Though widespread sexual and gender-based violence (GBV) is often thought of as the product of political instability or conflict, its scope is much larger and more complex, said Heidi Lehmann, senior GBV technical advisor at the International Rescue Committee (IRC), at "From Relief to Development: Gender-Based Violence Interventions in Conflict and Post-Conflict Contexts," a June 4, 2008, meeting sponsored by the Wilson Center's Environmental Change and Security Program. "When we talk about gender-based violence," said Lehmann, "we're talking about something very, very big." The Population Council's Ian Askew, along with discussant Margaret Greene of the International Center for Research on Women, echoed Lehmann's conviction that GBV is often too narrowly defined. On a continent like Africa, where, by some measures, half of all women have been victims of sexual violence, the traditional emergency-driven responses are often inappropriate and totally insufficient. "It doesn't start with conflict…[and] it's not going to end when peace comes," said Lehmann.

Forever Responding

Lehmann emphasized that GBV exists in all communities, not just those experiencing instability or conflict, and that "to get to the root cause," it is necessary to "challenge gender inequality." GBV is, she said, "a social problem…and because of that, if we are not working towards some sort of social change, we are going to forever be responding" to instances of GBV, instead of preventing them.

Paradoxically, the pervasive nature of GBV makes it more, not less, difficult to address. "Sexual violence in conflict is so common," said Lehmann, "that we've started to think of it as being inevitable." Statistics bear this out: Population Council data show that half of the women in Zambia, Kenya, and Cameroon have been victims of sexual violence, and more than 25 percent were targets during the year prior to being surveyed.

Lehmann also related a common misperception regarding GBV: "I don't think that we've clued in enough to the fact that this kills people. And when it doesn't kill them, it seriously impairs their quality of life." GBV is "seen as a sensitive and ‘soft' issue," she said, but the effects of GBV are concrete and far-reaching, encompassing sexually transmitted diseases like HIV/AIDS, severe internal injuries like fistula and organ damage, and emotional and psychological trauma. Moreover, because women who have survived GBV are often stigmatized, the "impact goes beyond the individual. It goes to the family unit, it goes to the community."

Once conflict breaks out, it is much more difficult to tackle the underlying causes of GBV. The attention of donors and of NGOs turns, understandably, to emergency relief services, and attempts to change attitudes and confront gender inequality are put on hold. In addition, international guidelines and resources for GBV focus on emergencies, which can limit funding sources and program options. For example, domestic violence is the most commonly encountered form of GBV, but emergency programming cannot begin to address it. As Lehmann remarked, "abuse continues well after any signature on a peace agreement." Sometimes, NGOs do not have long-term programs; they "can be overwhelmed by the scope and scale" of an issue that "is not a priority on donors' lists." Substantially larger funding commitments will be necessary for GBV programs to embark on long-term, prevention-oriented programs.

A Comprehensive Approach to Addressing GBV

"It's the health sector that lagged the furthest behind" in the fight against GBV, claimed Askew. Not only is the health sector uniquely equipped to tackle the problem, he said, it has a unique obligation to do so. Askew argues that the skills required to deliver additional services to survivors of GBV already exist in the health system, which is perhaps the best entry point for raising the profile of GBV and working to change entrenched attitudes. "The challenge," he believes, "is to try to bring together appropriate packages of skills and the infrastructure required."

Many people in Africa see GBV as a "social partner and power issue," he said, leading them to "underestimate the range of health consequences." In many communities, health care personnel wield a great deal of influence, and their authority can be harnessed to translate educational messages to the community. "My question," said Askew, "is how can we best organize services, and especially services for sexual assault?"

Several new approaches offer unique sets of challenges and benefits. One-stop medico-legal centers can work efficiently, but are inaccessible to people in remote areas, and consequently reach too few people to be viable on a large scale. More simply, a help desk, easily added to a clinic or hospital, could guide victims through the often-complicated process (one study found that sexual assault victims saw an average of 12 different providers in a hospital). Integrated, comprehensive medical services could help streamline this process at the district level, but are expensive to establish. More robust police involvement, which is often focused only on the legal aspects of assault, could also improve the process. Comprehensive treatment for survivors, Askew explained, will be facilitated by more coordination between police officers and health workers. "A bringing together of the sectors" is key, he said, though "how that can happen in each country is a major challenge."

The clear links between sexual violence and the spread of HIV/AIDS have added urgency to the movement to address GBV. HIV/AIDS "gives legitimacy" to government-level efforts to address GBV, said Askew, and is "opening up funding opportunities for providing [GBV] services, given the high level of funding going to HIV."

A more engaged health sector may not be a panacea for GBV, however. Health care providers might not be able to guarantee the safety of women who report attacks, and it may not be ethical to encourage such reporting if the system is not equipped to respond appropriately. Also, health care workers sometimes share the same attitudes that encourage GBV in the general community; therefore, training them to be empathetic is often a priority. In Askew's framework for a comprehensive response, the community, medical workers, and the justice system all play a role. "This does take a multi-sectoral response if it's going to work," he cautioned.

Community Mobilization Is Key

People consider GBV less important than other types of violence, said Greene, a misperception that dampens the international response of the media, donor organizations, and NGOs. GBV, she said, "does not just arise through conflict…it is a tool of conflict," and only the most visible symptom of a larger problem. The fact that GBV exists during peacetime is frequently overlooked by international aid programs.

Because GBV is seen as a less-important subset of general conflict, there is a dearth of funding for programs focused on prevention. The funding challenge, though, forces programs to be creative, argued Greene, by necessitating "not just … a focus on service delivery, but really on community mobilization," which is frequently key to changing societal belief systems and attitudes. Greene noted that "mobilizing people on their own behalf seems especially constructive" in conflict settings, where multiple issues vie for donor and media attention and programs must be self-sustaining.

GBV as a Development Issue

Challenging the underlying causes of—and misperceptions around—GBV is an immense undertaking, necessitating cooperation across multiple sectors. But increasing gender equality will benefit all sectors, including the economy and politics. Reframing GBV as a development issue, not just as a women's rights issue, will be central to encouraging large-scale programming focusing on prevention. Unfortunately, said Lehmann, "we've not put our money where our mouth is yet."

Drafted by Sonia Schmanski and edited by Rachel Weisshaar and Meaghan Parker.