Abstract
This study used focus group discussions to explore 29 Syrian women’s experiences of being displaced refugees in Lebanon. Women reported intimate partner violence (IPV), harassment, and community violence. They experienced difficult living conditions characterized by crowding and lack of privacy, adult unemployment, and overall feelings of helplessness. Most frequently, they used negative coping strategies, including justification and acceptance of IPV and often physically harmed their own children due to heightened stress. Some sought support from other Syrian refugee women. Although the study did not address the root causes of IPV, the results shed light on women’s experiences and indicate that training them in positive coping strategies and establishing support groups would help them face IPV that occurs in refugee settings.
The humanitarian crisis in Syria has displaced thousands of individuals and their families, many of whom initially fled to Lebanon. In 2012, the number of displaced Syrians in Lebanon was estimated at 48,000 who were hosted in Lebanese homes and dwellings concentrated mostly in North Lebanon and the Bekaa Valley. Today, this number has reached more than 1 million. The majority are women aged 18 to 59 years old and their children (United Nations High Commissioner on Refugees [UNHCR], 2014). Few studies have systematically examined refugees’ experiences of being displaced and until recently, researchers have overlooked women’s experiences with intimate partner violence (IPV). Unfortunately, IPV frequently occurs during widespread civil conflicts (Rehn & Sirleaf, 2002). During wars and within conflict zones, women face violence both outside and inside their homes (El-Jack, 2003) as societal order breaks down. Multiple forms of gender-based violence (GBV) stem largely from women’s subordination with regard to men across many societies (United Nations General Assembly, 1993).
A growing body of literature has highlighted the link between women’s exposure to violence by armed groups and their experiences with domestic violence in their own homes perpetrated by an intimate partner, spouse, or other direct family member (Catani, Jacob, Schauer, Kohila, & Neuner, 2008; Gupta et al., 2009; Pittaway, 2004). Reports from the Human Rights Watch noted increased levels of domestic violence during the second Intifada in the West Bank and Gaza (Human Rights Watch, 2006), and extensive domestic violence against refugee women in Tanzania (Human Rights Watch, 2000) and Nepal (Human Rights Watch, 2003). Civil conflicts in Sri Lanka were linked to increases in domestic violence in both the general population (Paudel, 2007) and in refugee camps (Rajasingham-Senanayake, 2004). There were high rates of domestic violence during the war in South Sudan (Jok, 1999) and in post-war Peru where the incidence of IPV differed between low (47%) and high conflict areas (54%; Gallegos & Gutierrez, 2011).
In a study in Lebanon, married couples were surveyed in Palestinian refugee communities. The results showed that 30% of the couples reported at least one experience of domestic violence, while 10% reported an episode in the previous year (Khawaja & Tewtel-Salem, 2004). A survey of 310 women displaced by the 2006 war in Lebanon revealed that 39% had at least one encounter with violence perpetrated by soldiers. Thirty-seven percent reported at least one incident of domestic violence during the conflict; with 13% of those reporting at least one incident of violence perpetrated by their husbands or other family members in the 6 weeks following the conflict (Usta, Farver, & Zein, 2008). Overall, domestic violence worsened and became more frequent following the 2006 war (Kvinna till Kvinna, 2010).
The present study was part of a rapid needs assessment carried out in 2012 in partnership with the United Nations Population Fund (UNFPA). In 2014, a large-scale survey of women’s reproductive health, GBV, and the overall experiences of Syrian refugee women in Lebanon was conducted (Masterson, Usta, Gupta, & Ettinger, 2014). The goal of the present study was to expand on the Masterson et al. (2014) report to more directly understand the challenges of being a displaced woman in Lebanon and to examine Syrian women refugees’ experiences with the ongoing conflicts and IPV using an in-depth, focus group methodology.
