Gender-based violence and its determinants among refugees and internally displaced women in Africa: systematic review and meta-analysis

Abstract

Background

Gender-based violence is a serious public health concern and affects a large number of women and girls in humanitarian emergencies. Despite this, there is a dearth of the summary data to address the issue. Therefore, this study aimed to assess the estimated pooled magnitude and factors associated with gender-based violence among refugees and internally displaced women in Africa.

Methods

PubMed/MEDLINE, Google Scholar, African Journals OnLine, PsycINFO, and EMBASE were among the databases that were used to search the primary articles. The reviewed papers were articles that evaluated the prevalence and contributing variables of gender-based violence against refugees and internally displaced women in Africa. We extracted the data using a Microsoft Excel spreadsheet, which we exported into Stata version 14 for further analysis. The I² test was applied to identify statistical heterogeneity. We used a random effect meta-analysis methodology because of the heterogeneity. A funnel plot and Egger’s weighted regression test were used to examine publication bias.

Results

This systematic review and meta-analysis reviewed 17 primary studies with a total of 6,161 refugees and internally displaced women in Africa. The findings of this study revealed that the estimated pooled prevalence of gender-based violence among refugees and internally displaced women was determined to be 48.20% (95% CI: 39.28, 57.12). Young age (AOR = 3.68, CI: 2.63, 5.14), alcohol consumption (AOR = 2.53, CI: 1.56, 4.11), and having no social protection (AOR = 3.21, CI: 2.22, 4.63) were factors significantly associated with gender-based violence.

Conclusions and recommendations

The present study showed that almost half of refugees and internally displaced women residing in Africa were survivors of gender-based violence. Younger women, alcohol users, and those without social protection were more likely to experience gender-based violence. Therefore, it is recommended that accessible information about the consequences of gender-based violence and early intervention for survivors be provided, taking these factors into consideration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20329-8.

Introduction

Gender-based violence (GBV) is defined as any harmful act perpetrated against a person’s will, based on socially ascribed gender roles and power differences between males and females. This encompasses a range of violent acts, including physical, sexual, and mental harm or suffering, threats, coercion, and deprivation of liberty, all of which occur in both public and private spheres [1]. Although the patterns, circumstances, and prevalence of GBV may differ from those experienced by women and girls, boys and men may become victims [2]. Boys and men who encounter gender-based violence frequently have significant barriers to reporting their experiences, such as shame, stigma, and the belief that men ought to be “strong” and “self-reliant [3, 4].” GBV is the most common form of violence affecting women and girls across all dimensions, times, societal levels, ages, religions, and ethnicities [5]. Violence against women (VAW) is characterized by any act of GBV that affects women physically, sexually, or psychologically. Whether the event occurs in public or private, it covers coercion, arbitrary deprivation of liberty, and threats of such acts [6]. People sometimes use GBV and VAW interchangeably because women suffer disproportionately (95% vs. 5%) compared to men [7–9]. In addition to impeding national development and gender equality, violence against women is one of the most prevalent human rights violations. Gender-based violence (GBV) can occur in a variety of contexts, including homes, streets, jails, organizations, colleges, and humanitarian emergencies [10].

Gender-based violence remains a major global issue, particularly in conflict areas [11, 12]. Opportunistic violence during war is often fueled by the collapse of protective institutions, social networks, displacement, economic crises, and other conflict-related factors [11, 13]. According to recent reports from the United Nations High Commissioner for Refugees (UNHCR), the number of forcibly displaced people worldwide has reached unprecedented levels. By the end of 2023, approximately 117.3 million people were displaced due to persecution, conflict, violence, and human rights violations [14]. Low- and middle-income countries (LMICs) host 75% of the total displaced people. This figure likely surpassed 120 million by May 2024, reflecting a 12-year trend of annual increases.

Refugees and internally displaced women are among the most vulnerable group of people to gender-based violence. According to the World Health Organization (WHO) report, approximately one in three women globally has experienced physical and/or sexual violence by an intimate partner, non-partner sexual violence, or both [15]. A multi-country study by the World Health Organization (WHO) reported that the prevalence of emotional violence ranged from 20 to 75%, while the prevalence of intimate partner violence ranged from 15 to 71%, over a lifetime [16]. GBV can be committed by intimate partners, relatives, or even strangers [17]. In humanitarian settings, GBV is especially common among young women and girls [18]. It is estimated that over 60% of displaced girls and women experienced gender-based violence in LMICs [19]. A recent study in Nigeria indicated that more than one-fifth of internally displaced women experienced GBV by non-family members, and 12.2% of displaced women experienced intimate partner violence by family members [20].

