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

The Perils of the Unknown: Intolerance of Uncertainty and Intimate Partner Violence Across the First Four Pandemic Waves

Theory suggests that intolerance of uncertainty (IU), a tendency to perceive uncertain events as threatening, may serve as a potential risk factor for increased intimate partner violence (IPV) perpetration; however, few studies have investigated this association, and none have taken a longitudinal approach. We investigated the issue in two longitudinal online investigations (initial N = 282 and 1,118), with time periods ranging from just before the COVID-19 pandemic to the fourth pandemic wave, approximately 1.5 years later. IU was a significant predictor of IPV cross-sectionally, and in the short term longitudinally (i.e., over periods of weeks); however, it did not predict IPV over the longer term (i.e., over periods of months or years). In addition, our longitudinal design allowed assessment of IPV trends across pandemic waves. Physical IPV rates remained low and steady across time. Psychological IPV rates showed an increase in the early days of the pandemic, but then dropped and stabilized, albeit at a somewhat higher rate than pre-pandemic. Study 2 had ample representation of LGBTQ+ respondents and showed that the patterns and processes worked similarly for LGBTQ+ and non-LGBTQ+ individuals.

A systematic review of the indirect impacts of COVID-19 on sexual and reproductive health services and outcomes in humanitarian settings

BACKGROUND

Humanitarian settings, particularly those in low-income and middle-income countries (LMICs), present increased sexual and reproductive health (SRH) challenges for individuals and health systems. Previous infectious disease outbreaks in such settings have negatively impacted SRH services and outcomes, as fragmented health systems are further overstretched. The COVID-19 pandemic has magnified the SRH challenges in LMIC humanitarian settings on an unprecedented scale. However, understanding of the impacts of COVID-19 is lacking. This review aimed to understand how the COVID-19 pandemic has impacted SRH service coverage, utilisation and outcomes in LMIC humanitarian settings, to inform current and future humanitarian research, programming and practice.

METHODS

A systematic review methodology was followed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. Three search fields related to humanitarian settings, SRH and COVID-19 were applied, and limited to LMIC settings only. Three bibliographic databases and nine grey literature sources were searched. Articles meeting inclusion criteria at full-text screening were critically appraised using standardised tools. Data extraction was undertaken on included articles and analysed through narrative synthesis.

RESULTS

In total, 7742 citations were screened and 42 were included in the review. All included studies were cross-sectional. The quality was mostly medium to high. Narrative synthesis identified the reduced provision of, and access to, SRH services, and increased morbidity including sexual and gender-based violence and unplanned pregnancies. Impacts on service uptake varied across and within settings. Adaptations to improve SRH service access including telemedicine were reported; however, implementation was hindered by resource constraints.

CONCLUSIONS

The COVID-19 pandemic has indirectly negatively impacted SRH at the individual and health system levels in LMIC humanitarian settings. Further research on the impacts on service uptake is required. SRH programmers should target interventions to meet the increased SRH needs identified. Policy-makers must incorporate SRH into emergency preparedness and response planning to mitigate indirect impacts on SRH in future outbreaks.

Gender based violence (GBV) coordination in a complex, multi-crisis context: a qualitative case study of Lebanon's compounded crises (2019-2023)

BACKGROUND

Since 2019 Lebanon has faced multiple compounded crises. Political and social instability, the COVID-19 pandemic, and the Beirut Port explosion, alongside the influx of refugees related to the ongoing Syrian conflict, have resulted in a nationwide economic emergency. In the context of the humanitarian response to the Syrian conflict, the UN and government-led gender-based violence (GBV) task force has coordinated the sub-sector since 2012. The compounded crisis, however, created new challenges for GBV coordination and service delivery, which we explore in this paper. We highlight lessons for strengthening GBV coordination in Lebanon and other complex emergencies.

METHODS

We conducted 29 remote in-depth interviews, reviewed key policy documents and observed seven GBV task force meetings. We analysed and presented our findings across three key themes: context-relevant and adaptable coordination mechanisms; coordination to support GBV service delivery; and stakeholders' roles, legitimacy and power.

RESULTS

Parallel response frameworks developed to address the multiple crises, created a complex humanitarian architecture within an increasingly challenging operating context, with some perceived inefficiencies. Positively, coordination was integrated under the established government-UN interagency system and the GBV task force maintained GBV sub-sector coordination. The task force was commended for effectively adapting to the evolving context, including working remotely, maintaining essential GBV services, assessing the compounded crises' impact on programming and adjusting accordingly, and harmonising guidance, tools and approaches. The importance of ensuring a government co-led response was highlighted by both UN and government informants, who pointed to examples where marginalising government leadership compromised coordination effectiveness and sustainability. The participation of local actors had become increasingly important but more difficult, with the impact of the various crises, and remote modalities, challenging service delivery and staff wellbeing.