Heise’s (1998) ecological model and Usta and Singh’s (2015) theoretical framework guided the present study. This framework proposes that, during wars, variables associated with violence against women operate at four levels: structural (patriarchy and degree of gender inequality, poverty level, breakdown of legal system, and displacement), community (altered sex ratio, changing societal norms, desensitization, access to weapons, and hosting/being hosted as a refugee), relationship (shift in gender roles, loss of social safety nets, and ethnic/religious differences), and individual (loss of income, insecurity, compromised psychological functioning, and coping mechanisms). More specifically, Usta and Singh, (2015) argue that an increase in IPV during wars and civil conflicts is not a new phenomenon but rather an extension of power asymmetry that underlies pre-existing gender inequalities in many societies (Nikolic-Ristanovic, 2000; Stark & Wessels, 2012). When nation-states break down during wars and civil conflicts, anachronistic views of gender roles often prevail. Moreover, as people are dislocated from their daily routines, lifestyles, and support networks, they must secure alternative shelter, food, and income for themselves and their families. With limited resources or access to viable employment, young women may drop out of school, marry young, accept low-paid jobs, or take on risky work, such as prostitution. Sustained exposure to violent acts during war and civil conflicts is associated with an elevated risk of both physical and sexual violence in families (Koenig et al., 2006), an altering of community-level norms about wife beating (Waldmann, 2007), and a tolerance for and acceptance of physical violence in how individuals solve simple problems. In patriarchal societies, men’s responses to stress are often aggressive and violent as they release their own frustrations and emotions and attempt to gain some power and control over their lives. Accordingly, armed conflicts place significant stress on individuals. Repeated traumatic experiences (direct or indirect), feelings of insecurity and instability, scarce resources, displacement, loss of income, uncertainty about the future, and death or disability of a close friend or family member, all serve to tax individuals’ coping mechanisms.
Method
Participants and Procedure
Participants were recruited by three local Non-Governmental Organizations (NGOs) that managed community centers to support Syrian refugees in Lebanon. The NGOs provided information about the study to women of reproductive age (18-45 years) who were Arabic speakers and had been present in Lebanon for more than a month. The women were told the purpose of the study was to learn about their living conditions, needs, and health issues since arriving in Lebanon, and that their participation would involve discussing their experiences in small groups of women (i.e., focus group discussions [FGDs]). Women were informed of the date, time, and location of the FGDs. To ensure their safety and confidentiality, they were told that no identifying personal information would be collected. Those who agreed to participate signed or marked an informed consent form indicating their understanding of the study, desire to participate, and agreement to be audio-tape recorded. Ethical approval was obtained from the Human Subjects Committee at Yale School of Public Health (YSPH) and UNFPA/Lebanon using standard procedures for written approval of study protocols. At the end of the FGDs, participants received a UNFPA “dignity kit” containing basic sanitation supplies and clothing as compensation for their time. They were also given telephone numbers for agencies that provide protection, health, and psychosocial resources for survivors of violence.
The theoretical framework mentioned above guided the study. FGD questions germane to the Lebanese situation were adapted from Reproductive Health Response in Conflict Consortium (RHRC, 2004) part of the Women’s Commission for Refugee Women and Children and linked to the theoretical framework. These questions included, Structural and Community (i.e., characteristics of life in Syria before the conflict and life now in Lebanon, access to services in Lebanon and barriers to access) and Relationship and Individual (i.e., overall general and reproductive health; experiences with violence, including domestic violence and violence related to the conflict; and strategies women used to cope with their situation).
Audio-recordings of the FGDs were transcribed verbatim in Arabic and then translated into English. Members of the project team separately read each transcript to identify themes and develop a coding scheme using the grounded theory methods (Glaser & Strauss, 1967). Four key themes consistent with the theoretical framework (mentioned above) emerged: (a) women’s experiences living as a refugee in Lebanon, (b) sources of significant stress, (c) exposure to conflict and domestic violence of any kind, and (d) strategies women used to cope with living as a refugee and violence exposure. Project staff coded the transcripts for these four key issues. After training, inter-coder reliability was established at the outset, midway, and at the end of the process with the members of the project team.
Results
The Study Sample
Twenty-nine displaced Syrian women agreed to participate in three, 1-hr FGDs conducted in NGO community centers located in areas with the highest concentration of Syrian refugees at the time of the study. These areas were Heshha (Wadi Khaled, North Lebanon; n = 8), Arsal (n = 9), and Baalbek (Bekaa Valley, n = 12). Most participants were registered with UNHCR as refugees.
The eight women who participated in the Wadi Khaled group were married, two had husbands who were detained by the Syrian government, most had sons or husbands who worked far away, and one was pregnant. On average, they had been in Lebanon for about 4 months.
In the Bekaa Valley center, three of the nine were Lebanese women who were displaced by the conflict in Syria. They were all married and most had their husbands and children with them in Lebanon. They had been in Lebanon for about 4 months. In the Baalbek group, participants self-identified as a mix of Sunni and Shia Muslims. Two of the 12 women were pregnant and this group had the youngest participant who was 15 years old.
