SCORA QMSA Journal: Gender-Based Violence (GBV) by SCORA QMSA

contents editor’s letter

what is GBV?

history of GBV

domestic violence

sexual assault & harassment

human traff icking

obstetric violence

female genital mutilation

words from healthcare providers

resources in Qatar

creative voices

activism

IFMSA, QMSA, & SCORA

feedback form

references

Human trafficking is the business of stealing freedom for profit. Traffickers usually trick, coerce, or force victims into sexual labour and selling their bodies in exchange for the trafficker to profit. Other times, victims are assaulted, threatened or manipulated into labouring for industries which have inhumane working conditions and exploitative natures. 24.9 million people around the world are affected by human trafficking, making it a multi-billion dollar industry. Under Gender-Based Violence, women are often the targets of sex trafficking and some forms of labour trafficking as they are susceptible by being deemed weaker or less worthy.

The reality of trafficking is that it affects people of all walks of life and situations, but disproportionately affect the needy and "weak." Girls are often groomed for sex, men for manual labour, and women for domestic labour which causes them to feel unsafe and trapped in their situations. Transporting victims between countries does not necessarily constitute trafficking – it can also take place within a single country. Trafficking and exploitation affects people in several forms, notably being forced into sexual exploitation, labour, begging, crime (often drug related), domestic servitude, marriage or organ removal. Being a multi billion dollar industry, human trafficking makes traffickers $150 billion a year, of which $99 billion comes from commercial sexual exploitation. Modern slavery worldwide affects 20 million and 40 million people. However, the United Nations estimates this "hidden figure of crime" which does not include all of the undetected cases worldwide. Only about 0.04% of cases are identified, so the vast majority of victims remain silenced..

Obstetric violence is abuse and a violation of women’s rights, including the rights to equality, information, freedom from discrimination, health, integrity and reproductive autonomy. Obstetric violence is multi-factorial context of institutional and gender violence and occurs both in public and private medical practice during health care related to pregnancy, childbirth, and postpartum. Obstetric violence can be manifested through the denial of treatment, the disregard of a woman’s needs and pain, verbal humiliations, invasive practices, physical violence, unnecessary use of medication, the abuse of medicalization and pathologizing natural processes of birth, forced ceasarean section, episiotomies, ad medical intervention, detention in facilities for failure to pay, coercive or unconsented medical procedures (including VWHULOL]DWLRQ ODFN RI FRQ¿GHQWLDOLW\ IDLOXUH WR JHW IXOly informed consent, refusal to give pain medication, gross violations of privacy, and dehumanizing or rude treatment and discrimination or humiliation based on race, ethnic or economic background, age, HIV status, gender non-conformity, among others.

Unfortunately, obstetric violence is an overlooked type of Violence Against Women. Lack of information about the issue complicates the design of public policies to prevent and eradicate it. However, emerging evidence worldwide shows that women in childbirth are being subjected to varied degrees of ill-treatment. Yet, still there is limited documented information and scarce literature on the millions of cases of obstetric violence happening worldwide. Every woman has the right to the highest standard of KHDOWK ZKLFK LQFOXGHV WKH ULJKW WR GLJQL¿HG UHVSHFWful health care throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination. In particular, pregnant women have a right to be equal in dignity, to be free to seek, receive and impart information, to be free from discrimination, and to enjoy the highest standard of physical and mental health, including sexual and reproductive health.

Words From Our Healthcare Providers

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&KLOGUHQ KDYH WKH ULJKW WR OLYH D OLIH IUHH IURP DEXVH :RUOGZLGH ¿JXUHV KRZHYHU VKRZ WKDW WKLV is far from reality, with up to one billion children having experienced some sort of physical, sexual, or emotional violence or neglect over the past year (1). This exposure to trauma in childhood can have lasting negative consequences on physical and mental health and well-being as adults (2). Gender-based violence (GBV) occurs when any of these forms of violence are perpetrated against children based on their sex or gender. While both boys and girls experience GBV, females are disproportionately affected. One out of every three girls and women globally experiences physical and/or sexual violence at some point in her lifetime, and twenty percent of women have suffered sexual abuse as a child (3). Forms of GBV targeting girls include sexual abuse/assault, sexual harassment, child marriage, female genital mutilation, intimate partner violence (domestic violence), ³KRQRU´ NLOOLQJV DQG IRUFHG SURVWLWXWLRQ *%9 XVHG DJDLQVW ER\V FDQ LQYROYH WUDI¿FNLQJ VH[XDO YLROHQFH SK\VLFDO DEXVH DQG IRUFHG UHFUXLWPHQW LQWR DUPHG IRUFHV LQ DUHDV RI FRQÀLFW &KLOGUHQ DUH increasingly targeted in online spaces, through grooming, harassment and abuse. Child maltreatment is a global phenomenon, occurring in all parts of the world regardless of socioHFRQRPLF VWDWXV HWKQLFLW\ UHOLJLRQ RU FXOWXUH :LWKLQ 4DWDU RQH LQ ¿YH FKLOGUHQ H[SHULHQFHV DEXVH or neglect in the home, school or community, with older boys reporting more physical abuse than girls (5). Children are at increased risk of maltreatment during these unprecedented times of the COVID-19 pandemic. The economic hardship and prolonged lockdown can heighten tensions in the household, placing children at greater risk of worsening violence in the home with little opportunity to distance themselves from their abusers and reduced access to outside help. Longer hours spent on the internet also exposes children to potential online predators. At the Sidra Medicine Child Advocacy Center, help is available for children and families affected by abuse or neglect. The Center actively engages in child abuse prevention efforts and is a hospital-based program with a mission to protect children and support families across Qatar. The Center offers a safe space for child-friendly interviews and medical evaluations with a team of pediatric healthcare professionals trained to recognize signs of child maltreatment. Ongoing support and follow-up and close collaboration with government agencies and community organizations promote the safety and protection of children. Anyone who suspects child abuse or is concerned about the welfare of a child can call the Sidra Medicine Child Advocacy Helpline at 4003 4000. If a child’s safety is at imminent risk, call 999.

