The effects of conflict and displacement on violence against adolescent girls in South Sudan: the case of adolescent girls in the Protection of Civilian sites in Juba

Risk and Protective Factors for Violence Against Women and Girls Living in Conflict and Natural Disaster-Affected Settings: A Systematic Review

This systematic review provides an overview of existing research on risk and protective factors associated with violence against women and girls (VAWG) in conflict and natural disaster settings. PubMed (Medline); PsycINFO; Scopus; and Cochrane Center trials registrar were searched as well as relevant internet repositories for VAWG research. The inclusion criteria covered studies that were published between January 1995 and December 2020, documented risk and/or protective factors for VAWG in conflict or natural disaster-affected settings and included primary or secondary data analysis. A total of 1,413 records were initially identified and 86 articles (covering 77 studies) were included in the final analysis. The findings show that many preexisting risk factors for VAWG are exacerbated in armed conflict and natural disaster-affected settings. Poverty and economic stress, men's substance abuse, exposure to violence, changing gender roles in contexts of inequitable gender norms, and a lack of social support are some of the risk factors associated with male perpetration or female experience of violence. In addition, risk factors specific to experiences during armed conflict or in a natural disaster (e.g., displacement, insecurity or congestion in and around displacement camps, militarization of society, killing of family, destruction of property, etc.) are associated with higher prevalence of VAWG in these contexts.

Socioecological Framework for Drivers of Conflict and Postconflict Violence Against Women and Girls

This article advances our understanding of the drivers and multidimensional nature of conflict-related violence against women and girls (CRVAWG). It presents an adapted socioecological model, which supports research, analysis, and programming and can be further adapted as the empirical evidence base grows. Although models to help explore violence against women and girls generally have advanced over recent decades, these have not addressed the specific dynamics of conflict-affected settings. This article makes a unique contribution by bringing together research on CRVAWG and presenting a new model for deepening current approaches to understanding and preventing CRVAWG.

Comparing Changes in IPV Risk by Age Group over Time in Conflict-Affected Northeast Nigeria

Increased risk of intimate partner violence (IPV) has been well documented among women and girls living in conflict zones. However, how residence in a conflict area differentially impacts adolescent girls and young women (AGYW) compared to older women is less understood. This paper examines whether the levels of IPV changed more among AGYW compared to older women in six Boko Haram (BH)-affected States in Nigeria. The Nigeria Demographic and Health Survey data was used to compare the level of the three types of IPV (emotional, physical, and sexual) among AGYW compared to older women before and during the BH conflict (2008 and 2018). We ran a multiple linear regression model with an interaction term for ever-partnered female respondents living in six Northeast States, adjusting for relevant covariates. A significantly higher proportion of both older and younger women reported experiencing emotional and sexual IPV in 2018 than in 2008, with a higher increase reported among AGYW. Sexual IPV increased by six percentage points more among AGYW compared to older women. AGYW in the BH-affected States are more vulnerable to experiencing sexual IPV relative to older women. This study highlights the need for youth-focused IPV interventions in the BH-affected States.

The measurement of war-related trauma amongst internally displaced men and women in South Sudan: Psychometric analysis of the Harvard Trauma Questionnaire

BACKGROUND

Studies from armed conflict settings, including South Sudan, have revealed the deleterious mental health impact of exposure to war atrocities. However, there is little consensus on what is meant by war trauma, how it should be measured, and how levels of trauma vary across men and women.

METHODS

We used psychometric analyses to measure war trauma among 1178 internally displaced adults (mean age = 39 years, 50% women) in the Malakal region of South Sudan. We used cross-sectional survey data and applied classical test theory, factor analysis, item response theory, and differential item functioning with the war events subscale (17 items) of the Harvard Trauma Questionnaire (HTQ).

RESULTS

We found good validity and internal consistency reliability for the HTQ. We found evidence for unidimensionality using factor analyses, and item response theory models showed that some war events (like witnessing the killing of family or friends) were more sensitive to the underlying 'war-related trauma' trait than others (like abduction). Differential item functioning analyses revealed that the measure performed differently for men and women, indicating the need for sex-stratified analysis in the measurement of trauma.

LIMITATIONS

The use of self-report may lead to recall and response bias, and the study sample may not be representative of the broader population in South Sudan.

CONCLUSION

This study emphasizes the need for cultural adaptation and psychometric evaluation of commonly used measurement instruments, especially in humanitarian settings where survey data are used to set priorities for mental health and psychosocial support services.

