Take five: “Gender-based violence survivors can guide the transformation of our health systems and shape policies that truly support them”

Dr Hans Henri P. Kluge has served as the World Health Organization (WHO) Regional Director for Europe since February 1, 2020, just before COVID-19 was declared a global pandemic, and is now in his second term. Since then, he and his team have led WHO’s pandemic response across 53 countries in Europe and Central Asia. As WHO/Europe builds and implements its second five-year European Programme of Work 2025-2030, together with its Member States, the organization will be launching a special initiative on violence against women and girls, including addressing the alarming pushback on sexual and reproductive health and rights. On October 21-22, 2024, Dr Kluge spoke at the Beijing+30 Regional Review Meeting, titled “Reviewing 30 Years of Beijing Commitments to Accelerate Gender Equality in the UNECE Region,” and shared his views on major public health challenges in addressing violence against women and girls in the UNECE region, focusing on emerging issues such as conflict and technology-facilitated violence. In this interview, we delve further into these issues and discuss the critical policy actions needed to accelerate the implementation of the Beijing Declaration Platform for Action, as well as his vision for the region by 2030.

What is the WHO’s primary strategy for addressing violence against women in Europe, and how is being tailored for the UNECE region?

First and foremost, we must address the root causes of violence against women and girls, because ending this epidemic is possible. This requires tackling underlying health inequalities, structural discrimination, and harmful norms that perpetuate violence, including toxic masculinity, patriarchal values, and femicide.

How do we do this? The core of WHO/Europe’s new health system strategy is built on trust and transformation. This means that we need to respect women and girls, and, crucially, we need to listen to the voices of survivors of gender-based violence. When survivors share their experiences, their insights can guide the transformation of our health systems and shape policies that truly support them.

Violence against women and girls manifests in many forms: from physical to sexual, psychological, technology-facilitated, or cultural and traditional norms that inflict and perpetuate deep harm.

All forms of violence are unacceptable. The health sector plays a pivotal role as an entry point for addressing violence against women. Why? Because many survivors seek care in hospitals. Therefore, we must increase healthcare workers' awareness of violence against women and equip them to respond effectively. According to the Organization for Economic Cooperation and Development, survivors often trust healthcare workers, particularly in primary care, more than any other professionals outside of close family and friends. This trust underscores the importance of having clear protocols and a commitment to prioritizing gender-based violence in the new WHO vision on health and well-being in Europe and Central Asia for the next five years.

Despite progress and commitment on various fronts, we know we're still not doing enough. As a physician and father of two daughters, it is deeply troubling to me that one in four women in the WHO European Region experience violence. This figure highlights the urgent need for change, especially as many survivors remain unheard.

We must also address the persistent stigma, fear, and discrimination, that prevent women from speaking out. Many women endure in silence, fearing retaliation, disbelief, or worsening of their situation if they share their stories. That's why I am committed to a collective approach. While the health sector has a crucial role, it is only one piece of a larger puzzle. Every sector of society must work together, with civil society playing a vital part – from grassroots organizations and crisis centres to community members - to create a safe environment where women and girls can find support, dignity, and empathy. 

Lastly, WHO is dedicated to improving research and data collection, especially sex-disaggregated data, to measure the true impact of violence on women.

These are the four pillars of our strategy. And as individuals, we must “walk the talk” in our actions. This commitment must be reflected in how we treat each other – whether in a public space or a meeting room.

What are the main public health challenges in preventing and responding to violence against women and girls in the UNECE region, particularly in light of emerging issues like conflict and technology-facilitated violence?

The first major challenge is awareness – among policymakers, healthcare workers, and the general public. Raising awareness of violence against women and ensuring it’s prioritized on political agendas is essential. In my five years as WHO/Europe Regional Director, I rarely encountered spontaneous discussions on this topic when speaking to Member States, largely due to the sensitivity surrounding it.

Access to sexual reproductive and health services remains a significant barrier for women in many countries. I witnessed this firsthand at the Poland-Ukraine border, where women crossing with their children were unable to access safe abortion and other reproductive health services in Poland at the time. Through behavioural and cultural insights research, we can identify barriers to these services, which help us create evidence-based policies and responses. There has been significant work done in Poland to amend the consent laws for sexual assault and the different Ministries are now working together to develop a national protocol for the clinical management of rape and intimate partner violence, applicable to all health institutions.

Another persistent challenge is outdated or inadequate legal frameworks, particularly regarding safe abortion. 

Additionally, discrimination remains a pervasive issue, affecting both men and women of migrant origin across Europe. We also see ongoing discrimination against LGBTQ+ individuals, with some countries enacting policies that breach the universal principle of respecting every person’s inherent dignity. 

The second key challenge is within the healthcare system itself. Healthcare professionals and systems must be equipped to identify and respond to violence against women effectively, given that one in four women in our region is affected.

We as health professionals also need to ensure that we do not support practices that violate the rights of women and girls. I am horrified that virginity testing continues to be practiced in some parts of our Region. This must stop immediately - it has no scientific merit and is rooted in harmful socio-cultural practices informed by archaic beliefs about the role and value of women. We have a responsibility to challenge myths related to virginity as well as the harmful gender norms that serve to control women’s and girls’ sexuality and bodies.

I am also very concerned about the mandatory reporting of adult survivors of GBV and policies that make health care contingent on the provision of a police report. Ministries of Health and Justice need to work together to remove barriers to accessing health care, including aligning laws and policies with WHO guidelines.

WHO has been actively collaborating with medical universities to integrate training on gender-based violence into medical and nursing curricula, ensuring that future healthcare workers are better prepared to support survivors.

Regarding the Beijing Declaration Platform for Action, what critical policy actions are needed to accelerate its implementation and achieve the Sustainable Development Goals (SDGs)? 

At a macro level, we must advocate for these goals with a strategic approach, particularly at global forums like the upcoming 69^th session of the Commission on the Status of Women (CSW69) at the UN in New York in March. The emphasis should always remain on substance and shared responsibility, without politicizing the conversation. Violence against women should never be politicized, as it impacts societies equally.

The health sector plays a vital role as an entry point to identify women at risk and provide essential support for survivors of violence. By strengthening health systems to respond to these needs, we can make meaningful progress in advancing both the Beijing Declaration and the SDGs’ targets on ending gender-based violence and related issues.

How would you like to see the region in the next five years, by 2030, in terms of gender equality, women's health, and women's safety?

Ideally, we would have zero out of four women experiencing violence.  While reaching zero may be a distant goal, we must at least see a swift and visible shift in mindset and culture. And for this, if I have to say one word, it's peace. There is no health without peace and no peace without health. We know that gender-based violence escalates amid conflict and disasters. Peace is the most important medicine that we need today.

As we conclude, what message would you like to send to policymakers, healthcare professionals, and citizens in the UNECE region about the importance of ending violence against women and girls?

Violence against women - or any form of violence - is unacceptable. What kind of society are we if we allow this to persist? We must nurture, respect, and cherish all women, whether they are our grandmothers, mothers, spouses, or anyone else, regardless of their background or orientation. The maturity of a society, in my view, is best measured by how we respect and value women and girls.