References Hillis, S., Mercy, J., Amobi, A., Kress, H. (2016). Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics, 137(3): e20154079. Centers for Disease Control and Prevention (CDC). (2020). Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html World Health Organization, (2014. Global status report on violence prevention. Retrieved from https://www.who.int/violence_injury_prevention/ violence/status_report/2014/report/report/en/ Supreme Council for Family Affairs (2013). Abuse and violence against children. Salem, M., Dargham, S.R., Kamal, M., Eldeeb, N., Alyafei, K.A., Lynch, M.A., Mian, M., & Mahfoud, Z.R. (2020). Effect of gender on childhood maltreatment in the state of Qatar: retrospective study. Child Abuse & Neglect, 101: https://doi.org/10.1016/j.chiabu.2019.104314

*HQGHU %DVHG 9LROHQFH *%9 LQ 4DWDU $QHFGRWHV IURP &OLQLFDO 3UDFWLFH 'U =DLQDE ,PDP 0%%6 05&3V\FK $GXOW DQG 3HULQDWDO 3V\FKLDWULVW DQG 0HGLFDO 6WXGHQWV &OHUNVKLS 'LUHFWRU :RPHQ¶V 0HQWDO +HDOWK 'LYLVLRQ 6LGUD 0HGLFLQH +DMDU 'DXOHK 0' 3HGLDWULFV +DPDG 0HGLFDO &RUSRUDWLRQ ,1752'8&7,21 According to the European Commission website (1), GBV is violence directed against a person because of that person’s gender or violence that affect persons of a particular gender disproportionately. Women and children, especially girls are disproportionately affected by GBV. It can take several forms; including physical, sexual or psychological and there are several examples such as domestic violence, sex-based harassment, forced marriages, female genital mutilation and online violence and it includes the threat of the violence as well. Hajar and I will explore this topic focusing on domestic violence which we also know can take any of the forms of GBV including physical, such as beating, strangling, pushing and the use of weapons, psychological, such as controlling and abusive behaviors, blackmail, economic and control due to religious believes, emotional and verbal manipulations and sexual violence as it obtains within family and home units or between intimate partners whether or not they share the same home. We hope to take a global look, focus on Qatar, with anecdotes from clinical practice, we will also explore the signs of unhealthy relationship, available help in Qatar, barriers to reporting and ways forward. */2%$/ 287/22. Domestic violence is a worldwide phenomenon; with victims being overwhelmingly women and they are more severely affected. It is a major public health issue and it is a recognized human rights violation. Over 1 in 3 (35%) of women worldwide have experienced either physical and / or sexual intimate partner violence or non-partner sexual violence in their lifetime and globally, as many as 38% of murders of women are committed by a male intimate partner (2). It is underreported worldwide, and it is still not regarded as criminal offence in many countries. ,W VLJQL¿FDQWO\ FRUUHODWHV ZLWK JHQGHU HTXDOLW\ 7KH KLJKHU WKH JHQGHU LQHTXDOLW\ WKH KLJKHU WKH LQFLdence of domestic violence and this can be estimated using The Gender Inequality Index (3,4) and The Global Gender Gap Index (3,5) which benchmarks national gender gaps on economic, political, education and health indices with Qatar ranked 127 and 119 respectively.

A woman who is economically independent and educated is more likely to be aware that she is being abused and also more likely to have enlightened parents and other family members who will support her should she decide to walk out of such a relationship; she is more likely to be aware of signs of abuse and therefore more likely to do something about it. It can affect all strata of the society; from low to high socioeconomic strata; the poor and the rich, all races, all religion, all income and education. It can also be intergenerational; a child who witnessed abuse growing up is more likely to become an abuser himself. Domestic violence is more likely when there is stigma associated with its reporting, when it is acceptable and condoned by the society, “it’s one of those things”. ,W LV GH¿QLWHO\ PRUH OLNHO\ LI WKH DEXVHU LV DZDUH WKDW WKH YLFWLP LV XQOLNHO\ WR UHSRUW KLP RU HYHQ ZKHQ UHSRUWHG KH NQRZV WKDW WKHUH DUH QR UHSHUFXVVLRQV VXFK DV MDLO WHUPV RU ¿QHV RU LI WKH KXVEDQG RU WKH DEXVHU IHHOV MXVWL¿HG LQ DQ\ ZD\ µ, FDXJKW KHU FKDWWLQJ WR KHU PDOH FRXVLQ¶ RU µVKH DQVZHUHG PH EDFN and made me angry’ )2&86 21 4$7$5 :,7+ $1(&'27(6 )520 285 &/,1,&6 .DOWKDP $O *KDQLP LQ KHU ¿UVW RI LW¶V NLQG SDSHU µ9LROHQFH $JDLQVW :RPHQ ,Q 4DWDUL 6RFLety’, noted that 23% of the 2787 female (Citizens and non Citizens) of Qatar University aged 15-64 years reported being victims of physical abuse from male family members, 24% of those who were married responded positively to domestic violence. In 2010, a poll about attitudes towards domestic violence showed that a quarter of the female responGHQW EHOLHYHG ZLIH EHDWLQJ ZDV VRPHWLPHV MXVWL¿HG DQG VR GLG D WKLUG RI WKH PDOH UHVSRQGHQW 8QGHU 4DWDUL ODZ IDPLO\ YLROHQFH LV QRW FODVVL¿HG DV DQ RIIHQFH A woman may attend clinic with bruises, broken noses or bring pictures of previous bruises with reports that she sustained the injury from her husband, they she may report being slapped, pushed, hair pulled, neck held, kicked including women who are pregnant women or those who are still nursing little babies. Shouting, name calling, texting ‘rains’ of abuses and expletives following simple requests from wives who brings along ‘screen shots’ as evidence, belittling the wife in front of his friends and family members, making newly delivered wife by caesarian section do all the household chores and refusing to employ helpers, controlling behavior; when the husband wants to know everything that the wife is doing, exactly where she is at every point during the day, the husband may prevent his wife from seeking essential medical or mental health care or stop them from taking necessary medications and when invited to clinic for psycho-education, promptly refuses to come are all scenarios in our clinics. means to care for her children.

