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Table of Contents
ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 1  |  Page : 22-30

Underrepresentation of men in gender based humanitarian and refugee trauma research: a scoping review


1 PhD, Medical Anthropologist, PhD Candidate in the Division of Social and Transcultural Psychiatry, McGill University, Canada
2 BSc, Registered Nurse at the Barnes-Jewish Hospital, St. Louis, Canada
3 MSc, Health Science Librarian at the University of Ottawa, Canada

Date of Web Publication28-Mar-2018

Correspondence Address:
William Affleck
Division of Social and Transcultural Psychiatry, McGill University, Montreal
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.1097/WTF.0000000000000157

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  Abstract 


Sex and gender are important considerations within refugee studies. Risks to health and wellbeing may manifest differently for refugee women and men, as may the use of health and social services and responses to interventions. Since the 1980s, increased attention has been paid to the experience of girls and women in refugee and humanitarian research, however, much less attention has been paid to boys and men. The purpose of this systematic scoping review was to investigate whether there is a gender bias in refugee and humanitarian research on refugee trauma. Findings demonstrate that since 1988, fully 95% of gender focused refugee research addressed women’s issues, while only 5% addressed the experience of refugee men. This article offers possible explanations for this gap and discusses its ramifications for both research and clinical practice.

Keywords: gender, gender bias, sex


How to cite this article:
Affleck W, Selvadurai A, Sikora L. Underrepresentation of men in gender based humanitarian and refugee trauma research: a scoping review. Intervention 2018;16:22-30

How to cite this URL:
Affleck W, Selvadurai A, Sikora L. Underrepresentation of men in gender based humanitarian and refugee trauma research: a scoping review. Intervention [serial online] 2018 [cited 2018 Jun 23];16:22-30. Available from: http://www.interventionjournal.org/text.asp?2018/16/1/22/228770



Key Implications For Practice

  • A large gender bias exists in gender focused refugee research
  • There is an urgent need for gender sensitive research on refugee men
  • Lack of research has implications for refugee interventions



  Introduction Top


Background

Sex and gender play a central role in all human experience. For refugees and displaced populations, risks to health and well-being may manifest themselves differently for women and men, as may the use of health and social services and responses to interventions (Gururaja, 2000). For example, the events that refugee women find the most stressful tend to surround issues of physical and social vulnerability (Mezey & Thachil, 2010). For male refugees, on the other hand, stressors tend to surround the inability to fulfill masculine gender norms and roles (Vitale & Ryde, 2016).

The effect that various stressors have on mental health and wellbeing can also differ between refugee men and women. For example, studies have found that issues of under­employment and lack of social standing, which are common amongst all refugees, can be especially difficult for refugee men as they can contradict men’s sense of identity and self-worth (Colic-Peisker & Tilbury, 2007). Refugee men also feel disproportionately excluded from economically and socially valuable activities, community support and social services, which can negatively impact their mental health and wellbeing (Correa-Velez, Spaaij & Upham, 2013).

Differences can also be seen within a clinical setting. Refugee men have been found to be suspicious of mental health practitioners, more fearful of being retraumatised by the clinical encounter than women and distrustful of psychotropic medications used to treat mental health problems (Mezey & Thachil, 2010; Vitale & Ryde, 2016). Throughout the world, refugee men are also far less likely than refugee women to seek help for emotional issues or visit psychosocial services (Weiss, Vu, Tappis, Mayer, Haskew, & Speigel, 2011). Understanding the various ways that sex and gender intersect with refugee mental health is essential for designing effective services (Young & Chan, 2015).

Like many other areas of health and social science, historically the field of refugee studies relied primarily on male research subjects, ignoring the specific realities of refugee girls and women (Barakat, 1973; Mezey, 1960). During the 1980s and 1990s, research on refugee women gained increased attention. This was largely the result of two factors: increased awareness of the lack of women in health and social science research (LaRosa & Pinn, 1993; Woods, 1994.) and western mass media reports of ethnic cleansing and rape camps during the Yugoslavian civil war (Pittaway & Bartolomei, 2001). Since then, research focusing on refugee girls and women has become a priority for funding agencies and refugee support organisations at every level (Ticktin, 2011). In recent years, however, concern about gender bias in refugee studies has begun to shift in a different direction. Researchers are increasingly calling attention to the underrepresentation of men in refugee research, particularly as it relates to trauma and mental health (Oosterhoff, Zwanikken & Ketting, 2004; Correa-Velez et al., 2013).

