Jocelyn Kelly, PhD, is a research scientist in the Brigham’s Department of Emergency Medicine and director of the Harvard Humanitarian Initiative’s Gender, Rights and Resilience program, where she conducts qualitative and quantitative research to understand and prevent gender-based violence, especially in the context of complex crises.

Earlier this month, the U.S. Institute of Peace (USIP) published a special report that Kelly co-authored, Gender-Based Violence and COVID-19 in Fragile Settings: A Syndemic Model. In the report, Kelly and her co-authors described the mutually reinforcing effects of the COVID-19 pandemic and gender-based violence in fragile settings — regions affected by crisis and conflict — which are often characterized by poverty, displacement and weak infrastructure. Their report is relevant to ongoing U.S. policy conversations, particularly around the implementation of the Global Fragility Act, and timely, given unfolding crises in Haiti, Afghanistan, Ethiopia and elsewhere.

CRN spoke with Kelly about the special report, its relevance to current events and the role that the health care community can play during humanitarian crises.

What does the term “syndemic” mean? How are gender-based violence and the COVID-19 pandemic connected?

JK: A syndemic is the co-occurrence of two or more epidemics or pandemics that interact with each other to compound the severity of each. We know that the COVID-19 pandemic and the associated lockdown measures have had adverse impacts for women around the world. And a lot of those impacts have resulted in socioeconomic losses – through women losing or having to leave jobs and through greater caretaking responsibilities that often fall upon women within homes and families. The pandemic has created myriad stressors for individuals, families and communities.

One result of this is that gender-based violence and intimate partner violence have been called a ‘shadow pandemic,’ occurring at the same time as COVID-19. Financial strain, social isolation and deteriorating mental health often mean that domestic violence and intimate partner violence can increase as a result of lockdowns.

On the one hand, we saw the negative impact of COVID-19 on gender-based violence. But one of the things that surprised us was how strong the association was between gender-based violence adversely affecting the spread of COVID-19 and associated lockdown measures. For instance, in fragile settings in particular, fear of virus transmission can be a barrier to seeking services for domestic violence, and social distancing measures may restrict women’s and girls’ access to safe spaces and their ability to connect with protective social networks.

To explore the syndemic association, we looked at three distinct pathways: barriers to health care and social services, the pathway of militarization of movement, and then also the reduction of socioeconomic opportunity.

What are some of the unintended consequences of efforts to combat one pandemic without considering the other?

JK: Gender-insensitive pandemic control policies could often exacerbate the very problems that they were meant to address. As a result of the COVID 19 pandemic and the associated lockdown measures in a number of countries, we saw that police or military forces were deployed to reinforce social isolation and lockdown. In some situations, this led to an increase in harassment, safety concerns, gender-based violence or coercion of women. And because of the pandemic, women were not able to leverage many normal social support mechanisms, such as moving in groups with friends or relatives. Having soldiers or police acting with impunity to reinforce social lockdown meant the potential for an increase in gender-based violence and, ironically, potential increases for the spread of the virus when militarized personnel interacted with women.

As we learned from previous pandemics like Zika and Ebola, epidemic response – particularly in fragile settings – diverts critical resources away from other important health care, including prenatal care, family planning and HIV/AIDS care. For instance, in Sierra Leone, disrupted services and decreased attendance at health care centers due to the Ebola epidemic contributed to an estimated 3,600 maternal and perinatal deaths, rivaling the number of Ebola deaths.

As we highlight the critical needs around an epidemic or pandemic, we also need to keep in mind some of the holistic care needs for women and girls. Other needs don’t just disappear because there’s a pandemic.

What are your biggest concerns for communities facing crises right now?

JK: There are enormous humanitarian disasters unfolding both in Haiti and Afghanistan, as well as the Tigray province of Ethiopia. In these places and beyond, we’re seeing extraordinary humanitarian need. The most vital thing to think about is the immediate health and safety of people affected by these horrific crises. But it’s important to also acknowledge that a humanitarian crisis can have long and hidden impacts on societies, particularly on women. Another part of my work uses mathematical modeling to trace the hidden impact of a humanitarian crisis in the long-term. We often see public trauma from a conflict or crisis disappear from the public eye when a crisis de-escalates or is no longer in the news. But trauma and violence persist within private spheres, including within people’s homes. In my previous research, I’ve found that places highly affected by conflict can have a 50 percent higher risk of intimate partner violence, even years after formal peace has been declared. We need to elevate and acknowledge those risks that happen both during and after a humanitarian crisis, and better address them through mental health services, by providing safe spaces for women and by improving access to domestic violence services.

What role can the health care community play?

JK: The health care community plays such a vital role in supporting people at their most vulnerable moments. Health care is one of the most critical avenues for survivors of violence to seek other forms of support. Through the COVID-19 pandemic, we’re really seeing the importance of public health communication and how communication around the pandemic can both provide avenues for opening the door to seeking care for gender-based violence or domestic violence synergistically.

How do you stay optimistic?

JK: I think one of the most incredible experiences of the past year and a half is that, even though I no longer had the opportunity to travel to communities that I’ve worked with for over a decade, we were able to work together as a global community. In the past, I would have traveled to Eastern Democratic Republic of the Congo or South Sudan. Now, women’s rights leaders and human rights defenders in these countries have pivoted to using WhatsApp and Zoom. Witnessing the way digital tools connect us was absolutely extraordinary. However, this is also a reminder that digital tools are still distributed really unequally around the globe, with women and particularly women in fragile settings often having quite limited access.

I’ve seen our colleagues in a number of conflict settings amplifying messaging around public health and safety and hand washing within the work they were already undertaking. In the Democratic Republic of the Congo, a number of the organizations we work with started sewing masks and paying for supplies out of their own pockets to better protect their staff and members of the community. A friend of mine opened a school for children orphaned from conflict. When COVID hit, he worked with his students to start sewing masks for their community. It’s been incredible to watch how service providers and community activists band together even when they are facing multiple, compounding crises.


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