Each year about 800 000 women and girls are victims of gender-based violence. GBV takes many forms — physical, sexual, emotional and psychological — and its consequences are devastating. Cutting across cultures, borders and communities, GBV is a public health emergency, and a serious violation of human rights. It is a scourge that affects one in three women worldwide. Hold that figure in your head for a moment. If the scale of the problem is staggering, so, too, is the inadequacy of the global response. The International Day for the Elimination of Violence against Women on Nov. 25 marks the beginning of 16 Days of Activism Against Gender-Based Violence, an annual international campaign that runs until Dec. 10, Human Rights Day. This year, as we face up to the horrifying extent of GBV, a single question is paramount. How many more must suffer before the world takes meaningful action? Nowhere is the crisis more pronounced than in conflict zones, such as Sudan and Gaza, where women and girls are being systematically targeted. In Sudan, where violence has spiraled since the outbreak of conflict, the UN reports that over 6.7 million people are at risk of GBV. Armed groups have weaponized sexual violence. It is a tool of war, used to instill terror and rip communities apart. In Al-Jazirah state in Sudan, where the situation has deteriorated rapidly in recent weeks due to intense fighting, hunger has intensified, health facilities have been attacked, and there are reports of mass rapes and killings. The victims of this violence are not statistics — they are women and girls whose lives are being deliberately torn apart. Nor does the violence end when they flee their homes. Displacement brings new threats. In Gaza, the conflict and blockade exposes women, girls, children, and adolescents to heightened risks of violence. There has been a rise in incidents of sexual violence, domestic abuse, and trafficking. The psychological toll of such violence is profound. These are not isolated incidents. The threats are systemic, pervasive, and cry out for immediate action. In humanitarian settings, women and girls face a double burden — the trauma of the emergency, whether wars, natural disasters or health outbreaks, coupled with the dramatic increase of GBV. Dysfunctional healthcare systems, when not destroyed, as well as the attacks on health facilities, mean survivors have little, if any, access to lifesaving care. And in food-insecure environments, victims are further marginalized, exposed to the threat of sexual exploitation and abuse, while access to healthcare becomes even more challenging. As the global community grapples with the challenges of emergencies and instability, we must recognize GBV as the profound public health crisis it is. One in four girls will experience violence by the time they reach their mid-20s. Thirty-one percent of ever-partnered women report experiencing GBV in our region. How much worse must the situation become before urgent collective action is taken? It is a tool of war, used to instill terror and rip communities apart Dr. Hanan Balkhy The theme of this year’s 16 Days of Activism, “Toward 30 Years of the Beijing Declaration and Platform for Action: Unite to End Violence Against Women and Girls,” is a stark reminder of the need for concrete steps to combat GBV. The Beijing Declaration highlighted the vulnerability of women in armed conflicts and, 30 years later, that vulnerability is greater than ever. It is a moment for governments, organizations, and individuals to step up and engineer support systems for survivors, find ways to hold perpetrators to account, and prioritize the elimination of GBV in conflict zones. Violence against women and girls is preventable. There is no excuse. Amid the destruction, the violence and the desperation inflicted on Sudan, Gaza, and other emergency settings, stories of resilience and survival have emerged. With the support of families and healthcare providers, survivors who have endured unspeakable suffering work to rebuild their lives. These include Fatima, a 16-year-old girl who fled Khartoum, was brutally assaulted in Port Sudan, and became pregnant as a result. With the help of her mother and counseling services, Fatima is taking back control of her future. And Sara, a 21-year-old woman who fled violence in Khartoum and was attacked while living in an internally displaced persons’ camp. Through the unwavering support of a midwife, Sara received the care she desperately needed. Their stories reflect the strength and courage of survivors who are determined to reclaim their dignity. Healthcare providers such as Ghada, a health service coordinator in Sudan, are at the forefront of the response to GBV, working tirelessly to raise awareness and provide essential care in desperate situations. In the face of enormous challenges, Ghada and her team offer critical services to survivors. Ghada urges more investment in healthcare infrastructure and training for providers: “Healthcare providers play a pivotal role in both protection and response, but we need more resources, more training, and more investment to meet the overwhelming need.” Her calls must be answered. Global bodies such as the World Health Organization are making great strides in addressing GBV. While WHO’s efforts in my own region, the Eastern Mediterranean, have focused on strengthening health systems by training thousands of healthcare providers, and integrating GBV services into mental health and psychosocial support systems to offer comprehensive, culturally sensitive care, much more remains to be done. GBV in Sudan, Gaza, and other conflict zones serves not only as a reminder of the urgent need for coordinated action, but also underscores how desperately we need peace to prevail. As we mark International Day for the Elimination of Violence Against Women, we must ask ourselves what kind of world we want for women and girls, now and in the future. The health response to GBV can be lifesaving, but requires systemic integration into global health and humanitarian programs, including mental health services, reproductive health programs and emergency response initiatives. As we stand in solidarity with survivors such as Fatima and Sara, we must commit to a world where no woman or girl is left behind. This means taking bold, immediate action. We must demand that leaders prioritize the health, safety, and rights of women and girls in every policy, decision, and program. The voices of survivors must be heard. Perpetrators must be held to account. Governments must take action. The future of millions of women and girls depends on collective action today. Together, we can break the silence, and move toward a world in which every woman and girl can live a life free from violence. Where they can reclaim their dignity and look forward to the future. We cannot wait. The lives of countless women and girls hang in the balance. • Dr. Hanan Balkhy is the World Health Organization’s Regional Director for the Eastern Mediterranean.