On Hierarchy of Emergencies: SGBV and Mental Health among Refugees in Times of COVID-19

Introduction: SGBV, Lockdown and Inequalities

Pandemics affect women and men differently and worsen existing gender inequalities. At the same time, the very services required particularly by women and girls during such crises, including safety, security and access to justice, are either disrupted or reduced. In a “state of emergency,” as priorities are outlined by governments and humanitarian agencies alike, resources are generally allocated to swiftly respond to the crisis’ health and socio-economic impacts. Movement restrictions and lockdown measures imposed to combat the COVID-19 pandemic have curtailed care and support to sexual and gender-based violence (SGBV) survivors around the world, and created a response gap both for survivors and those who remain at heightened risk. 

Globally, and in countries with strict lockdowns more specifically, face-to-face interaction, access to SGBV services and safe spaces have been considerably reduced or completely suspended[3]. As per COVID-19 restrictions, shelters have been unable to admit new cases unless they underwent the government-designated days of quarantine, a challenge for shelters who do not have enough room or capacity for quarantine rooms. Around the world, organizations responding to SGBV have shifted their service modalities and started, as early as mid-March, to the provision of support remotely [4]. Legal practitioners, social and health workers have additionally provided mental health and psychosocial support (MHPSS), legal aid and case management over the phone [5].

And though the pandemic has increased the risk of SGBV around the world, this trend has been particularly more evident in countries where strict lockdowns have been put in place such as Lebanon[6]. The Inter-Agency SGBV Task Force for Lebanon indicates that throughout the first quarter of the pandemic, Lebanon witnessed a 4% increase of intimate partner violence compared to the same time period in 2019 [7], and an 8% decrease in reporting in March 2020 compared to January 2020 [8]. This divergence between the increase of a certain type of SGBV and the decrease of an overall reporting sheds light on the very challenges that survivors are facing in the COVID-19 situation. Throughout prolonged lockdown periods, tensions can certainly intensify within the household. In Lebanon, this is more true than ever, as families are confined to their homes amid a dire economic situation that causes more stress, anxiety, and increased risk of violence [9]. Simultaneously, women and girls continue to experience major difficulties in reporting SGBV incidents or accessing services amid restrictions on movement, limited means of communication or privacy, or the presence of their abusers under the same roof [10].

Refugee Women Are at a Greater Risk

Refugee and displaced women have been at a greater risk of experiencing SGBV throughout their lifetime, even prior to the pandemic [11]. The pandemic has simply heightened their vulnerability [12].  While field data has yet to comprehensively surface, with displaced women often afraid or unable to seek help, patterns are becoming evident to governments and humanitarian agencies alike. The Global Protection Cluster – a UNHCR-led network of NGOs and UN agencies providing protection to people affected by humanitarian crises – noted in August 2020 that rates of SGBV dramatically increased in more than 90% of its operations including in Afghanistan, in Syria and Syrian Refugee camps in the region, as well as Iraq [13]. An International Rescue Committee’s October 2020 report found that 73% of refugee and displaced women across Africa reported an increase in domestic violence due to COVID-19 [14]. It additionally found a 51% rise in sexual violence and a 32% observed growth in early and forced marriages [15].

COVID-19 restrictions have made it increasingly challenging for SGBV survivors from refugee communities to report abuse and seek the help they need [16]. Refugee women often have very limited access to public health facilities and critical social services – relying solely on the ones made available through NGOs and UN agencies [17]. However, COVID-19 prevention and response measures have required many of those services to suspend their operations indefinitely. In refugee camps and informal settlements, humanitarian workers have been unable to physically visit refugees or organize prevention activities [18]. Internationally, UNHCR and its partner organizations have adapted their SGBV programmes in order for women to continue to access them [19].  In countries like Lebanon, this has involved a swift shift to virtual support groups and tele counselling [20]. SGBV staff moved from running prevention sessions for refugee women in physical safe spaces, to running them online [21]. Women are granted internet access in order to allow them to participate in the online sessions; however, the UNHCR in Lebanon has acknowledged that there are other barriers to delivering services remotely – mobile phones are not always in the hands of women and variance in levels of digital literacy has also posed a challenge [22].

The Impact of SGBV and Confinement on Refugee Women’s Mental Health

During their migration journey, Syrian refugees undergo increasingly difficult experiences such as surviving armed conflict, enduring traumatic events, suffering human and material losses, and being discriminated against [23]. Post-migration, most tend to reside in extreme poverty in informal settlements and harsh conditions, while being unable to provide basic necessities for their families due to reduced legal rights and opportunities for income generation [24]. In addition, because of the massive influx of refugees in Lebanon and their impact on existing resources, hostilities and tensions between them and host communities are reported [20]. These are some of many experiences that induce significant stress on Syrian refugees, ultimately placing them at higher risk than the general public for developing Mental Health Disorders (MHD). While this is true of the larger refugee population, the literature indicates poorer mental health outcomes among refugee women specifically [26] and highlights the presence of significant risk factors that are severely detrimental to their mental health such as their exposure to SGBV [27].

