Research for stronger health systems during and after crisis

From Gender Blind to Changing Minds: Five Steps to Building Back Better in Humanitarian Action

Posted on Thursday, 09 Nov 2017

In this blog, written as part of the Humanitarian Evidence Week, Valerie Percival and Sally Theobald describe five steps to facilitate gender transformative humanitarian programming.

In September 2016, at the United Nations General Assembly’s High Level Meeting which produced the New York Declaration for Refugees and Migrants, the international community pledged to:

. . . ensure our responses to large movements of refugees and migrants mainstream a gender perspective, promote gender equality and the empowerment of all women and girls and fully respect and protect the human rights of women and girls.  We will combat sexual and gender-based violence to the greatest extent possible.  We will provide access to sexual and reproductive health services.  We will tackle the multiple and intersecting forms of discrimination against refugee and migrant women and girls.  At the same time, recognizing the significant contribution and leadership of women in refugee and migrant communities, we will work to ensure their full, equal and meaningful participation in the development of local solutions and opportunities.  We will take into consideration the different needs, vulnerabilities and capacities of women, girls, boys and men.

While this sounds promising, the promotion of gender equality is much easier in the halls of the United Nations in Geneva and in New York than on the front lines of humanitarian operations. Below, we outline five steps to facilitate gender transformative humanitarian programming based on analysis, research and programme experience.

Gender Analysis, Not Rhetoric

Five years ago, we analysed Consolidated Appeals and discovered that efforts to undertake meaningful gender programming in humanitarian engagement had been largely lip service, dominated by projects that focused on maternal health and sexual violence.  Since that time, there has been meaningful progress. Gender advisors are more consistently deployed within the humanitarian response.  Humanitarian projects are assessed with a more sophisticated ‘gender marker’, which has been updated to include age variations.  Donor led initiatives, such as Safe from the Start and Call to Action, work to prevent and better respond to Gender Based Violence (GBV).  And UN Women has a strong voice at the negotiations for the Global Compact for Refugees, and is using that position to advocate for the centrality of gender equality and the recognition of the importance of women’s leadership.

But a review of current planning documents for several ongoing humanitarian crises, including Humanitarian Needs Overviews and Humanitarian Response Plans, shows decidedly mixed results at the field level.  Sex disaggregated data is not consistently presented in summaries of the humanitarian situation.  Gender analysis is incorporated in a piecemeal fashion throughout these documents, without a standalone summary of the differential impact of crises according to gender, age, and socio-economic and identity groups.  And the easily accessible summaries of humanitarian crises – such as Situation Reports - rarely contain either sex-disaggregated data or a gendered analysis; critical first steps for a gender responsive approach.

Gender based analysis is not an onerous task, nor simply a box checking exercise imposed by donors.  It provides the promise of more effective and efficient humanitarian engagement by identifying how men, women, girls and boys across different ages and groups are impacted by the conflict, as well as their differing resources, capacities and resiliency, vulnerabilities and needs. 

Gender based analysis needs to be a central component of the analysis of humanitarian emergencies.  If mainstreaming gender means a scattered approach to gender analysis, perhaps it is time to focus for a more direct approach.  Sex disaggregated data must always be presented, included in any overarching summaries of the crisis.  The  Humanitarian Needs Assessment for Myanmar or the most recent Refugee Statistics from South Sudan provides effective examples of how such data can be concisely presented.  All documentation of humanitarian needs and plans for the humanitarian response should include a brief stand-alone section that provides a gender based analysis, and this gender analysis must be included in any executive summaries to ensure it is read and acted upon. Experience has shown that, too often, a focus on gender can ‘evaporate’ in practice.

Gender is more than women and girls, and more than maternal, reproductive and GBV programs

When confronted with the tragic experiences of women and girls in humanitarian emergencies, it is easy to equate gender analysis with the analysis of the situation of women and girls.  And this was the case for much of the documentation that we examined.  Gender programming equates to the provision of additional resources for the specific challenges faced by women – namely maternal health, and GBV services.

As outlined below, such services are critically important to address the specific vulnerabilities of women and girls in many humanitarian contexts.  But without gender based analysis, we simply cannot understand how vulnerabilities and needs manifest themselves across gender, age and socio-economic and identity groups.  Moreover, we may miss important vulnerable groups.  Humanitarian engagement should be driven by data and analysis, not assumptions about gendered roles and gendered vulnerabilities.