Purpose

The purpose of this article is to investigate whether there is a gender bias in gender focused refugee mental health research. The general hypothesis guiding this inquiry, derived from seven years of studying refugee men’s experience, is that there is a dispropor­tionately high number of studies that focus on refugee women to the exclusion of studies that focus on refugee men.

In this article we use the term ’gender bias’, rather than ’sex bias’. Unlike sex, which is biologically determined, gender is a social construction, encompassing expectations and norms about behaviour, choices, roles, and interests (Scott, 1986). It is also a relational system of stratification that structures relationships and interactions between and among men and women, shapes access to resources and status, and signifies power (Connell, 1987; Butler, 1990). Various social scientific theoretical traditions have emerged to explain gender (Risman, 2004). Most interpret gender as the result of social interaction and accountability to others’ expectations. Lorber (1994) for example, views gender (like culture) as a ’human production that depends on everyone doing gender’ (Lorber, p. 2). Lorber argues that everyone ’does gender’ without thinking about it. Thus, if the men and women are not proportionally represented in gender focused, refugee mental health literature, the bias may well reflect societal forces that influence the various parties involved in research such as participants, researchers, funding agencies, etc.


  Methods Top


Data for the investigation of the hypothesis were collected from the following databases: Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Medline in Process (via OVID), Embase (via OVID), PsycINFO (via OVID), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). A search strategy was developed to define keywords for all searches (see Appendix 1 [Additional file 1] for the Medline search). The Cochrane Library was searched with Medical Subject Headings (MeSH) and keywords included from the Medline strategy. There were no date restrictions, with the search ending in February of 2017. For feasibility purposes, only articles in English and French were retrieved. All references were entered into an Endnote file for processing (n = 6076). After duplicates were removed, the search yielded 2427 studies.

Analysis

Two authors (WA and AS) independently coded the articles, selecting only those that fit the following inclusion and exclusion criteria: (a) were empirical (quantitative, qualitative, mixed-methods); (b) had women or men in the title, keywords, or abstract (or a corresponding designation; e.g. mother, father, grandfather, grandmother, aunt, uncle, etc.); (c) had refugee in the title or abstract (or a corresponding designation; e.g. displaced persons, internally displaced, asylum seeker, but not immigrant, migrant, etc.); and (d) focused on psychological trauma as it relates to the refugee experience such as war, sexual assault, rape, gender-based violence, displacement, political violence, and natural disaster (not motor vehicle accidents, childhood bullying, etc.). Among the initial sample of 2427 articles, 379 met the inclusion criteria. The two authors agreed on 375 of the studies. There were four studies upon which the coders did not agree. After further discussion, these studies were excluded from the final sample because they only made passing reference to refugee women, but did not focus on refugee women directly. Articles were then divided into two binary categories based upon the primary focus of the research: ’women studies’, which focused on refugee women, and ’men studies’ that focused on refugee men. Categories were mutually exclusive. In other words, studies were classified as either women studies or men studies. They could not be classified as both. There were a small number (six) studies that focused on the experience of both men and women. These studies were excluded from the final sample. Although they would be valuable for understanding how the refugee experience is gendered, they were not relevant to the primary research question of whether there is gender bias in the overall gender focused refugee literature.


  Results Top


The collected results support the hypothesis: the retrieved articles showed a significant underrepresentation of studies examining men’s experience. Of the 373 articles that met the inclusion/exclusion criteria, 94.5% (n = 352) of the studies focused on women, while only 5.5% (n = 21) studies focused on men. There were also surprisingly few male refugee researchers examining issues of gender. Of the 373 studies identified, only 36 (9.5%) had male first authors, while 337 (90.5%) had female first authors. Of the 352 studies that focused on women, 326 (92.5%) had female first authors, and 202 (56%) had all female authors. Of the 21 studies focusing on men, 14 (66%) had male first authors, and six (28%) had all male authors.


