As a resident doctor at AUB Medical Center, Lubna Abul-Husn  took a deep interest in domestic abuse. Ten years ago, she interviewed dozens of patients, cataloging their experiences at home with “intimate partner violence,” a term that refers to physical, emotional and verbal abuse of a close partner or spouse.
She then spent a year in France studying family legal medicine before returning home and ending her engagement with a fiance from her province.
Her fiance broke into her home, killed her, her mother and her sister, before committing suicide, according to her colleagues at the time.
“It was devastating,” said Johnny Awwad, Professor of Obstetrics and Gynecology and head of the division of Reproductive Endocrinology and Infertility at AUB Medical Center, and Abul-Husn’s colleague.
Awwad, along with other doctors at AUB, completed the analysis of Abul-Husn’s research. The paper was finally submitted for publication this year in the Journal of Interpersonal Violence.
“We couldn’t really look at this paper for the longest time,” he said. “We had been avoiding looking back at this phase but I don’t think that gives her justice.”
The study polled 100 married women aged 20-65 who were visiting the AUB Medical Center for gynecological care, 91 of whom responded to the survey. It is one of the few that tries to quantify the prevalence of domestic abuse in Lebanon, and that looks at the reasons behind why women here stay in abusive relationships.
But perhaps its most startling discovery is how even women in these relationships find it completely normal for such abuse to happen – a testament to how ingrained the gender imbalance is in society.
“Intimate partner violence is an underestimated problem in Lebanon and has been largely ignored by the local authorities,” the study said. “The Lebanese health care system has failed so far to play a proactive role in identifying and referring abused women, mostly because the recognition of an abusive pattern in women is often blurred by cultural and societal taboos.”
Over 40 percent of the women polled said they had suffered from physical abuse. A third endured sexual abuse, nearly two-thirds were victims of verbal abuse, and 19 percent said they had experienced emotional abuse.
More than a fifth of the women had suffered social isolation imposed by their husbands.
The top reasons women expressed as a reason for staying in an abusive relationship were a lack of familial and social support, lack of financial resources and fear that their husband would take away the children.
In eight of the cases that suffered physical abuse, medical attention was required and three cases were admitted to hospital with vertebral fractures and miscarriages.
But the study went further, selecting a subsample of 33 women and asking them open-ended questions on their husbands’ treatment.
All the women, including those who were abused, said they were satisfied with their husbands’ treatment.
“Many abused women are totally resigned to their situation and decide to stay in an abusive relationship because of the fear of losing their children, the need to conform to social expectations, t he lack of financial independence, the lack of family support, and the duty to obey their spouses,” the researchers said.
Domestic abuse appeared to usher in other social ills. Women who suffered physical and verbal abuse were more likely to be smokers. Husbands who had a history of alcohol abuse were more likely to impose social and economic isolation on their wives.
Declining monthly income  made it more likely for a husband to use a weapon against his wife, while a higher number of children offered a protective factor for women, illustrating the challenges wrought by economic, security and political instability in the country.
The head and the extremities were the most frequent areas of the woman’s body suffering from physical injury, and hitting was the most frequent mechanism of abuse followed by slapping and pushing.
The rate of domestic violence in Lebanon is in sync with other developing countries and Arab societies, where comparable rates of abuse are present as well as similar justifications for staying in abusive relationships.
As part of their recommendations, the study’s authors, who are all doctors at AUB Medical Center, said that health centers in Lebanon ought to routinely screen patients in order to identify victims of domestic abuse.
Awwad said that such a step, while there is no evidence that it reduces abuse, would be a first step toward referring victims of abuse to support groups and treating the root causes of some of their problems.
But part of the issue is that the conversation around domestic abuse in Lebanon often focuses on anecdotal cases of violence, rather than tracking the prevalence of the issue in society.
“It is not enough to create support groups in our society that come and tell you that he’s been hitting you, he’s been abusing you, come to us and we’re going to support you,” Awwad said.
“Then what? Who is going to support the kids and secure her re-entry into society that stigmatizes her,” he said. “They cannot create another society for her. It’s a dead end, unfortunately, in this part of the world.”
That is partly because of the tribal nature of Lebanese society.
“Lebanon is a big tribe,” he said. “Where you go people would know you and would stigmatize you. You would have to travel and leave the country. So you’d have to stay with the family and your husband and believe that it’s normal.”
This, he said, leads to an acceptance of domestic abuse as a normal part of existence. The other issue is cultural.
The study’s authors said that domestic violence against women tends to be seen as a private, internal matter and not a major public health issue in Arab societies that are “patriarchal and characterized by male authority and dominance.”
Awwad and his colleagues point to the initial rejections by religious authorities of domestic abuse legislation, which they saw as usurping the role of religion which already deals with the issue of domestic violence, and the continued failure to pass laws against domestic abuse.
A law protecting women from violence has been in legislative limbo for a long time due to Parliament’s failure to convene. Religious authorities initially opposed the legislation because they said Islam already deals with women’s rights and domestic relations.
“It would be a good step to pass this law,” Awwad said, adding that it could help deter some abuse, but would not be able to erase the “inherent right” that many men feel they have in wielding power in the household.
That built-in inequality is what poses enormous challenges to those who seek to challenge domestic abuse and society’s complacency toward it. There is little recourse but to begin at a young age, when minds are malleable and prejudice has not yet taken hold.
Values such as equality of women should be introduced at an early stage in education in order to combat such attitudes, Awwad said.
“I think it needs a generation, unfortunately,” he added.