Characteristics and Impacts of Sexual Violence Against Men and Boys in Conflict and Displacement: A Multicountry Exploratory Study

Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence against men and boys may not be rare in Myanmar (northern Rakhine state), Libya, eastern DRC, and South Sudan. Frequently reported forms of violence in these settings were genital violence, forced witnessing of sexual violence, and rape. Sites where violence was often reported included border crossings, along the roadside, and during imprisonment. In host countries, forms of sexual violence included sexual abuse of boys, sexual exploitation particularly of adolescents and persons with diverse sexual orientation and gender identity, and rape. Impacts on survivors involved short- and long-term physical, mental, economic, and familial dimensions. These findings aim to inform sexual violence-related prevention, mitigation, and response efforts in humanitarian settings. More research is warranted, including on sexual violence against men and boys in Somalia, sexual violence by family and community members in conflict and displacement settings, sexual exploitation of adolescent boys, and sexual violence including sexual exploitation of persons with diverse sexual orientation and gender identity.

Development and Validation of Lost Days of Labor Productivity Scale to Evaluate the Business Cost of Intimate Partner Violence

Developing scientific evidence showing the impact of intimate partner violence (IPV) on companies' productivity is an effective way to involve them in IPV prevention. However, there are no suitable and brief self-report instruments available that measure this impact on labor settings. This study develops and assesses the measurement properties of lost days of labor productivity scale based on tardiness, absenteeism, and presenteeism which may be due to IPV. Fourteen items have been developed and tested for 2,017 employees in 306 companies in Ghana, Pakistan, and South Sudan. Descriptive statistics, confirmatory factor analysis, heterotrait-monotrait matrix, and reliability coefficients have been conducted to assess the reliability of the scores. Confirmatory factor analysis indicates a two-factor second-order solution, stable by sex and countries. All subscales demonstrate good reliability, construct and discriminant validity, showing that the scale is a valid and reliable self-report questionnaire, which may measure the impact of IPV on businesses.

Adverse experiences and mental health problems in perpetrators of intimate partner violence in Northern Ireland: A latent class analysis

BACKGROUND

Trauma and adverse experiences among perpetrators of intimate partner violence (IPV) have been associated with more serious patterns of offending.

OBJECTIVE

To examine 1) how traumatic and adverse experiences cluster together and co-occur among IPV perpetrators, and 2) whether different patterns of trauma exposure are associated with specific mental health problems.

PARTICIPANTS AND SETTING

The sample consisted of 405 convicted IPV perpetrators from Northern Ireland.

METHODS

Data was collected between 2018 and 2019. Latent class analysis identified typologies of exposure to traumatic and adverse experiences. A series of binary logistic regression analyses explored associations between the identified classes and five categories of probable mental health problems.

RESULTS

Three adversity classes were identified: a baseline class (59.2%), characterised by relatively low levels of exposure to most types of adversity; a 'childhood adversity' class (32.9%), with high levels of childhood adversity; and a 'community violence and disadvantage' class (7.9%), which had high probabilities of endorsing adversities related to economic hardship and community violence. Regression analyses showed that the childhood adversity class was significantly associated with increased likelihood of all categories of mental health problems, except for neurodevelopmental disorders (ORs = 1.77-3.25). The community violence and disadvantage class was significantly associated with probable mood and anxiety disorder (ORs 3.92 and 8.42, respectively).

CONCLUSIONS

Different patterns of exposure to adversities were associated with distinct mental health problems in the present sample. Early intervention to prevent poly-victimisation, the clustering of adversities in childhood and the resulting accumulation of risk may be a useful component of preventive responses for IPV in Northern Ireland.

Risk and protective factors for GBV among women and girls living in humanitarian setting: systematic review protocol

BACKGROUND

While one in three women around the world are estimated to have experienced intimate partner or sexual violence, these rates are often exacerbated during conflict and humanitarian crisis. This systematic review seeks to provide an overview of existing research on risk and protective factors associated with gender-based violence (GBV) in conflict and humanitarian settings.

METHODS

Studies will be searched from the following databases: PubMed (Medline); PsycINFO; Scopus; Global Health; and Cochrane Center trials registrar. In addition, targeted searches of the internet repositories for GBV will be conducted. We will include studies that are published between January 1995 and December 2020 and document risk or protective factors for gender-based violence against women and girls in conflict or humanitarian settings. Two reviewers will independently screen and extract data for the review, with a third reviewer arbitrating disputes and ensuring quality. A quality assessment of the included studies will be undertaken using a modified GRADE system. Narrative synthesis will be utilized to analyze the data.

DISCUSSION

The results of this study will inform the design and delivery of GBV prevention programs in conflict and humanitarian settings as well as contribute to the attainment of Sustainable Development Goal 5. The results will be published in a peer-reviewed journal and will be utilized at the World Health Organization to inform efforts to prevent GBV in conflict and humanitarian settings.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered with PROSEPERO ( CRD42020198695 ).

