• OCMC, Koshi hospital, Morang, Staff Nurse Pramila Waiba

Addressing gender based violence in Nepal during COVID-19

Tuesday, 14 Jul 2020
Nepal's COVID-19 lockdown is putting women and girls at greater risk of gender-based violence. But international and national spotlight on the issue is an opportunity to make lasting improvements to the systems that were designed to protect them.

COVID-19 cases are rapidly increasing in Nepal as hundreds of thousands of migrant workers return from India and the wider region and spread out across the country. The lockdown and the economic downturn is exacerbating the challenges vulnerable communities face, heightening women and girls' risk of gender-based violence (GBV).

GBV happens in the shadows. It is usually hidden from sight, unspoken, and perpetuated by social norms that condone the use of violence to control and exploit women and girls who are often seen as the property of the family. Few survivors seek help. Restricted mobility, fear of COVID, and reduced availability of public services during COVID have further trapped women and girls at home with abusers, or left them isolated and in shame of having been violated.      

Official statistics barely capture the full extent of the problem. Nationally, close to a third of women aged 15 to 49 have experienced physical or sexual violence[1]. Women and girls with disabilities are especially at risk[2]. Those cases that are counted by authorities are only the most severe ones, often involving rape or serious physical and life-threatening injuries. Even when the police and hospitals are involved, families and victims often prefer to drop charges or conceal what has happened to avoid shame and stigma.

A study of survivor perspectives illustrates how social norms trap women and girls in this culture of silence. Options’ DFID-funded Nepal Health Sector Support Programme (NHSSP3) piloted and scaled hospital-based One Stop Crisis Management Centres (OCMCs), which were established in 2011[3] to address gender-based violence in the country. A 21-year-old woman with intellectual disabilities, who is deaf and unable to speak, was raped by an unknown person. When the pregnancy was detected at the OCMC, the parents did not want to take her back to the village due to the ‘hateful discrimination’ against the woman and the stigma they would face. The woman stayed at the safe home until delivery. The baby died and after multiple family counselling sessions the parents agreed to take the woman home. No case was filed to investigate who the perpetrator was[4].

The centres provide free health services, identify and treat survivors and offer them psychosocial counselling and medico-legal services. They also act as the coordination hub to multisectoral services including safe homes, personal security and rehabilitation programmes. From an initial seven in 2011, there are now 69 OCMCs across the country.

The programme has also provided forensic training of doctors to improve the quality of medico-legal reporting and the strength of evidence taken to court, introduced psycho-social counselling training of health staff and strengthened the centres’ reporting systems of cases[5].

But a lack of trained human resources and strong leadership have impacted the readiness and functionality of the centres. Adding to that are challenges stemming from recent shifts in Nepal’s political landscape, such as its transition to federalism, and subsequent changes in governance structures.

But timing has played well. In early 2020, Options supported the government to conduct a strategic review of the centres [6], including recommendations to address many of these challenges. The review’s findings and recommendations fed into Nepal’s COVID-19 response to GBV, informed emergency cluster coordination groups established by Government, and helped cement the coordination across the many sectors involved, including the police, health, women’s protection and rehabilitation.

In response to the crisis, Options’ Advisors pivoted from their role in advising Nepal’s government on how to strengthen the country’s health system to be more gender inclusive, to appear on talk shows on national TV to raise public awareness on how the lockdown has led to an increase in GBV and what help was available to survivors and perpetrators[7]. They were interviewed on several radio channels and have been instrumental in producing radio jingles to raise public awareness that GBV is illegal and harms individuals, families and society. The jingles on GBV and COVID have been translated into a few local languages and have been aired on over 200 national and community radio stations.

During lockdown, Options’ advisers have overcome restrictions on movement by providing virtual support to OCMCs across the country and facilitated the management of 15 rape cases across multiple agencies. These advisors have also supported the Ministry of Health and Population to prepare a COVID-19 protocol for OCMCs to help ensure they’re functional during the pandemic, introduced a rapid electronic reporting system of cases to higher authorities, and supported the establishment of eight new centres through virtual meetings.

The international and national spotlight on the impact of COVID-19 on gender-based violence also raises political pressure to address the underlying social determinants of GBV in Nepal, and the structural challenges of responding to the needs of survivors. This created an enabling environment that sped up the approval for improvements that were recommended by the strategic review. From a patchy period at the beginning of the lockdown in March, when the centres were inaccessible, successful advocacy has led to their inclusion in the Ministry’s list of essential health services. All centres in the country are now open, and many are actively involved in the public awareness campaign to end GBV.

Despite the enormous challenges COVID-19 pose for women and girls that are at risk of gender-based violence, the pandemic also presents an opportunity for the government to put measures in place that could help improve mechanisms to protect them in the future.

References

[1] Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal.

[2] Ministry of Health and Population and Nepal Health Sector Support Programme. 2019. Survivor perspectives on the nature, risks and response to Gender-based Violence in Nepal and the Implications for One-stop Crisis Management Centres.

https://nhssp.org.np/Resources/GESI/VFM%20Case%20Study%20OCMC%20-%20July...

[3] http://www.nhssp.org.np/nhsp3.html

[4] Ministry of Health and Population and Nepal Health Sector Support Programme III. 2019. Survivor perspectives on the nature, risks and response to gender-based violence in Nepal and the implications for One Stop Crisis Management Centres. https://nhssp.org.np/Resources/GESI/VFM%20Case%20Study%20OCMC%20-%20July...

[5] Ministry of Health and Population and Nepal Health Sector Support Programme. 2018. Support to the rollout of Gender-based Violence Clinical Protocol in three One-stop Crisis Management Centre based hospitals that are developed as training sites. http://www.nhssp.org.np/Resources/GESI/GBV%20clinical%20protocol%20train...

Ministry of Health and Population and Nepal Health Sector Support Programme. 2019. Improving hospitals’ responses to survivors of Gender-based Violence in Nepal.  http://www.nhssp.org.np/Resources/GESI/Case_Study_Improving_hospitals_re...

[6] Ministry of Health and Population and Nepal Health Sector Support Programme. 2020. Review of the scale-up, functionality and utilisation, including barriers to access, of One Stop Crisis Management Centres. http://www.nhssp.org.np/Resources/GESI/Scaling%20Up%20OCMCs%20%20-%20Apr...

[7] https://m.youtube.com/watch?v=Lzk2zb1haE8&feature=youtu.be

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