CONCLUSION

Experiences from Lebanon highlight the essential role of government leadership in coordination; the value of investing in local GBV capacity; the significance of effective national, subnational and intersectoral coordination to support service delivery and address cross-cutting GBV issues; the importance of targeted interventions to support marginalised populations; and the need to prioritize the well-being of front-line staff during crisis response. In Lebanon, and other complex crises, donors are encouraged to increase flexible, multiyear funding for GBV coordination and services, while women-led organizations should be at the forefront of recovery efforts, contributing to a more equitable society.

Methodological and Ethical Implications of Using Remote Data Collection Tools to Measure Sexual and Reproductive Health and Gender-Based Violence Outcomes among Women and Girls in Humanitarian and Fragile Settings: A Mixed Methods Systematic Review of Peer-Reviewed Research

Purpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any self-reported primary data related to SRH/GBV using information and communication technology, in the absence of in-person interactions, from women and girls in humanitarian and fragile settings. The search was run in March 2021 without filters or limits in Ovid Medline, Embase, Web of Science, Clinicaltrials.gov, and Scopus. Quality was assessed using an adapted version of the MMAT tool. Two reviewers independently determined whether each full text source met the eligibility criteria, and conflicts were resolved through consensus. A-priori extraction fields concerned methodological rigor and ethical considerations. Results: 21 total studies were included. The majority of studies were quantitative descriptive, aiming to ascertain prevalence. Telephone interviews, online surveys, and mobile applications, SMS surveys, and online discussion forums were used as remote data collection tools. Key methodological considerations included the overuse of non-probability samples, lack of a defined sampling frame, the introduction of bias by making eligibility contingent on owning/accessing technology, and the lack of qualitative probing. Ethical consideration pertained to including persons with low literacy, participant safety, use of referral services, and the gender digital divide. Conclusion: Findings are intended to guide SRH/GBV researchers and academics in critically assessing methodological and ethical implications of using remote data collection tools to measure SRH and GBV in humanitarian and fragile settings.

"The pandemic only gave visibility to what is invisible": a qualitative analysis of structural violence during COVID-19 and impacts on gender-based violence in Brazil

BACKGROUND

The COVID-19 pandemic produced alarming rates of disease and mortality globally, yet few nations were as severely impacted as Brazil. The pandemic also exposed and exacerbated persistent forms of structural violence across Brazil, which complicated gender-based violence (GBV) prevention and response efforts. While structural violence is not new, the systemic pressure and uncertainty introduced by COVID-19 intensified the detrimental impact of structural violence on the lives of Brazilians impacted by GBV. This work qualitatively investigated how the COVID-19 pandemic amplified structural violence and GBV in Brazil.

METHODS

We analyzed key informant interviews (KII) conducted with 12 service providers working in sectors related GBV prevention and response in Roraima, Boa Vista, and Rio de Janeiro. Interviews were audio-recorded, transcribed, and translated from Portuguese or Spanish into English, before applying deductive and inductive coding approaches through a collaborative data reduction process. The theoretical lens of structural violence outlined by Farmer and Rylko-Bauer guided the thematic development.

RESULTS

Analyses identified three themes. First, structural violence manifests as policies of inaction and erasure, which reduce the opportunity for upward social mobility among GBV survivors including Black women, trans persons, and people who live in the favelas. Policies of inaction and erasure fail to acknowledge/adequately respond to the significant health and safety needs of these communities. Second, structural violence is a fundamental cause of violence against women and children. Finally, service providers described community driven responses that address the dire survival needs (i.e., food insecurity) imposed by COVID-19, within a context of structural violence. These community driven responses were innovative, agile, and based on dire needs expressed to, and observed by, the service providers interviewed.

CONCLUSION

This analysis highlights how the COVID-19 pandemic exacerbated existing forms of structural violence prevalent throughout Brazil. Findings stress the urgency with which the Brazilian government and international organization must act to support community driven programs that strive to address the most basic human needs.