A meta-analysis and systematic review study across 14 countries (predominantly African) revealed a pooled prevalence of violence against women of 21.4% [21]. Although this study was conducted, it focused solely on sexual violence, one form of GBV, and did not provide a specific pooled estimate of the prevalence of sexual violence in Africa through subgroup analysis. Additionally, these findings were based on studies conducted before 2013, and numerous humanitarian crises have occurred in Africa since. To better estimate the overall burden of GBV, we initiated further studies encompassing over 11 years of research following the initial meta-analysis. Sub-Saharan African countries have provided high burden of gender-based violence in humanitarian settings including internally displaced people and refugee camps [22]. Several fragmented studies in Africa have been conducted, revealing that the prevalence of GBV among refugee women ranged from 31% [23] to 80.6% [24]. Furthermore, the incidence of GBV among internally displaced women in Africa was ranged from 18.5% [25] to 54.4% [26].

In Africa, several initiatives have been put in place to address GBV against internally displaced women and refugees. Programs focused on protection, response, and prevention have been formed by non-governmental organizations (NGOs) and international bodies like the United Nations High Commissioner for Refugees (UNHCR) [27]. Policies and legal frameworks have been established to ensure the safety of displaced women. For example, member states of the African Union (AU) are obligated under the Kampala Convention (2009) to combat gender-based violence (GBV) and to safeguard the rights of internally displaced persons (IDPs), including women [28]. In efforts to change societal norms that perpetuate violence, initiatives have been launched to educate both men and women about GBV. Women’s rights education and training workshops are common components of community-based projects. Women affected by GBV are provided with psychosocial support, counseling, and healthcare services, especially those related to sexual and reproductive health. Despite these efforts, GBV continues in African refugees and internally displaced women due to deeply entrenched patriarchal norms, stigmatization of survivors, ongoing conflicts, and resource constraints [29].

Gender-based violence can have significant negative consequences on both physical and mental health [10, 30]. These effects may include poor pregnancy outcomes, maternal mortality, sexually transmitted diseases, and an increased risk of stigma, loneliness, stress, difficulty negotiating sex, forced pregnancy, and risky sexual behavior [31–34]. Additionally, survivors often experience suicidal thoughts, anxiety, depression, and post-traumatic stress disorder (PTSD) [35]. Physical health consequences may include injuries, chronic pain, gastrointestinal issues, and disabilities.

Varieties of socioeconomic, behavioral, cultural, legal, and security-related factors are strongly associated with GBV against refugees and internally displaced women. Displaced women, in particular, are more likely to experience violence both during their flight and after arriving in camps, where protection is often insufficient. Conflict, the primary driver of displacement, is a major cause of GBV. Sexual assault as a weapon of war is one of the many ways in which wars lead to the breakdown of social order and an increase in violence [36, 37]. Poverty and economic dependence are significant contributors of GBV among displaced women. When displaced, women often become economically dependent on male companions or humanitarian aid, increasing their vulnerability to exploitation and abuse, which frequently traps them in dangerous situations [20, 38]. In many humanitarian emergencies, effective social and legal protections for GBV survivors are lacking. A culture of impunity persists, as offenders are rarely held accountable due to weak legal systems and inadequate law enforcement [39, 40]. Contributing factors of GBV include having a boyfriend [40], overcrowding in IDP settlements, alcohol consumption [24, 40, 41], female-headed households [42, 43], living with an intimate partner, having a drunken partner, age [40], lack of social protection [37, 40], and marital status [20].

Consolidating data from multiple studies through a systematic review facilitates a more comprehensive understanding of the types and prevalence of GBV experienced by internally displaced and refugee women in various African contexts. Many GBV studies are region-specific and focused on certain types of violence. A systematic review and meta-analysis can reveal gaps in the literature and might identify areas where further research is needed. The vulnerabilities faced by displaced or refugee women are often exacerbated by factors such as ethnicity, socioeconomic status, and their relocation circumstances. A systematic review can capture the intersectionality of these factors, offering a more nuanced understanding of how they influence GBV. Strong statistical evidence from a meta-analysis can help guide the development of effective interventions and policies to prevent and combat GBV. Therefore, this systematic review and meta-analysis aim to determine the overall estimated prevalence and determinants of GBV among refugees and internally displaced women in Africa. The research questions guiding this study are: What is the overall pooled prevalence of GBV, and what are the factors associated with it among refugees and internally displaced women in Africa?

