COVID-19: A Medical and Gender Crisis

By Charlotte Knight, Law student and participant in Sharifah Sekalala’s Global Health Law module

The current COVID 19 pandemic has been devastating, but government responses have failed to uphold human rights leading to disproportionate and exacerbated harms for women and girls globally. We know, from previous experience, that health and human rights are inextricably linked and Government responses should be guided by human rights to protect the most vulnerable and marginalised groups. [1] However, the emergence of the securitised approach to infectious diseases, viewing them as a security threat results in extensive restrictions on rights because of raising questions of global health security.[2]

This conceptualisation of Global Health Security was highlighted by the 2005 revisions to the International Health Regulations intending to ’prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade’.[3] This attempted to develop a national capacity for infectious disease surveillance and reaffirm the World Health Organisation (WHO) authority in global health governance allowing for the declaration of a Public Health Emergency of International Concern in which the WHO can make recommendations on public health measures in an emergency context. [4] This reservation also attempted to uphold d human rights as public health responses under the IHR, including emergency measures under a PHEIC must be implemented with ‘full respect for the dignity, human rights and fundamental freedoms of persons’. [5]

Thus, the International Health Regulations attempted to mitigate tensions between the securitisation of infectious diseases and the inextricably link between health and human rights but the COVID 19 crisis has highlighted this has not been the case, and this significant failure has resulted in a disrespect to the rights of women. Therefore, COVID 19 is not just a medical crisis but it has also given rise to a gendered crisis.

Initial concerns over the speed the virus was spreading back at the start of 2020 caused the WHO to call governments to take urgent and aggressive action but this lead to the breach of human rights because of the national lockdowns, quarantines and the resection of movement as well as increased surveillance that followed.[6] Restrictions to an extent can be justified because human right laws recognise that in the context of a public health emergency restrictions can happen but the 1966 International Covenant on Civil and Political Rights, international human rights law provides limitations must be necessary, proportionate and non-discriminatory to ensure restrictions are not harmful but an overall benefit to public health and this was reaffirmed by the United Nations Security General who argued state responses to the current COVID-19 crisis can respect human rights through measures that are proportionate.[7]

On January 30th 2020, following the recommendations of the Emergency Committee the WHO Director General declared this outbreak constitutes a PHEIC.[8] Upon its trigger, Emergency Committee continues to provide advice though out the duration of the emergency but human rights must be respected at every point of the public health emergency cycle. However, underneath the virus a separate crisis has emerged once again; a gendered crisis. Women make up 70% of the health and social workforce and rather than authorities taking steps to reduce the harms of women and prevent further gender inequality.[9]

The Ebola crisis highlighted how public health emergencies disproportionately impact women, as there is a significant difference in gendered experiences of outbreaks.[10] The fact the majority of health and social care workforce is made up of women, this alone puts them at a higher risk of contracting infectious diseases during outbreaks but in a humanitarian setting an even greater challenge arises because this setting poses a greater challenge for infectious disease control and prevention because of conflict, weak health systems and limited access to decent hygiene; creating an even greater vulnerability of women in this context. [11] This additional barrier creates a complex emergency, with additional social disruptions caused by the outbreak is likely to heighten existing vulnerabilities – especially to women. [12]

In a humanitarian crisis, the International Humanitarian Law also operates to protect civilians from the effects of armed conflict but also recognises the importance of protecting civilian’s health. [13] The Geneva Convention, specifically protects medical workers from attack and the Security Council adopted Resolution 2286 that strongly condemns attacks against medical facilities and personnel in conflict zones as an attempt to protect and ensure full access for civilians in conflict affected areas. [14] But still, during a pandemic, resources for and access to health are often disrupted as a result of emergency policy implemented, and of particular concern resources to deal with the pandemic either are inaccessible or diverted from essential health services. [15] Lessons learnt from previous disease outbreaks in conflict settings should be used to mitigate the gendered impacts of COVID 19 in conflict affected states.

