Sexual violence shatters the lives of millions of people around the globe. Providing care for victims of sexual violence is a growing part of the medical-humanitarian action of Doctors Without Borders/Médecins Sans Frontières (MSF).
Sexual violence can occur anywhere but is often more prevalent in unstable situations, such as during conflicts and mass population displacements. The harms are often compounded by a dire lack of health care services for victims. Since victims need rapid access to emergency health services, we strive to make comprehensive health care available for survivors—whether they are women, children, or men—in all our projects.
About sexual assault
What is sexual violence?
Sexual violence includes rape, sexual abuse, and sexual exploitation, as well as forced sterilization and female genital mutilation. Victims are usually women (and often children), but a significant minority are men and boys.
In conflict, rape is often used as a weapon against populations or as a “reward” for soldiers. Rape and other forms of sexual abuse are also used as a means of torture and to humiliate, punish, control, injure, inflict fear, and destroy communities.
Men and boys are even less likely than women to report sexual violence, due to fear of stigmatization and to enormous taboos. Sexual violence committed against men therefore remains particularly invisible and under-reported.
What are the medical consequences?
Sexual violence can have a wide variety of consequences for physical and reproductive health.
Physical injuries can range from stab wounds, fractures, and bleeding, to vaginal fistulas. People who are sexually abused are also more susceptible to developing a sexually transmitted infection such as HIV. Sexually transmitted infections are more likely to be transmitted by forced sex, since vaginal or anal tears provide an entry for pathogens.
Another medical consequence can be unintended pregnancy. According to the World Health Organization, women who have suffered sexual violence are twice as likely to have an abortion. Unsafe abortions performed in resource-poor settings are a leading cause of maternal mortality worldwide, and for survivors can have other negative reproductive health consequences.
What are the mental health consequences?
Survivors of sexual violence often suffer from severe psychological effects. It is common for them to feel guilty and to think the incident could have been avoided. A loss of control and trust can also affect a survivor’s ability to form relationships with others. These feelings are often accompanied with clinical consequences such as post-traumatic stress disorder, depression, and anxiety.
Many societies stigmatize sexual violence victims, which can cause additional damage to survivors’ mental health. In some cultures survivors are rejected by partners, family members, or communities.
Since sexual violence can occur anywhere at any time, we strive to ensure that all our projects are able to handle sexual violence cases. In some places with high levels of sexual violence—for example, in Papua New Guinea, Colombia, Kenya, and Democratic Republic of Congo—our projects have dedicated services for sexual violence victims, available around the clock. In all cases we strive to offer a comprehensive package of care, including medical treatment of injuries, preventive interventions, and psychological care.
How MSF responds
Our medics urge people to seek treatment within three days of an attack if possible, not only to treat physical injuries, but also to prevent disease. Our comprehensive care for victims includes the following:
- Post-exposure prophylaxis using medicines that prevent sexually transmitted infections, such as HIV, syphilis and gonorrhea. To be effective these drugs should be given within three days of the attack. Hepatitis B and tetanus vaccines are also given in some cases.
- Offer of emergency contraceptives for female victims where allowed by law, to prevent unwanted pregnancy.
- Treatment for physical injuries, including surgery, if necessary.
- Pregnancy tests for female victims at follow-up visits, to determine if they became pregnant from their attack.
- Support to female victims whose attack caused an unwanted pregnancy, to help them manage their care and treatment decisions.
- Psychological care (see below).
- Medical certificates to survivors, for legal purposes.
Immediately after sexual attacks, victims are often in a state of shock. It is also common for them to feel guilty and believe that they could have avoided the rape. They may feel that they have lost control of their lives and may become unable to perform everyday tasks, or may have nightmares and disturbing flashbacks. Many rape victims also fear for their safety. Where impunity is rife, victims may still encounter their perpetrators and fear further attacks. Rape survivors can also develop depression and post-traumatic stress disorder.
MSF support for the mental health of survivors includes initial counseling to help patients deal with shock, as well as counseling and follow-up care to prevent or manage post-traumatic stress.
Awareness and access to care
A crucial element of any project providing health care to victims of sexual violence is ensuring that they know about the services available, and about the importance of seeking care and of doing so as quickly as possible.
MSF is actively involved in raising awareness of the medical consequences of sexual violence. Talking to people door-to-door, and using theater, radio announcements, and billboard advertisements are among the tools our teams employ to communicate about sexual violence and encourage victims to seek help. We particularly emphasize the urgency of seeking immediate medical care.
In some areas, where care is not easily accessible, we have set up ambulance services that transport sexual violence victims to clinics where they can receive care.