Humanitarian professionals, with the lessons of the last emergency often fresh in their mind, must use their experience but resist the temptation to assume they fully understand this emergency.  One of the challenges of humanitarian action is that while many humanitarian situations appear the same, all populations have different cultures, histories, and community dynamics.  These contextual differences in gender roles and vulnerabilities need to be properly analysed and understood.

Analyse Differential Vulnerabilities of Girls and Women

Across conflict situations, women and girls face similar challenges. Due to their caregiving and reproductive roles, they are disproportionally impacted by disruptions to health services, and suffer heightened morbidity and mortality as a result.  With the increase in criminality and lawlessness that accompanies conflict, women and girls are also at higher risk of GBV.  If households lose adult men in fighting, women become solely responsible for household welfare, and economically and socially vulnerable. Domestic violence can also increase, with the strain of social and economic instability as well as changing gender roles as women may assume more leadership and responsibility within the household, and men may lose their breadwinning roles. Across many conflict contexts, families force girls into child marriages.  And single, unaccompanied women and girls as refugees and migrants are extremely vulnerable to GBV as well as to trafficking. 

Gender analysis must go beyond these generalities to better understand the experiences of all women across the life cycle and within different contexts. For example, older women and widows, or women or girls living with disabilities may be particularly vulnerable to ill-health and vulnerabilities. Critically, gender analysis must also understand how humanitarian engagement can create conditions for women and girls to empower themselves.  How have women exercised leadership within these communities, and how are they exercising leadership within this emergency?  What resources could help women and girls better exercise leadership roles in their communities in ways that promote health and well-being?

Understand and Analyse the Vulnerabilities of Boys and Men

Suspicion tends to accompany men and boy migrants and refugees.  With the rise in migrants and refugees seeking asylum in Europe, some analysts argue that this influx of boys and men is destabilizing, as it skews sex ratios towards men, which statistically is correlated with higher rates of crime and instability.  Fears of terrorists hiding in midst of refugees and migrants or of increased criminality are not offset by studies which demonstrate that most terror attacks have been committed by citizens; analysis that refugees and migrants are not more predisposed to crime; and evidence that any link between heightened criminality and refugees is a result of complex factors. Canada is responding to these fears by limiting refugee claims from single men, prioritizing families and women and girls. 

Such analyses and policy action is misinformed about the patterns of refugee and migrant flows as well as the specific vulnerabilities faced by boys and men in conflict situations.  These factors need to be better acknowledged and integrated into humanitarian programming and into migration and refugee policies.

In conflict, boys and men have a higher risk of dying from war-related violence. They also face the heightened risk of recruitment into armed groups, as well as suspicion of involvement in armed group, which increases their vulnerability to detention, arrest or death. Men also experience GBV in conflict: research conducted by ReBUILD in northern Uganda has highlighted men’s experience of sexual and gender based violence during war and its devastating impact on physical and mental health and well-being in both the short and long term.  In many conflict-affected areas, boys and men may leave first to identify and establish a location for the family.  They are perceived to be less vulnerable to violence than children and adolescent girls or women, and may be better able to secure employment upon arrival.  The journey of these boys and men is not without enormous difficulty and hardship. These risks are not trivial, and should also be integrated into gender-based analysis in humanitarian assessments. 

Seize the Opportunity to Challenge Gender Norms

Humanitarian crises result in loss of life; morbidity, stress and illness; disruption of livelihoods; separation of families; and destruction of communities.  Yet within this tragedy lies an opportunity to build back better – to transform gender norms and contribute to enhanced gender equality.  This outcome is good for all: women, men, girls and boys, as gender equal societies are more peaceful and more prosperous. 

Our research has documented how health systems can provide an opportunity to integrate gender into post-conflict recovery.  Yet this needs to be a deliberative effort – health systems experts must understand the gender dimensions of health systems, and undertake interventions to build gender equity. Critically, it must begin in the humanitarian period, as interventions undertaken by humanitarian actors can set in motion a serious commitment to gender based analysis, and gender responsive programming.  The time is now. Such efforts will support healthier populations and stronger, more peaceful societies.


Valerie Percival is Assistant Professor of International Affairs at the Norman Paterson School of International Affairs, Carleton University, with a current research focus on the relationship between conflict and health. She led the collaborative research between the Stockholm International Peace Research Institute and ReBUILD that produced the original paper on ‘Health systems and gender in post-conflict contexts: building back better?



Sally Theobald is Professor of Social Science and International Health at the Liverpool School of Tropical Medicine. She leads the work of the ReBUILD RPC on gender and health systems in conflict-affected settings, and is on the Steering Committee of the collaborative RinGs Programme on gender and ethics in health systems.