In the framing of public health emergencies, the IHR fails to discuss the gendered impacts of outbreaks or consideration of the gendered impacts of emergency policies. COVID 19 has emphasised the crucial need for equity-informed evidence and an evidence based rather than value-based responses – which we do not see currently. [16] Firstly under the IHR, states have obligations to meet core public health capacities to prevent and prepare for pandemics but there is no awareness for specific gender considerations that may arise. [17] This gender mainstreaming in preparedness phases means that there is no recognition of the potential impact of outbreaks on marginalised groups including women. Secondly, ‘women’ and ‘gender’ are only mentioned twice within this framework and none of these two instances require governments to recognise the gendered effects of disease outbreaks. [18] Knowing the majority role women play in the health and social care workforce, in the event of a public health outbreak women take the burden of significant responsibility to support the community. [19] Moreover, womens majority role as caregivers is Knowing the majority role women play in the health and social care workforce, in the event of a public health outbreak women take the burden of significant responsibility to support the community. [20]

These realities are not considered in preparedness or response plans and the effects of this fails to uphold the rights of women. This failure to recognise womens paid and unpaid labour, and the hazardous conditions in policies around pandemic preparedness has caused feminists such as Harman to argue this is a direct result of gender norms being reflected into legally binding obligations. [21] Globally, women are the predominant providers of informal care for the family but also make up most of the health and social care workforce. [22] The reason for this, arguably is the result of the cultural and societal expectations of women causing an over-represented in the in the unpaid reproductive economy but underrepresented in the paid productive economy that policy makers and society recognise and value. [23] From this, the performance of women ‘in care roles is just assumed or ignored in the design of policy responses’ as care and social reproduction roles are not only naturalised in public policy but made in respect of male bias.[24] Overall, it’s womens over representation in the reproductive sector and the lack of social value of such roles and it is this lack of value and visibility that has directly infiltrated gender natural policies that fail to account for the specific vulnerabilities of women in public health emergency preparedness.[25] These gender norms are more prominent in a humanitarian context so, there is higher gendered vulnerability as socioeconomic impact is disproportionality higher among women in conflict settings.

The fact women are invisible has resulted in devastating harms fearing this could potentially set women back decades. [26] Pandemic response policies reveal significant gendered impacts. Widespread quarantine measures limit womens abilities to distance themselves from perpetrators of violence and limiting access to GBV and psychological services.[27] This thus poses significant for women generally, but especially for those already in precarious settings. [28] Additionally, quarantines and girls being removed from schooling has too shown an increase in sexual violence and unwanted pregnancies but in conflict-affected areas the resources to deal with the pandemic are typically diverted from essential health services for women including sexual and reproductive services.[29] Previous public health emergencies have shown epidemic impacts on sexual and reproductive health often goes unnoticed as a result of the strained healthcare systems, consequently increasing infant and maternal mortality and long term physical and psychological harms.[30]

Economically, womens rights are also harmed as they bear the brunt of the economic fallout caused by COVID 19.[31] As schools and childcare facilities have closed the care of children typically falls on women, forcing women to give up paid work to take over the care of children and other vulnerable family members which is further compounded by the gender pay gap making it harder for women to meet families’ basic needs.[32] Since the start of the pandemic 25% of self-employed women have lost their jobs and as the pandemic has continued this unemployment has risen.[33] Quarantines have also economically impacted women as 72% of the domestic workforce of whom 80% are women have lost their jobs. [34]

Therefore, what this illustrates is the existing tensions between global health security and upholding human rights under the IHR in times of emergency. Even though the most vulnerable need the highest level of protection it is their rights that are conspicuously invisible in global health governance.


[1] JM Mann, S Gruskin, MA Grodin et al, Health and human rights: a reader (1 edn, New York Routledge 1999) 11-18.

[2] S Sekalala, L Forman, R Habibi, et al. ‘Health and human rights are inextricably linked in the COVID19 response’ (2020) 5 BMJ 1,2.

[3] UNSC 2000, 2014.