  Discussion Top


The lack of attention paid to men’s issues in specifically gender focused, refugee mental health research is not surprising. In research and policy practices, the notion of ’gender and health’ is often conflated with ’women’s health’ (Richardson & Carroll, 2009; Smith & Robertson, 2008; Wilkins & Savoye, 2009). In light of this historical disadvantage, the wealth of female oriented studies over the past 30 years is understandable. However, earlier refugee studies did not examine gender as a topic of study, and as such, did not address men’s gender experience. The United Nations High Commissioner for Refugees (UNHCR) and its Executive Committee have long stressed that situations of flight and displacement affect men and women differently and effective programmes must recognise these differences (UNHCR, 1980). This relies on understanding how the experience of disaster is gendered for both women and men. In light of this need, the scale of underrepresentation of men’s issues in disaster research is startling and deserves further consideration.

The most prominent reason given by researchers for their focus on women is the contention that women are more vulnerable during and after periods of mass catastrophe than are men. This is, of course, an understandable position: there are clear social and political inequalities that affect the lives of women and girls throughout the world and increase their vulnerability. Research also indicates that the life expectancy gap between men and women (which tends to favour women) narrows after both wars and natural disasters, suggesting that more women than men die as a result of mass catastrophes (Neumayer & Plumper, 2007). This claim is not unproblematic, however. Natural disasters provide one of the primary sources of population displacement (Campbell & Nair, 2014). Although few countries report deaths from natural disasters by gender, those that do track this distinction report higher numbers of male than female fatality in the wake of such disasters. In the USA, for example, between 2000 and 2015, almost twice as many men were killed in weather related disasters than women, on average (see Figure 1). This pattern holds for most types of natural disaster except earthquakes (where mortality rates tend to be higher amongst women).
Figure 1: Summary of fatalities for natural disaster by gender in the United States of America. US Source: National Weather Service, Office of Climate, Water, and Weather Services, 2016.

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Researchers attribute these differences to gender roles, which tend to keep men outdoors and women indoors. During an earthquake, it is particularly dangerous to be indoors, but covered shelter may provide protection during other types of weather related catastrophes, including hurricanes, cyclones and floods (Fothergill, 1996). Similarly, gender roles tend to dictate that men, as ’protectors’, are exposed to significantly higher risks, both during and after a disaster (Mishra, 2009). For example, the vast majority of the 800,000-plus ’liquidators’, civilians who helped clean up the Chernobyl site over several years and received the highest exposure to radiation, were men (World Health Organization; WHO, 2002).

In the case of war and human conflicts, another leading cause of population displacement (Campbell & Nair, 2014), mortality rates tend to be significantly higher amongst civilian men than amongst women: men are more often forced to engage in active combat, detained and killed at higher rates due to suspicion that they are secret combatants, and are usually the last to be evacuated from war zones (Reza, Mercy, & Krug, 2001; Murray King, Lopez,Tomijima, & Krug, 2002; Li & Wen, 2005; Spiegel & Salama, 2000).

Many researchers who focus on refugee women’s experience also argue that women experience the majority of suffering in the aftermath of war and natural disaster (Chew & Ramdas, 2005). This, too, is an understandable position: refugee women tend to shoulder the burden of responsibility for long-term caregiving of children and the elderly family members. In the aftermath of disaster, female headed households can be excluded from redevelopment programmes that privilege men as ’heads of households’ (Enarson, 2012). Additionally, refugee women lack full access to public affairs and, therefore, can be excluded from the post disaster decision making processes (Fothergill, 1996). Displaced women are more likely to have their land confiscated after war and natural disaster (Chew & Ramdas, 2005). Refugee women are dispro­portionately vulnerable to domestic violence and sexual assault (Vitale & Ryde, 2016). Also, a greater proportion of refugee women/ girls report suffering from emotional disorders and distress than refugee boys/men (Blight, Ekblad, Persson, & Ekberg, 2006).

However, the gender specific suffering of refugee women finds its counterpart in the experience of refugee men. Men suffer from their own vulnerabilities, which occur in different situations and for different reasons from those of women. For example, in times of war, men are subjected in greater numbers and with greater intensity to potentially traumatic events such as physical combat, assault, combat, injury and witnessing violent injury and death (Tolin & Foa, 2006).