The Psychosocial Impacts of Intimate Partner Violence against Women in LMIC Contexts: Toward a Holistic Approach

Work on the mental health impacts of intimate partner violence in low-and middle-income countries has focused primarily on clinical disorders such as post-traumatic stress disorder, depression, and substance abuse. This paper analyzes how non-clinical, psychosocial impacts from everyday stressors, particularly economic hardships and concern over one's children, cause extensive suffering and damage women survivors' well-being, influencing the development and expression of clinical disorders. Using a social ecological framework, the paper analyzes how psychosocial impacts arise at multiple levels, including societal levels where social norms often devalue women and privilege men, and how the stressor accumulation increases the harm caused by intimate partner violence (IPV) against women (IPVAW). Drawing on survivors' narratives and studies from diverse low and middle income country (LMIC) settings, including armed conflict and natural disaster settings, the paper underscores the importance of understanding both clinical impacts and the non-clinical, psychosocial impacts, which interact with and complement one another. Recognizing the interplay also between IPVAW and other forms of violence against girls and women, the paper calls for a more comprehensive approach to understanding and addressing the impacts of IPVAW. Recognizing the enormous variety within and across countries that are considered to be LMIC settings, the paper cautions against universalized approaches to understanding the effects of IPVAW and helping to support survivors.

Increases in Intimate Partner Violence During COVID-19: Prevalence and Correlates

Measures to contain the global COVID-19 pandemic led to stay-at-home orders across the world, accompanied by fears of a global surge in intimate partner violence (IPV). We administered an online general-population survey to 1169 women and transgender/nonbinary individuals throughout the state of Michigan in June-August 2020 to assess changes in the prevalence, severity, and correlates of IPV during the COVID-19 pandemic. Quota sampling was used to match the racial/ethnic and urban/rural distribution of the state. More than one in seven (15.1%) participants reported physical, sexual, psychological, or technology-facilitated IPV since COVID, similar to the prevalence in the 3 months before COVID (16.2%). However, there were indications that IPV severity increased and that novel cases of IPV are occurring in relationships that previously had no abuse. A majority (64.2%) of individuals who experienced IPV since COVID reported that the IPV was new to the relationship (34.1%) or of increased severity during COVID-19 (26.6%), representing 9.7% of the overall sample. New or increased IPV was significantly more prevalent among those who were essential workers, pregnant, unable to afford rent, unemployed/underemployed or had recent changes to their job, had partners with recent changes to employment, and those who had gotten tested or tested positive for COVID-19. Urban residence, trans/nonbinary identity, and having a toddler were more strongly associated with IPV during COVID as compared to before COVID. While findings do not support significant changes in the overall prevalence of IPV, the majority of survivors reported incident IPV in relationships that had not previously been abusive, or IPV that became more severe since the start of the pandemic. Cases of new or increased IPV were more concentrated in marginalized groups. Potential touchpoints for outreach and services during future lockdowns include prenatal and pediatric settings, daycares, employers of essential workers, and COVID-19 testing centers. Policies providing rental, childcare, and unemployment support may mitigate increases in IPV during COVID-19.

"At the Root of COVID Grew a More Complicated Situation": A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

A growing body of literature has documented an increased risk of gender-based violence (GBV) within the context of COVID-19 and service providers' reduced capacity to address this vulnerability. Less examined are the system-level impacts of the pandemic on the GBV sector in low- and middle-income countries. Drawing on the perspectives of 18 service providers working across various GBV-related sectors in Guatemala, we explored how the Guatemalan GBV prevention and response system operated during the COVID-19 pandemic. Findings highlight that the pandemic reinforced survivors' existing adversities (inadequate transportation access, food insecurity, digital divides), which subsequently reduced access to reporting, justice, and support. Consequently, the GBV prevention and response system had to absorb the responsibility of securing survivors' essential social determinants of health, further limiting already inflexible budgets. The pandemic also imposed new challenges, such as service gridlocks, that negatively affected survivors' system navigation and impaired service providers' abilities to efficiently receive reports and mobilize harm reduction and prevention programming. The findings underscore the systemic challenges faced by GBV service providers and the need to incorporate gender mainstreaming across public service sectors-namely, transportation and information/communication-to improve lifesaving GBV service delivery for Guatemalan survivors, particularly survivors in rural/remote regions.

Government responses to gender-based violence during COVID-19

Gender-based violence (GBV) significantly and substantially threatens women's health. The COVID-19 pandemic has exacerbated existing risks and patterns of GBV. The impact of COVID-19 on GBV is not inevitable, however, and can be mediated by the policies of governments. In this study we developed the Government GBV Response Index to systematically examine how countries (N = 60) performed in response to the pandemic with respect to the government 1) enacting specific national-level GBV policy; 2) making dedicated COVID-19 specific funding available; and 3) adapting existing GBV responses to COVID-19 related restrictions and challenges. Most countries (N = 33) delivered fewer than two policy responses. We also performed rapid case study analyses to investigate what might contribute to countries having more comprehensive government policy. We find that civil society organizations played a key role in facilitating GBV policy during the pandemic, especially if they are well-funded and well-connected to the government, and if the country has a high-level government official responsible for gender issues.

