The Gendered Impact of COVID-19 in Lebanon

Abir Chbaro
Gender Expert
March 26, 2020
While holding the XX chromosomes makes your immunity stronger, and gives you a higher life expectancy, as statistics show, being a female exposes you to higher risks of cultural, social and economic discrimination that sideline you and your wellbeing in the response of many countries to COVID19 pandemic.

COVID-19, the disease caused by a new coronavirus, has rapidly spread globally. The World Health Organization recently labeled COVID-19 a pandemic. Thousands of people are struggling for their lives in hospitals and millions are fighting the spread of the virus by adhering to the WHO directives, namely lock down, self-isolation, and overseeing proper hygiene, measures adopted by most governments of infected countries. The Lebanese cabinet took the decision to instate a “health emergency” and on March 15, 2020, the government proclaimed a state of general mobilization that called for the closure of public administrations and institutions, municipalities, autonomous utilities, universities, public and private schools as well as nurseries. The President of the Republic invited everyone to continue their work from home, in the manner that they deem appropriate, so that online education is pursued for students, and work for workers, and so that institutions remain as active as possible.

Although the various health sectors in Lebanon have been mobilized, under the direct supervision of the Prime Minister and the Ministerial Committee for Coronavirus Prevention, the emergency plan focuses on the ‘immediate’ health-care problems, while not considering the status of gendered inequality that underpins the prevailing unhealthy conditions. Not only is this Action Plan Gender Blind, it fails to include a response to the economic and social repercussions of the crisis, especially for the most vulnerable among which are women who are disproportionately affected in crisis and emergencies.

When Lebanese women felt the threat, they actively engaged in the fight using all their available resources. They were there at the medical front lines as healthcare workers, they sewed and manufactured masks and protective jumpsuits, they activated the traditional production of natural soap in some villages, they supported education and care. The women-led NGOs such as ABAAD, Kafa and RDFL continued delivering support to women who might be at an increasing risk of violence due to confinement. Women showed courage in facing the disease and its consequences. When May Chidiac tested positive for COVID19, she didn’t fear stigma and announced it publicly while a male former minister was afraid and stayed in the hospital under another name. But what about the repercussions of the crisis on women in general and the less privileged to be confined or get treated in particular, or those women and girls who might endure the burden of the crisis? Why should any response include gender mainstreaming?

A gendered understanding of COVID19 highlights the multiple and inter-related levels of inequality that shape vulnerability to the infection and the personal, social, and economic impact of the crisis. As a result, gender should be viewed as a cross-cutting issue that has implications on all aspects of the pandemic.

Occupational Health

Globally, 75-80% of healthcare workers are female. According to the latest statistics published by the Order of Nurses in Lebanon for 2019, 79.52% of the Lebanese nurses are females compared to 20.48% males . This puts female nurses at the forefront where they are the main carers and therefore the most exposed to occupational health risk in the hospitals. This can carry far more than just work-related accidents of contagion, it might expose their families too to a higher risk of infection especially if they are caring for vulnerable persons, such as infants or elderly or sick persons. The risk are compounded and might lead to death. These occupational risks carry a significant economic and social cost with them too. Such occurrences can be potentially damaging to the public health sector resources and efficiency as “accidents in workplaces costs almost 4% of the world’s annual Gross Domestic Product (GDP)”. Despite the fact that they are a majority, a minority of them hold leadership positions and this leaves many of their needs unmet, from planning interventions and shifts, to imposing on them family planning decisions and initially including menstrual hygiene products in their personal protective gear.

A gendered understanding of COVID19 highlights the multiple and inter-related levels of inequality that shape vulnerability to the infection and the personal, social, and economic impact of the crisis.

Infected medical or paramedical staff, like patients, might suffer stigma and social isolation and rejection, and this could be morally damaging. Responders and policymakers need to take these factors into account if they are to reach those healthcare workers most at risk of infection and most in need of care. They should also consider the mitigation of the social effects that family members of female healthcare workers suffer due to their separation from their families and long exhausting working hours. Although this is a new challenging approach, France has provided a creative solution as stated in President Emmanuel Macron’s speech where he announced that the government “will relieve caregivers by shouldering the burdens of child care.” The French government also committed to house and handle the transportation of these healthcare workers to ensure ease in commuting and to make sure that they rest properly. This will also support their decent isolation as they are exposed to higher risk of occupational infectious hazard.

Unpaid Work

Exacerbated women’s economic vulnerability is shaped by their inequality in the sphere of work, in both the formal and informal sectors. A majority of women are found in the informal sector, which lacks legal protection and increases women’s vulnerability to poverty and therefore to infection. In the formal sector women predominate in work such as part-time employment that falls mostly outside legal protection, and this increases their vulnerability. Many women are being forced to divert their often-meagre resources into providing treatment and care, especially in situations where mildly infected people lack access to treatment and to primary care in general.

