Elsevier

Social Science & Medicine

Volume 152, March 2016, Pages 125-137
Social Science & Medicine

Review article
Violence against children in humanitarian settings: A literature review of population-based approaches

https://doi.org/10.1016/j.socscimed.2016.01.052Get rights and content

Highlights

  • Analyzes prevalence studies of violence against children (VAC) in emergencies.

  • Reveals a lack of standard practice in measuring VAC in humanitarian emergencies.

  • Shows limited evidence of whether and under what conditions VAC increases.

  • Reveals fundamental assumptions underpinning VAC in emergencies are not data-driven.

Abstract

Children in humanitarian settings are thought to experience increased exposure to violence, which can impair their physical, emotional, and social development. Violence against children has important economic and social consequences for nations as a whole. The purpose of this review is to examine population-based approaches measuring violence against children in humanitarian settings. The authors reviewed prevalence studies of violence against children in humanitarian contexts appearing in peer-reviewed journals within the past twenty years. A Boolean search procedure was conducted in October 2014 of the electronic databases PubMed/Medline and PsychInfo. If abstracts contained evidence of the study's four primary themes – violence, children, humanitarian contexts and population-based measurement – a full document review was undertaken to confirm relevance. Out of 2634 identified articles, 22 met the final inclusion criteria. Across studies, there was varying quality and no standardization in measurement approach. Nine out of 22 studies demonstrated a relationship between conflict exposure and adverse health or mental health outcomes. Among studies that compared rates of violence between boys and girls, boys reported higher rates of physical violence, while girls reported higher rates of sexual violence. Children in infancy and early childhood were found to be among the most under-researched. Ultimately, the body of evidence in this review offers an incomplete picture regarding the prevalence, nature and impact of violence against children in emergencies, demonstrating a weak evidence base for some of the basic assumptions underpinning humanitarian practice. The development of standardized approaches to more rigorously measure violence against children is urgently needed in order to understand trends of violence against children in humanitarian contexts, and to promote children's healthy development and well-being.

Introduction

Violence against children represents a global public health crisis. It is well documented that violence against children not only impairs individuals' physical, emotional, and social development, but also has important economic and social consequences for nations as a whole (Felitti et al., 1998, Pinheiro, 2006, Krug et al., 2002). Children in humanitarian settings are presumed to face an increased risk of exposure to violence. Humanitarian emergencies can be brought about by armed conflict, natural disasters or political unrest, and can span the scope of days, months and even years, depending on particular contextual factors (The Sphere Project, 2011). The Sphere Project defines a humanitarian “disaster” as:

“… a serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts that exceeds the ability of the affected community or society to cope using its own resources and therefore requires urgent action …” (The Sphere Project, 2012, p. 4).

The term thus covers natural and man-made disasters and conflicts and encompasses related terms such as ‘crisis’ and ‘emergency’. Such events disrupt social structures typically in place to protect children, and create circumstances within which multiple forms of harm and abuse can occur (Apfel and Simon, 1996, Boothby et al., 2006, Machel, 2001, Montgomery and Foldspang, 2005).

While awareness of these risks is widespread, efforts to monitor prevalence or trends of violence against children in emergencies are challenging. Large numbers of cases go unreported due to social stigma, lack of appropriate reporting mechanisms, and the fact that violence is often perpetrated by parents, relatives, or close acquaintances, making it particularly difficult for children to come forward (Pinheiro, 2006, Stark, 2010, Stark et al., 2013).

Recently, there has been increased recognition that population-based surveys have an important role to play in understanding child maltreatment (Hovdestad et al., 2015, Reza et al., 2009). Such surveys have the potential to isolate drivers of violence, identify protective factors and allow for the study of health-relevant outcomes that may be undocumented in medical and social services databases. In addition, such studies may provide important insights for developing and testing theories of change that can prevent childhood violence. Yet, such surveys are far from standard practice in emergency settings.

The current lack of evidence on the scope and magnitude of violence against children in these settings interferes with the ability of humanitarian practitioners to ensure that children in need receive appropriate targeted care, or that sufficient resources for effective interventions are put in place. This paper analyzes existing attempts to measure violence against children in humanitarian settings, representing a first step towards the development of research methodologies to more accurately measure, prevent, and respond to violence against children, and to promote the healthy development of children in humanitarian emergencies.

Section snippets

Methodology

A rigorous review of peer-reviewed literature was undertaken in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines (Stroup et al., 2000), focusing on the measurement of violence against children in humanitarian contexts. The purpose of this review was to investigate existing prevalence data pertaining to violence against children in humanitarian settings and to examine methodologies that have been used to measure these issues. A Boolean search

Results

The initial search produced 2634 articles, of which 2554 were removed after a review of title and abstracts. Eighty articles were selected for full review, of which 58 were excluded. The remaining 22 studies were determined to meet full inclusion criteria and were further analyzed. This process is depicted in Fig. 1.

What do we know and what gaps remain?

Although the review allowed for inclusion of publications between 1995 and 2014, more than half (13 out of 22 papers) have been published during the past five years (2009–2014), suggesting that efforts to measure the prevalence of violence against children in humanitarian settings are relatively recent. In addition, the small number of studies that met final inclusion criteria suggests a limited evidence base by which to determine trends of violence against children in humanitarian contexts.

Conclusion

Findings from our review reveal a weak evidence base by which to determine the scale, nature and impact of violence against children in emergency settings. Without reliable data, humanitarian actors are limited in their ability to design effective prevention and response initiatives to address the forms of violence experienced by children, and to ensure that sufficient resources for needed programming are put in place. Humanitarian efforts around the world are to be lauded, but if they apply a

Acknowledgments

The authors acknowledge the support and guidance of the Child Protection Working Group, especially Katherine Williamson. Finally, the authors acknowledge the financial support of United States Agency for International Development's Office of Foreign Disaster Assistance. Statements made in this paper are the views of the authors alone, and do not constitute the policy of the above listed funding bodies. CUMC IRB exemption reference: AAAB7134.

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