Overall, very limited evidence was found on women leaders in the field of conflict and humanitarian health. We screened just over 160 papers and reports and found 54 relevant ones which were reviewed and critically discussed. Of these 25 were from grey literature sources from humanitarian and development organisations, eleven peer reviewed articles, six from online news sources, four opinion pieces, three commentaries, three from conference materials, one press release, and one from social media. Only 19 of the sources included overall specifically discuss women leaders in this domain. Of these six were from grey literature sources from humanitarian and development organisations, three from online media sources, three peer reviewed articles, two from conference materials, two opinion pieces, one commentary, one press release and one from social media. The humanitarian and development organisations represented in the grey literature sources are: UNOCHA, WHO, ALNAP, Humanitarian Advisory Group, CARE, Centre for Humanitarian Leadership, ActionAid, OECD and Grand Challenges Canada. There are also limited data on the percentage representations of men and women at different levels of management and leadership in most humanitarian (and related) organisations. The majority of the sources discussed humanitarian and conflict settings in general without specifying exact locations, however, some sources specifically mention the following regions and countries including: Asia, Middle East and North Africa, Africa, Syria, Jordan, Yemen, Bangladesh, Nepal, Malawi, the Democratic Republic of Congo, and the Philippines.
We begin by discussing why women leaders in conflict and humanitarian health are important, then focus on key barriers that hinder women’s leadership in this domain, namely, societal, organisational culture, funding, and policy and practice, and finally highlight the available opportunities for WLHC.
Role of Women’s Leadership
Studies on gender and leadership suggest that there are gendered differences in leadership styles; women tend to have a different yet complementary leadership style to men due to skills and strategies learnt whilst overcoming systemic barriers during their long stay in the mid-career phase, and capitalising on traits that they are traditionally associated with, including a more democratic and transformational approach to leadership than male counterparts.[39-41] A survey conducted by United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) of over 1000 women humanitarians in 115 countries found three unique attributes women bring to humanitarian action: firstly, the ability to speak to women from affected communities; secondly, unique perspectives; and lastly, a unique style of leadership.
Women’s representation and engagement in leadership roles would put women’s issues at the front of the global agenda, challenge the traditional hierarchies of knowledge and power by highlighting undervalued and unrecognised knowledge, and advocate for more inclusive, diverse and representative decisions.[43, 44] Therefore, rebalancing unequal power in the workplace by having more women leaders would improve organisational performance and revenues. Evidence from sectors such as the development, financial and private sectors show that greater diversity and inclusion results in macroeconomic growth, efficiency and better regulation overall.[45, 46] Christine Lagarde, current President of the European Central Bank and former President of the International Monetary Fund, argues that “employing more women and tackling sexism in the workplace is the key to making the world economy richer, more equal and less prone to financial collapses.” The Global Gender Gap Report 2020 states that persistent gender inequality in leadership is a significant global economic risk and obstacle for human development. The average human development index for women is six percent lower than that of men, with countries in the low development category suffering the widest gaps – which tend also to be countries impacted by conflict and humanitarian crises.
Some data suggest that leaders in this sector also require diverse, adaptable skillsets that enable them to effectively work across many cultures and contexts, working with communities, national and international staff and partners, whilst ensuring their leadership style facilitates capacity strengthening opportunities for national staff and partners.[38, 49] Evidence from leading humanitarian organisations suggests that global efforts to protect and assist people caught up in conflict and national disasters will be more effective if more women contribute in leadership roles.[1, 50, 51] In an article in the Lancet series on humanitarian health, Paul Spiegel states that the humanitarian system requires a major reform of leadership and coordination models, as the current system does not reflect the complexity and diversity of current humanitarian emergencies. Spiegel further notes that for any leadership revision to occur, governments, UN agencies, multilateral organisations, and international NGOs “need to put aside differences and relinquish authority, influence, and funding.” A similar sentiment was reiterated by Lan Mercado, Asia Regional Director of Oxfam who recently stated that “having more women humanitarian leaders will help transform the humanitarian system.” This may in turn, assist in the leadership change required to better meet the needs of those affected by conflict and humanitarian emergencies.