Among other emerging impacts is the increased workload in the domestic chores women are expected to carry out and this in turn drains them physically. Before the COVID crisis, an ILO study estimated that women in Arab states spend a daily average of 329 minutes (5h29’) on unpaid care work and 36 minutes on paid work while men spend 70 min and 222 min respectively .

With the mass shutdown of schools and universities, an estimated 1,132,178 learners enrolled in pre-primary to upper-secondary education and 231,215 learners enrolled in tertiary education programs in Lebanon will be confined to their home according to UNESCO.

Over and above the domestic duties relegated to them, women are expected to carry out additional unpaid work, home schooling their children while also attending to their “formal jobs” by working on-line and also ensuring a state of tranquility at home so that the so-called “male primary bread-winner” is able to deliver on his work. As a result, there are threats that women might not be able to engage and deliver on their paid formal economic activities, might lose their wages and earnings, which will widen further the already large gender gap placing Lebanon at 145 out of 153 countries by the World Economic Forum Global Gender Gap Report 2020.

However this crisis should have a silver lining for women. With such proximity to the community, women should profit from being well placed to positively influence the design and implementation of prevention activities and community engagement and should be given leading decision-making roles.

Gender Based Violence

It was noticed that in times of crisis, heightened tension as a result of lock-down, decrease in resources, and psychological stress increase the frequency of violence against women by intimate partners and family members. “Abuse is about power and control. When survivors are forced to stay in the home or in close proximity to their abuser more frequently, an abuser can use any tool to exert control over their victim, including a national health concern such as COVID-19,” the statement of the US National Domestic Abuse Hotline read. “The financial insecurity that often prohibits domestic violence victims from leaving abusers can also worsen in the aftermath of a crisis,” highlights the European Institute for Gender Equality’s Jurgita Pečiūrienė . Fear from exposing elderly parents to the virus if seeking refuge at their home may pressure victims to stay in abusive relationships. The overcrowding of the medical facilities and the fear of contracting the coronavirus might also stop them from seeking out medical care after experiencing physical abuse.

Another issue that is worth highlighting is related to divorced or separated mothers and their visitation rights. Due to the lock-down, some fathers might use the situation as a pretext to rob mothers of their visitation rights (usually 24 hours for some) in light of the pandemic and the restricted freedom of movement imposed. Parents should observe the children’s best interest, avoid conflict, and make-up for missed days after the confinement period, and keep the social contact and visual contact (phone and video calls) as a supportive psychological and emotional tool.

Vulnerable Women

Migrant domestic workers, living with their employers, need to be adequately informed and educated about the spread of the disease for their safety and that of their employers. With the lockdown in place, migrant domestic worker are unable to take their weekly day-off and this might indirectrly mean that they will have to work on their rest day. They also run the risk of gender-based violence (GBV) as a result of the heightened anxiety triggered by the pandemic. The crisis has as well negative multiplier effects on their livelihood: they are physically away from their family members whom they cannot support emotionally, they might also be at risk of seeing the value of their income decrease due to the lock down, the pandemic will limit their ability to travel to seek new economic opportunities, and therefore, those workers, mostly females, might face a higher risk of unemployment, poverty, and violence.

75-80% of healthcare workers are female.

Women refugees also face dire conditions and increased violence coupled with the additional burden of care given that their housing conditions lack heating and clean water. The Cabinet asked international organizations to assume their responsibilities in terms of caring for the displaced Syrians and Palestinian refugees to provide the necessary health care and proactive services for them in relation to “Corona” , but with travel bans, and shut down of the banking sector, and lack of funds allocated to the Lebanese Crisis Response Plan and UNRWA, conditions are expected to worsen if Corona spreads into the camps. Adequate education and communication on ways to prevent, limit, and care for the disease are primordial.

Sexual and Reproductive Health

“While fear and uncertainty are natural responses to the coronavirus, we must be guided by facts and solid information,” said Dr. Natalia Kanem, Executive Director of the UN Population Fund (UNFPA). “We must stand together in solidarity, fight stigma and discrimination, and ensure that people get the information and services they need, especially pregnant and lactating women.”

Sexual and reproductive health is a significant public health issue during epidemics, and safe pregnancy and childbirth depends on functioning health systems and strict adherence to infection precautions. On March 18, 2020, the Ministry of Public Health formed a Committee to take charge of the management of Pregnant women under COVID19 emergency plan.