In general, SGBV refers to acts that are intended to harm, suffer, or humiliate. They include but are not limited to, early and forced marriage, sexual exploitation and assault, domestic violence, and intimate partner violence. Despite it unfortunately being common worldwide, SGBV is especially prevalent among women in refugee populations in conflict settings, and tends to be perpetrated by armed actors, member(s) of the family, or member(s) of the community [28]. Based on recent studies, the most common forms of SGBV among Syrian refugee women in Lebanon are sexual harassment, abuse, exploitation, physical abuse, and emotional abuse [29]. 

SGBV causes profound psychological impacts on the survivor, such as guilt and isolation, and is associated with an array of detrimental mental health outcomes such as anxiety, Major Depressive Disorder (MDD), Post Traumatic Stress Disorder (PTSD), substance abuse, and suicide [30] . Moreover, SGBV among Syrian refugee women may have an important social impact that ripples across the family and the community, as it can lead to discrimination, unwanted pregnancies, stigmatization, ostracism, and in severe cases death threats from the community and family. Such consequences tend to worsen mental health outcomes because of reduced social support and sense of security, especially given refugee women’s hesitance to report them due to fear of legal ramifications and to avoid experiencing further stigma and abuse. In the context of COVID-19, the ramifications of these issues are further amplified because of added economic strains, limited access to social, protection, and healthcare services, and reduced capacity to exercise agency [31] .

Indeed, recent studies have shown sharp increases in SGBV in both the general and refugee populations, accounted for by the necessary measures imposed to control the spread of the virus such as movement restrictions and physical isolation [32] . While the COVID-19 pandemic has affected the mental health of the general population [33] , it has especially impacted that of Syrian refugee women exposed to SGBV given their forced confinement to small spaces within close proximity to their abusers (men who are partners, fathers, brothers, more powerful household or community member), without being able to distance themselves from them or to seek external support [34] . Due to added stress and pressure imposed on men given their reduced ability to enact masculine gender norms, provide for the family, and perform traditional duties, their frustration tends to be expressed through aggression, externalizing behavior, and abuse [35] . In this regard, and in the context and the COVID-19 pandemic, refugee women are at alarmingly high odds of developing MHDs because of the intersection of (1) vulnerability associated with being a refugee, (2) gender and associated disempowerment in their communities, (3) heightened risk of exposure to SGBV, and (4) isolation and anxiety due to COVID-19, while being confined with their abuser. 

Recommendations

Any attempt to address the mental health challenges of refugee women should be viewed in light of the aforementioned intersecting challenges, while prioritizing the provision of basic shelter, physical safety, and emotional security before delivering actual mental health interventions. Although some NGOs and private institutions usually provide services to address common challenges such as SGBV and mental health among refugee women, they tend to be scarcely accessible by this population due to geographical, financial, cultural (e.g. stigma, shame, dishonor, lack of perceived trust and need), and logistical barriers. And while some services have shifted online for the general population such as through leveraging tele-mental health services for online psychological treatments, Syrian refugee women in informal settlements may experience difficulty connecting or using mobile devices to benefit from these online services due to their costs, or may have trouble reaching healthcare centers that provide access to them. 

Seeing the complexities of tackling SGVB and its association with the mental health of Syrian refugee women in the context of the COVID-19, concerted efforts warrant to be designed, coordinated, and implemented to form sustainable solutions. This includes the mobilization of (1) community-based organizations to provide legal, social, protection, and health services, (2) academic institutions to assess the needs and design data-driven interventions, (3) governmental bodies to regulate and align efforts in accordance with national strategies and policies, and (4) major funding agencies to provide urgent financial support. 

Filters: SGBV, Gender, Mental Health, COVI-19, Refugees

Contributors

[1]: Refugee Health Program Coordinator and Research Associate in the Political Economy of Health in Conflict, Global Health Institute, American University of Beirut, Lebanon

[2]:  Project Coordinator of Evaluation of Capacity Building (eCAP) and Research Coordinator of Center for Research and Education in the Ecology of War (CREEW), Global Health Institute, American University of Beirut, Lebanon

References 

[3]: Dorkas, E. (2020), Not just hotlines and mobile phones: GBV Service provision during COVID-19, UNICEF, Retrieved at: https://www.unicef.org/media/68086/file/GBV%20Service%20Provision%20During%20COVID-19.pdf 