Some men will refuse to grant permission for their wives to use contraception and therefore women keep getting pregnant, with all the resultant medical complications and the man still threatens the wife with divorce or the marriage of second wives if she does not bear more children. Sexual assault does happen; many women do not recognize this as abuse / rape because the perpetrator is ‘my husband’. Also reported are threats of death and stalking or threats of taking the children away from the woman for those who eventually get the courage to leave such relationships. %$55,(56 72 5(3257,1* 25 /($9,1* $%86,9( 5(/$7,216+,36 ,1 4$7$5 In a culture such as Qatar’s where women are expected to uphold family’s honor, it is unacceptable to reveal anything that might bring shame and dishonor to the family and tribe (9). Excuses such as: ‘Their partners will change, family and the community will disapprove, it is due to his medical problem, and religious beliefs that divorce is forbidden (10) or frowned upon inhibit women from seeking help. $QHFGRWHV IURP RXU FOLQLFV KDYH LGHQWL¿HG WKDW FHUWDLQ ODZV VXFK DV VSRQVRUVKLS ODZV LQHYLWDEO\ SHUSHWuates the abuse, because, if a woman were to report her husband who is also her sponsor, he can choose to use the children as ‘weapon’ whereby he can leave with his children or terminate his sponsorship of his wife and she is then asked to leave the country without her children. 6,*16 2) $%86,9( 5(/$7,216+,3 Join One Love11 a website by a couple whose daughter was killed in an abusive relationship highlighted 10 signs that one might be in an abusive relationship such as: i. Intense and extreme feelings. ii. Possessiveness and jealousy. iii. Manipulation and control. iv. Isolation from friends and families v. Sabotage; purposely ruining the victim’s reputation, achievements and successes. vi. Belittling the partner and being disrespectful. vii. Guilting; its always the victim’s fault viii. Volatility; the abuser is very quick to anger L[ 'HÀHFWLQJ UHVSRQVLELOLW\ WKH DEXVHU QHYHU WDNHV UHVSRQVLELOLW\ DQG DOZD\V KDV H[FXVHV x. Betrayal- the abusers are often dishonest and more likely to be disloyal :KHQ DVNHG ³:KDW LV WKH PRVW GLI¿FXOW GHFLVLRQ \RX KDG WR PDNH WR IXO¿O \RXU GHVWLQ\"´ WKH $PHULFDQ actress Reese Witherspoon answered, “leaving an abusive relationship” (12). Melanie Brown, alias Mel B, a member of the Spice Girls, and judge on X Factor and America’s got WDOHQW VWUXJJOHG IRU \HDUV WR ¿QDOO\ IUHH KHUVHOI IURP DQ DEXVLYH PDUULDJH

A team of makeup artists would work hard to hide her bruises before going out on live TV. “You can’t get out” Mel B answered when asked in an interview why she never left earlier (13). 7KH LPSRUWDQW TXHVWLRQ RQH PLJKW ZRQGHU LV ZK\ LW LV VR GLI¿FXOW WR JHW RXW RI DQ DEXVLYH UHODWLRQVKLS" ,W LV GLI¿FXOW WR UHDOL]H WKDW \RX DUH LQ RQH LQ WKH ¿UVW SODFH $EXVH LV QRW DOZD\V REYLRXV DV being hit because people always think of domestic violence in terms of physical abuse alone, however, it includes any attempt by one partner to dominate and have control over the other person. It includes verbal, psychological and mental abuse as well. The abuser’s main goal is to achieve control and dominance, which is achieved by shattering the RWKHU SHUVRQ¶V FRQ¿GHQFH WKH DEXVHU PDNHV KLV SDUWQHU EHOLHYH WKDW WKH\ FDQ¶W VXUYLYH ZLWKRXW KLP hence the victim feels helpless, hopeless and scared to leave the relationship. They also utilize shame, guilt, intimidation and social isolation to keep their partners under their thumbs. Abusers often master emotional manipulation and threats to force the victim to comply with their wishes. They intend to manipulate their victim’s sense of reality and their view on what’s acceptable and unacceptable, in order to normalize their abusive behavior. Abusers are usually charming, smooth talkers and attractive, that is why it is very easy to fall for them and believe they are hopeless romantics. ,Q RXU FOLQLF DQHFGRWHV ¿QDQFLDO DEXVH LV D UHFXUULQJ WKHPH LQ PDQ\ DEXVHG ZRPHQ DQG LW LV EHKLQG WKH UHDVRQV ZK\ PDQ\ ZRPHQ ZLOO QRW UHSRUW WKH IROORZLQJ DUH ZD\V WR UHFRJQL]H ¿QDQFLDO DEXVH L 6RPH KXVEDQGV ZLOO WDNH FRPSOHWH FRQWURO RI WKH KRXVHKROG ¿QDQFHV ZKHWKHU RU QRW WKHLU wives work and contribute to the income, they will budget and allocate resources without the wives’ input and they will require their wife to account for everything she is spending, even when she is the sole earner in the home. LL ,W LV QRW XQXVXDO WR ¿QG WKDW VXFK PHQ ZLOO SUHVVXUL]H WKHLU ZLYHV WR TXLW WKHLU MRE RU sabotage their employment opportunities by creating chaos that makes the wives go late to work or insisting that the wife must cover her face if she wants to continue to work when he knows that this is not her preference. iii. Our clinic anecdote includes patients whose husband feels very entitled to the wives’ money and will often spend her money without her knowledge. The relation can be abusive at so many levels that the victim tends to take blame and feel ashamed and embarrassed. The abusers manipulatively convince the victim that she deserves the violent treatments and they don’t deserve any better. We can all learn to love better by recognizing unhealthy signs and shifting to healthy behaviors.

