Tackling the structural drivers of gender-based violence in conflict: a syndemic-informed scoping review and population health policy model

Background Gender-Based Violence (GBV) is amplified in conflict-affected societies, including Northern Ireland (NI). The structural origins of this phenomenon are underexplored, limiting impactful health policymaking. This exploratory study utilised a conceptual framework which advanced a novel application of syndemic theory to GBV. It posited that conflict exacerbates the synergistic interaction of structural drivers of GBV such as militarism and impunity, worsening GBV-related population health outcomes.

Methods A scoping review was conducted to map the structural drivers of GBV and their interaction in conflict regions globally. The protocol was registered [INPLASY202570049] and the study followed Arksey and O’Malley (2005), PRISMA-ScR, and JBI guidance. Reflexive thematic analysis was conducted using Braun and Clarke’s (2006) methodology. EMBASE, Scopus and Medline were searched on 18/05/2025 using terms related to GBV, conflict, and health. Academic journal articles were included if they discussed the structural drivers and health outcomes of GBV in conflict-exposed adult women.

Results Of 2,140 citations screened, 93 were included. Contextually varying forms of physical and non-physical violence were reported. GBV precipitated mortality and adverse physical, psychological, reproductive, sexual, and infective health outcomes. Papers identified structural drivers across militaristic (93%), ideological (84%), socioeconomic (67%), discriminatory (62%), geographical (47%), infrastructural (42%), and environmental (5%) themes. Suggesting interactivity, 92 papers discussed overlapping drivers. No papers employed syndemic theory or measured interactions empirically; interactivity was conceptualised using socioecological, continuum, or compounding models.

Conclusion Findings support the proposition of a novel, conflict-specific ‘Health in All Policies’ model for GBV. Policies should be equity-driven, salutogenic, and tackle the interacting structural drivers of GBV through multisectoral transformative justice initiatives. Operationalised to NI, this model expands the definition of conflict-related injury, positioning GBV as an unresolved population health legacy of The Troubles. The NI Assembly should work cross-departmentally with British and Irish governmental support, embedding women’s community organisations in participatory policymaking, implementation, and governance structures.