• Description of suffering is without dialogue – a character-less voice

• Creates space for the traumatized individual to emerge during the psychological assessment

Silence: Strategies

• Maintain family relationships and social cohesion amongst a backdrop of ‘shame’

• Limitation of trustful objects during conflict

• Sharing of sexual violence especially to a male elder is problematic

Justice?

• Justice: “there will be no justice, unless women are part of that justice” [Hoefgen, 1999] – Islamic concept of justice is integral feature of rehabilitation and therapeutic context for a Muslim rape victim [compared to the clinical management of rape in the Western system]

• Disclosure against societal norms

Silent [not silenced]

• Misinterpreting silence as an ‘empty mind’ results in loss of recognition of individual suffering and the way that suffering is endured and/or embodied

• Suffering is culturally contextualized and must be evaluated aside from normative measurements

Silence

• Nuances of silence relate to the internal processing of GBV

• Silence is not necessarily indicative that an individual’s story is omitted or negated

• Silence and embodiment of trauma are not mutually exclusive

Suffering in silence

• A 35 year old Syrian mother of 3 children in a refugee camp in Jordan seeks medical treatment. On examination, the doctor suspects the woman has been a victim of sexual violence. The doctor confronts the victim, but the victim denies. What is the diagnosis here? How far should the doctor express his/her professional opinion?

Current Challenges for Humanitarian Action

• Yazidi community: sexual violence on the basis of religious justification – one survivor saying “they made us convert to Islam and we all had to say the shahada. They said, “You Yazidis are kufar”…

—abduction of women, women and girls raped, forcibly married from 9 years old, forced abortion if pregnant when captured, intentionally made pregnant by ISIS fighters in order for the child to inherit their father’s ethnicity and religion

Nadia Murad

Conclusion

• Humanitarian action demands both protection of and treatment for women

• Conceptual framework of humanitarian action “depends on controlling abundant variables including cultural factors, psychological factors, international factors, social factors, political factors and the relation between these factors as well” (Zhianpour et al., 2015)

• Gender-based violence is societal construct and determines nature of violence

• Violence is closely linked to causing mental distress such as trauma – by virtue of a violent action, the intention is to traumatize

• Preventive measures is the main approach to tackling violence