To safeguard women and girls from sexual violence, protection is a broad concept that spans measures to prevent violence, and responses after violence has occurred.
Where Médecins Sans Frontières is present, we contribute to prevention through community liaison, by raising awareness about sexual violence and its consequences, and identifying who is most vulnerable. In settings such as displacement and refugee camps, we can also contribute through physical design, carefully considering risk factors such as distance to latrines and showers, separation of male and female facilities, and lighting, amongst others.
Once a sexual assault has occurred, there are multiple, practical ways that Médecins Sans Frontières’ work can contribute to the immediate need for safety. For longer term solutions, however, Médecins Sans Frontières must connect with other organisations and authorities working under a protection mandate.
Practical protection measures include:
· round-the-clock services, including public holidays
· toll-free hotline
· ambulance pick-up
· strong linkages with the police
· safe houses
By reducing logistical barriers, a victim can receive care as soon as she can reach us. But night-time can be a risky time for travel; transport may also be less available, and more costly. For this reason in Mathare, Nairobi, for example, we have incorporated an ambulance that can be dispatched in response to a call to a free hotline. The ambulance has a route of designated pick-up points that have been chosen to be as accessible to as much of the community as possible, and has been influential in increasing the number of victims reaching us within 72 hours.
The police also play a vital role in linking us to victims; in many cases women come to us because the police have referred them.
In the clinic, our medical care is accompanied by a variety of measures to avoid our patient being assaulted again. Our objectives are:
· to place a sexual violence victim out of danger, and
· help them to defend themselves against the perpetrator/s.
To place someone out of danger our staff investigate, with the individual, or the individual and their guardian, for the most appropriate solution, given the environment and available resources. In Tari, in Papua New Guinea, the Family Support Centre has a short-stay ward, where victims can stay overnight before the next steps are undertaken the following day. In Mathare, links have been established with short-stay shelters and spare clothes are available too. Longer-term shelter solutions rely on networks developed with other actors.
Only the victim of the assault can decide (or not) on the timing and manner of filing a complaint with the authorities, and legal proceedings should only be suggested if a reliable legal system exists which would make a legal procedure possible. Médecins Sans Frontières will never make the decision to pass on information to the police, the UN High Commissioner for Refugees, or other organisations. This includes the medical certificate, completed at the first consultation, and then available whenever the victim decides. If she wishes to have it presented in court, Médecins Sans Frontières staff will attend to verify it. This is a common occurrence in Nairobi and Harare.
Where the victim is a minor, and the perpetrator a member of their family still living in close proximity, Médecins Sans Frontières must protect the best interests of the child. This requires specific attention from the medical practitioner, and the timely involvement of external services for protecting minors.
Without a doubt there are large gaps in longer-term protection services in many places where Médecins Sans Frontières work, but In the contexts where we work we have seen improvements, such as in Papua New Guinea where there has been growing recognition that violence, both within and outside the family, is a national problem to be tackled across all levels of society. However, deeper acknowledgement of the problem has not always translated into the urgent, robust action required to safeguard the lives, health and dignity of victims [see below].
Working closely with the community and authorities at all levels is the key to increasing awareness about sexual violence; improving access to services; expanding the offer of care; and developing important protection mechanisms for women and children at their most vulnerable. Without protection, our patients will remain physically and psychologically at risk—victims both of a brutal assault and of failures in society as a whole.
Returned to the Abuser
“My husband then said that since my daughter has been raped before he would also do it. Then he raped her in front of me. He asked me to join in. I refused. I was just crying. There was nothing I could do.”
– Woman, Safe House, Port Moresby
Recognition of a serious problem
In Papua New Guinea violence is widespread, with disturbing levels of family and sexual violence directed towards women and children. A 2013 study of 10,000 men across ten Asia-Pacific countries found the highest rates of family and sexual violence in Papua New Guinea, where, in one location, one in five women’s first experience of sex was rape and one third of men had experienced sexual abuse as children.
A serious but neglected issue for too long, when MSF first began running projects to support survivors of family and sexual violence, national capacity and expertise to provide assistance in-country was limited. What services did exist were fragmented and piecemeal, and psychosocial support was almost entirely absent.
Today, there is growing recognition that this violence is a national problem and there have been some notable improvements to address the issue in recent years, with authorities identifying gender-based violence as a public health and social emergency and a major threat to the country’s development. Nevertheless, there is still so much more to do.
Since 2009 MSF has treated 27,993 survivors of family and sexual violence care in the country and carried out 68,840 major and minor surgeries, one third of which were for violence-related injuries. MSF teams have also run trainings in around 50 health centres across the country, and trained other service providers – such as police units for family and sexual violence and community leaders – about survivors needs for timely medical and psychosocial care.
Almost 70 per cent children
Two out of three (69%) of all survivors of sexual violence that MSF treated in Port Moresby, from January 2014 to June 2015, were children under the age of 18. In Tari, across 2014 and 2015, at least two out of five (46%) of all the survivors of sexual violence that MSF treated were younger than 18. The majority (91%) of these children had been raped. However, across the country there is a serious lack of adapted services for abused minors. A lack of temporary shelters or alternative care, and children’s inability to effectively access the justice system, means that they are frequently forced to return to their abusers.
Call for greater protection
On March 1, 2016, MSF releases the report ‘Returned to Abuser’. It identifies where positive steps have been taken particularly in medical and psychosocial care but where the major gaps remain: namely – the complete lack of protection for women and child survivors. There are only six safe houses in the country, and five of them are in the capital, Port Moresby and none of them accept unaccompanied minors. For those who report abuse to Police, a lack of appropriate training and an under-staffed Police force means abusers are rarely brought to justice.
The overall message of this report is that these gaps in services and protection systems must not force survivors to remain with or return to their abusers to experience repeated, worsening violence. These gaps mean that medical and psychosocial care, while vital, is relegated to patching up survivors between abuse sessions, making survivors double victims of their abusers and system failures.