Women, disasters, epidemics and health

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What are the connections between women’s inequality and our health during a disaster? For example, why are women more likely to be victims of violence after an earthquake? Why is it better to put emergency food aid directly into the hands of women, instead of men? And why is preventing sexual assault against women crucial in the fight against HIV/AIDS? In this primer we explore these and other questions. Gender, health and disaster is a growing area of study that is enabling aid workers and others striving to help all people - women, men, girls and boys – survive during catastrophes.

“Disaster” can refer to a multitude of terrible events: from hurricanes to oil spills to stock market crashes. We focus in this Primer on natural disasters, epidemics and pandemics, and war. We also look at the ‘collateral damage’ of disaster, such as how violence against women rises in its aftermath. Not least, we examine why marginalized women – poor women, women of colour, Aboriginal women, disabled women – are the most vulnerable when calamity occurs.

Note: Environmental degradation and climate change can also be considered disasters, and we deal with those topics in Women’s Health and the Environment.

Why should we consider gender in the midst of disaster?

Traditional gender roles have a tremendous bearing on women’s health during disaster. Women have perished during cyclones while waiting for their husbands to come home and make the decision to evacuate. Women have gone hungry because food aid was distributed by men and the women were not allowed to interact with men who were not their kin. And, during catastrophic events, women tend to take on much more of the caregiving than usual, ignoring their own health and well-being. Grasping these realities is crucial for those who work in disaster relief.

Women, Gender and Disaster: What’s the Connection? Webinar
Canadian Women’s Health Network, 2010

An hour-long webinar with disaster sociologist Dr. Elaine Enarson discussing how women and men experience and respond to disasters differently.

“Hidden in Plain Sight:” A Sex‑ and Gender‑based Analysis of Disasters and Emergency Planning
By Elaine Enarson, in Rising to the Challenge:
Sex‑ and gender‑based analysis for health planning, policy and research in Canada, pp. 86-91, Atlantic Centre of Excellence for Women’s Health, 2009
A case study introducing the issues facing women and men, boys and girls when disasters occur – whether these are triggered by environmental emergencies, biological hazards or technological risks, or are deliberately induced.

Not Just Victims: Women in Emergencies and Disasters
Women and Health Care Reform, 2009

Describes the typical ways that women are likely to be affected by disasters and emergencies and how they cope with and recover from such events.

Prairie Women Prepared for Disaster: An Emergency Planning Guide for Women’s Community Organizations
Elaine Enarson, Prairie Women’s Health Centre of Excellence, 2009
Explains why planning ahead for emergency is important for women’s organizations, describes the planning steps, and introduces the global movement of women for social change to reduce avoidable harm.

Gender, Women and Health: Gender and disaster
World Health Organization, 2009

Introduces the health issues for women in disaster and provides links to key resources.

Gender and Disaster Sourcebook
Gender and Disaster Network, 2008

An online guide to the links between gender and disaster risk.

How “Mad Cow” Disease Affects Farm Families and Communities across Canada
By Carol Amaratunga, Wilfreda E. Thurston, Sarah Crowe, Madhu Sindhwani and Allison Farber, Network, Volume 10, Number 1, 2007, pp. 21-22

A case study of how the economic effects of a (feared) epidemic in animals affect women and men differently.

Women, Girls, Boys and Men Different Needs – Equal Opportunities: IASC Gender Handbook in Humanitarian Action
Inter-agency Standing Committee, 2006

Describes how the needs of women and men differ in the midst of disasters, and how best to serve those needs.

Gender Equality in Disasters: Six Principles for Engendered Relief and Reconstruction
Gender and Disaster Network, 2004

Factsheet that briefly outlines the main principles for working with women during disaster, aimed at disaster relief and reconstruction workers.

When natural disaster strikes, what do women need and how can women help?

Women have particular health needs following natural disasters, needs that include but are not limited to reproductive health care. And because of our traditional gender roles as caregivers, women have particular strengths that can greatly aid in relief efforts.