The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru

Background: Gender-based violence (GBV) is an increasing social problem worldwide, but it has been neglected despite its high relevance to women’s health. In this study, we aim to assess the coronavirus disease 2019 (COVID-19) pandemic impact on GBV incidence in Peruvian, determine the physical violence prevalence and its associated factors among GBV victims. Methods: We assessed the impact of the COVID-19 pandemic on the GBV weekly incidence by fitting an autoregressive integrated moving average model. Additionally, we assessed the physical violence prevalence and its associated factors by fitting a multivariate Poisson regression model with a link log and robust variance. Results: We analyzed 588,587 cases of women victims of GBV and calculated an annual GBV incidence of 518, 714, 958, 596, and 846 cases per 100,000 women during the years 2017-2021, respectively. During the COVID-19 pandemic, the observed GBV weekly incidence went significantly below the forecasted GBV weekly incidence since 2021. Overall, most GBV cases were of middle to high-risk (76%), regular (75%), and verbal (82%) violence. Most victims were single (81%), rural (75%), mothers with children (60%), who did not complete high school (54%). Most aggressors were men (81%), paid workers (77%), had completed high school education (63%), and partner of their victims (58%). Around 44% of the victims suffered physical violence and its main associated factors were aggressor’s school education (adjusted prevalence ratio = 0.89; 95% confidence interval: 0.88-0.89), aggressor’s age <40 years old (1.30; 1.29-1.30), aggressor’s paid job (0.99; 0.98-0.99), prior violence report (1.27; 1.26-1.27), victim’s age <40 years old (1.23; 1.22-1.24), and victim non-Peruvian citizenship (1.04; 1.01-1.07). Conclusions: GBV is endemic in Peru, but the COVID-19 pandemic reduced its burden significantly in 2020-2021. Several characteristics of the cases, victims, and aggressors have changed over time, offering new opportunities for implementing interventions to address this social problem.

"The pandemic made us stop and think about who we are and what we want:" Using intersectionality to understand migrant and refugee women's experiences of gender-based violence during COVID-19

BACKGROUND

Migrant and refugee women have faced a myriad of challenges during COVID-19, which are often exacerbated by the interaction between this population's diverse identities and established systems in the local context. This qualitative study uses the lens of intersectionality to understand migrant and refugee women's experiences of gender-based violence and access to and quality of support services in Italy during the first year of COVID-19.

METHODS

Data were gathered from 51 key informant interviews and eight focus group discussions of 31 participants. Key informants included service providers across sectors, including gender-based violence and anti-violence organizations, government and law, health, psychology, social work, and anti-trafficking administration. Focus group participants were migrant and refugee women aged 18-65 from the following countries of origin: Bangladesh, Cameroon, Colombia, El Salvador, Gambia, Ghana, Honduras, Libya, Nigeria, Pakistan, Peru, Senegal, and Syria. Interviews were audio-recorded, transcribed and coded using a collaborative process with partners from UNICEF. Transcripts were then evaluated for arising themes using three methods of intersectionality analysis.

RESULTS

Data analysis revealed how COVID-19 converged with sexism, racism, and xenophobia in Italy, leading to increased public and domestic violence against refugee and migrant women. Another prominent theme was the exacerbated vulnerability for refugee and migrant women in precarious socioeconomic situations, which prompted many service providers to recognize and address gaps in service offerings and coordination around basic needs. However, due to resource constraints and bias, providers did not systematically incorporate inclusive language and cultural mediation into remote and online services, creating a heightened barrier to access for non-Italian women despite their complex needs. As such, refugee and migrant women highlighted community-based solidarity and support as protective factors during lockdown periods.

CONCLUSION

Findings emphasize how overlapping dominant sociocultural and socioeconomic systems impacted refugee and migrant women's experiences of violence during COVID-19 in Italy, and how some support services were unprepared to respond to the complex needs of diverse, newcomer populations. We discuss how policymakers and practitioners might consider intersectionality in their preparedness and response planning for gender-based violence services during health emergencies moving forward.