In her book, ‘Crazy Love’, Leslie Morgan Steiner documented her experience of domestic violence and explores why domestic violence victims don’t leave DQG LQ D VXPPDUL]HG YHUVLRQ LQ KHU 7HG 7DON VKH LGHQWL¿HG WKH IROORZLQJ DV barriers to leaving an abusive relationship: i. Victims believe that they are alone. ii. Sometimes, a victim is not aware that she is being abused. iii. Victims would often give the abusers excuses such as ‘he is deeply troubled’, ‘I can help him become better by staying’. iv. Victims are able to see that it is incredibly dangerous to leave evidenced by the fact that more than 70 % of domestic violence murders takes place after the victim have ended the relationship. Other devastating outcomes following the end of the relationship could be: i. Long term stalking. LL 'HQLDO RI ¿QDQFLDO UHVRXUFHV iii. Manipulation of the family courts and justice system. These are the reasons why it is very important to pick up the early signs of unhealthy relationship as it can escalate quite quickly. Leslie and many advocates have all said that the most important step to leaving is to break the silence, speak out and seek help as quickly as one realizes the situation.

$9$,/$%/( +(/3 5(6285&(6 ,1 4$7$5 Pointers are available at the government website/page on domestic violence (15) It documents all the available departments /centers with their telephone /hotlines Protection and Social Rehabilitation Center, “Aman” (16). Dar Al Aman Center: The center looks after the protection & rehabilitation of and provides shelter for women and children who are victims of violence or break up, and reintegrating them in society. (Hotline - 108), Telephone 44679444, 44666673, 44666672 They provide the following services: - Safe accommodation - Meals - Health care - Psychological - Social rehabilitation - Legal counseling - Other services Aman 24 hours Support (Hotline – 919), Telephone 44090999 Doha International Family Institute (DIFI) - Telephone 44548200 Family Consulting Center “Wifaq” - Family Helpline (16003) - Family Counselling and Consultation. Telephone 44892888 Ministry of Administrative Development, Labor and Social Affairs (For Social Assistance) - Telephone 16008, 40288888 - Social Insurance for Divorcees: Applies to any woman who has been divorced, has not remarried and KDV QR VXI¿FLHQW LQFRPH - Social Insurance for Abandoned Wives: Assists women if they are declared by a court of law to be DEDQGRQHG E\ WKHLU KXVEDQGV DQG DUH ZLWKRXW VXI¿FLHQW LQFRPH Nama (Empowerment & Entrepreneurship) - Telephone 40363000 1DWLRQDO +XPDQ 5LJKWV &RPPLWWHH 1+5& 7R ¿OH KXPDQ ULJKWV FRPSODLQWV 7HOHSKRQH 66626663 Police Department: 999

:$<6 )25:$5' 1. Opening of emergency telephone lines to improve the incident reporting and speaking out culture 2. Initiation of Programs that aim to promote the empowerment among Qatari women with the hope that these actions will result in better outcome for women and children 3. Education; great example is The Aspire Initiative, an interactive curriculum started in American schools to help young people get educated on abusive relaWLRQVKLSV VR WKH\ OHDUQ KRZ WR SLFN XS WKH UHG ÀDJV HDUO\ DQG GHDO ZLWK LW 4. Making Gender Based and any Domestic Violence criminal offences 5. Review the law so that men who abuse or are violent to their wives are prosecuted and punished for it across board. 6. Esta Soler (18), advocates community organizing, provision of decentralized shelters, speak out, document painstakingly, funding research and lobby for laws WR EH FKDQJHG ZKLFK OHG WR VLJQL¿FDQW UHGXFWLRQ E\ 7. Safeguarding vulnerable adults training for all health care workers to prevent such situations as experienced by a patient who presented to A/E for protection following battery and the nurse on duty told her husband she was escaping, or the staff at the health records’ department who was going to release a woman’s medical record to her husband because he came with her QID without written / verbal consent from her. 8. Raise young men who will treat women with kindness and dignity.