Gender and Natural Disasters
Pan-American Health Organization

Briefly explains why women are disproportionately affected by natural disasters, and how women should play a vital role in disaster relief and response.

After the Quake, Depend on Women
Marie St. Cyr, Madre, 2010
In the context of the 2010 Haitian earthquake, discusses why women should be integral to designing and carrying out relief efforts.

Providing Gender Responsive Aid in Haiti
Feminist Peace Network, 2010

In context of the 2010 Haitian earthquake, explains why women need different kinds of aid and contribute differently than men when responding to disaster.

Pakistan: Only Women Can Rescue Women
By Jan Goodwin, Marie Claire, 2006

Story of an all-women search and rescue team in Pakistan that carries out rescue efforts for other women, where religious custom prohibits women from being touched by men outside their immediate family.

The Stories that Women Tell About the Flood of the Century
By Karen R. Grant and Nancy C. Higgitt, National Network on Environments and Women’s Health, 2007

Describes women’s experiences of the 1997 flood in Manitoba, the nature of women's work during the flood, and the health and social impact of the flood.

Women and Girls Last? Averting the Second Post‑Katrina Disaster
By Elaine Enarson, Understanding Katrina: Perspectives from the Social Sciences, 2006

Describes how natural disasters affect women differently than men, and how disaster planning must fully involve women as well as men. 

The Tsunami’s Impact on Women
Oxfam, 2005

Explains why and how the 2004 Asian tsunami hit women harder than men.

Why is there more violence against women after a disaster, and how can it be prevented?

A harsh reality is that women are more likely to be victimized by sexual assault and other violence during and after a disaster. This is especially true for women who are already victimized – poor women, women of colour, and women who were being abused by their partners before disaster struck.

Women More Vulnerable to Violence During Floods
The Daily Star, 2008

Describes how women become are more vulnerable to violence during the natural disasters, not only from their partners, but also from abuse in relief shelters and relief queues.

To Render Ourselves Visible: Women of Color Organizing & Hurricane Katrina
By Alisa Bierria and Mayaba Liebenthal, INCITE! Women of Color Against Violence, 2007

Excerpt from the book What Lies Beneath: Katrina, Race, and the State of the Nation discussing how women of color bear the brunt of compromised safety during a disaster and after.

Guidelines for Gender-based Violence Interventions in Humanitarian Settings
Inter-agency Standing Committee, 2005

Describes how to prevent and respond to the sexual violence against women and girls that worsens during armed conflicts.

Rape-Reporting Procedure Missing After Hurricane
By Nancy Cook Lauer, womensenews.org, 2005

Examines the high risk of rape and other forms of assault against women in the aftermath of a disaster.

Katrina, Natural Disasters and Sexual Violence
New York City
Alliance against Sexual Assault
Explains why rapes often occur in the aftermath of natural disasters and other humanitarian crises.

How do epidemics affect women differently than men?

Research shows that women and men fare differently in epidemics, largely due to our gender roles rather than our biological differences. Women, as the primary caregivers both at home and in healthcare settings, are more exposed to infected people than are men. Biology is a factor, of course, for pregnant women, for whom many epidemics have more disastrous consequences than for men. Biology is also implicated in sexually transmitted infections such as HIV/AIDS, where female physiology makes us more susceptible to becoming infected.


Addressing Sex and Gender in Epidemic-prone Infectious Diseases
World Health Organization, 2007

Discusses how infectious diseases affect women and men, and shows how, by taking sex and gender differences into account, it is possible to improve ways to prevent and treat these diseases, using dengue, Ebola haemorrhagic fever and SARS as examples.

Influenza and Severe Acute Respiratory Syndrome (SARS)

Sex, Gender and Influenza
World Health Organization, 2010

Examines how flu outbreaks affect women and men differently and concludes that much more research is needed to understand why and how this is so.

H1N1 Pandemic Flu Hits Pregnant Women Hard
By Steven Reinberg, HealthDay, 2010

Discusses how H1N1 affects pregnant women.

