COVID-19: urgency for distancing from domestic violence.

BACKGROUND: Although COVID-19 is a major worldwide health threat, there is another global public health emergency that is becoming a growing challenge. Domestic violence is a public health and human rights issue that primarily affects women and children worldwide. Several countries have reported a significant increase in domestic violence cases since the COVID-19-induced lockdowns and physical distancing measures were implemented. The COVID-19 health crisis is exacerbating another pre-existing public health problem by increasing the severity and frequency of domestic violence, thus demonstrating the need to adopt significant and long-term measures.
OBJECTIVE: Therefore, it is urgently necessary to promote and increase actions and policies to guarantee the safety and dignity of all victims of domestic violence worldwide.
METHODS: This paper describes preventive measures and action plans to combat violence against women and children during the COVID-19 pandemic.
CONCLUSION: The prevention of domestic violence must indeed be every government's priority and every citizen's responsibility.

COVID-19 had led to an increase in domestic violence worldwide

Following confinement orders is essential to control the spread of COVID-19. However, home confinement might also increase the risk of domestic violence. According to the United Nations Women policy brief, a significant increase in violence against women and children (VAWC) cases has been reported in several countries since the COVID-19-induced lockdown and physical distancing measures have been implemented (UN Women, 2020). This confirms that the risk of domestic violence is increased in the present context of confinement (UN Women, 2020). At this early stage, data regarding the increase in domestic violence during confinement are based on issue briefs and press articles. In France, the Minister of Interior reported a 30% increase in cases of domestic violence across the country and a 36% increase in Paris alone since 17 March 2020 (EuroNews, 2020). In several other countries, similar increases in emergency calls about domestic violence have been reported. Calls on emergency helplines to report domestic violence have increased by 20% in Spain, 30% in Cyprus, and 40–50% in Brazil (Graham-Harrison, Giuffrida, Smith, & Ford, 2020). Increases in the need for emergency shelter and reports of domestic violence have also been observed in Canada, Germany, and the USA (UN Women, 2020). ‘Refuge’ (a UK-based charity supporting victims of domestic abuse) reported a 25% increase in calls to the national domestic hotline since lockdown began (Refuge, 2020). A survey of 400 frontline workers in Australia (the Women’s Safety New South Wales survey) indicated that there has been an increase in the number and complexity of domestic violence cases during the COVID-19 pandemic (Lattouf, 2020)

Why has the COVID-19 pandemic led to an increase in domestic violence?

Studies focusing on the impact of humanitarian crises and natural disasters on domestic violence have shown that the stress associated with these emergencies leads to an increase in VAWC (Molyneaux et al., 2019; Rubenstein, Lu, MacFarlane, & Stark, 2020; Seddighi, Salmani, Javadi, & Seddighi, 2019). In the current context of the COVID-19 pandemic, the confinement measures may have amplified this increased risk of VAWC. The quarantine and physical distancing measures might have led to an increase in the severity and frequency of partner violence. Furthermore, lockdown measures may have created a high-risk environment for the emergence of violent behaviour by increasing pandemic-related stressors and by limiting access to protective resources.

Increased risk due to pandemic-related stressors and forced proximity. Due to the implementation of confinement measures, the usual daily occupations of most people have changed. Spending more time in the same environment with close others might increase the risk of conflicts between family members and could be a triggering factor for violent behaviour. Several studies have shown that unemployment and poverty could increase the likelihood of perpetrating partner violence (Capaldi, Knoble, Shortt, & Kim, 2012; Fulu, Jewkes, Roselli, & Garcia-Moreno, 2013). The confinement measures created a context in which these risk factors are amplified. In addition to these measures, pandemic-induced stress might have important economic, social, and psychological consequences, which could increase the risk of domestic violence. A recent systematic review revealed the negative psychological impacts of quarantine, such as posttraumatic stress symptoms, confusion, and anger (Brooks et al., 2020). The COVID-19 pandemic has led to greater levels of financial insecurity, fear, and social pressure (United Nations Department of Economic and Social Affairs, 2020). Physical distancing and lockdown measures have facilitated tension and reinforced the previously existing risk factors for VAWC. For instance, a decrease in income and the presence of economic stress are usually risk factors for VAWC (Schwab-Reese, Peek-Asa, & Parker, 2016; Stith, Smith, Penn, Ward, & Tritt, 2004). Research has also revealed that men who have witnessed or experienced violence as a child (Roberts, Gilman, Fitzmaurice, Decker, & Koenen, 2010), have lower level of life satisfaction, or have a higher level of depression are more likely to perpetrate VAWC (Stith et al., 2004). Substance and alcohol abuse are also associated with the perpetration of partner violence (Abbey, Wegner, Woerner, Pegram, & Pierce, 2014; Leonard & Quigley, 2017). These existing risk factors might be amplified by the current quarantine and lockdown measures.