Methods

Registration and protocol

In this systematic review and meta-analysis study, we strictly followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines (Supplementary file 1). This study is registered under the in the International Prospective Registry of Systematic Review (PROSPERO) with the registration number CRD42024555873, as of June 07, 2024.

Search strategy

In this study, both published and unpublished articles were included to assess the overall pooled magnitude and determinants of gender-based violence among refugees and internally displaced women. The included primary studies were searched from June 7 to July 6, 2024, using the following databases: PubMed/MEDLINE, Google Scholar, African Journals OnLine (AJOL), PsycINFO, and EMBASE. The search terms applied were: (“magnitude” OR “prevalence” OR “epidemiology OR “proportion” OR “incident” OR “burden”) AND “gender-based violence” OR “sexual violence” OR “sexual coercion” OR “sexual harassment” AND “risk factors” OR “determinants” OR “predictors” OR “correlates” AND “refugee women” OR “internally displaced women” AND “Africa” (Supplementary file 2). Two authors (SF and TT) independently searched articles using the Boolean operators “AND” and “OR,” as appropriate.

Criteria for eligibility

Inclusion criteria

This study included articles that provided evidence on the prevalence of gender-based violence among refugees and internally displaced women in African countries. Studies that included both sexes (females and males) were considered if they specifically reported the prevalence among females separately, and only the prevalence of gender-based violence among females was used. Full-text articles written in English, reporting the prevalence of gender-based violence regardless of publication year, were included. Additionally, this study considered all observational studies that reported the prevalence of gender-based violence among refugees and internally displaced women in Africa.

Exclusion criteria

Initially, the authors evaluated titles and abstracts to determine their eligibility. Then, the authors thoroughly read the entire article texts to assess whether these studies met the inclusion criteria for the review. Articles not written in English and those conducted outside of Africa were excluded. Additionally, articles without abstracts or full-texts were excluded from this study. Before discarding any articles, we attempted to contact the principal author by email at least twice [44, 45]. Systematic review and qualitative studies [46] were excluded as well. Articles that did not provide data on the prevalence of gender-based violence among refugees and internally displaced women based gender were discarded. Furthermore, studies that included both males and females but did not report on the sexes separately were also excluded.

Data extraction

The two authors (SF and TT) separately extracted the data from the included primary studies using a standardized data extraction form adapted from the Joanna Briggs Institute (JBI) [47]. They worked together to resolve any disagreements through discussion with the third author (GR). The data extraction form included the following information: the first author’s name, publication year, the country where the study was conducted, sample size, study group (IDPs or refugees), response rate, and the prevalence of gender-based violence with 95% confidence intervals. The characteristics of the included studies were summarized in the Microsoft Word (2010) (Table 1). Additionally, the data extraction form included associated factors of GBV and their effect sizes (Odds Ratios). Furthermore, the raw data on gender-based violence and associated factors among refugees and internally displaced women were compiled using Microsoft Excel (2010) (Supplementary file 3).

Table 1.

Characteristics of included studies on the prevalence of gender-based violence among refugee and internally displaced women in Africa

