Dr. Manal Tahtamouni is an OBGYN with 15 years of national and regional experience in the management and development of health programs, with a special focus in reproductive health & rights and sexual & gender-based violence. She has managed large-scale projects with multiple international organizations, including the European Union, the UN Refugee Agency, the UN Population Fund, UNICEF, the World Health Organization, and the US Agency for International Development. She participated in the development of the ‘The National Guideline for the National Family Protection Framework', ‘National Guidelines in Dealing with Child Protection and Gender-Based Violence’, and the ‘National Guidelines for the Health Sector in Dealing with Sexual Assault’ among others. She recently became the president of Sisterhood is Global Institute (SiGi).
Unfortunately, we have no idea about the levels of harassment in the health sector since it has never been researched or investigated. Although there are many attempts to stop discrimination and sexual harassment in the workplace, I am not familiar with any efforts made to explore harassment in the health sector from a research standpoint.
While I was a practicing doctor, I never heard of any policy or training related to sexual harassment within the health sector, except when I was working in a hospital in Saudi Arabia in 2002. One of the documents that HR handed us was the sexual harassment policy.
While I was a practicing doctor, I never heard of any policy or training related to sexual harassment within the health sector, except when I was working in a hospital in Saudi Arabia in 2002. One of the documents that HR handed us was the sexual harassment policy. It was very surprising because, during my medical studies, we never were taught how to deal with these so-called ‘social issues’. In fact, gender-based violence (GBV) was just recently introduced to the Jordanian health sector. GBV was not even a term used in Jordan until 5 or 6 years ago and became common during Jordan’s response to the Syrian crisis. But before that, all violence fell under family protection or domestic violence, which is why violence in the workplace was not mentioned during this time. Most of the literature, documents, and policies were related to family protection rather than to women’s protection.
In 2009, the Ministry of Health (MoH) developed their internal guidelines on dealing with domestic violence for healthcare providers working within the Ministry. However, sexual violence was mentioned infrequently in their written guidelines. All the guidelines were related to physical injuries and sexual, emotional, and psychological violence was not mentioned, apart from the classification of violence. This is very important to note because if the health sector is not recognizing sexual violence as a medical problem, that means injuries and illnesses from sexual violence will not be taken seriously.
After working with a Non-Governmental Organization (NGO) as a medical doctor and manager, I realized there is a large gap between what is happening internationally in regard to sexual violence compared to what is happening specifically in the health sector. Although the World Health Organization (WHO) recognizes health as a human right, most of the healthcare workers in Jordan view health as a service delivery rather than being rights-based. There needs to be an understanding that service delivery does not define what health truly is.
In 2007, I started working on defining the role of health providers in dealing with patients suffering from domestic violence since studies in Jordan indicated that nearly 30% of Jordanian women are affected by domestic violence. Yet, women do not seek assistance from authorities and lawyers due to social barriers. If they are to approach someone, it would be their doctors who treat them in dealing with their acute illnesses, injuries, and psychological disorders.
From this work, I collaborated with the National Council for Family Affairs in developing the national guidelines for the health sector to deal with sexual assault in Jordan, which were launched in April 2019. I worked on the development of the national guidelines for GBV and child protection including dealing with sexual violence. Instead of using the term ‘family protection’, we started using child protection and GBV, which includes sexual violence. This was a major step forward in dealing with sexual violence, however, these guidelines have not yet been adopted by the healthcare providers themselves, other than some NGOs that are providing health services. These guidelines target healthcare providers and survivors of sexual violence, but sexual harassment within the health sector has not yet been tackled.
Most definitely, there were individual cases that approached me as a manager or as an expert in violence. Yet, women are very reluctant to approach for help or talk about this issue causing harassment within the workplace to be under-reported. The problem that I face as a health manager, is the lack of policies needed to deal with these issues. All that I was able to do was initiate an investigation and perhaps terminate the perpetrator from his position, but I was unsupported due to the lack of solid policies.
I think they are treated the same, but the problem is that many girls and women cannot differentiate between what is normal behavior and what is harassment. For example, when I was in my last year of university, I suffered from vertigo due to anxiety and was examined by a neurologist. During the examination, he asked the nurse to leave the room and he started to touch me in a way that made me feel uncomfortable. Yet, I was unsure if this was normal and acceptable behavior. I felt particularly uncomfortable when he asked the nurse to leave the room, which is the main boundary set for male doctors. They must be accompanied by a female nurse in order to be in the same room as a female patient.
I never talked about this incident until I started using this story in the training sessions I provided. Therefore, if I was unable to voice my discomfort in this situation, then I am sure that other women and patients are dealing with this as well. People always make excuses for the male doctor or nurse in such incidents saying, “No, I am sure he is innocent. I am sure he was not trying to hurt you”. The usual reaction I find from female nurses is excusing this behavior as a misunderstanding. It is difficult to understand and recognize sexual harassment, but after receiving so many training sessions and participating in so many committees, I realized that if you feel uncomfortable, then that means something is wrong. Harassment is based on your perception rather than the intention of the other person.
Unfortunately, in the global health sector, more than 70% of the workforce were females, but less than 10% of women reach leadership positions. The first problem is that women are not given enough opportunities due to socio-economic reasons, including marriage expectations.
Another issue, especially in Jordan, is the early retirement options available to women. We are trying to modify these laws so that the age of early retirement is extended to 50 years of age rather than 40 years. Early retirement leads women to think that it is better to collect their pension and stay home with our kids. When women quit early, they are unable to obtain leadership positions.
Lastly, the health sector is gender blind and they do not realize that women can lead in setting health policies. They view women as the workforce (nurses, doctors, etc.) but not as policymakers. After all, most hospital boards consist of all men or only have one woman, whom they use as a token. In Jordan, we have never had a female Minister of Health or a female Secretary-General. Women’s participation is based on reaching quotas rather than the woman’s competence and experience. Even if women are present in committees, they are not regarded in the way that men are in the same positions.
Research needs to be conducted in order to identify the actual problem. This research needs to be culturally sensitive and health-specific. There needs to be a distinction between sexual violence perpetrated by health providers towards patients and sexual violence within the health sector workplace. Based on the results of this research, I think we will have the adequate documentation needed to modify laws. Laws need to give a clear definition of sexual violence and be mentioned in labor law rather than in criminal law. The implementation of these laws is crucial, therefore, we need to develop policies and procedures that are related to each organization.
Further, we need to create safe spaces for women to be able to talk about sexual harassment. I worked in UNICEF as the Chief of Health in Jordan and found that it was very difficult for women to discuss harassment and the common misunderstanding of certain words. We need to help women in better understanding what harassment is. In most of my discussions with women, they believed that if they were not touched, then it was not harassment. It is about defining the phrase ‘sexual harassment’.
