96 \ Global Youth Development Index and Report 2016 In addition to homicides, young people also disproportionately suffer from other forms of violence including sexual violence, bullying and physical fighting, road traffic injuries, suicide etc. For example: young people, especially females, continue to be victims of dating and sexual violence. According to a 2016 WHO report, nearly one in four women is likely to experience sexual violence by an intimate partner, and up to one-third of adolescent girls see their first sexual experience as being forced.35 Similarly bullying and physical fighting are common among young people. A 2014 WHO study found that, worldwide, one in two young males were involved in physical fighting during the past 12 months compared with one in four young females.36 Gender differences were less marked for bullying, with a cross-country average of 43 per cent for young males and 37 per cent for young females. Besides direct physical violence, young people also disproportionately endure structural violence. Structural violence is a form of violence where, rather than a physical or verbal confrontation between people, a social structure or institution limits a person’s ability to meet their needs.37 This type of violence manifests itself as a form of intense yet unspoken disregard.38 It is experienced most seriously by young people marginalised by poverty, social status, gender or disability. It is often communicated through passive rejection of their existence.39 Marginalised young people facing this form of violence are denied access to key social services such as health, education and justice, and are excluded from decision-making processes. It is often prevalent in contexts where inequalities are entrenched and have become institutionalised. For example: in the area of health, young people – especially young women – face significant forms of structural and institutional violence. These include experiencing barriers to independent health advice and treatment, access to abortion or reproductive health services, and mental health services. In some countries, young men and women may be able to leave school, be employed, get married and have children from the age of 16, and still require parental consent to see a doctor for sexual advice and services. These kinds of structural barriers infringe young people’s rights, but also push them into dangerous situations: an estimated 22 million women have unsafe abortions each year, resulting in 47,000 annual deaths.40 Just as when young people’s political participation is restricted they turn to protest and revolution, when youth are denied access to vital services they seek an alternative – potentially more risky – path. Another example of institutionalised discrimination against young people is the minimum age legislation that denies or restricts their access to vital services and rights. International law encourages states to raise the minimum age of criminal responsibility to 18 years.41 Despite a near-universal legal age of majority and right to vote at 18 years, the global average age of criminal responsibility is 12.1 years. While adolescents do not have the right to act independently or express political views, they are held legally responsible for their actions. In 65 countries, the age of criminal responsibility is 10 years or below.42 Academic research has shown that juveniles imprisoned at a young age are likely to suffer longterm mental health problems, earn less and find it harder to find and sustain employment, achieve lower levels of education and have a higher likelihood of engaging in crime and re-offending throughout their lives in comparison with juveniles who have not been imprisoned at a young age.43 A legal framework that allows for the imprisonment of children is likely to restrict and deny their development as young people and independent adults. 4.3 How does violence affect youth development? Violence and armed conflicts have long-lasting and wide-ranging consequences for young people and the communities they are a part of. Deaths and injuries are the most damaging outcomes of violence. Beyond these, violence can result in mental health problems and increased healthrisk behaviours among young people, such as smoking, alcohol and drug use, and unsafe sex.44 At the societal and national level, violent conflicts negatively affect access to and quality of healthcare, education, employment and judicial services.45 A recent report estimated the impact of conflict on education in terms of direct and indirect costs and concluded that conflict reduces educational access and has significant negative impact on economic growth in the long run.46 Similarly, another recent study shows that political unrest and civil wars have reversed much of the progress many Arab countries had made in healthcare over the past couple of decades.47 The last five years, the study reveals, have a seen rapid deterioration of healthcare systems in Egypt, Jordan, Libya, Syria, Tunisia and Yemen. Young women and girls, as well as those who are the poorest among young people, are hardest hit by violent conflicts. While violent conflicts’ mortality burden is disproportionately borne by young males, young women and children face serious psychological effects and constitute the majority