To date, there is no scientific evidence about the increased susceptibility of pregnant women to COVID-19. There was no vertical transmission of COVID19 from mother to newborn as has been reported in 9 cases in a study published by The Lancet but this is not enough evidence. Dr Firas Abiad, CEO of Rafik Hariri University Hospital (RHUH), the frontline healthcare facility fighting COVID19 in Lebanon, announced in a tweet on his account on March 18, 2020, that “the OBGYN team came up with recommended protocols to manage suspected pregnant patients presenting in labor, and that the required facilities were prepared and staff trained, protocols shared with other hospitals.”

As to breastfeeding, considering its benefits and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding or expressing her milk, while applying all the necessary precautions according to UNICEF.

Recommendations

In its Action Plan, as many other countries did, Lebanon focused only on health goals, targets and indicators. It has failed to adopt a “transformative development agenda based upon securing human rights for all” as required by UN standards . This includes a range of human rights namely the right to social security, housing, health care and education as enshrined in the Covenant on Social, Economic and Cultural Rights.

In order to improve our national response and to avoid the ‘tyranny of the emergency’ in the future, Lebanon should draw on the Recommendation of the High-level Panel on the Global Response to Health Crises and on the recommendations of UNWOMEN as to preparedness and response efforts to take into account and address the gender roles, responsibilities, and dynamics during COVID19 outbreak. Not recognizing that this creates different needs means you are then not creating policy to mitigate against it.

79.52% of the Lebanese nurses are females compared to 20.48% males .

Gender experts must be included at all levels of planning and operations to ensure the effectiveness and appropriateness of the response, that containment and mitigation measures address the exacerbated load of unpaid care work, highlight GBV risks and response, and mitigate economic and livelihood impact of pandemics on the situation of women through targeted women’s economic empowerment strategies, or explore cash transfer programming to support them to recover and build resilience for future shocks.

The National Action Plan on Women, Peace and Security developed by the National Commission for Lebanese Women and approved by the government does include this objective under the Relief and Recovery pillar. The time is now to activate the implementation of this strategic pillar.

● In order to tackle the spread of infection, women who play a major role as conduits of information in their communities must be enabled to get information and should be educated about how to prevent and respond to the pandemic in ways they can understand.

● Access to sexual and reproductive health services, including pre- and post-natal healthcare should be prioritized in measures taken to relieve the burden on healthcare structures.

● Providing mental health and psychosocial support for affected individuals, families, communities and health workers should be a critical part of the response.

● Providing and raising awareness on availability of support to GBV survivors including mental health and protection. Gender-based violence referral pathways must be updated to reflect changes in available care facilities, while key communities and service providers must be informed about those updated pathways. The activity of the Hotline 1745 dedicated to report GBV to the Internal Security Forces should be maintained. Even though, the work of the courts and judicial departments was suspended to prevent the spread of the virus, the services which ensure the treatment of essential disputes were maintained according to a statement by the Minister of Justice. Awareness should be raised that those do include cases of domestic violence (protection orders).

● Civil society has always been the backbone of Lebanon. The formation of solidarity networks among feminist groups, NGOs and governmental women’s machineries should be supported in order to ensure the response to COVID-19 does not reproduce or perpetuate harmful gender norms, discriminatory practices and inequalities especially against marginalized groups such as elderly women, women with disabilities and those in extreme poverty; and to share resources and experience, to amplify voices and to make women more resilient to help transit from state of crisis to recovery.

● Collect sex disaggregated data related to the outbreak and response in order to understand gendered differences when designing preventive and interventional measures.

Increased poverty, reduced productivity, the consequent decline in national food security, deteriorating living conditions, depletion of the skilled work force and general social instability and malaise all jeopardize national development and political stability and threatens the well-being and security of the entire nation.

To learn from the previous outbreaks of infections at the international level, the problem in the case of both Ebola and Zika has been that leaving structural gender inequalities out of the crisis response has further compounded those inequalities. We should argue for a contextual human rights analysis that takes into account gender as a social and economic determinant of health.

The gaps in care provisions exposed by this crisis demonstrate once again the urgency of moving towards a socio-economic model that recognizes women’s invaluable contributions to society and places care at the center, where all women and men have equal, flexible options to balance their work and care responsibilities, and live a dignified life. This highlights the urgency of adoption by Parliament of key laws, legislations, and execution decrees to remove discrimination against women and to support their participation and protection in the economic life to enhance equality and resilience and contribute to socio-economic recovery and sustainable development .

The time is up for sidelining women!

The government must remember that the coronavirus pandemic is a gendered issue and an equity issue—one that requires dedicated attention and response for the most vulnerable women, in order to protect us all.

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