5()(5(1&(6 1. https://ec.europa.eu/info/policies/justice-and-fundamental-rights/gender-equality/gender-based-violence/what-gender-based-violence_en 2. https://www.who.int/news-room/fact-sheets/detail/violence-against-women 3. https://evaw-global-database.unwomen.org/fr/countries/asia/qatar 4. https://movendi.ngo/news/2017/03/21/undp-human-development-report-2016/ 5. http://www3.weforum.org/docs/GGGR16/WEF_Global_Gender_Gap_Report_2016.pdf 6. K. Al Ghanim, ‘Violence Against Women in Qatari Society’ Journal of Middle East Women’s Studies 5(1):80-93 · January 2009 7. A. Fazeena, ‘Some Qatari Women Not Against Wife Beating - The Peninsula. 7, January 2011 8. Penal Code, arts 268, 279, 290, 308-9 & 325 (Qatar). Al Meeran, Law No 11 of 2004, Issuing The Penal code. 9. L. Kassem, F. Ali & T. Al- Malek - ‘Domestic Violence Legislation and Reform Efforts in Qatar’ Perspective 29 - 30. (November 2012). 0XWD] 4D¿VKHK 6WHSKHQ 5RVHQEDXP µ([SHULPHQWDO /HJDO (GXFDWLRQ LQ D *OREDOL]HG :RUOG The Middle East & Beyond. 11. https://www.joinonelove.org/ KWWSV ZZZ \RXWXEH FRP ZDWFK"Y &5 (H. ]8$ W V KWWSV ZZZ \RXWXEH FRP ZDWFK"Y = N; JT3(1 W V KWWSV ZZZ \RXWXEH FRP ZDWFK"Y 9 \: ,VQ6MR 15.https://portal.www.gov.qa/wps/portal/topics/Religion+and+Community/Marriage+and+Family/ domesticviolence 16. www.aman.org.qa 17. https://www.whengeorgiasmiled.org/aspire-curriculum/ 18.https://www.ted.com/talks/esta_soler_how_we_turned_the_tide_on_domestic_violence_hint_the_ SRODURLGBKHOSHG"XWPBFDPSDLJQ WHGVSUHDG XWPBPHGLXP UHIHUUDO XWPBVRXUFH WHGFRPVKDUH

CREATIVE VOICES

1. the anatomy of healing poem by lauren poole

@laurenapoetry

2. my brushes with death poem by japkaran saroya

@js.writes

3. domestic violence is not gendered essay by dana manson 3. unmasked artwork by rudo masendeke

ZKDW H[SODLQV KRQRXU NLOOLQJV SDWULDUFK\ RU LVODP" essay by zeest marrium

6. words from the tortured souls of gender-based violence poem by fatima nazar 49

WKH DQDWRP\ RI KHDOLQJ so the boy’s hands are rivers and you’re trying to tread water, trying not to get swept away because you have drowned enough times at the wrong hands of waterfalls to know exactly how the calm ends. to know that you cannot get used to it. but when the boy speaks, it’s in the language of light and you don’t remember what came before that. somewhere warmer than here, his pomegranate mouth swallows you whole DQG \RX IRUJHW HYHU\ GH¿QLWLRQ RI IHDU \RX KDYH EHHQ FOXWFKLQJ OLNH FDUGV WR \RXU chest. and you remember what it is to not have to worry who has the upper hand. you remember the wanting before the knife. you are brightly and brutally enamoured, and still the water doesn’t run red, but you keep waiting. you know better than eve that to know eden is to be on the cusp of destroying it. it would be foolish to love a mouth enough to forget its capacity for ruination: the world was whole and innocent as apple before we sank our teeth into it. and so you are made of walls and hope; a miracle of standing, a contradiction. it’s not that you want to be afraid. just that you don’t know if the house would be safe without the fear to guard it. and besides it has its own room now. which is to say the fear is as much a part of you as the hope that this time, there is nothing to be afraid of. which is to say that his name is your favourite and you are quietly hoping it won’t become another synonym for violence. this is the true meaning of prayer. this is what it is to witness war; to have it embed itself in your ribcage, take up residency within you. to be free, yet still feel like occupied land. and you know too much to make a bomb shelter out of a boy again. you are just afraid that if he gets too close, he will taste the trenches on your lips. the small, quiet deaths history couldn’t make space for. this is the anatomy of healing; to some, the word ‘survivor’ sounds like hero. to you, it sounds like ticking. most days, you feel more time bomb than girl. which is to say that you are afraid of your battleground body. afraid it will haunt him the way it haunts you. how seethingly, savagely human, to fear the very thing that holds you. to return to the very place that kills you. for in dreams, you still hear the gunshots. in dreams, you are all exit wound and hopeless prayer. but you wake up to him still, soft and beating, his body just another way of saying you are here, alive, even now. you wake up still, the warmest thing in the room, clean and breathing and Lauren Poole empty of ghosts. The University of Manchester, UK

Instagram: @laurenapoetry

P\ EUXVKHV ZLWK GHDWK when i looked in the bathroom mirror, i saw the purple bruises and the red scratches. once again, i cover them up and pretend your show of affection doesn’t cause me so much pain. KDYH \RX HYHU EHHQ WKURZQ RQWR \RXU NLWFKHQ ÀRRU had someone get on top of you wraps their hands around your throat until you felt no air coming in or out. have you ever felt so numb your whole body shakes have you ever felt so helpless in a situation have you ever had a nightmare that came true have you ever felt like you couldn’t scream have you ever seen someone and thought WKH\¶G QHYHU KLW PH have you ever been wrong have you ever seen so much rage and anger within someone have you ever felt your life leave your body did you ever think WKDW WKLV ZDV KRZ \RX ZRXOG PHHW GHDWK" your life being held in the hands of someone ZKR DOZD\V EULQJV \RX FORVHU DQG FORVHU WR LW"