Authors	Assessment tools	Population	Country of study	Response rate (%)	Sample size	Prev GBV (%)
Hossain M, et al.(2021) [53]	WHO’s multi-country study on women’s health and domestic violence against women	Refugees	Kenya	N/R	209	47
Adejumo et al.(2022)	Adapted from the Nigerian Demographic and Health Survey (DHS) questionnaire	IDPs	Nigeria	96	288	22.2
Workie et al.(2023) [40]	Assessment Screen to Identify Survivors Toolkit questionnaire for Gender-based violence (ASIST-GBV)	IDPs	Ethiopia	97.2	412	37.9
PE NGALA (2021)	Assessment Screen to Identify Survivors Toolkit questionnaire for Gender-based violence (ASIST-GBV)	Refugees	Kenya	94.1	283	80.6
Gitobu Cosmas Mugambi* and Karin Michotte(2021)	N/R	IDPs	Somalia	100	264	41.3
H.A. Dahie et al.(2023)	A structured interview questionnaire created by the researchers	IDPs	Somalia	100	384	18.5
Logie et al.(2019)	A structured interview questionnaire created by the researchers	Both	Uganda	100	333	53.7
Stark et al.(2017)	Adapted from ICAST and VACS questionnaires	IDPs	DRC	100	377	54.4
Stark et al.(2017)	Adapted from ICAST and VACS questionnaires	Refugees	Ethiopia	100	919	50.5
Feseha et al.(2012)	Adopted from WHO questionnaire on domestic violence and intimate Parner Violence	Refugees	Ethiopia	100	422	31
Kinyanda et al.(2010)	War related sexual violence questionnaire (11 items)	IDPs	Uganda	100	573	28.6
P. Parmar et al.(2012)	A structured interview questionnaire created by the researchers	Refugees	Cameroon	100	191	55.5
L Stark et al.(2010)	A structured interview questionnaire created by the researchers	IDPs	Uganda	68.2	204	51.7
D.F. Morof et al.(2014)	A structured interview questionnaire created by the researchers	Refugees	Uganda	N/R	117	77.5
Hadush et al.(2023)	Adopted from the EDHS IPV assessment questionnaire	Refugees	Ethiopia	96.2	406	48.3
Johannes John-Langba (2007)	Gold Standard SGBV Questionnaire (GSSQ) of the Reproductive Health of Refugees Consortium	Refugees	Botswana	100	402	75
Mwenyango(2021)	A structured interview questionnaire created by the researchers	Refugees	Uganda	100	377	46.7

Study selection

The study selection process was carried out according the PRISMA flowchart, as indicated in the diagram (Fig. 1). After the authors identified relevant articles through database searches, duplicate publications were removed, and the articles were imported into Endnote X20. Two investigators, SF and TT, worked independently during this phase, screening the titles and abstracts to assess the eligibility of the articles. Finally, these authors independently evaluated the full-text articles using the inclusion and exclusion criteria outlined above. Disagreements were resolved through discussion with the third author (GR) before beginning analysis.

Fig. 1.

A flow chart shows study selection for a meta-analysis of gender-based violence among refugee and internally displaced women in Africa

Outcome measurements

The first objective of this study was to determine the pooled estimated prevalence of gender-based violence among refugees and internally displaced women in Africa. The pooled prevalence of gender-based violence was calculated by dividing the number of women who experienced gender-based violence by the total number of women included in this review and multiplying by 100. The second objective of this systematic review and meta-analysis was to identify the estimated factors associated with gender-based violence among refugees and internally displaced women in Africa. The odds ratio (OR) was calculated from the reviewed primary articles using 2 × 2 tables. The questionnaires used to evaluate gender-based violence in the included primary articles were initially generated in English, then translated into the local language by language experts, and subsequently back-translated into English. This process ensured consistency, as the measures for gender-based violence implemented in the local language before being translated back.

Quality assessment

The Joanna Briggs Institute’s (JBI) critical appraisal tool was developed to assess the methodological quality of observational studies [47]. The tool consists of nine items focused on potential bias in study design, addressing the target population, analysis, and response rate. Disagreements between the two reviewers were resolved by calculating the Cohen’s Kappa coefficient and discussing the findings. If a disagreement persisted, the third author (GR) intervened to help resolve the issue. Primary studies that scored ≥ 8 out of 9 were regarded as high quality; those scoring 5–7 were considered moderate quality; and studies scoring ≤ 4 were deemed low quality. In this systematic review and meta-analysis, only primary articles rated as medium and high quality using the JBI tool were included for review (Supplementary file 4).

Data synthesis and analysis

For further analysis, the extracted data from Microsoft Excel spreadsheet was exported to STATA 14.0. The findings of this systematic review and meta-analysis were conveyed using forest plots, tables, and text summaries. Key findings and characteristics of the included studies are summarized in a table. STATA version 14 was used to calculate the pooled estimated prevalence of gender-based violence, generate funnel plots, conduct Eager’s test, and analyze pooled associated factors of GBV. The I² test [48] and forest plot graphic representation [49] were employed to assess heterogeneity among the included studies [50]. An I² test result greater than 50% is indicates the presence of heterogeneity among the included primary articles [51]. Due to this heterogeneity, the authors applied a random effect meta-analysis. Subgroup analysis was conducted to investigate possible sources of heterogeneity, and sensitivity analysis was performed using a leave-one-out technique. To identify and test for publication bias, two techniques were applied; visual inspection of funnel plot symmetry [48], and Eager’s weighted regression test [49] at a 5% significant level.

