**4. Potentially most significant trigger for sexual violence and resulting mental illness in a humanitarian disaster**

There is a dearth of information on effective interventions for mental health consequences of sexual violence in humanitarian disaster situations. It is widely acknowledged that violence against children and women increases during conflict, natural disasters and humanitarian crises. Humanitarian disasters and conflict increase the vulnerability of already more vulnerable groups to sexual violence. The conflict and humanitarian disasters in Afghanistan and Syria for example, have greatly increased the number of female child marriages and the risk of violence and abuse that female children experience. Other regions such as South Sudan and Somalia for example see rises in rape and group rape as a result of conflict, drought, hunger and other humanitarian crises. However, the crises and conflict aren't necessarily the root causes of the sexual violence and coordinating trauma and mental illness. The underlying issues of social and gender norms, the way that love is learned, and the power dynamics within societies and cultures are all triggered and aggravated when there is severe stress on any system [19].

However, addressing underlying root issues of cultural beliefs and power dynamics, and the way that all individuals in a society are respected and given human dignity even before there is conflict or a humanitarian crisis is not only an important part of prevention but also addressing the psychological consequences from sexual violence. Gender equality is one piece of the issue, however depending on how it is measured, perceived and evaluated, it doesn't necessarily mean sexual violence won't be an issue in the event of conflict or humanitarian disasters. This is in part because of the history and cultural beliefs, as well as family and intergenerational patterns that are passed down from generation to generation. Some of the beliefs, like racism, sexism, xenophobia, homophobia, and other types of prejudices, in times of relative stability, abundance and peace may not be as expressed or societally acceptable. However, there is a trend throughout the world that instability, disasters, disease, poverty, hunger, drought, and other crises can bring out toxic beliefs, patterns, hatreds, power and control issues and prejudices that may not otherwise be accepted and brought to the surface. For example, in Germany the poverty and depression that many Germans experienced in the 1930's led to the reemergence and scapegoating of prejudice and old hatreds of certain groups such as people of Jewish descent. In the United States, we have recently seen how COVID-19 has triggered underlying societal issues of racism that were largely suppressed in cultural consciousness before COVID-19 [21].

Another way of framing this is that when beliefs are tested, their authenticity might not be as deep as expected when not under stress or duress. Meaning, on the surface in a society, it may not be socially acceptable to participate in perpetrating sexual violence, however, if given the opportunity and certain conditions, an individual would not stop themselves and would even perpetrate it multiple times because the conditions allow and promote these underlying belief justifications and motivations. Therefore, this points to a very significant differentiation between 1) the surface beliefs individuals hold when there is less stress in a society due to outside conditions functioning at a higher level (ie. when there is no humanitarian disaster) and the societal tolerance for something like perpetrating sexual violence is lower versus 2) higher stress on a societal system due to a humanitarian disaster and higher tolerance culturally for perpetrating something like sexual violence. This points to the reality, that it given the right conditions, someone would perpetrate sexual violence because the barriers and consequences are low. Their ethical locus of control is external, not internal. The unconscious beliefs that perpetuate sexual

violence can be passed on through cultures and societies, so that an individual is not even conscious of them until they are tested by challenging or changing circumstances. Situations of conflict and humanitarian crisis definitely test underlying cultural constructs and can reveal the ugliness of opportunity that may not otherwise be revealed. Conflict and humanitarian crises demonstrate and test whether an individual will participate in sexual violence when circumstances change and which populations are made even more vulnerable than before [21].

### **5. Country contexts**

When implementing interventions, it is relevant and important to investigate the unique manifestation of sexual violence in various country contexts that have experienced humanitarian disasters. In many cultures with sexual violence and humanitarian disasters, it is not only the perpetration of sexual violence that creates mental illness. It is also largely the response from society and family to the survivors. In some societies, there is victim-blaming, shaming the survivor, forcing them to marry their perpetrator. In some cultures, there are even honor killings where family members kill the survivor of violence for the honor of the family. In Syria for example, many refugees have gone to Jordan. The young female refugees are at high risk of perpetration of false marriage by men from other countries that are hoping for sex with a young virgin female. Syrian teenage girls at the refugee camps in Jordan, are often sold by their families for one-hour marriages, or maybe a marriage that lasts several days. The purpose of this marriage is the buying and selling of sex. Due to the impoverished conditions the families live in, they often consent under duress, essentially prostituting their female children for money. In many other countries such as Somalia and the Democratic Republic of Congo, even if a survivor goes to the police, they may be treated with prejudice and told they are at fault by the police themselves, or even if they have a rape kit done, the rape kit may never be processed for evidence. Throughout the world, the treatment of sexual assault survivors generally creates greater harm for the survivor, if they are a child or an adult and there is little focus on accountability and intervention for the perpetrator [22].

## **6. Proposed framework for investigation**

There has typically been a belief or understanding that addressing mental health issues related to sexual violence in conflict and humanitarian disaster areas is somewhat linear. That it begins with 1) prevention before the event or heightened circumstances occur, then 2) addressing the situation when the events occurs, and then 3) addressing the aftermath of the effects of the event. Another way of understanding and viewing this is to see it cyclically. Meaning an intergenerational pattern that occurs through the conscious and unconscious belief patterns that exist within societies, families, cultures, religions and even between couples and within ourselves [19]. A diagram created by the author is provided below to better demonstrate the cyclical nature of the underlying harmful belief patterns that emerge in reaction to a humanitarian disaster (**Figure 1**).

Therefore, addressing conscious and unconscious societal norms that relate to sexual violence and investigating how those norms manifest themselves is critical for addressing the issues. In addition to this, to best address this cycle of violence and prevent it from flaring up as severely as it potentially could, there need to be long-term grassroots funding and interventions. A typical humanitarian funding intervention may be twelve months is length. It is not typically long-term and is

*Sexual Abuse and Mental Health in Humanitarian Disasters DOI: http://dx.doi.org/10.5772/intechopen.97457*

#### **Figure 1.**

*Framework for understanding societal belief systems that perpetrate sexual violence.*

built on addressing emergencies, symptoms and aftermath from conflict and crisis. However, to shift negative cultural beliefs and norms requires longer term interventions that may even be intergenerational. Short-term interventions that address the symptoms of the trauma the survivors experience and the consequences of the perpetrator's actions are incredible, but they are not enough to sufficiently impact the layers and depths of what triggers these issues during conflict and humanitarian disasters [23].

#### **7. Conclusion**

An innovative, effective approach to addressing mental health issues due to sexual violence in humanitarian disasters is possible. Through the evidence base that currently exists in the literature, there are certain interventions that may prove more effective than others. A significant component for addressing the problem of mental illness due to sexual violence in humanitarian disasters is for the society and culture to recognize the issue. A normalization of sexual violence does not reduce the mental health impacts that occur such as depression, post-traumatic stress disorder, difficulty sleeping, loss of appetite and other trauma symptoms that generally co-occur. In fact, a normalization of the issue can create social stigma for those that speak out and try to seek help for the problem or stop the problem from occurring. Stigma alone increases mental illness and social damage. The process of de-normalizing sexual violence in humanitarian disaster situations, particularly in conflict regions, is powerful, innovative and will likely result in significant positive change.

*Sexual Abuse - An Interdisciplinary Approach*