[4]: Ibid

[5]: Ibid

[6]: UNHCR Staff (2020), Gender-based violence on the rise during lockdowns, UNHCR, Retrieved at: https://www.unhcr.org/news/stories/2020/11/5fbd2e774/gender-based-violence-rise-during-lockdowns.html 

[7]: Inter-Agency SGBV Task Force Lebanon (2020), Impact of COVID-19 on the SGBV Situation in Lebanon, Retrieved at: https://reliefweb.int/sites/reliefweb.int/files/resources/76729.pdf 

[8] : Ibid

[9] : Ibid

[10] : Ibid

[11] :  Yazdani, D. (2020), Overlooking Energy Needs in the COVID-19 Pandemic Response Will Push Displaced Women and Girls to the Edge, Women’s Refugee Commission, Retrieved at: https://www.womensrefugeecommission.org/blog/overlooking-energy-needs-in-covid-19-pandemic-response-will-push-displaced-women-girls-to-edge/ 

[12] : Ibid

[13] : Global Protection Cluster (2020), Protection and COVID-19, Retrieved at: https://www.globalprotectioncluster.org/covid-19/ 

[14] : International Rescue Committee (2020), New Report Finds 73% of Refugee and Displaced Women Reported an Increase in Domestic Violence Due to COVID-19, Retrieved at: https://www.rescue.org/press-release/new-report-finds-73-refugee-and-displaced-women-reported-increase-domestic-violence 

[15] : Ibid

[16] : Ibid

[17] : Ibid

[18] : Ibid

[19] : UNHCR (2020), Protecting Forcibly Displaced Women and Girls during the COVID-19 Pandemic, Retrieved at: https://data2.unhcr.org/en/documents/download/77783 

[20] : CARE (2020), Rapid Gender Analysis: COVID-19 and Beyond (Lebanon), CARE International, Retrieved at: http://www.careevaluations.org/wp-content/uploads/CIL_RapidGenderAnalysis_COVID-19_FINAL-2007022.pdf  

[21] : Ibid

[22] :Ibid

[23] : Hassan, G., Ventevogel, P., Jefee-Bahloul, H., Barkil-Oteo, A., & Kirmayer, L. (2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25,129-141.

[24] :  UNHCR. Survey finds Syrian refugees in Lebanon became poorer, more vulnerable in 2017. 2018. Retrieved from https://www. unhcr.org/news/briefing/2018/1/5a548d174/survey-finds-syrian-refugees- lebanon-poorer-vulnerable-2017.html

[25] : UNHCR. Lebanon crisis response plan. Beirut; 2019. Retrieved from: https://www.unhcr.org/lb/wp-content/uploads/sites/16/2019/04/LCRP-EN-2019.pdf

[26] :  Naal, H., Nabulsi, D., El Arnaout, N., Abdouni, L., Dimassi, H., Harb, R., & Saleh, S. (preprint). Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon. BMC Public Health. 

[27] : UNHCR. (2014). Gender based violence. Echoes from Syria (protection sector), 3,1-5. Retrieved from http://www.refworld.org/ pdfid/53f1b2b34.pdf.

[28] : UNDP. (2018). Tenth consolidated annual progress report on activities implemented under the UN action against sexual violence in conflict fund report of the administrative agent of the UN action against sexual violence in conflict fund for the period. Available from: http:/mptf.undp.org   

[29] : Roupetz, S., Garbern, S., Michael, S., Bergquist, H., Glaesmer, H., & Bartels, S. (2020). Continuum of sexual and gender-based violence risks among Syrian refugee women and girls in Lebanon. BMC Women’s Health 20,176,1-14

[30] :  Hassan, G., Ventevogel, P., Jefee-Bahloul, H., Barkil-Oteo, A., & Kirmayer, L. (2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25,129-141.

[31] :Singh, N., Abrahim, O., Altare, C., Blanchet, K., Favas, C., Odlum, A., & Spiegel, P. (2020). COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences. Conflict Health, 14, 79, 1-9. 

[32] :  International Federation of the Red Cross and Red Crescent. (May, 2020). Prevention and response to sexual and gender-based violence in COVID-19. A protection, gender, and inclusion (PGI) technical guidance note.  

[33] : Ettman, C., Abdalla, S., Cohen, G., Sampson, L., Vivier, P., Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Open, 3,9,1-12

[34] :Singh, N., Abrahim, O., Altare, C., Blanchet, K., Favas, C., Odlum, A., & Spiegel, P. (2020). COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences. Conflict Health, 14, 79, 1-9.

[35] :Charles, L., & Denman, K. (2013). Syrian and Palestinian Syrian refugees in Lebanon: the plight of women and children. Journal of International Women’s Studies,14,5