[4] A Ferhani & S Rushton, ‘The International Heath Regulations, COVID-19, and bordering practices: Who gets in, what gets out, and who gets rescued?’ (2020) 41 Contemporary Security Policy 458, 459.

[5] WHO, ‘International Health Regulations (2005)’ (2 nd edn, WHO 2008) 10-11.

[6] Human Rights Watch, ‘Human Rights Dimensions of COVID-19 Response’, (hrw.org, 19 March 2020) accessed 20 Jan 2021.

[7] Human Rights Watch, ‘Human Rights Dimensions of COVID-19 Response’, (hrw.org, 19 March 2020) accessed 20 Jan 2021

[8] World Health Organisation, ‘COVID-19 Public Health Emergency of International Concern (PHEIC) Global research and innovation forum’ [2020] WHO Publications accessed 20 January 2021.

[9] N Ryan & A Ayadi, ‘A call for gender-responsive, intersectional approach to address COVID-19’ (2020) 15 Global Public Health 1404, 1405.

[10] A Guterres, ‘UN Security-General addressing the impact of COVID-19 on women’ (Twitter, 9 April 2020) < https://twitter.com/antonioguterres/status/1248321088481832960> accessed 20 January 2021.

[11] N Ryan & A Ayadi, ‘A call for gender-responsive, intersectional approach to address COVID-19’ (2020) 15 Global Public Health 1404, 1405

[12] N Ryan & A Ayadi, ‘A call for gender-responsive, intersectional approach to address COVID-19’ (2020) 15 Global Public Health 1404, 1405

[13] International Committee of the Red Cross, ‘War and International Humanitarian Law’ (icrc.org 29 October 2010) accessed 20 January 2021.

[14] United Nations, ‘Security Council Adopts Resolution 2286 (2016), Strongly Condemning Attacks against Medical Facilities, Personnel in Conflict Situations’ (un.org 3 May 2016) accessed 20 January 2021.

[15] K Meagher, N Singh, P Patel, ‘The role of gender inclusive leadership during COVID-19 pandemic to support vulnerable populations in conflict settings’ (2020) 5 BMJ 1.

[16] C Wenham, S Asthana et al, ‘Strengthening pandemic preparedness and response begins with answering the question: where are the women?’ (Thebmjopinion, 20 November 2020) https://blogs.bmj.com/bmj/2020/11/20/strengthening-pandemic-preparedness-and-response-begins-withanswering-the-question-where-are-the-women/ accessed 20 January 2021.

[17] As above

[18] As above

[19] As above

[20] K Meagher, N Singh, P Patel, ‘The role of gender inclusive leadership during COVID-19 pandemic to support vulnerable populations in conflict settings’ (2020) 5 BMJ 1.

[21] S Harman, ‘Ebola, gender and the conspicuously invisible women in global health governance’ (2016) 37 Third World Quarterly 524

[22]0 N Sharma, S Chakrabarti & S Grover, ‘Gender differences among family- caregivers of people with mental illnesses’ (2016) 6 World Journal of Psychiatry 7.

[23] S Harman, ‘Ebola, gender and the conspicuously invisible women in global health governance’ (2016) 37 Third World Quarterly

[24] As above

[25] As above

[26] A Topping, ‘COVID-19 crisis could set women back decades, experts fear’ The Guardian (London, 28 May 2020) accessed 20 January 2021.

[27] UN Women, ‘COVID-19 and its economic toll on women: The story behind the numbers’ (unwomen.org, 16 September 2020) < https://www.unwomen.org/en/news/stories/2020/9/feature-covid19-economic-impacts-on-women> accessed 20 January 20

[28] As above

[29] As above

[30] As above

[31] Womenkind Worldwide, ‘How is COVID-19 affecting women and girls?’ (womenkind.org.uk) accessed 20 January 2021

[32] As above

[33] UN Women, ‘COVID-19 and its economic toll on women: The story behind the numbers’ (unwomen.org, 16 September 2020) < https://www.unwomen.org/en/news/stories/2020/9/feature-covid19-economic-impacts-on-women> accessed 20 January 2021.

[34] As above