The pace of progress
The UKK clinic was conceived as a model of effective treatment for SGBV survivors—open 24 hours, seven days a week—that could be replicated across India. The idea for the program was spurred by the Nirbhaya case, a horrific attack in which a 23-year-old medical student was gang raped, beaten, and tortured by six men on a bus, and later died from her injuries. The crime, which occurred in December 2012, received international media attention and triggered a storm of protests about the prevalence of violence against women in India. In March 2020, four of the men convicted of gang rape and murder were executed by the state, but the news was largely buried amid concerns over the pandemic lockdown.
Over the last eight years, the Nirbhaya case and others like it across India have increased awareness of how widespread sexual violence is, says Divya, but there is still a long way to go. “The blame or the responsibility is still more on the survivor than the perpetrator themselves,” she says. “That is still the key notion that is there.”
When the lockdown order was eased in May, Seema and the other ASHAs began bringing survivors to the UKK clinic again—and in record numbers. By summer, the clinic was seeing three times as many people coming for treatment.
Poonam and Pooja began re-establishing relationships with the NGOs, introducing themselves to new case managers and explaining what MSF is and what services the UKK clinic offers, so they could start collaborating again.
The clinic was facing an increased need and the same difficult challenges.
“The main issue with survivors of intimate partner violence is that they are not able to leave their partners, so they are chronic survivors,” says Dr. Geetika. “Even if we give them medicines for gonorrhea or chlamydia, for example, and treat their injuries, they are going back to the same person.” A month later, they might come back with the same problems, she says. “I think it's really tough on these women, and we also feel helpless at times because the cycle—it just goes on and on.”
“If you look at intimate partner violence, the concrete and obvious solution would be, okay, so you leave the marriage and then your problem may be solved,” says Divya. “But that is not an option with the majority of the women that we see.” Most of them are financially dependent on their husbands, which is a major barrier, she says. Since many of them are migrants, they are not very familiar with the area or the rest of the community. And they often have little or no support from the people closest to them because violent behaviors and suffering have become normalized.
Complaining about it carries a lot of stigma and is not encouraged in the country’s laws. “Indian law doesn't recognize marital rape as a crime,” Divya says, “so that gives the sense that it's not something we should see as wrong.”
Globally, at least 60 percent of women who experience sexual violence of any kind never report it, according to UN Women. The factors that make SGBV such a difficult crime to report and seek care for—including fear, shame, and stigma—are stark for survivors of intimate partner violence, reducing the likelihood that they will leave an abusive partner. “They've accepted that this is their reality and don't see the violence as something they need to get away from. But, that's where the outreach team comes in,” Divya says. “They will tell them there is a solution outside of living like this, and there is a way you can come out of it.”
“The first person a survivor of intimate partner violence is going to go to is a family member or friend,” says Pooja, who spends a lot of time talking one-on-one with people in the community. Unfortunately, survivors often don't get any support from the people closest to them, she says. Instead, they are told to go back to their abuser—they might even be mocked for complaining about it. “And if their family members don't understand, why would they think a clinic or someone they don't even know from the outside would be able to help? This is why establishing trust is one of the major things we work on.”