Gender-based violence (GBV) does not take a break during times of crisis, disaster, or pandemic. In fact, it increases. Several countries have seen an increase in calls to domestic and sexual violence hotlines during disasters, and the COVID-19 pandemic is no exception.^1–4 Stay-at-home orders place a victim and perpetrator in proximity for longer periods of time than normal. In addition, financial stressors, a loss of job/income, and fear of the virus can all contribute to an increased risk of GBV. Staying at home also increases the risk of sexual violence.

In addition, disaster and pandemic situations create several unique challenges to providing care to victims of GBV, including:

• Access to Care: Emergency departments may be overwhelmed caring for disaster- and pandemic-related patients and may not be able to respond to other patients unless it’s truly a life-or-death situation. Patients may experience long waits in a busy, loud, crowded ED waiting room.
• Access to Sexual Assault Nurse Examiners (SANEs): These nurses may be recruited to the emergency department and other parts of the hospital to provide care. They may be too overworked and overwhelmed to provide SANE services. If their role is part of an additional assignment or overtime-based position, their forensic role may be suspended to focus on patients of the pandemic/crisis. If you have a community-based program that responds to the emergency department, its ability to enter your hospital may be limited by restrictions on visitors.
• Access to Rape Crisis Services: Many domestic and sexual violence programs may not be considered essential and may be forced to close during an emergency or pandemic. Shelter-in-place/at-home orders may prevent them from providing ED accompaniment services. They may not be considered essential workers. They may be prevented from providing hospital services by hospital visitation policies and the lack of personal protective equipment. Domestic violence shelters may be overwhelmed or unable to accommodate normal numbers of clients due to social distancing and gathering restrictions.
• Evidence Handling: Police departments and crime labs may be overwhelmed with calls and other cases. They may see a diminution in their workforce due to illness and quarantine as well. Physical evidence and recovery kits may not be picked up and processed in the usual, timely fashion. This creates storage issues at an emergency department during a chaotic period.

Solutions

The key to handling GBV patients during a disaster or pandemic is the same as anything else in health care: planning. The community should have as part of its sexual assault response team protocols a plan of what to do in a disaster, emergency situation, or pandemic. This planning should include all the key players within the community to ensure no victim is left out. This includes domestic, sexual, elder, and child violence advocates and crisis centers; the police department; the hospitals; the district attorney’s office; and other social service agencies such as protective services and victim advocacy organizations.