Indeed, Cooperative for Assistance and Relief Everywhere (CARE) International’s research on women working in the humanitarian sector shows that women might be better at identifying needs and realities of different groups; they may be able to use social capital and networks to reach other women at different geographical levels; they might provide a space for women’s voices, and supporting women’s leadership potential; provide solidarity to other women and girls in day-to-day spaces and activism; and may help to make interventions gender transformative, and potentially more sustainable. However, unlocking the benefits of greater diversity in the conflict and health domain requires focused action to address the underlying causes of persistent gender gaps in a systemic way.
Barriers hindering women’s leadership in conflict and humanitarian health
a- Societal level
Entrenched socio-cultural gender discrimination results in an immense pool of untapped talent in many countries. Patriarchal sociocultural values and their associated gender ideologies are negatively related to women's career development, limiting career choices to those that adhere to the traditional division of labour and which do not compromise domestic responsibilities.[2, 59] Women are also expected to occupy lower‐level roles due to culturally coded linkages between leadership and masculinity. For example, women remain largely underrepresented at all levels of governance in the Arab region with the average proportion of female members of parliament is 19 percent, which is below the global average (25 percent). [48, 60] Even in “women friendly” sectors, a study conducted on women leadership in academia in the Arab world, found that women lead fewer than seven percent of Arab higher-education institutions (48 out of 702 universities). This non-permissive environment impacts women’s construction of their leadership identities and their self-perception as leaders, which results in low self-confidence and discouragement from the pursuit of high-level positions. The few who decide to break the norm could be subjected to discrimination, opposition, life threats, or imprisonment.
Many of these barriers are echoed in humanitarian, fragile and post-conflict contexts including, but not limited to, Bangladesh, Ethiopia, Nepal, Gaza, the Philippines, Sierra Leone, Zimbabwe, northern Uganda, Cambodia, Guatemala, El Salvador, Honduras and Nicaragua.[2, 62, 63] The barriers reported in these settings include socio-cultural and economic obstacles for women exercising agency and leadership in humanitarian crises; patriarchal attitudes and norms that restrict women’s participation in public space and undermine their contribution as leaders; women’s burden of unpaid work; a lack of experience and opportunities to participate in leadership, exclusion from emergency response decision-making structures; low self-confidence; poverty and access to resources; and low levels of education and literacy.[2, 64]
b- Organisational level
Organisational culture across the conflict and humanitarian health domain is a replication of societal level challenges as it is discriminatory, deeply misogynistic and generally hinders women pursuing leadership roles. Few of the leading organisations working in this sphere have (or have had) a woman in their leading managerial role although Oxfam, MSF, and the WHO are notable exceptions, with Winnie Byanyima and Joanne Liu both being appointed to the top leadership roles at Oxfam and MSF respectively in 2013. Margaret Chan was WHO Director General from 2006-2017 and Gro Harlem Brundtland served in that role from 1998-2003. WHO is one of the few UN agencies to have had a female Director General; indeed the UN has never appointed a female Secretary General. Organisational cultures in conflict and humanitarian health and beyond tend to be gendered, meaning that assumptions about leaders and the contributors to effective leadership are typically male-normed.[56-58]
In 2018, Oxfam and Save the Children were rocked by a cascade of sexual misconduct accusations. It was revealed that Oxfam UK staff, including the Country Director, had been paying local young women for sex in Haiti whilst working on the humanitarian response to the 2010 earthquake. Following this, further allegations of sexual abuse and misconduct of staff within aid organisations emerged, including Save the Children, including allegations of poor standards of process and governance in the way some of these cases have been dealt with. In addition to the reputational damage caused by sexual misconduct, harmful organisational cultures also have a strong impact on financing shortfalls. In light of the sexual exploitation scandal in Haiti within Oxfam, the organisation was forced to make £16 million cuts to aid projects with several private donors being cancelled., while Save the Children was suspended from its bidding for UK government funding.