Community perceptions of the impact of war on unintended pregnancy and induced abortion in Protection of Civilian sites in Juba, South Sudan

Conflict and mass displacement into Protection of Civilian (POCs) sites in South Sudan led to the breakdown of community and family structures, increasing women and girls' vulnerability to gender-based violence and exacerbating already poor sexual and reproductive health outcomes. As one component of a study on post-abortion care, this study explores community perceptions of unintended pregnancy and abortion in a POC in Juba. Four focus group discussions were conducted with 36 women and married men aged 18-45 living in the POC. Although initial reactions to induced abortion were generally negative, participants discussed that unintended pregnancy and induced abortion appeared to have increased during the current conflict. Their discussion of abortion became less condemnatory as they described changes in people's situation due to war, including instability and poverty, transactional sex, disruption of marital norms, rape, and low contraceptive use. This is one of the first studies to investigate community perceptions and practices related to unintended pregnancy and abortion in South Sudan. Despite the beliefs that these are taboo topics, the discussions provide an opening to reduce abortion stigma. To ensure lasting stigma reduction, investment in women and girls to improve gender equity is needed.

Epidemiological study of injuries caused by violence and conflict in forensic medical records of selected cities of Sistan and Baluchistan province in 2020

Background and Aims

Interpersonal violence is a socially traumatic and unpleasant phenomenon. These violence-related injuries are sometimes irreparable and can become a permanent problem, Violence in Iran is one of the five most socially harmed and has increased dramatically in recent years, therefore the present research aimed to investigate epidemiological study of injuries caused by violence and conflict in forensic medical records of selected cities of Sistan and Baluchistan province in 2020 considering this subject must be one of our priorities.

Methods

This study was a descriptive study performed in forensic medicine centers of two cities in Sistan and Baluchistan province, Iran. The population consisted of existing citations and records, sample size based on similar studies and the recommendation of professors, all available records were considered and census method was used to select the samples. The data gathering tool consisted of two sections: demographic information and violence and conflict. Content validity method and reliability test were used to determine the validity and reliability. Data were analyzed using SPSS24 software.

Results

The results showed that the majority of the sample was 20-29 years old, male, married, self-employed and high school graduated, living in the eastern part of the city, with no history of mental illness, domestic violence, child abuse, and spouse abuse. The majority of the study units did not use any drugs. The most violent were beatings and bullying. It included several organs such as limbs, soft tissue damage with bleeding.

Conclusion

The results of this study indicate the importance of epidemiological analysis of violence and conflict in the provinces under study and show that appropriate solutions and culture building, as well as increasing awareness of the impact of violence and conflict on individuals and their injuries.

Associations between exposures to occupation-related events, depression and intimate partner violence among women in the occupied Palestinian Territories

War and conflict impact on women's mental health and experiences of intimate partner violence (IPV), including in the occupied Palestinian Territories (oPT). Drawing on a cross-sectional population representative sample (n=534) collected in February 2017 in the oPT, we sought to (i) characterise the patterning of occupation-related events among women (18+) living in the oPT, (ii) to descriptively assess factors associated with this patterning, (iii) to assess the health impacts of occupation-related events by this patterning, specifically experience of IPV and poor mental health, and (iv) to assess the pathways through which occupation-related events are associated with IPV experience. Using Latent Class Analysis we identified three 'classes' of exposure to occupation-related events: 1 in 20 experienced multiple forms directed at themselves, their families and homes, 42.3% reported experiences against family members and their homes, and half reported relatively few direct experiences of occupation-related violence. Group membership was associated with increased past year IPV experience, and depressive symptoms. Using structural equation modelling we demonstrate that experiences of occupation-related events increased IPV experience via two mediated pathways; increased gender inequitable attitudes, and increased depressive symptoms and quarrelling with their husband. Preventing IPV requires addressing occupation-related events as well as transforming gender norms.

Nowhere to go: disclosure and help-seeking behaviors for survivors of violence against women and girls in South Sudan

Background

Despite high rates of violence against women and girls (VAWG) in conflict and humanitarian contexts, many survivors do not tell anyone about their experience or seek help from support r services (e.g. health, legal, psychosocial support, police).

Methods

This paper examines disclosure and help seeking behaviours of survivors of non-partner sexual violence (NPSV) and intimate partner violence (IPV) among women and girls aged 15–64 from three sites in South Sudan. It seeks to understand how exposure to armed conflict is associated with disclosure and help seeking practices.

Results

For NPSV, respondents for whom an incident of sexual violence occurred during conflict had twice the odds of telling someone about their experience (aOR: 2.2; 95%CI: 1.3–3.7; p < 0.01) and three times the odds of seeking help (aOR: 3.1; 95%CI: 1.7–5.9, p < .001), compared to respondents for whom the incident of violence did not occur during conflict. Age, the identity of the perpetrator, working status of the woman, poverty and location also affected disclosure and help seeking behaviours for survivors of NPSV. For IPV, exposure to conflict increased the odds a respondent would tell someone about her experience (aOR 1.7; 95%CI 1.2–2.5; p < .01), but was not associated with seeking support services. The severity of IPV affected both disclosure and help seeking behaviours, with the odds of disclosing IPV increasing if the respondent experienced both physical and sexual IPV (compared to only sexual violence), had been injured, thought their well-being was affected, was afraid of their partner, or was controlled by their partner. However, not all these factors were subsequently associated with help seeking behaviours for survivors of IPV and respondents who reported they were sometimes afraid of their partner had reduced odds of seeking help, compared to those who were never afraid of their partners.

