What happens when “safer-at-home” doesn’t apply to everyone? 

NOTE: The term sexual violence refers to crimes like sexual assault, rape, and sexual abuse, which can be perpetrated by anyone. Domestic violence includes emotional, physical, and/or sexual harm by a current or former intimate partner. Research into the specific types of violence during and following emergencies is limited and often combines domestic and non-domestic sexual violence.

For more than six weeks, the world has been consumed with talks of the global pandemic and subsequent lockdowns caused by COVID-19. As quarantine and stay-at-home efforts drag on, a second, silent pandemic persists. Evidence shows that rates of sexual violence increase during states of emergency, including natural disasters, active conflict, and health crises. For example, reports indicate that sexual assault increased by 45% during Hurricane Katrina and the recovery period. The stress, fear and sense of helplessness associated with emergencies tend to increase risk factors for perpetration of violence against women. The 2005 report of the World Health Organization (WHO) tells us that “there is a pattern of gender differentiation at all levels of the disaster process: exposure to risk, risk perception, preparedness, response, physical impact, psychological impact, recovery and reconstruction.”

Still, governments around the world failed to prepare for the uptick in violence as a result of the public health measures aimed at quelling COVID-19. For example, Equality, a Beijing-based NGO dedicated to combating violence against women, has seen a surge in calls to its help line since early February when the government locked down cities in Hubei Province, then the outbreak’s epicenter. In Spain, the emergency number for domestic violence received 18% more calls in the first two weeks of lockdown than in the same period a month earlier. French police reported a nationwide spike of about 30% in domestic violence, which includes sexual violence, since their lockdown began.

Terri Poore, Policy Director of the National Alliance to End Sexual Violence, says close to 40% of the rape crisis centers her group surveyed had seen increased demand for services since the outbreak. Interestingly, some hospitals are performing fewer sexual assault forensic exams (i.e. rape kits) than this time last year. For example, forensic nurse examiners in Washington D.C. performed only 24 forensic exams in March of this year, a 43% decrease from March 2019. The reason behind the decrease is multi-faceted, but fear of going to the hospital is likely a large contributor. This decrease is not unique to COVID-19. According to the National Sexual Violence Resource Center (NSVRC), “the reporting of sexual violence in disasters is often considered a ‘luxury issue–something that is further down on the hierarchy of needs’ for disaster victims.” This should be alarming, as it indicates that the uptick in sexual violence during emergencies is actually much larger than we think.

Further, studies show that abusers are more likely to murder their partners in the wake of personal crises, including lost jobs or major financial setbacks. With more than 30 million Americans now out of work, swift and decisive efforts need to be implemented to protect victims of this second, silent pandemic.

Populations at Increased Risk

In March, minors made up half of the calls to the National Sexual Assault Hotline for the first time ever. “Unfortunately for many, and especially for children experiencing sexual abuse, ‘stay at home’ doesn’t mean ‘safe at home,’” said RAINN President Scott Berkowitz. Of minors who reported coronavirus-related concerns, 67% identified their perpetrator as a family member, and 79% said they were living with that perpetrator. This is unsurprising, as approximately 80% of sexual assaults are committed by someone known to the victim. Children living in foster care or with someone other than biological family may be particularly at risk.

In addition to minors, individuals with physical disabilities, homeless residents, and those suffering from mental illness or substance misuse are particularly vulnerable to all types violence during emergencies.

Nowhere to Escape

Earlier this month, the New York Times interviewed a woman named Ana who was being abused by her husband while sheltered in their apartment in Spain. Ana described how her husband insisted on constant surveillance and refused to allow her any privacy, even in the bathroom. While undoubtedly upsetting, this type of behavior is commonplace among abusers.

Harvard Medical School’s own Judith Lewis Herman, a renowned trauma expert, has found that the coercive methods domestic abusers use to control their partners and children “bear an uncanny resemblance” to those kidnappers use to control hostages and repressive regimes use to break the will of political prisoners. “The methods which enable one human being to control another are remarkably consistent,” she wrote in a widely cited 1992 article published in the Journal of Traumatic Stress. Lewis writes that “common tools of abuse include isolation from friends, family and employment; constant surveillance; strict, detailed rules for behavior; and restrictions on access to basic necessities such as food, clothing and sanitary facilities.” This strict control compounds the problems caused by stay-at-home orders and makes escaping or reporting the violence nearly impossible for victims.