Gender-based violence (GBV) coordination in humanitarian and public health emergencies: a scoping review

Background

Gender-based violence (GBV) is a global health, human rights, and protection issue, which can increase during emergencies. GBV coordination is an essential component of every humanitarian response, ensuring that, from the earliest phases of a crisis, accessible and safe services are available and prevention and mitigation mechanisms are implemented to reduce GBV. We sought to address the limited evidence on GBV coordination, by reviewing literature on GBV coordination in emergencies, identifying facilitators and barriers influencing effectiveness.

Methods

We conducted a scoping review on GBV coordination in emergencies from 1990 to 2020. Studies explicitly discussing GBV coordination in humanitarian, natural disaster and public health emergencies, in low or middle-income countries, were included. Using thematic analysis, we developed a six-topic framework to synthesise evidence on effective GBV coordination and present recommendations for strengthening GBV coordination in emergencies.

Findings

We included 28 of 964 sources identified, covering 30 different emergency settings across 22 countries. Sources spanned emergency settings, with minimal evidence in public health emergencies and none focussed solely on GBV coordination. Several sources suggested that timely establishment of GBV coordination mechanisms, led by dedicated, experienced coordinators, increased funding and strengthened service provision. GBV risk mitigation was compromised by weak commitment across sectors, poor accountability systems, and limited engagement of affected women. Inclusive GBV coordination, involving national and local actors is vital but engagement efforts have been inadequate and localisation funding targets not yet achieved. Implementation of the GBV Information Management System has reinforced coordination, funding allocation and service provision. While specialist GBV services remain insufficient, emergencies can present opportunities for expansion. Sustainability and long-term impact are compromised by over-reliance on international leadership and funding, weak commitment by governments, and limited attention to GBV prevention.

Conclusion

Despite enhanced global commitments to addressing GBV in recent years, it remains consistently under-prioritised and under-resourced. Recommendations to strengthen GBV coordination in emergencies include: funding dedicated GBV coordination positions across all types of emergencies, building the global GBV coordination workforce, expanding inclusion of national actors and investing in GBV risk mitigation and prevention through multiyear funding. The evidence-based framework for effective GBV coordination presented here, can guide further research in diverse emergencies.

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos, Nigeria

BACKGROUND

Gender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities.

OBJECTIVE

To examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown.

METHOD

This cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling.

RESULTS

The mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents.

CONCLUSION

The fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.

Assessing gender responsiveness of COVID-19 response plans for populations in conflict-affected humanitarian emergencies

Background

The COVID-19 pandemic has necessitated rapid development of preparedness and response plans to quell transmission and prevent illness across the world. Increasingly, there is an appreciation of the need to consider equity issues in the development and implementation of these plans, not least with respect to gender, given the demonstrated differences in the impacts both of the disease and of control measures on men, women, and non-binary individuals. Humanitarian crises, and particularly those resulting from conflict or violence, exacerbate pre-existing gender inequality and discrimination. To this end, there is a particularly urgent need to assess the extent to which COVID-19 response plans, as developed for conflict-affected states and forcibly displaced populations, are gender responsive.

Methods

Using a multi-step selection process, we identified and analyzed 30 plans from states affected by conflict and those hosting forcibly displaced refugees and utilized an adapted version of the World Health Organization’s Gender Responsive Assessment Scale (WHO-GRAS) to determine whether existing COVID-19 response plans were gender-negative, gender-blind, gender-sensitive, or gender-transformative.

Results

We find that although few plans were gender-blind and none were gender-negative, no plans were gender-transformative. Most gender-sensitive plans only discuss issues specifically related to women (such as gender-based violence and reproductive health) rather than mainstream gender considerations throughout all sectors of policy planning.

Conclusions

Despite overwhelming evidence about the importance of intentionally embedding gender considerations into the COVID-19 planning and response, none of the plans reviewed in this study were classified as ‘gender transformative.’ We use these results to make specific recommendations for how infectious disease control efforts, for COVID-19 and beyond, can better integrate gender considerations in humanitarian settings, and particularly those affected by violence or conflict.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-022-00435-3.

Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda

Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.

Gender-based violence and infectious disease in humanitarian settings: lessons learned from Ebola, Zika, and COVID-19 to inform syndemic policy making

BACKGROUND

The impacts of infectious disease outbreaks, epidemics, and pandemics are not gender neutral. Instead, infectious diseases and gender-based violence (GBV) mutually reinforce each other. Women and girls in humanitarian settings are disproportionately impacted as crises exacerbate gender inequality, violence, and community transmission. A syndemic model of infectious disease and GBV draws attention to their critical linkage, enabling more effective approaches to address both infectious disease transmission and GBV prevalence.