To mitigate these issues, zero tolerance policies of sexual harassment and gender-based violence have been implemented in a number of organisations working in conflict-affected areas. While this is a significant development, it is insufficient to stymie the prevalence of sexual misconduct. The UN adopted such a policy in 2018, after a survey found that one third of UN staff and contractors experienced sexual harassment. Large aid organisations working across multiple countries and contexts have found that instilling a comprehensive zero tolerance culture can be challenging, particularly when contractors are not covered by their sexual harassment and abuse policies.[69, 70] Helen Clarke, former Head of the UN Development Programme, urges organisations to act on their promises of zero tolerance in the workplace in order to see more women take on leadership roles and improve gender parity. In a recent report, Deloitte (a large multinational accounting company) states that strategies designed to address conduct and culture in the workplace fail upon implementation because they conflict with entrenched practices. Furthermore, the report notes that organisations must implement reporting mechanisms that employees can utilise without fear of reprisals.
Evidence also shows that sexism, sexual harassment, gender pay inequity, and fewer chances for promotion are key barriers that women in the scientific, medical and academic sector face.[49, 62, 73, 74] Laurie Garrett’s article in the BMJ provides recent analysis of the barriers experienced by women leaders in the scientific and medical sector. Female advancement in this sector faces significant barriers in access to advanced education, career progression and promotions, extreme bias in research funding, access to journal publication, and invitations to present at high-level meetings. Several factors have been identified: inadequate guidance and mentoring, difficulty balancing family responsibilities while meeting promotion criteria (especially mid-career), and overt bias and gender discrimination in the workplace. People are also less likely to recognise leadership qualities in women than in men.[77, 78]
At a recent research symposium in London on Conducting Research in Complex Environments, Dr Aula Abbara drew attention to disparities in the experiences of female health researchers in Lebanon who are increasingly conducting the on-the-ground research whilst being excluded from the processes of recognition.[72, 79] A study specifically investigating gender-based challenges of female health trainees and professionals in research institutions found that many participants viewed gender discrimination as a normal part of their culture. As for sexual harassment, most of the studies on harassment within academia are limited in sample size. Sexual harassment is underreported since many academic institutes lack a reliable and transparent reporting mechanism.[80-82] Other factors contributing to underreporting include stigma, especially in conservative societies, fears of job loss in a highly competitive market, and power imbalances.
Many organisations include gender equality and empowerment as part of their core missions in various settings. In 2016-2017, the total aid target focused on gender equality from the Organisation for Economic Co-operation and Development (OECD) was at its highest amount. However, support for aid programmes specifically dedicated to gender equality and women’s empowerment as their principal objective remained below four percent (4.6 billion USD) of total bilateral allocable aid showing a major gap in funding such projects.[84, 85] A study also demonstrated a lack of long-term support for gender equality projects as countries receiving such funds in 2008 were found to be no longer among the top recipients in 2013.
Besides funding constraints, which are very common for development projects, gender equality and empowerment projects face additional challenges in humanitarian settings. For instance, a local NGO working on women’s empowerment in Syria reported challenges in finding a balance between local needs and donor conditionality. For example, a donor’s pre-defined strategic priority was to fund an intervention focusing on women’s political participation while neglecting a highly needed psycho-social support scheme. Similarly, the same NGO struggled with a another donor that insisted on focusing exclusively on gender based violence (GBV) but through a counterterrorism lens.
Another study highlighted how gender empowerment projects in conflict settings are still being conducted, monitored and evaluated using the same purposive and extractive approaches which focus on numbers rather than needs. In other words, projects which are intended to be feminist and impactful are merely transactional. They are not conducted using feminist research designs, which incorporate reflexivity and reciprocity and challenge the intersecting power hierarchies that negatively affect women, as the current humanitarian system lacks diversity and inclusion. The weakness of the humanitarian system in terms of inclusion and support of women leadership was described in a recent report on local NGOs led by women in Bangladesh and South Sudan. The report explored how the “dearth of examples of women’s leadership related specifically to local humanitarian leadership does not reflect a lack of women’s leadership in this context”, but rather local NGOs led by women were found to lack the required support and recognition in which their efforts are not recognised in the humanitarian system.