Community and Structural Level—Women’s Experiences Living as a Refugee in Lebanon
All women reported significant hardships associated with daily living. These hardships included water shortages and traveling long distances to get water, insufficient food, and lack of access to health care. Some women reported receiving both food and non-food items from UN agencies and local NGOs, as well as help from the Lebanese community (household appliances, fans, fridges, mattresses). Yet, there was much confusion and frustration about why some women received these items, whereas others were denied. Some women highlighted their perceptions of discrimination in distribution of household items as a major barrier to access. Access to aid and supported health services seemed to be limited to those registered with UNHCR. This was a barrier to services because some women did not register for fear that their names would reach the Syrian regime or they would be affected by lack of official papers. “I forgot my papers in Syria. We had to run and could not get things with us.” Moreover, women commented on the discrimination in distributing goods by some local NGOs or international agencies. “The distribution is very haphazard, not equal to all; they discriminate and prefer some people over others.” Aid is said to be used to gain political power, and to potentiate community hierarchy “Those who are getting the privileges are looking down on others” and religious division “There was no difference between Shia, Sunni, or Christian, now we’re all being divided.”
Relationship Level—Exposure to Conflict and Domestic Violence of Any Kind
Women were open to reporting IPV. They mentioned their husbands frequently released their stress by hitting or beating them. One woman admitted that the neck pain she was having was due to a beating she received from her husband. Yet, some women reported that their husbands were less likely to beat them in the presence of non-family members living with them “men control their temper when there are strangers.” This was attributed to embarrassment or shame as men would be seen as weak and unable to tolerate stress.
Some women spoke of experiences with sexual violence, although most initially denied being aware of such incidents. Instead, they blamed other women for bringing sexual harassment upon themselves by going out uncovered, wearing full make-up, or not staying near their families. When probed further, women reported sexual propositions in shops or taxis. To evade verbal harassment, most avoided going out in the streets unless they were accompanied by other women. A few women elaborated on the hostility received from the host community: “Last night there were young men throwing stones at us and shouting ‘Assad is coming to get you and kill you all.’”
Individual Level—Sources of Significant Stress
Most women reported that their children were an additional source of stress as many were perceived to be “bad tempered” and “difficult to manage.” They attributed their children’s behavior to being physically constrained most of the time and prevented from playing outside to avoid clashes with the local children. One mother commented on the discrimination even their children faced: “The children of [local community] used to hit our children; they make fun of their Syrian accent, they don’t treat them well.” Several mentioned the crowded living conditions, the lack of privacy, and the impact on their families; children cannot play outdoors because it is not safe nor indoors because there is no room: “We are six families with 13 children all living in a tin house. There are no toys, games, or play grounds.” Women attributed much of their stress to being unable to help their psychologically distressed children: “The kids are scared, afraid and stressed, they need psychological treatment.” Women mentioned that men were overly irritable because their normal lives had been displaced and life in Lebanon was “. . . a boring routine with nothing to do.” Moreover, even when working, men could not earn enough to cover the high cost of living in Lebanon. Unstable housing and moving frequently also increased tension within families. Women spoke of harassment and propositions from landlords as one of the reason for frequent moves.
Individual Level—Strategies to Cope With Living as a Refugee and Violence Exposure
To cope with their experiences of IPV, most women reported doing nothing. In general, most women tried to accept their situation while others justified their experiences with IPV as a result of stress and worry their husbands experience with the uncertain political issues and ongoing conflict in Syria. Most mentioned they preferred to stay quiet and not talk about it. One woman commented, “My husband threatened to take me back to Syria if I raise my voice,” and another added, “If we say a single word they say we’ll take you back to Syria, so we shut our mouth and accept.” Some felt helpless: “There is nothing to do, we have to accept the situation”; while try to avoid thinking about it: “We just cover ourselves and sleep.” . . . “There is no place to go. We just need to avoid trouble and keep a low profile” (bidna elsotra in Arabic).
In reaction to IPV and the stress they experienced, some women admitted that they frequently took it out on their children. One woman confessed, “I think I am getting crazy, I really beat my child hard and then I started crying, regretting what I did.” Another said, “We are letting go [of stress] on our children. Our kids want to go back home, they sense how we have become and don’t like it.”
A few women reported a feeling of solidarity brought out by spending time with members of their community, this seemed to help in coping with their situation. Syrian women reported that the experience of displacement had brought them closer to each other. Friends, neighbors, and relatives were helping each other through the difficult times, lending each other kitchen utensils, sharing experiences, and providing solutions to problems. One woman said, “All Syrians help each other. We are a group. Everyone helps everyone.” Some women spoke also of supportive neighbors who helped them with basic necessities. “Neighbors can sometimes be nice. We ask them to give us cold water and they do.”