MAIN BODY

Implementation of infectious disease control measures have been consistently absent of critical gender considerations in humanitarian settings. We drew learnings from Ebola, Zika, and COVID-19 to highlight how women and girls living in humanitarian settings have faced bi-directional syndemic vulnerabilities between GBV and infectious disease. Our findings indicate that Ebola, Zika, and COVID-19 exacerbated GBV risk and experience of GBV increased community transmission of these infectious diseases. Moreover, we identified a failure of existing policies to address this mutually deleterious linkage. Thus, we advocate for policymakers to ask three foundational questions: (i) What are the gendered bi-directional risk pathways between infectious disease and GBV?; (ii) How can we act on the gendered risk pathways?; and, (iii) Who should be involved in designing, implementing, and evaluating gender-sensitive policies?

CONCLUSION

Our syndemic policy framework challenges existing thinking on a neglected issue that disproportionally impacts women and girls. By offering foundational guidance to address and thwart the syndemic of infectious disease and GBV in humanitarian settings, we endeavor to proactively and holistically address the reinforcing linkage between GBV and current or emergent infectious diseases.

'I will rather be killed by corona than by him…': Experiences of abused women seeking shelter during South Africa's COVID-19 lockdown

BACKGROUND

In April 2020, the United Nations predicted that the COVID-19 pandemic will have a 'calamitous' impact on the lives of women. This was based on concerns about an upsurge in Intimate Partner Violence (IPV) arising from increased opportunities for relational conflict due to forced co-existence and therefore additional time spent with abusive partners.

AIM

Research has shown an increase in IPV during times of crisis. The COVID-19 pandemic has generated unprecedented circumstances and stress, and opportunities to do research to understand whether the COVID-19 pandemic impacted on IPV experiences were limited. Thus, the present study aimed to understand women's experiences of being in and leaving an abusive relationship during the COVID-19 pandemic.

METHODS

Individual, telephonic interviews were conducted with 16 women living in domestic violence shelters within three Provinces during South Africa's lockdown period.

RESULTS

Findings reveal that the public health measures implemented by the South African Government to curb the spread of the virus, may have placed vulnerable groups at increased risk of violence. Specifically, lockdown likely magnified the risk for escalation of abuse in families already experiencing IPV prior to COVID-19. The study highlights an IPV and COVID-19 relationship, showing that the gender insensitive pandemic control measures, such as stay at home orders and travel restrictions, likely placed women at risk of increased abuse. Given the recurrency of COVID-19 epidemic waves, attention must be given to gender disparities or many South African women may experience worse outcomes.

CONCLUSION

This study reminds us that being ordered to stay at home is not always the safest option for women and thus, in a country with one of the highest levels of GBV, it becomes imperative to ensure that IPV safeguards are integrated into COVID-19 measures. It also becomes evident that COVID-19 requires enhanced ways of responding by paying attention to gender disparities.

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

Although programmes and policies targeting violence against women and girls (VAWG) have increased in the past decade, there is a paucity of evidence on the effectiveness of these interventions. To expand this evidence base, researchers increasingly employ remote data collection (RDC)-including online surveys, mobile applications and telephone interviews-in their evaluations. Although RDC allows for evaluations without in-person interactions-which are restricted during crises such as the COVID-19 pandemic- information about these methods is necessary to understand their potential usefulness and limitations. This scoping review examines remote evaluations of VAWG interventions to describe the landscape of RDC methods, reflect on safety and ethical considerations, and offer best practices for RDC in VAWG research. Fourteen studies met eligibility criteria, with seven, five, and two studies employing telephone interviews, online surveys, and mobile applications, respectively. Studies commonly stated that participants were asked to use a safe email or device, but the method for verifying such safety was rarely specified. Best practices around safety included creating a 'quick escape' button for online data collection to use when another individual was present, explaining to participants how to erase browsing history and application purchases, and asking participants to specify a safe time for researchers to call. Only eight studies established referral pathways for respondents as per best practice. None of the eligible studies took place in low/middle-income countries (LMICs) or humanitarian settings, likely reflecting the additional challenges to using RDC methods in lower resource settings. Findings were used to create a best practice checklist for programme evaluators and Institutional Review Boards using RDC for VAWG interventions. The authors found that opportunities exist for researchers to safely and effectively use RDC methodologies to gather VAWG data, but that further study is needed to gauge the feasibility of these methods in LMICs and humanitarian settings.