Results

Study selection process

A total of 728 primary studies were identified through various databases and sources after removing duplicate articles (Fig. 1). Following the review of titles and abstracts, 685 studies were excluded as they did not focus on gender-based violence. After further screening, 26 of the remaining 43 studies were eliminated because they did not provide a clear analysis of the prevalence and contributing factors of gender-based violence. Ultimately, 17 studies were included for data analysis and interpretation. Of these 17 studies, 13 assessed the general prevalence of gender-based violence (without focusing on specific types), including three that evaluated intimate partner violence. Additionally, three studies examined sexual violence, while one focused on physical violence (Supplementary file 3).

Characteristics of the reviewed primary studies

The primary studies in this review were conducted using a cross-sectional study design. With the exception of one primary study [24], the remaining articles were published in scientific peer-reviewed journals. Most studies (n = 9) focused on refugee women [24, 52–59], seven focused on internally displaced women [20, 40, 52, 60–63], and one study included both refugees and internally displaced women [64]. Five of the included studies were conducted in Uganda and four studies were conducted in Ethiopia, while the other four studies were carried out in Somalia (n = 2) and Kenya (n = 2). The remaining studies were conducted in Nigeria, Democratic Republic of Congo (DRC), Botswana, and Cameroon. The sample sizes ranged from 117 to 919, with these extremes reported in studies from Uganda and Ethiopia, respectively.

All studies were conducted between 2005 and 2022 and made available online between 2007 and 2023. In total, 6,160 refugees and internally displaced women were included in this systematic review and meta-analysis. The majority of the included studies (n = 6) were evaluated using a structured interview questionnaires developed by the researchers. Two studies assessed through the Assessment Screen to Identify Survivors Toolkit questionnaire for Gender-based violence (ASIST-GBV), while two others used adapted questionnaires from the ISPCAN Child Abuse Screening Tool (ICAST) and the Violence Against Children Survey (VACS) (Table 1). Out of the 17 included studies, nine (53%) were rated as high quality, while the remaining eight (47%) were rated as medium quality.

The estimated pooled prevalence of gender-based violence among refugee and internally displaced women in Africa

This study reviewed a total of seventeen primary studies conducted in African countries, involving 6,161 displaced women. Based on the findings, the estimated pooled prevalence of gender-based violence among refugees and internally displaced women in Africa was 48.2% (CI: 39.28, 57.12) (Fig. 2).

Fig. 2.

The estimated pooled prevalence of gender-based violence among refugee and internally displaced women in Africa

Heterogeneity and publication bias

The I² test was applied to assess the statistical heterogeneity of the included studies. We found a high degree of heterogeneity between the studies (I² = 98.3%, p = 0.000). To assess publication bias, we applied two techniques. First, a funnel plot was used, showing a symmetric distribution upon visual inspection (Fig. 3). The second technique was Egger’s test. As shown in table (Table 2), Egger’s test indicated no publication bias, with a p-value greater than the significance threshold (p-value = 0.303).

Fig. 3.

Funnel plot of gender-based violence among refugee and internally displaced women in Africa

Table 2.

Egger’s test of gender-based violence among refugee and internally displaced women in Africa

Std_Eff	Coef.	Std. Err.	t	P > t	[95% Conf. Interval]
Slope	25.03623	20.0427	1.25	0.231	-17.68379, 67.75624
Bias	8.755009	8.21547	1.07	0.303	-8.755852, 26.26587

Sub-group analysis

Since we confirmed a high level of heterogeneity among the included primary studies, we employed a sub-group analysis. These subgroups are based on the countries where the studies were conducted and the population groups (IDPs or refugees). Based on the findings of the subgroup analysis, the estimated pooled prevalence of gender-based violence in studies conducted in Kenya, Uganda, Ethiopia, Somalia, and others (Cameroon, Botswana, Nigeria, Democratic Republic of Congo) was found to be 63.90%, 51.45%, 41.97%, 29.79%, and 51.78%, respectively. The estimated pooled prevalence of gender-based violence among refugee women was 56.86%, while among internally displaced women, it was 36.24%. According to the subgroup analysis by violence type, the estimated pooled prevalence of general GBV was 51.03%, followed by sexual violence at 41.57% (Table 3).