Japkaran Saroya MacEwan University, Canada Instagram: @js.writes

DOMESTIC VIOLENCE IS NOT GENDERED Domestic violence is not gendered –– it affects both men and women, boys and girl –– physically, emotionally, sexually and financially. According to WebMD (n.d.), approximately every 38 seconds, males are abused in the United States. Men and boys are “three times as likely as women” to underreport their abuse (Lester, 2018). Meanwhile, according to Robinson and Segal (2019), one in three men are victims of emotional and verbal abuse. From possessiveness, controlling and jealous tendencies to systemic abuse such as threats of never seeing their children if they leave or report their abuse. Similar to female abuse victims, it is difficult to escape an abusive relationship due to isolation, manipulation, threats and denial. However, men notably lack resources and suffer societal/patriarchal stigmas. Toxic masculinity causes denial (of pain), the refusal to seek help (seen as a sign of weakness) and the need for dominance (feelings of inferiority). This also causes a lack of resources such as shelter and international counselling services. The idea of being a victim is perceived as a “feminine” feature, causing men to avoid such a label, hence denial. Men avoid self-defence, especially physically because of the notion that “real men don’t ever hit women... regardless of their size and strength”. Into the bargain, false accusations of abuse from their partners may escalate. Being masculine is associated with suppression of pain. Research show men disregarding the severity of their abuse, falsely expressing their partners “did not really hurt them”. This behaviour, however, is also shown in some abused women. Moreover, when a man is a victim, it results in a “shame/anger spiral” –– feelings of embarrassment and shame, hence avoiding the discussion of their experiences (Migliaccio, 2001). Just like female victims, they too may suffer Post Traumatic Stress Disorder (PTSD). Symptoms include diminished self-esteem and self-worth, hypervigilance; comorbid substance abuse disorder and depression; sleep disturbance; self-destruction and potential dissociative symptoms (American Psychiatric Association, 2013).

Furthermore, because of the patriarchal system, men are regarded as the abusers, and women: victims. This causes male victims to appear rare when it is almost as frequent as women. The perpetrators can be both men and women. One in six boys under the age of 16 fall victim of sexual abuse/assault. 94% of which are caused by men and 6% by women. Statistics also indicate 16% of adult men were raped by their partners. Additionally, one in five male prisoners in Canada fall victim of sexual assault. Around 10% of men experienced stalking by former partners. In 2000, 440 men were murdered by their partners, while 3% endure non-fatal violence. According to the Government of Canada (2009), once a woman accesses a firearm, domestic violence against a man “increases by five times”. Unfortunately, there are limitations of studies due to underreporting and inaccuracy. The context of abuse and its severity is undocumented. To heal from such abuse, men must understand that they are not alone. Understand that abuse is non-gendered. Claims of scepticism and negative reactions from society and legal authorities were made in Migliaccio (2001)’s study. Education and training must arise to destigmatise abuse against men and toxic masculinity. Huntley et al. (2019) suggest seeking help from primary healthcare as it provides fixed confidentiality. Therapy can help with symptoms of depression, PTSD and insecurities. Keeping a record of the abuse can help with the development of a case Reducing the Risk of Domestic Abuse. (n.d.). Seeking legal aid resources and possibly get a restraining order or “order of protection” against a partner, along with temporary child custody if needed. Seeking support from someone trusted like a friends or family can help with symptoms of trauma (Robinson and Segal, 2019; Gaille, 2017). The Arab world does not recognise male abuse, but there is hope. One can seek online one-on-one chatting services or emailing services: 1in6.org/helpline and Mensadviceline.org.uk

Dana Manson University of Wisconsin, USA

In this piece I wanted to show the fear and sadness in the womans eye. She also has a bruised eye. I also included a small piece of fencing so show how survivors of GBV once felt trapped or caged in. There is a knife because in extreme case the utensil is used either by the attacker or the victim themselves for self harm. The ripped paper is to show how their life at that stage is shattered. But we know with the right help survivors can heal and get back parts of themselves they thought they lost.

Rudo Masendeke College of Medicine University ofMalawi, Africa

“In the spring of 2012, five women from a remote village in Kohistan, Pakistan, were allegedly killed by their own family” (Chinoy, 2018). Their crime was to appear in a grainy cell phone video that showed them singing and clapping with two young brothers. In another instance, a 21-year-old Palestinian woman, Israa Ghrayeb, was murdered by her family for posting a video on Facebook of an outing with her fiance (Oppenheim, 2019). Be it the five innocent women from Pakistan or Israa Ghrayeb from Palestine, today, more than five thousand women are killed annually across the globe for bringing alleged ‘dishonor’ to the family (Thomson, 2016). These women were killed by none other but their brothers, fathers, and other close members of the family who often use religious overtones, Shariah law, in particular, to defend practices that aim at the subjugation of women. According to the Honor Based Violence Awareness Network, there may be more instances of honor killings in the Middle East and Southeast Asia, however despite there is no single religious indicator of honor-based violence (Gharib, 2016). Instead, the male patrons of society exert patriarchal control over women through institutionalized “restrictive codes of behavior and ideology, which associates family honor to female virtue” (Hadi, 2017). These patriarchal societies use Islamic values to blur the boundary between honor killing and murder, and that is further enabled by the local laws and values which require necessary changes. For years, patriarchy has elevated the status of men over women who often become subject to violence under male superiority. Instances of this violence subsist in Pakistan, particularly where socio-cultural values subjugate the status of women and thus determines their conduct. For example, while responding to the question, why did you kill your daughter Saba? Maqsood said, “ I did what was right because I am her father and an honorable man… she had no right to flee from home with her lover” (Chinoy, 2016). Similar news of wives strangled, daughters shot, and sisters drowned make their way to the headlines every week in Pakistan (Baloch, 2019). Reasons for these killings range from refusal to comply with an arranged marriage or illicit sexual relations to owning a cellphone or even being a victim of rape. In the local culture of Pakistan, a woman’s body or her existence is perceived as the bearer of the family’s name and, most importantly, the ‘honor’ associated with it. The cultural values, by default, entitle men with the responsibility to regulate a women’s sexuality and their way of living. As the family’s honor embodies female virtue, it is perceived as binding for women to guard their chastity (Hadi, 2017). Failure to comply with the code of conduct set by patriarchy leads to punishment often in the form of physical abuse or even murder in the name of ‘honor.’ The man who refuses to kill a woman for bringing alleged dishonor is often “regarded and insinuated as ‘socially impotent’

