Lindsay Stark

A Systematic Review of Prevalence Studies of Gender-Based Violence in Complex Emergencies

Current methods to estimate the incidence of gender-based violence in complex emergencies tend to rely on nonprobability samples. Population-based monitoring is undertaken relatively infrequently. This article provides a systematic review of published literature that represents attempts to quantify the magnitude of gender-based violence in emergency settings. Searches adopted a Boolean procedure, which led to initial selection of material that was then reviewed against set criteria. Only 10 studies met the final criteria for inclusion. Intimate partner violence, physical violence, and rape were the three categories of violence most frequently measured. Rates of intimate partner violence tended to be quite high across all of the studies—much higher than most of the rates of wartime rape and sexual violence perpetrated by individuals outside of the home. Direct comparisons of rates of violence were hindered by different case definitions, recall periods, and other methodological features. Recommendations for future studies are offered based on lessons learned from the studies reviewed.

Sexual Violence as a Weapon of War

SEXUAL VIOLENCE DURING TIMES OF CONFLICT HAS BEEN historically viewed as a spoil of war or as an individual act of violence rather than one that is politically or ideologically motivated. Today, however, there is an increased understanding that rape—the forced vaginal, anal, or oral penetration of either a male or a female with either a person or an object—is used as a strategic and systematic tactic during armed conflict. This Viewpoint examines why sexual violence is an effective weapon of war, its health and psychosocial sequelae, and its association with other forms of gender-based violence. The concept of wartime sexual violence is examined from 3 perspectives: as a strategic, political, and ideological weapon; as a hyperexpression of machismo and gendered norms; and as a systematic form of aggression against communities. This article also explores how another form of sexual violence—intimate partner violence—may be a prevalent form of wartime violence that remains largely unrecognized and understudied. Systematic sexual violence has been used in conflict as a means of ethnic cleansing. In Kosovo in the late 1990s, for example, Serbian paramilitaries used gang rape to terrorize the Kosovar population into fleeing their homes and land. During the Rwandan Civil War, extremist Hutus sought to eradicate Tutsis by sexually assaulting and impregnating Tutsi women. The use of sexual violence to force a vulnerable group of people to leave their homeland in fear for their safety and to eradicate other ethnic groups through insemination and reproduction has also been documented in civil conflicts such as those in Guatemala and the Sudan. Guided by a racist or supremist ideology, armed perpetrators may see sexual violence as a means of protecting their own ethnic group while dehumanizing another group. In the Democratic Republic of Congo (DRC), soldiers have been reputed to use sexual violence to dehumanize and destroy the dignity of the enemy as well as to vent their own discomfort and frustration. Thus, sexual violence in these contexts constitutes an attack on a cultural and ethnic group’s identity, humanity, and ultimately their history. Within armed groups, sexual violence has also been assimilated into norms of machismo and expressed through the sexual domination and degradation of females or weaker males. In conflicts such as those in Liberia and the DRC, men have been reported to engage in individual or gang rape as a means of displaying their masculinity, bonding with peers, and establishing their place in the armed group. In these settings, militarization and military training may encourage the development of violent, heterosexual masculinities. Research findings suggest that sexual violence in times of armed conflict reflects issues of power asymmetry, patriarchy, masculinity, and the devaluation of women that are pervasive even in settings not affected by armed conflict. In this respect, sexual violence in conflict settings is best viewed not as something completely new and extraordinary but as an extension of universalized power dynamics, gender norms, and discrimination against women that harm survivors on a large scale even in presumably peaceful situations. Despite the recent attention devoted to sexual violence in armed conflict, some evidence suggests that wartime violence also occurs within the family. Although valid prevalence rates of intimate partner violence before, during, and after conflicts are largely unknown and may vary significantly by context, recent studies have revealed high rates of intimate partner sexual violence in conflict and postconflict settings. Moreover, women who experience one form of gender-based violence are more likely to experience other forms of gender-based violence during their lives. The effects of wartime sexual violence are both individual and communal and pertain to both physical and psychological health. Well-known health consequences may include sexually transmitted infections, gynecological problems (including fistula), physical injuries, disability, and maternal mortality. Psychosocial consequences may include depression, suicidal ideation, social stigma and rejection by family or community or inability to marry, impaired ability to fulfill a parental role, exclusion from education and employment, increased risk of further violence, and social dysfunction. The psychosocial effect of sexual violence is greatest for survivors who experience multiple forms of gender-based violence. Recent evidence

