Etobssie Wako

Date of Award


Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Monica H. Swahn - Chair


Background: War disproportionately affects women and children, and gender based violence (GBV) has become an increasingly common means of fighting wars and targeting civilians. Such is the case in the Democratic Republic of Congo (DRC), particularly in the eastern provinces, where among the multitude of human rights violations, sexual violence and abuses against women and girls are committed on a large scale. Documented efforts addressing GBV in refugee communities have mainly focused on medical, programmatic, and legal responses; few studies explore the prevalence of GBV among conflict-affected populations. Objective: To determine the prevalence and correlates of outsider violence during and after conflict, and lifetime and past year intimate partner violence (IPV). To determine differences in the proportions of violence victimizations, including the differences in the proportions of outsider violence during and after conflict, and the differences in the proportions of lifetime and past year IPV. To describe patterns of reporting and healthcare seeking related to violence victimization. Methods: Cross sectional data were obtained from a sample of 810 women of reproductive age (WRA) living in two Rwandese refugee camps. GBV was defined as physical violence, sexual violence, or controlling behavior that is committed by intimate partners (IPV) or persons outside the family (outsider violence). Univariate analysis was used to describe the study population as a whole. The chi-square test for independence was used to measure significant differences between women who had identified experiencing GBV and those who did not. A z-test was conducted to explore differences in the proportions of outsider violence during and after conflict, and lifetime and past year IPV. Bivariate and multivariate logistic regression analyses were conducted to assess the unadjusted and adjusted associations between GBV and select variables of interest during and after conflict. Statistical analyses were conducted using SPSS version 14.0 Results: 434 WRA experienced GBV; of which 399 reported experiencing outsider violence before and after conflict, and 130 reported experiencing IPV. The logistical model indicated that there was a consistently significant association between a period of one to five years spent in a refugee camp and outsider violence during conflict (Adj.OR= 0.16; 95%CI:0.10-0.27; P <0.0001), lifetime IPV (Adj.OR=0.17;95%CI:0.10-0.32, p<0.0001), and IPV in the last year (Adj.OR= 0.15;95%CI:0.08-0.28, p<0.0001). Discussion: The results of this study illustrate the importance of assessing the impact of conflict on GBV among refugee and displaced populations. The high prevalence of GBV among this study population, with a prevalence of 53.3% for all forms of violence, is evidence of the great burden GBV poses on this population. Ongoing violence generated by conflict is a major public health concern that urgently requires effective interventions. For example, legal, health, and psycho-social services should be well integrated to adequately screen and address the needs of violence survivors.