Difficulty in accessing protective resources. Victims of domestic violence might be quarantined with an abusive partner and disconnected from their usual support system, which makes it very difficult or impossible to ask for help and to escape from the abusive relationship. Lockdown measures amplify the risk for domestic violence by isolating victims from their family, friends, and community. In this unique context, difficulties in leaving home and accessing the internet could limit a victim’s opportunities to seek help without alerting the abuser. In Italy, Telefona Rosa reported a 55% decrease in calls to the domestic violence helpline during the first two weeks of March 2020. The New York Police Department also expressed worries about the underreporting of domestic violence cases during the lockdown period in New York. Similarly, in Norway, a decrease in domestic violence calls and in the number of people contacting the police were reported. Additionally, fewer requests for domestic violence shelter were made (Council of Europe, 2020). Similar to these decreases in domestic violence reports, some studies reported a substantial decrease in medical consultations (Héquet et al., 2020; Mehrote, Chernew, Linetsky, Hatch, & Cutler, 2020; Roy, 2020). According to one survey in France, the main reasons for this decrease were the fear of being infected and the fear of disturbing medical doctors during the COVID-19 pandemic (Roy, 2020). These data highlight the importance of caution when interpreting official statistics during or following pandemics. The observed decrease in domestic violence cases might not reflect the reality or severity of the problem.

What actions are required during the COVID-19 pandemic?

The COVID-19 pandemic has highlighted the importance of preventive measures and action plans to combat domestic violence. Both short- and long-term responses as well as a multidisciplinary approach are required.

First, it is important to have clear prevention strategies and application plans at the governmental level (Council of Europe, 2011). The amplification of risk factors for VAWC and difficulties in accessing protective resources are more common in male dominant environments (Vieira, Garcia, & Maciel, 2020). This highlights the importance of women’s presence in decision-making processes (Vieira et al., 2020) as well as the importance of coordination and communication for combatting VAWC during confinement. It is essential to find new and innovative ways to provide support to victims through multiple platforms during the COVID-19 pandemic. It is also important to bolster violence-related first responder systems (O’Donnell, Peterman, & Potts., 2020; Peterman et al., 2020; UN Women, 2020). This may include an increase in staff, temporary operations, or training employees to detect and intervene in domestic violence cases (Peterman et al., 2020). Security- and privacy-related measures must also be taken. Preventive measures for domestic violence must include the expansion of free and easy-to-access national helpline services that are available 24/7 (Guedes, Peterman, & Deligiorgis, 2020). A coding system for reporting domestic violence without alerting the abuser should also be set up (UN Women, 2020). The expansion of protection services for victims in the current context should be provided, e.g. ‘pop-up’ groceries (Guedes et al., 2020). Similarly, it is essential to ensure access to domestic violence shelters and temporary housing for victims (UN Women, 2020).

Guaranteeing the victim’s economic safety and strengthening social support for victims are also necessary. It is important to help victims gain economic stability, secure housing and assistance services (UNFPA, 2020). In case of immediate need, direct help in the form of cash or food must be provided. Another key measure for combatting domestic violence is to ensure that the justice system is still working and able to respond to cases during lockdown periods (UN News, 2020). Public awareness campaigns via multiple platforms (e.g. mass media, television, radio, newspaper, social media) are necessary to raise the visibility of the crisis and to urge authorities to take action. These campaigns are also a beneficial way to show the victims that help and support are still available and to inform the public that the restrictions for abusers still apply (Council of Europe, 2011).

Physical isolation is an important risk factor that should be mitigated by keeping in contact with friends and families through digital platforms (e.g. phone calls, SMS, social media, video calls) during confinement (Peterman et al., 2020). Strengthening community support is another key factor for combatting domestic violence. Therefore, it is important to encourage informal support systems and reinforce online communication (O’Donnell et al., 2020; Peterman et al., 2020).

Protecting potential victims also requires inhibiting the risk factors associated with violent behaviours during confinement, such as banning alcohol sales or limiting access to deadly weapons (Guedes et al., 2020). It is also necessary to provide a safe environment for frontline healthcare workers and to protect them from violence (UN Women, 2020).