Table 3.

Sub-group analysis of gender-based violence among refugee and internally displaced women in Africa

Variables	Sub-groups	Number of studies	Prevalence (95% CI)	I2(%)	P-value
Country	Uganda	5	51.45(36.20, 66.70)	97.5	‹ 0.001
	Ethiopia	4	41.97(32.67, 51.27)	94.8	‹ 0.001
	Somalia	2	29.79(7.44, 52.13)	97.5	‹ 0.001
	Kenya	2	63.90(30.97, 96.82)	98.5	‹ 0.001
	Others	4	51.78(27.87, 75.69)	98.9	‹ 0.001
Population	Refugees	9	56.86(45.59, 68.13)	97.9	‹ 0.001
	IDPs	7	36.24(26.15, 46.32)	96.8	‹ 0.001
	Both IDPs and refugees	1	53.70(48.34 59.06)	N/A	N/A
Violence type	GBV (not specific type)	13	51.03(40.33, 61.73)	98.4	‹ 0.001
	Sexual violence	3	41.57(26.19, 56.96)	95.8	‹ 0.001
	Physical violence	1	31.00(26.59, 35.41)	N/A	‹ 0.001

Sensitivity analysis

In this systematic review and meta-analysis, we employed a sensitivity analysis to evaluate the heterogeneity among the reviewed articles. To examine this heterogeneity, we removed one study at a time to determine the effect of each study’s results on the estimated pooled prevalence of gender-based violence. Our findings confirmed that all the results fell within the expected 95% CI for the estimated pooled prevalence of gender-based violence (Table 4). Therefore, we concluded that excluding a single study did not affect the estimated pooled prevalence of gender-based violence.

Table 4.

Sensitivity analysis of gender-based violence among refugee and internally displaced women in Africa

Study omitted	Estimated prevalence	[95% Conf. Interval]
Hossain M et al.(2021)	48.27	38.92, 57.62
Adejumo et al.(2022)	49.82	40.84, 58.81
Workie et al.(2023)	48.85	39.39, 58.30
PE NGALA (2021) [24]	46.14	37.89, 54.39
Gitobu Cosmas Mugambi* and Karin Michotte (2021)	48.63	39.24, 58.01
H.A. Dahie et al.(2023) [25]	50.06	41.55, 58.57
Logie et al.(2019) [64]	47.85	38.46, 57.25
Stark et al.(2017)	47.81	38.39, 57.23
Stark et al.(2017) [26]	48.06	38.26, 57.86
Feseha et al.(2012) [23]	49.28	39.96, 58.59
Kinyanda et al.(2010) [62]	49.43	40.22, 58.64
P. Parmar et al.(2012) [58]	47.75	38.45, 57.05
L Stark et al.(2010) [26]	47.98	38.65, 57.31
D.F. Morof et al.(2014) [55]	46.40	37.44, 55.37
Hadush et al.(2023) [56]	48.19	38.70, 57.68
Johannes John-Langba (2007)	46.49	37.98, 55.01
Mwenyango (2021)[57]	48.29	38.82, 57.77
Combined	48.20	39.28, 57.12

Factors associated with gender-based violence among refugee and internally displaced women in Africa

Several factors identified in the reviewed primary studies, were significantly associated with gender-based violence among refugees and internally displaced women. For example, being young (ages 15–24) was significantly associated with gender-based violence in three primary articles [24, 40, 63]. Furthermore, lacking social protection [40, 63] and current alcohol use [40, 63] were significantly associated with gender-based violence in two primary studies. This systematic review and meta-analysis revealed that individuals in the younger age group were more than three times (AOR = 3.68, CI: 2.63, 5.14) more likely to experience gender-based violence than their counterparts. Individuals without social protection had more than two times the odds (AOR = 2.53, CI: 1.56, 4.11) of experiencing gender-based violence compared to those with adequate social protection. Moreover, respondents who drank alcohol had more than three times higher odds (AOR = 3.21 CI: 2.22, 4.63) of being exposed to gender-based violence compared to their counterparts (Fig. 4).

Fig. 4.

Factors significantly associated with gender-based violence among refugee and internally displaced women in Africa

Discussion

The present study estimated the pooled prevalence and identified factors associated with gender-based violence among refugees and internally displaced women in Africa. This study reviewed 17 primary articles from eight African countries. The combined sample size across the 17 reviewed articles was 6,161. Our estimate revealed that 48.2% of refugees and internally displaced women in Africa experienced gender-based violence. Despite underreporting of violence against women due to the fear of retaliation, humiliation, and societal stigma, our findings indicated that nearly half of displaced women experienced gender-based violence.