The impact of the school-based Psychosocial Structured Activities (PSSA) program on conflict-affected children in northern Uganda

BACKGROUND Children in northern Uganda have undergone significant psychosocial stress during the regions lengthy conflict. A Psychosocial Structured Activities (PSSA) program was implemented in 21 schools identified as amongst those most severely affected by conflict-induced displacement across Gulu and Amuru Districts. The PSSA intervention comprised a series of 15 class sessions designed to progressively increase childrens resilience through structured activities involving drama, movement, music and art (with additional components addressing parental support and community involvement). METHOD Eight schools were selected by random quota sampling from those schools receiving the PSSA intervention. Two hundred and three children were identified in these schools as being scheduled to receive intervention, and were followed up 12 months later following engagement with PSSA activities. A comparison group comprised 200 children selected from schools that had met inclusion criteria for receipt of intervention, but were not scheduled for intervention coverage until later. Preliminary research used participatory focus group methodology to determine local indicators of child well-being as viewed by parents, teachers, and children respectively. Pre- and post- assessments focused on ratings for each child - by parents, teachers and children - with respect to these indicators. RESULTS Significant increases in ratings of child well-being were observed in both intervention and comparison groups over a 12-month period. However, the well-being of children who had received the PSSA intervention increased significantly more than for children in the comparison group, as judged by child and parent (but not teacher) report. This effect was evident despite considerable loss-to-follow-up at post-testing as a result of return of many households to communities of origin. CONCLUSION General improvement in child well-being over a 12-month period suggests that recovery and reconstruction efforts in Northern Uganda following the onset of peace had a substantive impact on the lives of children. However, exposure to the PSSA program had an additional positive impact on child well-being, suggesting its value in post-conflict recovery contexts.

Developing culturally relevant indicators of reintegration for girls, formerly associated with armed groups, in Sierra Leone using a participative ranking methodology

This article describes a participative ranking methodology for identifying local understanding of reintegration and adjustment of potential value in programme planning and evaluation. It was applied in the specific context of girls formerly associated with fighting forces in Sierra Leone. Fourteen discussion groups, utilizing spontaneous listing and participative ranking activities, within a focus group framework, were conducted in 10 communities. Discussions served to identify family support, marriage, involvement in communal activities and income generating activities as locally seen as significant indicators of a girls successful reintegration after the war. This method offers a flexible approach to identifying culturally relevant indictors of reintegration that have the potential for wide use in programme planning and evaluation.

Creating opportunities through mentorship, parental involvement, and safe spaces (COMPASS) program: multi-country study protocol to protect girls from violence in humanitarian settings

BackgroundViolence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces – COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings.Methods/designTwo wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10–14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13–19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls’ perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change.DiscussionThese trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings.Trial registrationClinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).

Child Protection Assessment in Humanitarian Emergencies: Case Studies from Georgia, Gaza, Haiti and Yemen.

OBJECTIVES The paper reviews the experiences of conducting child protection assessments across four humanitarian emergencies where violence and insecurity, directly or indirectly, posed a major threat to children. We seek to identify common themes emerging from these experiences and propose ways to guide the planning and implementation of assessments that effectively identify, and suggest means of response to, threats to childrens rights and well-being in emergency settings. METHODS In the context of a field evaluation of an inter-agency resource kit, crisis settings where an inter-agency assessment of child protection had been considered in the period August 2008 to July 2010 were identified. Email correspondence, telephone-based structured interviews and documentary review collated information from child protection coordinating agencies from a total of twenty sites, the minority of which had proceeded to complete an assessment. This paper presents case studies of the experience in Georgia (following the conflict between Russian and Georgian forces in August 2008), Gaza (following the Israeli military incursion beginning in December 2008), Haiti (following the earthquake of January 2010), and Yemen (following the ceasefire agreement between the government and rebel forces in early 2010). CASE STUDY FINDINGS: In each setting the context of the humanitarian emergency is outlined. The processes of the planning (and, where appropriate, implementation) of the child protection assessment is described. Where available, the findings of the child protection assessment and their use in shaping interventions are summarized. PRACTICE IMPLICATIONS Case studies document experience across humanitarian settings widely divergent in terms of the nature of the emergency, social-political context, and institutional capacity. Despite such differences, analysis suggests securing inter-agency coordination, preparation and capacity building, and means of ensuring timeliness of findings to be recurrent themes in the effective mobilization of an effective assessment able to inform programming.