Men are also subjected to more torture and imprisonment, and are tortured and imprisoned for longer periods than women (Spiric et al., 2010). Male refugees are also more likely than women to be persecuted in their own country in order to eliminate their ethno-cultural group (Carpenter, 2006). Like women, men are also subjected to sexual violence and sexual torture during war, often at shockingly high rates. An extensive study of 434 male political prisoners in El Salvador, for example, found that 76% reported at least one form of sexual torture (Agger, 1989), while a study of 184 Sri Lankan Tamil men seeking asylum in London found that 21 % had been sexually abused (Peel, Mahtani, Hinshelwood & Forrest, 2000). However, sexual abuse in men often goes unrecognised, both because men are less likely to report the abuse due to shame and stigma, and because medical professionals and aid workers are less likely to look for sexual abuse in male refugees or recognise symptoms of sexual trauma in men (Oosterhoff et al., 2004).

There are also a number of vulnerabilities of the refugee experience that are unique to men; the loss of the ’provider and protector’ role, the stigma of being dependent on relief agencies after a disaster, and the lack of self-determination that accompanies the refugee experience separate men from their traditional masculine identities, roles and relations. When these experiences lead to feelings of inadequacy and failure, they may trigger or accentuate mental health issues in refugee men (Jaji, 2009), as evidenced by the high correlation between mental health symptoms and unemployment that exists for refugee men, but not refugee women (Blight et al., 2006). There is a particularly significant danger that older men, who tend to lack the social connections of elderly women, will become socially iso­lated after a disaster and be left unsupported, leading to higher rates of depression and ex­acerbating pre-existing posttraumatic stress disorder (PTSD) (Sollund, 2010).

It has been suggested that the loss of way of life that often follows a disaster can be especially acute for refugee men. Unlike women’s gender roles, such as child rearing and cooking, men’s roles, which are often tied to local geography (farms, businesses, fishing, etc.), are likely to be lost in times of disaster and resettlement or replaced by aid organisations (Maflia, 2006). Finally, men can face discrimination from medical practitioners and aid workers during post-disaster reconstruction. The dominant discourse within nongovernmental organisations (NGOs) and international aid com­munities constructs women as extremely vulnerable; as a result, programmes tend to be designed to assist mostly (or only) women, causing men to feel neglected and emasculated (Kabachnik, Grabowska, Regulska, Mitchneck, & Mayorova, 2012; Lwambo, 2013).

Male refugees also face a number of institutional challenges. For example, they are often met with greater levels of suspicion by immigration officials than women (Deuchar, 2011) and endure harassment and arbitrary attacks from police and security guards (Jaji, 2009). Men are less likely to be granted asylum than women, and are more frequently deported by resettlement countries. During the recent Syrian refugee crisis, single men were explicitly excluded from the refugee populations accepted by many resettlement countries, including Canada (Aziz, 2015). The suspicion with which refugee men are viewed by citizens of the host country can make it harder for them to ’break into’ the resettlement culture (Hart, 2008).

The discussion of mortality statistics and examples of men’s vulnerabilities presented in this section are in no way meant to downplay the suffering of refugee women, deny the ill effects of sexism, or detract from the importance of examining refugee women’s experience. Nor is the authors’ intent to participate in what Hancock (2011) termed ’the oppression Olympics’, whereby different ’special interest’ groups compete to prove their vulnerability. Particularly in the case of refugees and displaced populations, such us-versus-them, my-pain-is-worse-than-your-pain rhetoric can lead only to unfruitful battles between the sexes (White, 1997). Rather, our intention is simply to highlight a broad and crucial question: given that an equal (or even slightly higher) number of men die in disasters than women, and given that men have their own biologically and socially determined vulnerabilities, why are men so underrepresented in gender and disaster research?

Potential explanations

The most likely explanation for the predominant focus on women in disaster research is that refugee and humanitarian researchers themselves are making this choice. Why might this be so? First, there may be an ongoing desire among researchers to redress dis­crimination by prior generations of refugee researchers who paid exclusive attention to the male experience, generalising ’human’ (a.k.a. men’s) experience to all persons (Annandale & Hunt, 2000). The early, long lasting failure of scientific research to incorporate women’s perspectives certainly sparked a shift in focus beginning in the 1980s; the overwhelming focus on refugee women’s experience may, therefore, constitute an attempt by researchers, either consciously or unconsciously, to rebalance the knowledge base by focusing on refugee women.

