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By Lynn Lawry
Washington, DC, April 6, 2007—The endless trickle of people moved slowly along the road. There was nowhere to go, but away—away from home, where disaster had struck a few days ago. Carrying their most prized possessions, they had walked for hours—some even for days—sleeping on the side of the road. They had passed bodies that nobody took care of and had seen people collapsing with exhaustion and dehydration.
Children, clinging to their mothers, would not stop crying. Pregnant women sat on the curb, too tired to press on; beside, them, mothers nursed their children in the blaring sun. The disaster had hit hard, but women and children suffered most, physically and mentally. Their blank stares were full of fear and their worry-lined faces expressed disbelief about what had happened to their lives.
One might assume that this scene transpired in Africa or Central Asia, but this was the United States Gulf Coast in the summer of 2005, just after Hurricanes Katrina and Rita had struck. For me, it was a two-disaster year. Only a few months prior, I was in Darfur, Sudan, assessing groups of internally displaced people (IDPs). And here I was again talking to displaced people—this time Americans.
For fifteen years, I have gone from disaster to disaster and never gotten used to the way people look right through me when I ask them about their condition and their needs. Of course, comparing disasters works only to a certain degree. The people of Darfur are suffering under a man-made brutal conflict over power and identity that some believe has killed tens of thousands and displaced over two million. Some call it the worst humanitarian catastrophe in the world. Hurricanes Katrina and Rita were natural disasters that displaced more than two million people in the richest country in the world. But in both places women and children were hit hardest, threatened by violence and health risks at the same time.
Up to 80% of the world’s internally displaced persons are women and children who are particularly affected by the loss of assets and entitlements, the breakdown of social networks, and the disruption of their household life. At least one in three of the female population in the world has been either physically or sexually abused at some time. Sexual violence remains a hidden crime against women and girls, who go on to suffer in silence. Where chaos ensues, existing patterns of gender-based violence become stronger with profound physical, psychological and social consequences. Women’s health declines while services to address these problems remain hampered, inadequate and sometimes inappropriate.
I decided to use the same survey we had designed for our Darfur study to evaluate the health concerns of displaced Americans, because Louisiana and Mississippi had turned into disaster areas of proportions we generally find only in resource-poor countries.
In a survey I conducted for IMC in 2005, women living in IDP camps in Darfur expressed that they had only limited sexual and reproductive rights. Under the harsh living conditions in the camps, women in Darfur reported high pregnancy rates and limited prenatal services. Poor reproductive health and limited women’s rights have been proven to lead to negative health outcomes for not only their own families but their community at large. This does not bode well for the populations of south Darfur as women are the majority of the adult population and head the bulk of households.
There have been widespread reports of sexual violence in Darfur, particularly among women and girls foraging for wood beyond camp borders. The predominance of women and children gatherers found in this study underscores the risk they face when leaving the camps to support their families.
Closer to home, the displaced populations I assessed in Louisiana and Mississippi were already predisposed to high rates of chronic disease-related deaths. Louisiana and Mississippi rank among states with the highest rates of heart-disease-related risk factors and cardiac deaths among women. Women in general, and the displaced studied by IMC in particular, shared a disproportionate burden of depression, suicide attempts, and suicidal thoughts.
Within the travel trailer population, we also found domestic violence rates nearly triple the national yearly rate, and intimate partner rape 16 times the yearly national rate. These rates of victimization concur with general safety concerns in the trailer IDP population, particularly for women. Forty-nine percent felt unsafe walking in their communities at night and 45 percent of mothers did not feel safe letting their children play in the trailer park during the day.
Survivors of sexual violence are at risk for a range of physical, psychological and social consequences. Violence against women in emergency and displaced settings, however, does not happen in a vacuum. It often reflects women’s subordinate status and the discrimination and abuse that they face in times of relative calm and stability,and should be recognized by all as an important and prevalent form of gender- based violence in emergencies.
Based on data we have collected in many countries, basic needs, security/violence, mental health issues, and especially gender violence are cross-cutting. It does not matter if you are displaced and living in a lean-to in Darfur or a travel trailer in Mississippi. Existing health problems—both physical and mental—will get worse, and gender-based violence does increase. We found that close to half of the women we interviewed in Mississippi and Louisiana were clinically depressed. Among the displaced women in Darfur, about 6,000 miles away, the depression had risen to over one third.
When disaster strikes, recovery efforts must pay particular attention to the risks faced by the most vulnerable. Whether in Africa or the U.S., the programs we choose to help survivors should be tailored to well-developed and well-studied international models of rights-based care as a means for improving the health and well-being of the most vulnerable. And this means protecting and addressing the needs of women and children first.
Lynn Lawry (formerly Lynn Amowitz) is IMC’s Director of Evidence-Based Research in Washington, DC. Lynn Lawry is also with the Divisions of Women’s Health and General Internal Medicine, Brigham and Women’s Hospital; Department of International Health, Bloomberg School of Public Health; Johns Hopkins University; Baltimore, Md; and Harvard Medical School.
