March 01, 2016

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In Papua New Guinea, women and children endure shockingly high levels of family and sexual violence, with rates of abuse estimated to be some of the highest in the world outside a conflict zone.

This is backed up by the experience of Doctors Without Borders/Médecins Sans Frontières (MSF), which has treated 27,993 survivors of family and sexual violence in the country since 2007.

In 2014 and 2015, some 3,056 people sought care for the first time in MSF-run Family Support Centers in the capital, Port Moresby, and in Tari, in the Highlands region. Their accounts provide important insights into the patterns of intimate partner violence, family violence, and sexual violence in these areas. Their experiences suggest that large numbers of people are suffering grave physical and psychological wounds in the very place they should feel the safest—within their homes and families.

The overwhelming majority—94 percent—of these patients were female. Most had been injured by their partners, family, or community members, and in more than a quarter of all incidents involving intimate partners, the women had been threatened with death. Nearly all—97 percent—of those patients had injuries that required treatment. Two in three had been attacked with weapons, including sticks, knives, machetes, and blunt instruments.

Children are also exposed to serious violence from a very young age, MSF’s data shows, most often at the hands of family members or others they know in their community. More than half of all MSF consultations for survivors of sexual violence were with children, around one in six of which were with children younger than five years. Children also made up one in three of all family violence consultations in Port Moresby, and one in eight in Tari.

Forty-nine percent of patients who sought care following sexual violence said the abuse—in most cases, rape—occurred at home. The younger the survivor, the more likely it was that they were abused at home. For most patients, the perpetrator of sexual violence was someone they knew. Again, the younger the child, the more likely this was, with a known perpetrator involved in the sexual violence against almost nine in ten children younger than five years.

Many of the patients who returned home after their consultation were in danger of experiencing further abuse. One in ten adult women reported that the latest incident of sexual violence was part of a repeated or ongoing pattern. For children, this risk was heightened, with almost two in five children experiencing repeated or ongoing sexual violence.

Family and sexual violence are clearly widespread and destructive in Papua New Guinea. This makes it all the more vital that survivors have access to free, quality, confidential treatment; in addition to services beyond medical care to keep them safe. But, at present, this is too-often not the case. Patients face multiple obstacles for obtaining essential medical and psychological care, and they face severely limited options for accessing the legal, social, and protection assistance they require. They are thus made "double victims"—suffering first from brutal attacks, and then from failures in service provision and in the protection system.

Inadequate or inappropriate responses from the country’s hybrid system of formal and traditional justice, and the dysfunction of the protection system, are putting survivors’ lives and health at risk. Patients’ experiences expose a culture of impunity, and a continuing reliance on traditional forms of justice to solve serious family and sexual violence cases. The widespread tradition of "compensation," whereby either money or pigs are paid to victims’ families for crimes committed, means that perpetrators often remain within their communities, exposing survivors to the threat of repeated violence.

Without access to social assistance, women’s financial dependence creates obstacles to seeking safety and obtaining justice. With no way to feed themselves or their children, many simply cannot afford to leave an abusive partner. Cultural practices, such as the payment and repayment of "bride price," also hinder women’s ability to obtain protection, often trapping them with a violent partner.

Those who wish to flee violence need access to safe alternative accommodation, such as refuges or safe houses. Yet delays in the creation and implementation of critical laws and policies have stalled the development of much-needed safe houses. With only six in the country, five of which are in the capital, most survivors have no hope of escape. This is alarming, considering that partner and family violence tends to be repetitive and often escalates over time.

For child survivors, gaining access to protection and justice is even more difficult. None of the existing safe houses will accept boys older than seven years. In addition, safe houses currently operate in a legal limbo with regard to children who flee violence without a guardian’s consent. Most safe houses will refuse to take these children in. Without official fostering in place, unaccompanied minors are effectively abandoned by the formal system. If their family or community is unable or unwilling to protect them, they are forced to remain with their abusers, with often devastating consequences.

As MSF prepares to hand over its final Family Support Center in Papua New Guinea to the Provincial Health Authorities, it acknowledges the significant strategic and policy steps already taken by the country to address family and sexual violence. However, an adequate response to survivors’ needs is still far from reality in many areas of the country.

There is simply not enough comprehensive medical and psychosocial care for survivors of family and sexual violence. As a result, many survivors are left on their own to suffer in silence. Only seven of 16 Family Support Centers across the country are deemed to be fully functional by national authorities, with services in the remaining nine centers varying greatly. Too often, the minimum package of medical care that should be available to all survivors of violence exists only on paper. There is also no effective referral pathway to connect them to assistance beyond immediate medical care, particularly in rural areas without hospitals, safe houses, or an effective police presence.

MSF hopes that this report will accelerate an improved response from all sectors of society, but especially from the national government and provincial authorities in Papua New Guinea. MSF encourages these authorities to build on recent improvements and to address serious shortcomings in services and safety provision. This will require the investment of resources and a sustained political will. It will also be essential to implement existing legislation and policies quickly and effectively. In addition, MSF trusts that this report will help propel increased support and efforts from international donors working with Papua New Guinea.

The scale-up of essential medical and psychosocial services is urgently required. What needs to be addressed, in particular, is the lack of functioning protection mechanisms, combined with the continuing culture of impunity and weak justice systems. Special attention must be paid to increasing appropriate care and protection for child survivors.

Without an escalated response, women will remain trapped in violent relationships, unable to remove themselves or their children from harm; vulnerable minors who are raped or beaten in their homes will continue to be returned to their abusers; and medical assistance, while vital, will be relegated to patching survivors up between abuse sessions, with medical staff treating the same patients for repeated and escalating injuries.

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