When Estherline* arrived at our hospital doors in rural Haiti with near-fatal stab wounds, my colleagues and I weren't fazed. It was 2004 and Haiti was in the midst of escalating violence from rebel groups that would eventually lead to a bloody coup to oust president Jean-Bertrand Aristide. Seeing patients who'd experienced violence was not uncommon. But Estherline's wounds weren't the result of the political turmoil in her country. They had come from her husband.
Although we were well-versed in contingency planning for the crisis such as ensuring adequate medical supplies, staffing, and community outreach to patients with chronic illnesses, we were ill-equipped to meet the needs of someone like Estherline who had been the victim of intimate partner violence. There were no shelters to refer her to, no domestic violence advocates. As a women's health professional, all I could do was buy her food and see her in the hospital every day until she healed---at least from her physical wounds. Here we were, in a hospital preparing to address security concerns that may arise when treating enemy groups, but nothing was in place to protect this woman from the violence she experienced from her husband.
All forms of violence against women, whether it is sex trafficking or gang rape, pose a grave threat to the security of women and girls. However, on a global level, violence that a woman faces in the most private aspects of her life, such as within marriage or an otherwise intimate relationship, is by far the most common. Recent findings from a World Health Organization report show that worldwide, 35% of women experience physical or sexual violence at some point in their life. Most of this violence is intimate partner violence. That is, 1 in 3 women experience physical or sexual violence perpetrated by a male partner, such as a husband or boyfriend. The U.S. is no exception, 1 in 4 women experience such violence in their lifetime.
The story is similar in complex emergency settings. A 2011 report found that intimate partner violence occurred frequently in crisis situations, often times at higher rates than public forms of sexual violence against women like wartime rape. In 2012, the International Rescue Committee released a report calling for the humanitarian community to consider intimate partner violence as a humanitarian issue. Their work across 3 conflict-affected countries in West Africa showcased how 1 in 6 women who sought services for violence were doing so because of violence they experienced from their husbands in what is perceived as a safe space--their home.
Why then are such private forms of violence against women largely an afterthought in settings impacted by humanitarian crises? Because violence in the home is not what captures the public's attention during a crisis. Public forms of violence against women, such as wartime rape or sexual assault by peacekeepers, are what make the headlines. Mirroring the media and the public's interests, many organizations focus their time and resources for programming to prevent and respond to public forms of violence against women in humanitarian crises, without adequate attention to the very private violence happening to women before, during, and after a crisis.
Certainly, conflict zones and other crisis settings require specific targeted policies to protect women and girls from wartime rape in public places, but resources for addressing violence against women in such settings as a whole are scarce. Last year, CARE International UK released a report showing that only 3% of the U.S.'s humanitarian aid is spent on programs that focus on gender, including gender-based violence against women. However, intimate partner violence cannot be overlooked. It has dire health and economic consequences. In addition to injuries, partner violence compromises the emotional health of women and children, increases women's vulnerability to HIV/AIDS, and threatens women's reproductive health. According to the World Bank, the economic costs of lost productivity due to partner violence are estimated to be around 1.2-2% of GDP. This is close to what the Democratic Republic of Congo spends on education. These health and economic tolls can threaten any chances of stability long after wars end.
Perhaps there is resistance and inaction to tackling intimate partner violence due to a belief that not much can be done to combat it in such crisis-affected settings. My recent work suggests in Côte d'Ivoire suggests otherwise. In partnership with the International Rescue Committee and Innovations for Poverty Action, I led a study with 900 women to determine effective strategies to lower intimate partner violence in crisis settings. Through the study, my team and I were able to observe reductions in partner violence when we combined women's economic empowerment with a program that engaged men to challenge traditional gender norms.
On Valentine's Day, for the second year in a row, over one billion activists across more than 200 countries will gather in public spaces to call attention to violence against women through the One Billion Rising Campaign. This is just weeks after President Obama declared "sexual assault as an affront to our society". With this momentum and the reintroduction of the International Violence Against Women Act (I-VAWA) into the U.S. Congress last fall, there is immense opportunity to allocate funds to integrate violence against women, including intimate partner violence, into ongoing diplomatic work with conflict afflicted nations. The time is now for the U.S. to show leadership in addressing intimate partner violence against women as a humanitarian issue.
*name changed to protect privacy
Jhumka Gupta is an assistant professor in the Division of Social and Behavioral Sciences at the Yale School of Public Health. She is a Public Voices Fellow with The Op-Ed Project.