Measuring the incidence and reporting of violence against women and girls in liberia using the 'neighborhood method'

BackgroundThis paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia.MethodsThe study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent’s household, and those of her four closest neighbors to make up the full sample.FindingsHouseholds in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners.ConclusionsViolence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.

Children and fighting forces: 10 years on from Cape Town

It is 10 years since the adoption of the Cape Town Principles and Best Practices on the Prevention of Recruitment of Children into the Armed Forces and on Demobilization and Social Reintegration of Child Soldiers in Africa. The field of programming for the reintegration of children associated with armed forces and armed groups has made significant strides in this period. However, important gaps in the knowledge base remain. This paper examines empirical evidence that supports lessons learned from work with children formerly connected with fighting forces. It evaluates what is known, where promising practice exists, and lacunae in five programming areas: psychosocial support and care; community acceptance; education, training and livelihoods; inclusive programming for all war-affected children; and follow-up and monitoring. While the 2007 Paris Commitments to Protect Children from Unlawful Recruitment or Use by Armed Forces or Groups mark an emerging consensus on many issues, there is still a critical need for more systematic studies to develop the evidence base supporting intervention in this area.

Violence against children in humanitarian settings: A literature review of population-based approaches

Children in humanitarian settings are thought to experience increased exposure to violence, which can impair their physical, emotional, and social development. Violence against children has important economic and social consequences for nations as a whole. The purpose of this review is to examine population-based approaches measuring violence against children in humanitarian settings. The authors reviewed prevalence studies of violence against children in humanitarian contexts appearing in peer-reviewed journals within the past twenty years. A Boolean search procedure was conducted in October 2014 of the electronic databases PubMed/Medline and PsychInfo. If abstracts contained evidence of the studys four primary themes--violence, children, humanitarian contexts and population-based measurement--a full document review was undertaken to confirm relevance. Out of 2634 identified articles, 22 met the final inclusion criteria. Across studies, there was varying quality and no standardization in measurement approach. Nine out of 22 studies demonstrated a relationship between conflict exposure and adverse health or mental health outcomes. Among studies that compared rates of violence between boys and girls, boys reported higher rates of physical violence, while girls reported higher rates of sexual violence. Children in infancy and early childhood were found to be among the most under-researched. Ultimately, the body of evidence in this review offers an incomplete picture regarding the prevalence, nature and impact of violence against children in emergencies, demonstrating a weak evidence base for some of the basic assumptions underpinning humanitarian practice. The development of standardized approaches to more rigorously measure violence against children is urgently needed in order to understand trends of violence against children in humanitarian contexts, and to promote childrens healthy development and well-being.

The disconnect between community-based child protection mechanisms and the formal child protection system in rural Sierra Leone: Challenges to building an effective national child protection system

Efforts to strengthen national child protection systems often encounter problems of low utilization rates by local people. A rapid ethnographic study in two districts of Sierra Leone documented local views of harms to children and which mechanisms people used in responding to and preventing the harms. Key harms included teenage pregnancy out of wedlock, out of school children, heavy labor, and maltreatment of children who do not live with their biological parents. Overwhelmingly, people used traditional family and community mechanisms in responding to these harms. Even in regard to criminal offenses, they very seldom used formal child protection mechanisms such as the Child Welfare Committees, and the police and government social workers as mandated under the 2007 Child Rights Act. This disconnect between the local mechanisms that people actually use and the government-led aspects of the national child protection system owes partly to problems of access but also to cultural and social norms and negative perceptions of the formal system. Additional research, including on community-driven interventions for linking communities and formal mechanisms, is needed to identify the effective means for addressing these obstacles and enabling the alignment of the endogenous and formal mechanisms.