Second, logistical factors may account for some of the bias. It is widely recognised that it is more difficult to study men than women, particularly in qualitative research. Men are more reluctant than women to participate in health studies (Oliffe & Thorne, 2007), and a number of problems can arise during data collection–especially for studies addressing highly personal or emotionally complex topics–including minimised responses, subdued emotional expression and non-disclosure. These issues can add a great deal of stress for researchers and affect the quality of the data (Schwalbe & Wolkomir, 2001; Affleck, Glass, & Macdonald, 2012).

Third, it is possible, as suggested by Polit and Beck (2008; 2013) in the context of nursing re­search (that the gender of the researchers themselves influences their choice of topic. Like culture, gender is a social construction, which encompasses expectations and norms about behaviour, choices, roles and interests. Lorber (1994) argues that everyone ’does gender’ without thinking about it. Ninety-four and a half percent of the researchers in our sample were female. Researchers may simply be drawn to issues facing other women. Conversely, because men’s experiences of disaster do not align with these interests or sympathies, their experience may be overlooked. Again, a proper examination of this possibility is beyond the scope of this paper. However, the fact that there were a higher number of studies that focused on refugee men when some of the researchers were male gives tentative support to this explanation.

Fourth, researchers may be overlooking, or otherwise failing to recognise, men’s vulnerability in the aftermath of disaster. There are several possible reasons why this situation might arise. First, men’s own behaviour may fail to communicate or acknowledge their vulnerability. Hegemonic masculinity refers to the dominant ideal of masculinity within any specific culture (Connell, 1987). Though social constructed and variable across time and place, throughout the world, hegemonic masculinity stresses toughness and emotional control, and emphasises rationality over emotionality. As a result, men tend to censor outward expressions of vulnerability, indulging these expressions in private, or masking them behind a fagade of stoicism (Connell, 1987). Hegemonic ideals of masculinity also affect men’s help seeking behaviour (Courtenay, 2000), especially in relation to emotionally vulnerable topics such as torture, sexual assault, bereavement and mental health problems (Oliffe & Phillips, 2008).

Men also have a different style of distress expression, which may contribute to their vulnerability being overlooked within main­stream trauma research. In contrast to women, who are inclined to direct their emotional/psychological distress inward, men tend to ’act out’. Thus, where women become quieter, cry more, or seem down or with­drawn when distressed, men consume more drugs and alcohol, take greater risks and become more hostile or otherwise aggressive (Walinder & Rutz, 2001). This behaviour may make it difficult for outside observers, such as researchers, to recognise men’s emotional vulnerability. Without knowledge of mental health, it may be difficult for researchers to distinguish men’s mental health symptomatology from every day masculine behaviours, especially within different cultural groups. The morally objectionable and destructive nature of men’s distress response behaviour can also evoke feelings of blame and condemnation in observers, rather than sympathy, particularly when it is directed towards other vulnerable populations such as women and children. Compounding this difficulty, these male specific symptoms are not included in generic screening tools for many common mental disorders, including depression, anxiety disorder (Oliffe & Philips, 2008).

It is also possible that the conceptual framework used by gender and development commentators may contribute to the lack of focus on men’s vulnerability. The conceptual framework currently in vogue relies on the feminist model of patriarchy, which holds that women are more vulnerable than men within any given group, due to socially gendered power relations and women’s structural dis-privilege. Humanitarian disaster researchers have relied heavily on this framework to view issues of gender and disaster. As Juran (2012, p. 2) explains:

’The post disaster period is merely an alternative sphere in which pre-existing gender inequalities are maintained and regenerated, if not magnified. Thus, while the post disaster arena varies greatly from the ’normal time’, the overarching parallel is that disparities that existed before the disaster are perpetuated and exacerbated both during and after disasters.’