Discussion
Given the scarcity of research exploring IPV in armed conflicts or refugee settings, the present study adds to the existing literature by providing a description of the factors that contribute to IPV and women’s responses. On the community/structural level, Syrian refugees identified infrastructural changes and daily stressors that contributed to IPV. This was corroborated later by reports from Syrian refugees in Lebanon (El-Masri, Harvey, & Garwood, 2013; International Rescue Committee & ABAAD (Dimesions), 2012) and is also characteristic of situations that involve environmental disasters (Adams &Adams, 1984; Delica, 1998; Dobson, 1994; Enarson, 1997; Stark et al., 2010). Displacements of any sort represent serious environmental factors that often predispose women to abuse.
To some extent crowded living can serve as a protective factor for IPV. Syrian refugees living in crowded places with several families reported that their husbands refrained from beating them when others were around. Although this contradicts findings from the Balkans where men were more likely to use violence despite the presence of others in the home (Nikolic-Ristanovic, 2000), this difference could be related to the conceptions of manhood in the Arab world. In the Arab world, a man is expected to have self-control and wife beating in a stressful refugee setting could be perceived as a sign of weakness, the loss of self-control, and shameful.
At the community level, Syrian refugees faced resentment and harassment, including sexual, from the local community. Skjelsbaek (2001) argues that IPV and public violence increases among refugees when there is an increase in the level of frustration which is often inflicted on weaker individuals.
From the Lebanese perspective, many people were losing their jobs due to the available and cheaper Syrian labor force. Therefore, there was competition for scarce services and food resources, and a fear that the violence in Syria would spillover to Lebanon. Moreover, the discrimination reported in aid distribution has further exacerbated overall community tensions and could lead to internal disputes within the refugee community, weakening their social support network.
A survey of Iraqi refugees in Syria indicated a potential relation between financial stress and IPV. Wars place a strain on the couple relationship by shifting gender roles and power dynamics. Women are most often the focus of attention for relief and protection agencies. In addition, women may have greater ability to find work and earn income for the family, while men lose their role as “provider” and “protector,” making them feel powerless. IPV can constitute a means for men to reaffirm their power over women and over their families (Munn, 2008).
On the individual level, reports of unemployment and the resulting boredom and emasculation may predispose men to IPV. This notion is supported by observations of domestic violence in other refugee settings (Hynes & Cardozo, 2000). Feelings of displacement can lead to frustration among men and the use of violence to solve problems or deal with stress (El-Masri et al., 2013).
When facing IPV, most of the women remained silent and accepting. This response has been reported in immigrant communities where there is strong pressure to maintain a positive image of their community and remain silent about the problem of IPV. Acknowledging IPV as a problem may be detrimental to the collective survival of the community (Runner, Novick, & Yoshihama, 2009), and further perpetuated if the displaced community is struggling to survive in a hostile and discriminatory environment. Moreover, community hostility may deter women from seeking help and reporting IPV because they run the risk of being exposed to hostility and violence as there will be mistrust. Therefore, women would often prefer being exposed to familiar violence than violence from the unknown—in essence IPV becomes the lesser of the two evils. In general, women justified violence, admitted using painkillers, and sometimes venting their stress on their children by sometimes beating them. By adapting to the violence they experience, Syrian woman may be creating another major problem involving the abuse of their children.
IPV in humanitarian settings has not been adequately studied and this research reveals several factors operating in refugee settings that predispose women to IPV. Further work is needed to clarify how culture affects some contributing factors, such as crowding, and how refugee women respond to IPV. The finding that Syrian refugee women were reluctant to seek services for IPV outside their community despite the high prevalence highlights the importance of tailoring a response sensitive to their culture. Training some refugee women in appropriate skills to provide psychological support to other survivors of violence may be a good alternative solution that can be integrated into efforts made by humanitarian agencies to address GBV. This approach could alleviate the negative impact of violence on survivors and decrease secondary child abuse. Developing programs that would engage refugee men should also be considered, as the issue stems largely from men’s experiences and responses to their situation.
While a strength of this study was the focus on the naturalistic context in real time as opposed to using retrospective accounts, it should be noted that to some extent, the sampling was “opportunistic” and based on individuals who were seeking help. Clearly, other methods and data collection procedures could yield a different account of this large-scale problem. Moreover, these experiences may be unique to the Middle Eastern context and may not generalize to other areas experiencing a refugee crisis.
Footnotes
Authors’ Note
The study was conducted in cooperation with the United Nations Population Fund (UNFPA; Lebanon office), International Medical Corps (IMC), Rafik Hariri Foundation, and Makassad Association.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the United Nations Population Fund (UNFPA) and the Okvuran Fund for International Support from Yale School of Public Health002E.