Many governments and non-profit organizations have already taken important measures to combat domestic violence during lockdown periods (Table 1). It is important to emphasize that action and policy programs have been widely implemented in countries with high economic statuses. Many low-income countries have not addressed this issue and have taken no actions due to their limited budget and resources. This reality reflects another challenge regarding VAWC (Guedes et al., 2020).

Table 1.

Country prevention measures during COVID-19 outbreak.

Countries	Preventive measures for VAW during COVID-19
Australia	- Creation of COVID-19 Family and Domestic Violence Task Force (Shepherd, 2020).- Continuation of justice system (Shepherd, 2020).
Canada	- Emergency financial help package (Patel, 2020).- Domestic violence shelters and supports services remain open (Patel, 2020).- Communication via text, online, messaging apps (Gills & Hasham, 2020).- Free legal support (Gills & Hasham, 2020).
China	- Published special manuals for survivors, explaining how to protect themselves and directing them to online legal aid (Wanquing, 2020).- Live stream workshop on what witness of domestic violence can do (Wanquing, 2020).
France	- Accessible Online Internet platforms for 24/7 to alert a domestic violence.- Free and anonymous helplines (Libert & Frotté, 2020).- Emergency shelters provision and converting hotels to safe houses (Libert & Frotté, 2020).- Coding messaging system (“Mask 19”) in pharmacies to seek help (Libert & Frotté, 2020).- “Pop up” counselling centres outside the grocery shops (Libert & Frotté, 2020).- Counselling helpline services (Libert & Frotté, 2020).
India	- New domestic violence helpline have launched and assured that a female officer would handle the case (Graham-Harrison et al., 2020).
Italy	- Converting the existing structure into new shelters with online and additional online booking options services (Davies & Batha, 2020).- Ensure that all domestic violence shelters and communication channels remains open (Graham-Harrison et al., 2020).
Lebanon	- Statement of International Security Forces addressing to victims of domestic violence (Houssari, 2020).- Set up domestic violence hotline (Houssari, 2020).- Website for report online complaints file (Houssari, 2020).
Netherlands	- Coding messaging system (“Masker 19”) in pharmacies to seek help (DutchNews, 2020).- Launching information campaigns urging victims to contact with police or domestic violence prevention organization “Veiling Thuis” (DutchNews, 2020).
Spain	- Coding messaging system (“Mask 19”) in pharmacies to seek help (Graham-Harrison et al., 2020).- Chat services with geolocation technology to contact with the police (Davies & Batha, 2020).
UK	- Free and 24/7 accessible National Domestic Abuse Helpline services (Grierson, 2020).- Emergency financial package for domestic abuse support services (Grierson, 2020).

A lack of evidence

Currently, in addition to reports from governments and non-profit organizations, there are limited reliable data on domestic violence during the COVID-19 outbreak. The research regarding domestic violence during the COVID-19 pandemic is still in the early stages. We can only estimate the severity of this problem with uncertain data. Moreover, the data about the increase in domestic violence complaints only partially reflect the reality, as these data underestimate the extent of VAWC.

Similarly, the outcomes of the preventive measures that have been taken against domestic violence during this period of time are not clear. Additional studies are required to understand the efficacy of these actions. However, based on previous studies and scientific knowledge, we have enough evidence to say that confinement is an important risk factor for increasing domestic violence (Guedes et al., 2020; O’Donnell et al., 2020; Peterman et al., 2020; UN Women, 2020).

Health consequences of VAWC

Domestic violence victims might suffer direct health consequences such as injuries, but victims might also suffer from several important indirect and long-term health problems because of violence (WHO, 2013). These important health consequences might persist long after the abuse has stopped (Campbell, 2002). It is necessary to be vigilant in examining the short- and long-term consequences of VAWC on the psychological and physical health of victims during and after the lockdown period.

Conclusion

Although the COVID-19 pandemic and isolation have created another challenge to the prevention of domestic violence, reports about this issue were already indicating the presence of a crisis before the pandemic. The COVID-19 pandemic highlights the limits of the existing preventive measures against domestic violence. VAWC is an important issue that requires worldwide prevention campaigns. We need to promote and increase action policies to prevent domestic violence in every country. Beyond screening the data, long-term prevention solutions and immediate actions are available and should be implemented. This crisis has highlighted the limits of current preventive measures against domestic violence and showed that there is still much work to be done. The COVID-19 pandemic might be an opportunity to reconsider the world of tomorrow and to take more significant long-lasting measures. Since the terrorist attacks of 9/11, we have demonstrated our ability and willingness to take security measures on an international scale. This new international crisis should encourage us to do the same for the fight against domestic violence.