Like all conceptual lenses, this framework, while valuable risks sidelining evidence that does not fit within its frame. When women are assumed to be socially more vulnerable than men, their suffering automatically becomes the focus of attention. Similarly, the relative privilege of men, as a group, leads to their vulnerability being overlooked. In the specific case of disaster, the use of the patriarchy framework may be particularly problematic. In the aftermath of mass catastrophes, vulnerability is seldom clearly distributed along gender lines. Despite men’s general position of privilege, marginalised groups of men (including the mentally ill, the homeless, and those without jobs or money) are excluded from traditional positions of power and privilege. Not only do such disadvantaged men suffer disproportionately from disasters, but with the terrible loss of property, wealth and health that accompanies disaster, the number of these men is likely to increase dramatically. Additionally, the patriarchy framework tends to overlook the role that humanitarian aid organisations play in the post disaster context. As anthropologist Miriam Ticktin observes, in modern times, both NGOs and INGOs, tend to come to effectively ’govern’ disaster zones (Ticktin, 2011, p. 255). Virtually all of these organisations have a stated mandate to prioritise the protection of women and children (Hawkes & Buse, 2013). The starting point of the patriarchy framework, therefore — i.e., that women are more vulnerable than men because of socially struc­tured dis-privilege — discounts the central role that these organisations play in disaster relief and recovery, and the effect that these organisations have on pre-existing gender relations and patriarchal structures. As Turner (1999, p. 6) explains:

’The UNHCR’s ideology and practice of equality together with the nature of living in a refugee camp has seriously challenged notions of structures of authority. Old values and norms about essential issues such as relationships between husbands and wives, between parents and children, and between rich and poor are being challenged in the camp regime. Old authorities are losing their grip and a new authorityrepresented most strongly by the UNHCRis in control of resources, live­lihoods and ideological formations (e.g. the ideology of equality between men and women.’

The ’women-and-children first’ approach of relief agencies can dramatically affect gendered access to resources. For example, although aid organisations give food and aid on an equitable basis, this policy of equality is supplemented by special programmes for women and other disadvantaged groups. Since aid is distributed on the basis of perceived necessity, the needs of men often takes second place to those of women (Lwambo, 2013). As Jaji (2009, p. 13) explains: ’while masculinity entails privilege in "normal" situations, in exile it becomes an albatross around a refugee man’s neck.’

Lastly, the political discourse surrounding aid and humanitarian assistance may also contribute to the lack of attention to men (Cornwall, Harrison, & Whitehead, 2007). Advocacy of women’s rights sits high on western political agendas. Western donor countries and private foundations that fund most humanitarian research rely on mascu­line stereotypes to uphold and advance their political agendas (Del Zotto & Jones, 2002). Consciously or unconsciously, government and private bodies seek to position themselves as protectors of women, which is echoed in the direction of their funding (Apperley, 2015). Like all other development players, refugee researchers depend upon these countries and private foundations to fund their projects. As such, they may be pressured to focus on refugee women and overlook refugee men (Apperley, 2015).


  Implications Top


Regardless of the explanation for men’s underrepresentation in the humanitarian and refugee disaster literature, this oversight has serious implications. First, it is scientifically problematic. The omission of one sex or the other implies an untenable assumption of gender and sex neutrality or universality of the disaster experience. Yet, there is ample evidence that males and females differ in their experiences, needs and responses to interventions (Johnson, Greaves, & Repta, 2009; Oliffe, Ogrodniczuk, Bottorff, Johnson & Hoyak, 2012). To exclude the disaster experience of men undermines the evidence base on which health realities are understood and future support decisions are made. As Nieuwenhoven and Klinge (2010) put it, ’it is plainly unscientific to leave out half the population’ (p. 314), whether they be women or men.

There are also clinical implications of the neglect of research on men’s issues. There is already a widespread concern that men’s mental health issues are overlooked in clinical practice (Oliffe & Philips, 2008), and that traumatic stress interventions do not adequately consider the needs of men (Wade, Varker, Kartal, Hetrick, O’Donnell, & Forbes, 2016). The exclusion of men from the humanitarian and refugee disaster literature limits the evidence base from which health workers and humanitarian aid workers can develop viable practice.

The argument for increasing research attention to men’s disaster experience is also a practical one. Families and communities are better served when service providers are attuned to the mental health needs of both men and women following disasters. Men are rarely, if ever, completely absent from the nexus of social relationships in which women, children and families exist. Research has consistently shown that in the aftermath of disasters, the mental health and wellbeing of one family member can affect the mental health and wellbeing of the family as a whole, including refugee women and children (Fox, Cowell, & Johnson, 1995; Nickerson, Bryant, Steel, Silove & Brooks, 2010). This may be especially true when a male family member is suffering from mental illness. As discussed earlier, masculine specific expressions of emotional and psychological distress tend to include increased use of alcohol and recreational drugs, financial mismanagement, as well as increased anger, irritation and propensity for interpersonal conflict. These behaviours can substantially increase stress for families and communities that are already struggling to rebuild their lives after a disaster. The impact that a male family member suffering from psychosocial stress can have on the family may be especially significant in traditional societies where there is high gender inequality, where divorce is not culturally acceptable and where there are limited work opportunities for women (Pedersen, Trem-blay, Errázuriz, & Gamarra, 2002).