and ‘beghairat’ (without honor) in society,” (Hadi, 2017). Therefore, to publicly demonstrate their power to protect reputation, men find themselves obligated to kill women. Since the patriarchal society discerns the act as an appropriate and legitimate punishment, it blurs the boundary between a murder and honor killing in Pakistan (Hadi, 2017). Most Muslims, however, claim that patriarchy in Pakistan mainly persists as a result of religious authorities who refuse to condemn honor killings, thus making the hope of abolition remote. Muslim ulema (religious leaders), in particular, argue that honor killings are legitimized and derived from Islamic teachings that further reinforce the phenomenon (Warraq, 2018). Although most people consider Islam as an underlying factor, honor killings are one of the more archaic customs that existed since the pre-Islamic period (Raza, 2006). As mentioned in the Asian Journal of Women’s Studies, honor killings in Pakistan date back to pre-Islamic tribal societies that inhabited Baluchistan, Sindh, NWFP, and southern Punjab in particular. These patriarchal tribal societies followed a certain idea of ‘justice,’ not based on mere sudden provocation but rather “on appropriate punishment after merits of the case had been proven by the community elders,” (Raza, 2006). To maintain family order and to retain tribal community structures, the need to “control the body and behavior of women remained a central concern” (Raza, 2006). Back then, according to tribal customs, if a man discovered his wife committing adultery, “control had to be undertaken by her rightful ‘owner’... who retained the right to punish his disobedient ‘property’ (woman)”, (Raza, 2006). Once the act was justified, the jirga (tribal council) would mutually put forth their final orders of killing. Today the motive remains unchanged as the primary constructs of society remain embedded in the patriarchal practice of evaluating women based on piety and according to the situational threats to male dominance (Raza, 2006). Moreover, in the wake of globalization and imperialism, today, tribal societies find the preservation of their ancient patriarchal identity imperative, thus hindering their ability to transform through the processes of change. For instance, to refute the resolution condemning the practice of honor killings in Pakistan, men of the National Assembly rose against it. They retorted, “We are Pakhtuns before we became Muslims, and our codes are ancient, and no one should meddle with them” (Raza, 2006). These customs and rituals thus have not only survived through history but have transitioned to become unquestionable. Moreover, some sources argue that the extent of cultures following the ‘honor code’ is more geographical than ideological. The regions most notorious for honor killings include the Middle East and Southeast Asia, which establishes a general impression that honor killings are restricted to Islamic countries only (Frazier, 2020).

However, several other countries add to the long list of regions where honor killings occur, thus signifying that the phenomenon of honor-based violence intertwines with culture. In addition to the Subcontinent and the Middle East regions like Africa, Europe, Latin America, and Australia have all maintained patriarchal structures that “sanctions control over women’s bodies and sexuality in a bid to maintain power structures” (Raza, 2006). In an article in The Jerusalem Post, Hochberg said that “Arab women are killed because of honor, Jewish women are killed because of passion, and women in other societies are killed for being women” (2019). So-called ‘honor’ crimes come as a result of society’s acceptance of discrimination against women (Almaleki, n.d.). As Jaraysah mentioned in her book, “the issue of using violence is an internal issue... based on ancient norms and not laws, regulations, or religion” (2011). In instances where a woman’s desire surpasses the honor culture, men are encouraged to adopt violent measures to restore order and maintain power. For example, Noor, a 20-year-old girl from Phoenix, was killed by her father for becoming ‘too westernized’ (Almaleki, n.d.). In another instance, 21-year-old Banaz Mahmoud was murdered in London by her father and uncle for falling in love with the ‘wrong’ man (Rajani, 2019). “It is all related to the idea that women are property, and you can do anything with your property,” says Heather Barr, senior researcher for women’s rights at Human Rights Watch (Gharib, 2016). The phenomenon of ‘owning’ women is so deeply rooted in the local culture that today honor killings have become a social epidemic across the globe. Moreover, part of the reason why the phenomenon of honor killing still persists is that the perpetrators of crime often go unpunished. In 2014, the International Humanist and Ethical Union submitted a statement at the United Nations, noting that honor related crimes often go uninvestigated as the laws against them are rarely implemented in most countries (Gharib, 2016). While some cases go unreported, others are covered up as suicides and disappearances by the victim’s family. In countries where the laws have been enforced, the “penalty is often far less strict than equally violent crimes, and pardons can be easily arranged” (Gharib, 2016). According to the Human Rights Commission, the law considers honor killing “an offense against individual and not the state,” thus allowing the victim to choose to forgive the perpetrator, (Hassan, 2016). Therefore, to abolish the phenomenon of honor-based violence against women, governments need to strengthen laws to protect them. For example, in 2009, the Syrian government repealed the law that waived punishment against men for killing female family members and replaced it with a two-year sentence (Gharib, 2019). Similarly, a new scheme of law was put into practice in Pakistan after the death of the social me-

dia celebrity, Qandeel Baloch. The penal code, section 302, now treats killing in the name of honor as punishable with death (Shah, 2016). Similar alterations in the state’s regulations, coupled with creating widespread awareness of the issue of honor-based violence, might bring the fearless honor killings to a halt. In conclusion, patriarchal societies in many countries across the globe, such as Pakistan, in particular, continue to use Islam as an excuse for honor-based violence against women. Once introduced as a measure to restrain the order of tribal communities, today, women continue to thrive under brutality as mere ‘objects’ for men in many countries. Therefore, changes in the state’s legislations are imperative to provide security to women and to ensure that the criminals are punished. Therefore, in both Muslim and non-Muslim countries, women must continue to challenge injustices and cultural values that deny the dignity and respect for them. The nightmare of violence will only end when the notion of honor is modified and sustained by valuing lives.