Fragile Systems Scramble to Meet Increased Demand

During an emergency, basic resources that can protect people from sexual may not be readily available. Shelters around the world have closed or are operating at limited capacity in an effort to decrease infection risk. France, Italy, Spain, and several U.S. states have begun using vacant hotel rooms as makeshift shelters. Most law enforcement agencies have moved to remote operations. State social service agencies and child advocacy centers are triaging in-person cases based on imminent harm standards. Sexual assault forensic exams are still conducted in some areas, but availability of rape kits may be limited in areas hit hardest by COVID-19.

Even without the added burden of a global pandemic, only 23% of sexual assaults are reported to the police. In the cases that have been reported during the COVID-19 pandemic, victims are finding it increasingly difficult to access the resources they need. Across Europe and the United States, governments rushed to implement lockdowns without making sufficient provisions for victims of sexual violence. Several weeks later, after calls to sexual assault hotlines increased and a public outcry ensued, governments scrambled to come up with a solution.

There is an urgent need for emergency funding to ensure rape crisis centers can respond to survivors entering the justice system or seeking medical attention. Eighty-nine percent of programs need emergency stimulus funding to respond to requests, and along with other advocates, the National Alliance to End Sexual Violence has sent a letter to Congress seeking $100 million for the Department of Justice’s Sexual Assault Services Program to assist rape crisis centers meet the needs of sexual assault victims during the COVID-19 crisis.

Response During the Acute Period

According to the WHO, the focus during and immediately following a crisis should be on caring for victims of violence and taking measures to prevent abuse and exploitation.

The WHO has outlined the following recommendations:

• Health service delivery must include care for survivors of [sexual violence]. This care should include at a minimum treatment of physical injuries, pregnancy prevention, treatment for sexually-transmitted infections, and, where appropriate, HIV postexposure prophylaxis.
• Ideally, health workers should be trained to identify victims of violence and provide care that ensures their safety, privacy, confidentiality and dignity, and victims should be referred for counselling and other services.
• Women's access to resources and assistance should be ensured, and women must be made part of the response and distribution networks.

This last point is especially important as nationwide attacks against Planned Parenthood and other abortion referrals continue.

Response During the Recovery

According to the WHO, the following steps can help ensure safety of the community and help preserve its ability to prevent and respond to violence:

• Community networks and programs that addressed violence before the disaster should be identified, revitalized and strengthened through training and support.
• Efforts to address violence must engage men, women and children of the affected community in the planning phase, taking care to get input from groups who tend to be overlooked in program development, such as abused women and persons with disabilities.
• Violence should be included in any surveillance system that is established.
• Community education and awareness campaigns are useful for informing residents how to report acts of violence, what services are available and where they can go for care. Campaigns can also be used to influence social and cultural norms related to violence.

How Can We Support Survivors?

Thankfully, there are organizations working to protect the growing number of victims of sexual violence, both during the COVID-19 crisis and beyond. The Relief Fund for Sexual Assault Victims collects donations to fulfill the needs of survivors during and after disasters in the U.S. You can donate online through the NSVRC store.

NSVRC and other national partners created the relief fund to:

• Support relocation/rebuilding efforts for damaged advocacy programs
• Support the needs of sexual assault survivors and advocacy program staff
• Aid with expanded direct service needs
• Assist with prevention initiatives to protect evacuees from sexual violence

In addition, Rise, the D.C.-based nonprofit organization that wrote the Survivors’ Bill of Rights Act of 2016, has launched the Survivor Safe Haven, which partners with restaurants, pharmacies, and other essential businesses to serve as “safe havens” for survivors during the COVID-19 pandemic. Survivor Safe Haven allows victims to seek help from participating businesses by using the code word “Rise Up 19” to be provided with the RAINN.org hotline and a safe place to make the call. You can get involved with Rise and Survivor Safe Haven by connecting with them on Facebook, Twitter, and Instagram.

For more details on current guidelines, recommendations and resources for sexual violence victims in the United States, please visit RAINN.org.

If you or someone you know is experiencing sexual violence, please visit RAINN.org or call the National Sexual Assault Hotline at 1-800-656-HOPE (1-800-656-4673).

**Feature photo by Eric Ward on Unsplash

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Taylor Walker is an incoming Family Medicine Resident Physician at Cambridge Health Alliance. She received her medical degree from East Tennessee State University Quillen College of Medicine, where she focused on rural and underserved communities, and received her Master of Public Health from George Washington University while traveling through 18+ countries across Europe, Asia, Central, and South America. She is passionate about women's health and family planning in the primary care setting.