Gender-responsive healthcare in UN peacekeeping operations

Picture: Courtesy of African Union – A woman peacekeeper in Somalia. Interviews with women and LGBTQI peacekeepers indicate that they have in some cases faced discrimination and the lack of appropriate services when trying to seek healthcare and other support, the writer says.

By Jenna Russo

Increasing the number of women peacekeepers in United Nations (UN) missions is a key part of the women, peace and security (WPS) agenda, the UN’s Uniformed Gender Parity Strategy, and Action for Peacekeeping (A4P).

Creating an enabling environment for women peacekeepers that “promotes a diverse, inclusive, and respectful work culture” is key to this objective, including by providing gender-responsive healthcare. Increasing healthcare capacity within UN peacekeeping operations has been referenced in several UN documents and settings, including the report of the High-Level Independent Panel on Peace Operations, the Santos Cruz report, the UN Action Plan, the A4P Declaration of Shared Commitments, and the 2021 Peacekeeping ministerial.

Yet, interviews with women and LGBTQI peacekeepers indicate that they have in some cases faced discrimination and the lack of appropriate services when trying to seek healthcare and other support.[1] Thus, more needs to be done when it comes to providing gender-responsive healthcare. This includes deploying qualified health practitioners, providing gender-responsive training to all healthcare providers, establishing appropriate facilities, and recognizing the specific health needs of all genders of peacekeepers, including, but not limited to women.

In consultations carried out by UN Women, women peacekeepers regularly cited the lack of specialists, including gynecologists, as a real need.[2] Male medical professionals are often trained to care for male patients, and they may not be well trained to provide appropriate care for women, including sexual and reproductive healthcare and treatment of other health conditions that may affect women, including various forms of cancer, disease, or providing family planning care. There may also be gaps in their ability to communicate appropriately and effectively with women patients.

Some missions do have gynaecologists as part of gynaecology “modules,” in enhanced level 2 hospitals. However, they are not present in all mission settings and both cost and sustainability challenges prevent their wider deployment. It may be difficult to sustain the presence of specialists within troop rotations, particularly as some troop-contributing countries (TCCs) may not have many specialists within their own countries. In addition, gynecological specialists require specific equipment and platform, which may not be present in all settings.

Thus, the UN Department of Operational Support (DOS) is supporting what they describe as a more “practical and sustainable” approach, by building the capacity of general practitioners to provide more gender-responsive healthcare.[3] To accomplish this, DOS is currently developing a Women’s Health online training course, with a pilot launch expected in the first quarter of 2023.

The ten-module training will target all medical professionals working in UN field duty stations. It aims to upgrade the knowledge and skillsets of general practitioners and nurses and promote the provision of gender-sensitive quality care at the first point of contact, which usually occurs in Level 1 facilities, including the ability of general practitioners to properly diagnose and refer patients to higher level facilities when needed. Once the course is rolled out, DOS aims to expand it in all UN-owned and equipped medical facilities and TCCs’ medical facilities in field missions, and in the UNDP-administered clinics at various duty stations.

Within medical facilities, more can be done to ensure gender-responsive camp design, some of which has been laid out in the UN Women field-specific enabling environment guidelines, published in 2021. This includes, for example, ensuring that medical offices have sufficient soundproofing and privacy, access to sanitary items for women, pregnancy tests, and proper bathroom and ablution facilities.

In some cases, enhancing telehealth services has been recommended to increase the availability of specialised healthcare. This option has been pursued in some mission settings, including in South Sudan, Somalia, and Iraq, and it may be particularly beneficial for individuals working in smaller field locations that are a far distance from level 1 or level 2 facilities. While telehealth services may be effective for certain types of medical consultations, they do not allow for examinations and procedures and are therefore not a substitute for in-person care.

Additional capacity may also be needed when it comes to providing adequate care for peacekeepers who are victims of sexual assault and other forms of abuse. According to survey research done by IPI of more than 450 UN military and police peacekeepers, more than one in ten respondents indicated they had been victims of sexual abuse, including harassment and/or sexual assault while serving in mission. The numbers are higher when looking specifically at women peacekeepers, with more than 28 percent indicating they have been victims of such abuse.

Yet, there has been little focus on addressing this abuse, including providing appropriate channels for reporting or the provision of medical and psychological support to victims. It is important to note that rape and other forms of sexual assault are criminal acts that require attention beyond medical support. At the same time, healthcare workers need to know how to provide appropriate medical care as needed. This includes having access to rape kits, PEP kits and ensuring medical professionals are trained on how to use them properly. They must also be trained in how to ask appropriate questions and provide or refer individuals for mental health counselling.

Ensuring the mental health of peacekeepers has been noted by the Special Committee on Peacekeeping Operations (C-34) and has been an area of increasing attention in recent years, including via the new mental health strategy for uniformed peacekeepers, which is currently being developed. The pressures of conflict environments and the COVID-19 pandemic has further increased stress on peacekeepers and made the provision of mental health services even more imperative.

Nevertheless, there continue to be gaps in this area, including along gendered lines. In particular, previous research has shown that some women peacekeepers face a double hurdle of accessing appropriate services given stigma around mental health generally, and because women may not want to come across as weaker than their male counterparts.

Therefore, missions should continue working to reduce stigma around receiving mental health services, and should increase access to mental healthcare providers, including women providers and those who are knowledgeable in various languages and cultural backgrounds. For example, the International Organisation for Migration (IOM) has established a team of multilingual counsellors that provide tele-counselling in 11 different languages.

This model could be replicated in UN peacekeeping environments. More could be done to prevent mental health challenges among peacekeepers by working to reduce gender-based violence and other forms of abuse within peacekeeping operations and establishing a culture of accountability and respect.

Finally, in addition to providing appropriate services for women, UN peacekeeping should provide for peacekeepers of all genders. For example, men peacekeepers may face unique stigma around receiving mental healthcare. They also may require specific sexual and reproductive healthcare. Appropriate care should also be provided for LGBTQI peacekeepers, which can be challenging due to legal and normative barriers in some countries.

However, medical health professionals need to be trained to provide gender-sensitive care for LGBTQI peacekeepers, including sensitivity in their communication and appropriate screening and awareness of individuals’ specific needs. Up to this time, little has been done in this regard, though forthcoming training from DOS does include a chapter on this topic.

Creating an enabling environment is key to the UN achieving its gender parity goals for peacekeepers. While some attention has been paid to healthcare capacities in peacekeeping operations broadly speaking, more needs to be done to enhance gender-responsive healthcare. Peacekeepers regularly put their lives on the line when serving in mission, and the UN owes it to them to provide the care they need and deserve.

[1] According to a UN official who has been undertaking interviews with field staff to assess healthcare needs in the field (interview; April 2022).

[2] Interview with official from UN Women; June 2022.

[3] Interview with DOS officials; October 2022.

Jenna Russo is Director of Research and Head of the Brian Urquhart Center for Peace Operations at the International Peace Institute.

This article is taken from The Global Observatory