Failing to examine men’s disaster experience may also unintentionally reinforce false so­cial attitudes and beliefs surrounding men’s vulnerability that contribute to the under-representation of men in post disaster mental health interventions. These include the belief (which exists in many cultures) that mental illness is predominantly a women’s affliction for which only they can legitimately seek help (Riska, 2009), or that men are naturally less susceptible to mental illness and better able to cope with their trauma experience than women (Affleck, Thamotharampillai, Jeyakumar, & Whitley. ’If one does not fulfll his duties he must not be a man: Defeated Masculinity amongst Sri Lankan Tamil refugee men in Canada’; in preparation). Without more research on men’s experience, these beliefs may continue to go unchallenged.

Finally, including men in humanitarian and refugee disaster research is a matter of justice. The medical community in the 1970s and 1980s was criticised for its exclusion of women in research, based on the contention that this exclusion represented a type of dis­crimination. The present gender bias in the humanitarian and refugee disaster literature represents a similar type of discrimination; it is not only professionally unbecoming, it also interferes with the right to health guaranteed by the Universal Declaration of Human Rights (UN, 1948).


  Limitations Top


There were several limitations of this study. Firstly, the search strategy focused broadly on trauma and PTSD, not specifying the various types of trauma that refugees can experience such as torture, rape and sexual and gender based violence (SGBV). Many of the specific types of trauma may have been captured by the subject headings and search terms included in the search strategies, but this cannot be guaranteed as they were not specifically incorporated. Secondly, search terms such as gender and masculinity were not used on purpose, in order to keep the search broad and encompass both genders. It is unclear as to what extent these limitations may have biased or limited the results. It should also be noted that many studies addressing specific types of trauma such as rape, torture and so on, for both genders were included in the results. As well, it is likely that studies that addressed gender and masculinity would have included ’women’, ’men’ or term equivalents such as ’male, female, grandmother, grandfather, mother, father, uncle, aunt in the title or abstract. Lastly, in global health research and policy practices, gender and gender and health are often conflated with women and women’s health (Hankivsky, 2012). It is likely that the inclusion of gender as a specific search term would have contributed to rather than decreased the gender gap outlined by this study. As such, it would not have impacted the central finding that men are underrepresented in gender focused refugee research.


  Conclusion Top


Gender bias in the refugee and disaster gender literature is pervasive and widespread. Of the 373 articles that met the inclusion/exclusion criteria of this study, 94.5% (n = 352) examined women’s experience of trauma, while only 6% (n = 21) looked at men’s experience. We also found a large underrepresentation of male researchers examining issues of gender and trauma. Only 36 studies (9.5%) had male first authors, while 343 studies (90.5%) had female first authors.

Considering the uniqueness of women’s experience and vulnerabilities in the aftermath of disaster and the disregard for gender that has historically existed in disaster studies, the desire to focus on women in research is laudable. However, failing to also examine men’s experience of disaster is both ethically and practically problematic. In a 2002 report, Gender and Disaster, the WHO outlined a ’general lack of research on sex and gender differences in vulnerability to the impact of disaster’ and noted an ’urgent need for international data sets to provide sex disaggregated data on disaster related mortality, morbidity and long term health con­sequences’ (WHO, 2002, p. 4). More recently, this call was reiterated by Mazurana, Benelli, & Walker (2013), who, in recognising the anecdotal evidence on which humanitarian aid policy relies, and the problems this can cause for critical decision making in humanitarian response to emergencies called for increased sex and age disaggregated data, as well as gender and generational analysis. The findings of the present study underline the importance of these recom­mendations. Sex data and gender analysis need to be incorporated into evidence based practice for those wishing to aid civilian survivors of disaster, and this requires that research on the health and social issues of both females and males be equitably pursued. Finally, considering the potential impact that the gender of the researcher has on choice of research topic, we also echo Polit and Beck’s (2008; 2013) recommendation that measures be taken to increase the number of male investigators pursuing issues of gender in health research.[77]





 
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