“What Explains Honour Killings, Patriarchy or Islam?”

Zeest Marrium Northwestern University in Qatar

GBV ACTIVISM IN IFMS A : E VERY ACTION COUNT S! Shaimaa Adel IFMSA Gender-Based Violence Program Coordinator Sexual and gender-based violence (SGBV) is an umbrella term for any harmful act that results in, or is likely to result in, physical, sexual or psychological harm or suffering to an individual on the basis of biological sex, gender identity, gender norms and unequal power relationships (1). While GBV affects women disproportionally, the term is also inclusive of men, LGBT-identifying, and gender nonconforming individuals. Globally, the activism for gender equality and abolishment of GBV passed through multiple milestones from the establishment of the Commission on the Status of Women - the main global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women - through the adoption of various landmark agreements such as the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. And finally, introducing the Sustainable Development Goals, with Goal 5 solely dedicated to Gender Equality and empowering all girls and women. Despite all of this, GBV is still considered one of the most prevalent human rights violations world-wide knowing no social, economic or national boundaries (2). According to the World Health Organization (WHO), 35% of women worldwide have experienced either physical and/or sexual IPV or non-partner sexual violence. Moreover, while women represented 39% of world employment, only 27% of managerial positions in the world were occupied by women in 2018 (3). Pre-COVID-19 crisis the World Economic Forum predicted that at current rates of progress it will take 257 years to close the

economic gender gap (4). Now, initial evidence is showing that COVID 19 disproportionately affects women economically and socially and advances towards equality are likely to be further hindered. It is alarmingly estimated that for every 3 months of lockdown, an additional 15 million cases of GBV are expected (5). Now more than ever, it is crucial to accelerate efforts towards achieving gender equality and putting an end to GBV. Every Action counts! IFMSA is the largest organization representing medical students world-wide, it was created to impact the world and to empower its members in taking their vision and ideas, and making them a reality. So, as the youth of today and the future health care leaders, we are committed to promote public health and contribute in advances towards achieving SDGs. As medical students and future physicians, we will be at the forefront of recognising violence often as a first point of contact, however very few medical schools train students how to recognise and subsequently manage cases of GBV. Additionally, we are not only in a unique position to sensitively respond to individual cases of gender-based violence (secondary prevention) but also have the chance to affect the root causes of GBV. Primary prevention can be achieved through the promotion of gender equity and the questioning of harmful gender norms. National and Local activities are the heart of IFMSA, the emphasis is placed on students returning to their local environments with new ideas and the skills to implement them, hence “Think Global, Act Local”.

This year, activities tackling GBV took place in all 5 regions in IFMSA (fig.1) impacting more than 80,000 people world-wide. Most of the activities focused on providing sustainable interventions and prevention strategies. The greater part of the program’s work was in the area of women empowerment and tackling underlying cultural traditions and concepts that reinforce GBV. Many activities focused specifically on training future health care workers on recognizing violence and providing the essential health care for survivors while others included directly empowering and supporting the survivors. The most widely represented focus areas were Women Empowerment, Domestic Violence and Sexual Exploitation and Rape followed by Female Genital Mutilation and Forced and Early Marriage. While child abuse is not a focus

area in itself, some activities were conducted tackling child abuse as a form of both domestic violence and sexual exploitation and rape. In some instances, regional variations affected the focus areas of implemented activities, for example FGM activities happened only in Africa and EMR while activities addressing violence against sexual and gender minorities took place only in Europe. Designing and conducting activities is not only about what the target group will learn, but also about how much you will learn and develop through the process. The experience of adapting our work with the COVID 19, showed us that change is possible and

in many cases beneficial. It unfolded a set of new possibilities for us using online methods and platforms shedding light on a new perspective through which we can achieve greater outreach in the future. It is always important to walk out of the comfort zones and explore new challenging areas. For example, very few activities in our NMOs attempt to advance national advocacy efforts. This is an area that needs to be further developed in the future, NMOs can engage in national advocacy and make use of IFMSA policy documents on GBV to influence decision makers.

“Projects we have completed demonstrate what we know, Future projects decide what we will learn” - Dr. Moshin Tiwana Everyday, many human beings are subjected to different forms of violence because of how they express themselves. Being medical students, people trust us, and with trust comes responsibility and motivation to stand up against hate, discrimination and all types of violence. No one deserves to be punished for who they are, your action makes a difference. It is important to remember that we live in the world we create, so dare to dream, dare to be different , dare to challenge social norms and most importantly dare to say NO to GBV. Resources 1. USAID Toolkit GBV https://2012-2017.usaid.gov/sites/default/files/documents/1865/ USAID%20Toolkit%20GBV%20EG%20Final%20Section%202.pdf 2. https://www.unfpa.org/gender-based-violence 3. https://sustainabledevelopment.un.org/sdg5 4. https://www.weforum.org/projects/closing-the-gender-gap-accelerators 5. Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_ impact_brief_for_UNFPA_24_April_2020_1.pdf *Information on IFMSA activities are found in the Programs annual impact report.

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