Younger Women Hard Hit by H1N1 Virus, Study Suggests
By André Picard, The Globe and Mail, 2009

Discusses a study that found that more than two-thirds of those who fell critically ill and died of H1N1 influenza in Canada have been younger women.

Study on the Gender Aspects of the Avian Influenza Crisis in Southeast Asia - Final Report
European Commission, 2008

Examines the roles sex, gender and economic status in the spread of Avian Flu in Southeast Asia.

Do Men Have a Higher Case Fatality Rate of Severe Acute Respiratory Syndrome than Women Do?
By J. Karlberg
, D. S. Y. Chong and W. Y. Y. Lai, American Journal of Epidemiology, Volume 159, Number 3, 2004, pp. 229-231
A study that found men had much higher death rate from SARS than women (the study excluded healthcare workers).


Blueprint for Action on Women and HIV/AIDS: Manifesto 2010
Blueprint for Action on Women and HIV/AIDS, 2010

Describes a comprehensive strategy to stop the HIV/AIDS epidemic among women globally.

Engendering HIV/AIDS Policy
By Barbara Clow, in Rising to the Challenge:
Sex‑ and gender‑based analysis for health planning, policy and research in Canada, pp. 136-144, Atlantic Centre of Excellence for Women’s Health, 2009
Argues that the “populations‑specific approach” to HIV/AIDS prevention practiced in Canada has failed to halt the pandemic here because it ignores the role of gender. Sets out the elements of a coherent national strategy that would address HIV/AIDS among women.

The Silent Voices of the HIV/AIDS Epidemic in Canada: African and Caribbean Women in Toronto
Women’s Health in Women’s Hands, 2005

Discusses the high rates of HIV/AIDS infection among African and Caribbean women in Toronto and the lack of services for them.

Violence against Women and AIDS: Critical Intersections
The Global Coalition on Women and AIDS & World Health Organization, 2004

Discusses the crucial connections between violence against women and the spread of HIV/AIDS.

What are the needs of healthcare workers - mostly women - during epidemics?

Women, who tend to be both the formal and informal caregivers in any given culture, are especially at risk from infection during epidemics because of their caregiving roles. The following resources look at this issue in the light of SARS, which had such a great impact in Canada in 2003.

Caring for Nurses in Public Health Emergencies: Enhancing Capacity for Gender-Based Support Mechanisms in Emergency Preparedness Planning
By Carol Amaratunga et al.,
Canadian Policy Research Networks, 2008
Summarizes a research project examining how to best deal with public health crises by identifying how we can better support health care workers during those crises.

SARS Unmasked: Final Report on the Nursing Experience with SARS in Ontario
The Registered Nurses Association of Ontario, 2004

Reports on the experiences of healthcare workers who lived through the 2003 SARS epidemic, and examines how deaths can be avoided in future epidemics.

How does war affect women’s health?

Women and girls form 65 % of those displaced by war, and have many particular health needs that range from maternal and reproductive health, to the need to be protected from the increased violence against women that is often used as a strategy by those waging armed conflict.

Reproductive Health
Women’s Refugee Commission, 2011

Describes the Reproductive Health Program of the Women's Refugee Commission. Links to several resources on reproductive health for women in crisis settings, including a factsheet that describes the issues and possible responses.

Conflict and Crisis Settings: Promoting Sexual and Reproductive Rights
By Rosalind P. Petchesky, Reproductive Health Matters, 2008

Editorial on the health of women in war and crisis, in an issue of the journal devoted to this topic. All the abstracts in this issue are freely available online. A subscription is needed to see the full articles.

Because I am a Girl: The State of the World's Girls 2008 - Special Focus: In the Shadow of War
By Nikki van der Gaag, Plan International, 2008

Report on the double discrimination of gender and age that girls face, describing how this discrimination affects them during times of war.

Video: UNFPA Web Film on War and Women's Health
United Nations Populations Fund, 2003

Three minute video showing that women and girls have particular health needs, including maternal health and protection from violence. (Available in nine languages.)