The prevalence of detrimental policy and practice, including gender pay inequity and the motherhood leadership penalty, has been demonstrated across a number of sectors; but it is not well documented in the conflict and humanitarian health domain. A recent International Labour Organisation report highlights the issue of the motherhood leadership penalty in which mothers of young children have the lowest participation rates in managerial and leadership positions: only 25.1 percent of managers with children under six years of age are women, and for women without young children, 31.4 percent are managers. Where men share unpaid care work more equally with women, more women are found in managerial positions. Some humanitarian organisations, such as Islamic Relief, recognise the vital role of women in leadership and have introduced more transparent, flexible internal roster recruitment processes. Embedded policies such as these would encourage more women to take up leadership roles, particularly in conflict and humanitarian health where the unique demands of a humanitarian career disadvantage those with caring responsibilities, typically mothers of children. While many of the required changes to support working women require implementation at the national policy level, organisations can support mothers by implementing more flexible policies and working environments. Parenthood is a key determinant of equality of career opportunities for women and men in all sectors. Furthermore, redefining family-caring roles as shared rather than the principal responsibility of women promotes women’s retention and progression in the workforce.
Opportunities for Women Leaders in Conflict and Health
Although the bulk of the literature highlights significant barriers to women’s leadership roles in the conflict and humanitarian health domain, there are also some key opportunities for women leaders in conflict and health. Action Aid’s field research shows that conflict and humanitarian crises create potential spaces to challenge the barriers: women’s rights advocacy and localised responses facilitate shifts in power and resources can transform gender relations and empower women over the longer term. Similar trends in breaking the gender norms were also observed in the Middle East and North Africa (MENA) region. Following the Arab Spring (I) in 2011 and Arab Spring (II) in 2019, women were at the frontline of protests, which has challenged the deeply-embedded institutional and cultural barriers to gender equity.
The Syrian crisis has also created opportunities for women in host countries such as Jordan and Lebanon to work in the humanitarian field. For example, with a highly educated female workforce and an overall low employment rate among women in Jordan (21 percent), the influx of international humanitarian organisations has provided new career opportunities for women especially as humanitarian work is seen as an extension of the traditional more female-dominated domains such as health, education and social work. Since most of the international NGOs provide vacancies of equal opportunities where people are recruited based on skills, women are more capable of fulfilling senior positions in the humanitarian field and of “silently” defying the odds by working in traditionally male-dominated professions within NGOs.
Southern perspectives on barriers and opportunities for women leaders in conflict and health within the broader Women in Global Health movement have been largely missing from the current dialogues at leading international conferences, academic outputs and other events. Conferences such as the 10th anniversary of Empowering Women in Science in Kuwait in October 2017, highlighted achievements, challenges, areas for further research and policy for women in the MENA region and globally. Why women have been left behind in leadership in the Global South was a major theme at a conference on Accelerating Women’s Health Agenda: Priorities and Opportunities Through Sustainable Development Goals, in Kenya in November 2018. Around the same time, the Manila Declaration set out ambitious targets for 50 percent of all programmes to have women as leaders across the Red Cross Societies. These events and targets will hopefully set a trend for other organisations to ensure more equitable pathways for several young women aspiring to become women leaders in conflict and health.
New funding streams and activities led by Research for Health in Humanitarian Crises (R2HC)-ELRHA, NIH Fogarty, Hope in Conflict, and others aim to encourage more research in humanitarian emergencies, increase collaboration among investigators and aid organizations, and identify strategies to ensure uptake of evidence into policy and practice. About a third of proposals for “Creating Hope in Conflict: A Humanitarian Grand Challenge,” and about half of all successful research bids for R2HC came from women although it is unclear how many of these women were based in high, middle or low-income countries.[101, 102]
Prominent organisations in the humanitarian health and conflict sector must lead the way. The UN is arguably the world’s leading humanitarian organisation, whose work impacts those working on conflict and health in development and humanitarian settings. It must therefore set a leading example, and not electing a female Secretary-General in 2016 was a missed opportunity. The UN has made progress on gender equality in leadership; gender parity was again met at top levels of UN leadership, yet women continue to hold fewer positions than men at middle-management level. A 2019 report shows that only about one third of the UN’s Humanitarian Coordinators are women. A number of UN agencies, including United Nations High Commissioner for Refugees (UNHCR), UNOCHA, UN Women, have established platforms to promote the voices and experiences of women working in conflict and humanitarian emergencies. The UN, therefore, is in an opportune position to drive gender-transformative change that encourages diverse leadership across sectors by acting on its commitments and engaging with a wide range of stakeholders.