Blanca Obón, doctor at the Clinical Hospital: “The violence and poverty suffered by women do not end when the war ends.”

A study involving doctors Blanca Obón and Isabel Gutiérrez from the Lozano Blesa University Clinical Hospital concludes that sexual violence is not an inevitable consequence of armed conflicts, but a deliberate strategy with physical, psychological, and social repercussions that can last for decades.

When we talk about war, the image that usually comes to mind is one of bombings, fighting, or buildings reduced to rubble. However, there is another, far less visible devastation that continues long after the shooting stops and that rarely occupies the center of public debate. It is the devastation suffered by thousands of women and girls whose bodies become a battlefield and whose physical, mental, and social health is scarred for years.

This is the starting point of the study 'Impact of armed conflicts on the health of women and girls', prepared by a group of researchers including two doctors from the Lozano Blesa University Clinical Hospital in Zaragoza, Blanca Obón and Isabel Gutiérrez. Both belong to the Health Services Research Group of Aragon (GRISSA), which is part of the Aragon Health Research Institute (IIS Aragón). The study is funded by the Spanish Society of Epidemiology and the Working Group on Gender, Sexual Diversity and Health (GEyDIS).

The work, which also includes Christian Gil Borrelli, María Ángeles Rodríguez Arenas and Carmen Vives Cases, reviews the scientific evidence published between 2013 and 2025 and analyzes how wars specifically affect women from a public health and gender perspective.

Among the conclusions, the Valid identity document She states that “sexual violence is not an inevitable side effect of armed conflict, but rather a tool deliberately used to sow terror, break up communities, displace populations, or alter the ethnic composition of certain territories.” This direct violence is compounded by the collapse of healthcare systems, which leaves millions of women without access to obstetric care, contraceptives, medical treatments, or basic menstrual hygiene products.

“It is important to make visible that war is also this,” summarizes Blanca Obón Azuara, a specialist in Preventive Medicine and Public Health, adding that “armed conflicts massively affect the entire population, but with a greater disproportion among women and girls because they face specific vulnerabilities.”

In an interview with elDiario.es, the researcher explains that much of the violence perpetrated against the civilian population has a clear gender component. In fact, as she points out, attacks against women aim, among other things, to destroy family and community ties, humiliate the population, or cause forced displacement.

“Systematic sexual violence acquires a biopolitical component and is used to force pregnancies with the aim of altering the ethnic composition of a population, constituting a form of domination and a mode of extreme control over women's bodies,” she points out.

A war strategy, not collateral damage

One of the main messages of the study is to dismantle the idea that sexual assaults appear as a consequence of the chaos inherent in any conflict.

The review includes evidence from international organizations such as the United Nations, the World Health Organization, Amnesty International, and Human Rights Watch, which document repeated patterns of gang rape, sexual torture, genital mutilation, and forced pregnancies in settings such as Bosnia, Rwanda, Ethiopia, and Ukraine.

“International organizations document how in armed conflicts there are patterns of gang rape, genital mutilation and sexual torture as a systematic practice during military occupation,” explains Obón-Azuara.

In other cases, she adds, rape is used as a mechanism of political punishment or the forced displacement of entire communities. Therefore, recognizing this reality represents a shift from both a legal and a healthcare perspective, since for decades many of these attacks were rendered invisible or considered inevitable consequences of war. However, sexual violence is now recognized as a war crime and, in certain contexts, as a form of genocide.

“Recognizing all these war crimes that previously went unpunished and invisible means developing systems to prevent them from happening again and implementing appropriate health responses to the situations of women in the affected territories,” she says.

When the healthcare system also disappears

The study insists that war causes harm even when no one is directly shooting at a woman, due to the destruction of hospitals, the lack of medical staff, or the disruption of basic services, which therefore affect women's health.

During a conflict, prenatal care, contraception, urgent obstetric care, post-sexual assault prophylaxis, and access to menstrual hygiene products also disappear. All of this translates into an increase in unwanted pregnancies, infections, obstetric complications, and preventable deaths.

“In conflict situations, essential services are disrupted, which directly contributes to increased maternal morbidity and mortality,” the doctor explains, adding that “it is estimated that more than 500 women die every day from causes related to pregnancy or childbirth in these conflict contexts.”

Regarding the lack of menstrual hygiene products, although "it might seem like a secondary issue", it translates into recurrent infections, anxiety and exposure to situations of shame, isolation or insecurity.

While the physical consequences are evident, the psychological ones often last much longer. As Obón points out, the study shows that women survivors of sexual violence have “a three times greater risk of developing post-traumatic stress disorder than those exposed to other forms of violence during war.”

Depression, anxiety, chronic insomnia, guilt, social isolation, or suicidal thoughts are some of the aftereffects that do not disappear when the conflict ends.

“It is important to differentiate the trauma resulting from sexual violence from the general trauma of war because only in this way can appropriate and culturally adapted responses be designed that avoid the stigmatization of survivors and truly contribute to their recovery,” she points out.

That is why the study insists that the health response cannot be limited to treating physical injuries, but must "incorporate specialized psychological care and long-term support."

The war continues after the war

As this professional acknowledges, one of the aspects that most caught the researchers' attention during the review of the scientific literature was the realization that many of the most serious consequences appeared after the fighting had already ended. Although direct violence and the collapse of health services predominate during conflict, there are other forms of violence that, at first glance, "go unnoticed."

In their view, women take on the care of their families, face the loss of income, suffer difficulties in accessing employment, and even lose the right to own land.

“Poverty does not result from individual decisions of women, but from the interaction of property norms, exclusion from credit and land markets and the absence of these variables in the institutional design of reconstruction,” she emphasizes.

This phenomenon is called the feminization of poverty and constitutes one of the main obstacles for survivors to rebuild their lives.

Aragon can also learn

Although it may seem like a distant reality due to the distance, Obón points out that Spain “is not an external observer,” but rather an “active recipient.” This position, he adds, makes it “a legitimate and necessary place to generate and apply knowledge.”

In Aragon, she adds, there is a legal framework that guarantees healthcare for refugees and specific protocols for responding to situations of sexual violence or female genital mutilation. However, she laments that “these protocols have not been audited and their actual implementation is unknown.”

Added to this situation are administrative barriers that delay access to healthcare and difficulties arising from language or the fear many women have of losing asylum if they reveal the violence they have suffered.

During the arrival of refugees from Ukraine, rapid reception systems were activated in Zaragoza thanks to institutional coordination. However, the researcher questions whether that same capacity to respond would exist in the face of conflicts with less media attention: “We are technically prepared, but operational compliance is uneven.”

The study also focuses on how healthcare professionals must not only treat the physical injuries of victims, but also "know how to detect situations of violence, accompany women towards social, psychological or legal resources and document each case rigorously."

“The medical record has legal and expert weight as evidence, which will scientifically corroborate what people have suffered and allow a reparation process to begin,” he maintains, in addition to sharing that this ethical dimension is an “inseparable” part of the practice of medicine.

Investigate so that oblivion does not win.

The researcher is concerned that the constant succession of international crises ends up normalizing this violence. “The neglect isn't just media-driven. It has a measurable budgetary impact,” she argues.

The data shows that, three years after the start of the invasion of Ukraine, almost half of the organizations dedicated to women's economic empowerment had reduced their programs, especially as the social and health consequences began to become more visible.

Source: eldiario.es