The prevalence ratio of gender-based violence in this study was higher than that reported in a recent systematic review and meta-analysis of the general population of Sub-Saharan African women [65]. The social and community networks that typically provide protection for women are disrupted during displacement. In displacement settings, traditional social norms and safeguards may collapse, making women more vulnerable to GBV [66]. Due to their limited access to financial resources, displaced women are particularly vulnerable to abuse and exploitation, including forced marriages and sexual assault [67]. Additionally, the estimated pooled prevalence in the current study was higher than that reported in another other study conducted in high-income countries worldwide [68]. The discrepancy in the prevalence rates between the studies may be related to the scope of the primary outcome variable. The primary outcome of the previous study among refugee women residing in high-income countries was determined solely by sexual violence. In contrast, our study focused on various forms of violence, including unspecified GBV and GBV perpetrated by intimate partners, as well as physical violence and sexual violence.

Moreover, to identify the possible sources of heterogeneity among the included studies, the current review employed subgroup analysis based on the population group (refugees versus internally displaced women) and the country of the study. Our findings indicated that the estimated pooled prevalence of gender-based violence among refugee women is higher than that among internally displaced women. Refugees are more likely to be disconnected from their social networks and local support systems, which are essential for their resilience and safety. Their vulnerability to GBV may increase as a result of this isolation [69]. Even if they are internally displaced, internally displaced persons may still maintain relative attachment to their communities and social networks. In contrast, the protection systems in place for refugees are often complex and respond slowly. As a result, refugee women may be left unprotected for extended periods due to delays and gaps in these systems. Although internally displaced persons are frequently overburdened as well, they may have more direct access to national security measures [70]. Moreover, the estimated pooled prevalence of gender-based violence in Kenya was higher than that in Uganda, Ethiopia, and others, while the lowest prevalence was observed in Somalia.

This study also identified the estimated factors significantly associated with gender-based violence. Based on the findings, young age, current alcohol use, and lack of social protection were independently associated with experiencing gender-based violence. Younger women were more than three times more likely to experience gender-based violence than their counterparts. They are more susceptible to exploitation and abuse because they often have less authority and influence in relationships and societies. Additionally, younger women are less likely to be financially independent, which may hinder their ability to seek assistance or escape violent situations [71]. In many cultures, younger women are expected to be subservient to men [72]. Leaving abusive situations may be particularly challenging for them, especially if they are displaced. These risks are often exacerbated by displacement by war or natural disasters, which can dismantle institutions and protective measures [17].

Individuals without social protection were more than twice as likely to experience gender-based violence compared to those with adequate social protection. Displaced women often face social isolation from their regular support systems of friends, family, and the community [73]. This lack of a safety net renders them more susceptible to exploitation and abuse. Displaced women may also lack access to social assistance, legal representation, or law enforcement; all of which can help prevent and address gender-based violence [74]. The disintegration of societal structures and norms during crisis can exacerbate lawlessness and injustice. Without tangible repercussions for their actions, perpetrators of gender-based violence may feel more emboldened. Furthermore, guardians (such as a father, brother, or other relative) may resort to physical force against offenders, while some perpetrators may be less inclined to use violence against a woman [75].

Moreover, respondents with alcohol use habits had more than three times the odds of being exposed to gender-based violence compared to non-users. This may be related to women’s alcohol and drug use, which can impair their ability to foresee potential hazards and consequences, as well as diminishing their awareness regarding GBV. Therefore, women who abstain from alcohol and other drugs may have a more positive outlook on their situation than those who engage in risky behaviors [76, 77]. Excessive alcohol consumption by a woman and her partner significantly impairs their decision-making abilities, potentially affecting and exacerbating any violent or unlawful activities [78]. Studies have shown that excessive alcohol use by women or their partners can lead to impaired judgment and an increased risk of violence [79].

