Prevalence and health outcomes of domestic violence amongst clinical populations in Arab countries:a systematic review and meta-analysis

Abstract Background An estimated 30% of women worldwide experience intimate partner violence (IPV) during their lifetime. Exposure to IPV is associated with poor health outcomes and the prevalence of violence may be higher amongst women seeking healthcare. Existing evidence from the Arab region is limited. We conducted a systematic review and meta-analysis of prevalence and health outcomes of domestic violence (IPV or violence from a family member) in clinical populations in Arab countries. Methods Using terms related to domestic violence, Arab countries, and date limit > year 2000, we searched seven databases: Medline, EMBASE, PsycINFO, CINAHL, Web of Science: core collection, IBSS, Westlaw, IMEMR. We included observational studies reporting estimates of prevalence or health outcomes of domestic violence amongst women aged > 15 years, recruited while accessing healthcare in Arab countries. Studies that collected data on/after 1st January 2000 and were published in English, Arabic or French were included. Title/abstract screening, full text screening, quality assessment and data extraction were carried out. Extracted data were summarised and meta-analysis was performed where appropriate. Results 6341 papers were screened and 41 papers (29 studies) met inclusion criteria. Total 19,101 participants from 10 countries were represented in the data. Meta-analysis produced pooled prevalence estimates of lifetime exposure to any type of IPV of 73·3% (95% CI 64·1–81·6), physical IPV 35·6% (95% CI 24·4–47·5), sexual IPV 22% (95% CI 13·3–32) and emotional/psychological IPV 49·8% (95% CI 37·3–62·3). Domestic violence (IPV or family violence) exposure was associated with increased odds of adverse health outcomes: depression OR 3·3 (95% CI 1·7–6·4), sleep problems OR 3·2 (95% CI 1·5–6·8), abortion OR 3·5 (95% CI 1·2–10·2), pain OR 2·6 (95% CI 1·6–4·1) and hypertension OR 1·6 (95% CI 1·2–2·0). Conclusions Domestic violence is common amongst women seeking healthcare in Arab countries. Exposure to domestic violence is associated with several poor health outcomes. Further research into domestic violence in the Arab world is required. Trial registration Systematic review protocol was registered on PROSPERO: CRD42017071415

High rates of maternal depression amongst Syrian refugees in Lebanon - a pilot study

This pilot study compares symptoms of depression and risk factors amongst Syrian refugees and low-income Lebanese mothers accessing a primary care centre in Beirut between January and June 2018. Women who gave birth in the previous two years or who were currently pregnant were included in the study. Depressive symptoms were assessed using the Arabic Edinburgh Postnatal Depression Scale (EPDS). Correlations between EPDS score and sociodemographic and mental health variables were analysed using Pearson’s coefficient and ANOVA. 35 Syrian and 25 Lebanese women were recruited, 15 of whom were pregnant. EPDS scores were high in the whole group (mean 16.12 (SD 7.72), n=60). Scores were higher amongst Syrian refugees than Lebanese mothers (17.77, SD 7.66 vs, 13.80, SD 7.34, p<0.05). Illegal residence (p<0.001), domestic violence (p<0.05) and a history of mental illness (p<0.01) were associated with higher scores. This pilot study demonstrates high rates of symptoms of depression amongst mothers in this population. Symptoms were particularly prevalent amongst Syrian refugees; three-quarters were ‘probably depressed’ and would warrant psychiatric assessment. This highlights the importance of improved mental healthcare for refugee mothers, the importance of addressing the social determinants of maternal mental health and further research into the effects of depression on these women and their children

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC

A positive yet complicated case of gender-based violence coordination: a qualitative study of Lebanon's protracted humanitarian emergency, 2012–22

Gender-based violence (GBV), a global health and human rights concern, often intensifies during emergencies. This paper explores the evolution of GBV coordination in Lebanon's protracted Syrian refugee crisis from 2012–22. Utilising 38 in-depth interviews and a document review, the findings were analysed using the framework for effective GBV coordination. Lebanon provides a positive yet complicated example of GBV coordination. Initially established to address the refugee crisis, it matured into a collaborative national coordination mechanism, fostering trust and advancing localisation amidst sectarian complexities. However, the volatile, restrictive policy context hindered government co-leadership and engagement with refugee-led organisations. While essential GBV response services were expanded nationwide, lack of an interagency strategy on GBV risk mitigation and prevention compromised lasting change. The paper emphasises the importance of dedicated GBV coordinators, multi-year funding, and increased attention to GBV prevention. The findings underscore the transformative potential of humanitarian responses and advocate for enhanced engagement with national stakeholders to promote sustainability in protracted crises

Gender-based Violence in the Middle East Region

(Product of workshop No. 11 at the 11th MRM 2010

Prioritising women’s and girls’ health in disaster settings: Lessons from the COVID-19 pandemic and the overlapping crises affecting Beirut, Lebanon

The COVID-19 pandemic has placed strain on healthcare systems across the world; however, countries experiencing overlapping crises such as economic or political unrest face immense pressure in ensuring routine healthcare services can continue to operate. Despite being less likely suffer severe disease or die from COVID-19, data suggest women have experienced poorer mental health, higher rates of unemployment, and more social isolation during the pandemic. In general, we know women and girls experience multiple forms of disadvantage in disaster contexts including being more likely to become homeless, work as an unpaid carer, and to experience poverty. Research from previous disaster contexts has demonstrated that women’s healthcare services tend to be deprioritised in the emergency response, and reports suggest this has been the case during the COVID-19 pandemic. This paper highlights key priorities for safeguarding women’s and girls’ health in disaster contexts, especially during the COVID-19 pandemic, by drawing on learning from the multiple crises facing Beirut, including responding to the pandemic, economic collapse, and the Beirut Port Explosion in 2020