Conclusions

These findings are important as, prior to this analysis, it was unclear how experiencing conflict-related VAWG would influence disclosure and help seeking. Given the findings of this paper, it is important that the international community consider how to reduce barriers to reporting and help seeking for non-conflict-related forms of violence in these settings.

Disability, violence, and mental health among Somali refugee women in a humanitarian setting

BACKGROUND

There is limited evidence on the relationship between disability, experiences of gender-based violence (GBV), and mental health among refugee women in humanitarian contexts.

METHODS

A cross-sectional analysis was conducted of baseline data (n = 209) collected from women enrolled in a cohort study of refugee women accessing GBV response services in the Dadaab refugee camps in Kenya. Women were surveyed about GBV experiences (past 12 months, before the last 12 months, before arriving in the refugee camps), functional disability status, and mental health (anxiety, depression, post-traumatic stress), and we explored the inter-relationship of these factors.

RESULTS

Among women accessing GBV response services, 44% reported a disability. A higher proportion of women with a disability (69%) reported a past-year experience of physical intimate partner violence and/or physical or sexual non-partner violence, compared to women without a disability (54%). A higher proportion of women with a disability (32%) experienced non-partner physical or sexual violence before arriving in the camp compared to women without a disability (16%). Disability was associated with higher scores for depression (1.93, 95% confidence interval (CI) 0.54-3.33), PTSD (2.26, 95% CI 0.03-4.49), and anxiety (1.54, 95% CI 0.13-2.95) after adjusting for age, length of encampment, partner status, number of children, and GBV indicators.

CONCLUSIONS

A large proportion of refugee women seeking GBV response services have disabilities, and refugee women with a disability are at high risk of poor mental health. This research highlights the need for mental health and disability screening within GBV response programming.

Social ecological factors associated with experiencing violence among urban refugee and displaced adolescent girls and young women in informal settlements in Kampala, Uganda: a cross-sectional study

BACKGROUND

Research on violence targeting urban forcibly displaced adolescent girls and young women (AGYW) is limited, particularly regarding polyvictimization (exposure to multiple forms of violence). Yet there is a global trend of refugee urbanization, and urban AGYW are at the nexus of violence disparities among adolescents, forcibly displaced persons, and slum dwellers. This study explored factors associated with young adulthood violence (> 16 years) (YAV) and intimate partner violence (IPV) among forcibly displaced AGYW in Kampala, Uganda.

METHODS

We conducted a cross-sectional survey with forcibly displaced AGYW aged 16-24 from five informal settlement (slum) communities across Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) using peer network sampling. We assessed YAV (experienced at age 16 or above) (sexual, physical, emotional violence) and recent (past 12-month) IPV (physical, sexual, control violence). We conducted descriptive statistics, followed by multinomial logistic regression analyses to explore social ecological factors (e.g., intrapersonal: depression; interpersonal: sexual relationship power, community: food insecurity) associated with experiencing YAV and YAV polyvictimization, and IPV and IPV polyvictimization.

RESULTS

Over half of participants (n = 333; mean age = 19.31; SD = 2.56, range = 16-24) reported YAV (n = 179; 53.7%) and 9.3% (n = 41) reported YAV polyvictimization. Most participants that were in an intimate relationship in the last 12 months (n = 200; 85.8%) reported IPV, among these, 45.5% reported one form of IPV and 54.5% reported IPV polyvictimization. In adjusted analyses, experiencing any YAV was significantly associated with: adolescent sexual and reproductive health (SRH) stigma; sexual relationship power; mobile app usage; depressive symptoms; childhood abuse; and childhood polyvictimization. In adjusted analyses YAV polyvictimization was associated with: depressive symptoms; childhood polyvictimization; sexual relationship power; and food insecurity. Recent IPV polyvictimization in adjusted analyses was associated with owning/using a mobile phone and depressive symptoms. Participants with higher sexual relationship power had lower odds of recent IPV polyvictimization.

CONCLUSION

Findings suggest that YAV and IPV polyvictimization require urgent attention among forcibly displaced AGYW in Kampala. Multi-level strategies are required to address intrapersonal e.g. (depression), interpersonal (e.g. childhood abuse, sexual relationship power) and community (e.g. adolescent SRH stigma, food insecurity) factors associated with experiencing violence. Future research can tailor approaches to advance health, agency and human rights among urban forcibly displaced AGYW.