The volume of research that investigates the incidence of gender-based violence among displaced and refugee population during conflicts is challenging due to the sensitive subject matter and situation. To determine the prevalence of gender-based violence, researchers use a variety of assessment tools and approaches, while also facing the challenge of contacting the affected populations. Our findings demonstrate the need for coordinated action to reduce gender-based violence among refugees and displaced populations in conflict situations, even after accounting for methodological difficulties. The systematic review highlights the need for more standardized techniques and shared definitions in future research, much like the recent systematic review by Stark and Ager [80], which concentrated on the prevalence of gender-based violence in complex emergency situations. Greater standardization would lead to a deeper awareness of gender-based violence among displaced and refugee communities. Furthermore, implementing more uniform strategies leads to the identification of a higher number of sexual assault survivors.

Strengths and limitations of the study

The present study was able to identify the estimated pooled prevalence of gender-based violence among refugee and internally displaced women in Africa. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in this systematic review and meta-analysis. To mitigate potential reviewer bias in the evaluation of paper quality, the third author resolved disagreements arising from the primary article searches conducted by the study authors. This review also examined the source of heterogeneity through subgroup analysis, based on population type and the country in which the study was conducted. We have also identified the risk factors for gender-based violence. This review has certain limitations in addition to its strengths. A significant degree of heterogeneity was observed across the included primary studies. A cross-sectional study design was employed for all of the included primary studies; this design only shows a temporal association, not a causal relationship. Additionally, most of the included articles used unstandardized assessment tools, which may have overstated or underestimated the prevalence of gender-based violence.

Implications of the study

Even though there is considerable heterogeneity across the study’s findings, gender-based violence remains an important public health concern. This suggests that GBV is common among refugees and internally displaced women in Africa. This study has significance for Africa’s policy framework, implementation strategies, and prevention efforts. It also suggests that Africa should address service provision, adopt intervention strategies, and develop strategies to combat violence against women. Gender-based violence has a detrimental effect on the Sustainable Development Goals (SDGs) and negatively impacts youth, particularly women and girls. Eradicating GBV among internally displaced people, and refugees is essential to achieving Sustainable Development Goal 5 (gender equality). This study can also serve as baseline information for both governmental and non- governmental organizations to take specific actions for survivors and to prevent future instances of violence.

Conclusion and recommendations

This study concluded that almost half of refugees and internally displaced women are survivors of gender-based violence. Young age, alcohol consumption and lack of social protection were some of the risk factors significantly associated with experiencing gender-based violence. To prevent gender-based violence, it is important to advocate for more restrictive laws and ensure their appropriate implementation. This includes educating law enforcement personnel on how to effectively and sensitively handle GBV cases. The implementation of laws and interventions focused on these key factors is crucial.

It is recommended to provide shelters, specialized legal assistance, mental health support, and healthcare services for survivors of gender-based violence. Educate the community on GBV), its effects, and the value of gender equality, focusing on both men and women to shift cultural perceptions. To empower women and reduce their vulnerability to abuse and exploitation, provide programs for education and professional development. Encourage the development of local support networks that empower women to seek help and support from local, national, and international organizations. To successfully adapt interventions, conduct in-depth investigations to identify the unique factors leading to GBV in different contexts. Encourage funding agencies and international organizations to collaborate on GBV response and prevention initiatives.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

WHO

World Health Organization

GBV

Gender-Based Violence

AOR

Adjusted Odds Ratio

SDGs

Sustainable Development Goals

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

CI

Confidence Interval

Author contributions

Writing – original draft: Gebresilassie Tadesse, Setegn Fentahun, Techilo Tinsae, Gidey Rtbey, Girmaw Medfu Takelle, Asnake Tadesse Abate, and Girum Nakie. Writing – review & editing: Gebresilassie Tadesse, Ayenew Molla, Fantahun Andualem, Getasew Kibralew, and Mulualem Kelebie.Conceptualization: Gebresilassie Tadesse, and Techilo Tinsae. Data curation: Gebresilassie Tadesse, and Fantahun Andualem. Formal analysis: Gebresilassie Tadesse, and Techilo Tinsae. Investigation: Gebresilassie Tadesse, Ayenew Molla, and Setegn Fentahun. Methodology: Gebresilassie Tadesse, and Getasew Kibralew. Resources: Girum Nakie, Asnake Tadesse Abate, and Fantahun Andualem. Software: Gebresilassie Tadesse, and Gidey Rtbey. Supervision: Girmaw Medfu Takelle, and Mulualem Kelebie.

Funding

Funding not applicable.

Data availability

The study’s original contributions are included in the article and supplementary material; contact the corresponding author with any further inquiries.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.