The Simelela center was set up to offer medical care, the collection of forensic evidence, counseling and follow-up care for victims of sexual violence in the rape-ravaged township of Khayelitsha.
“We did a lot of work to raise awareness. We went door-to-door, held marches, and put on puppet shows for children at schools and crèches. We told them, ‘Speak up and break the silence about rape’. Married women or girlfriends who had been imprisoned in their own bedrooms told us what happened to them."
South Africa 2006 © Wayne Conradie
Read more about sexual violence and spread the word on MSF's Shattered Lives web site.
How MSF Cares for Victims of Sexual Violence
In communities where MSF works, teams use every tool at their disposal to communicate about sexual violence and encourage victims to seek help. MSF urges victims of sexual violence to come to a clinic within 72 hours of the attack. Treatment with antiretrovirals (ARVs) can prevent HIV infection, but only if begun within three days of the rape.
MSF also administers drugs for prevention and treatment of hepatitis B and other sexually transmitted diseases. Pregnancy can be prevented if the victim comes in within 120 hours of the attacks by administering the morning-after pill. If victim has sustained serious injuries, MSF will treat them, or perform surgery.
MSF offers psychosocial care for victims of sexual violence to help them restore their ability to carry on with their lives. Initial counseling helps stabilize symptoms such as shock, and prepare them for medical consultation. Timely counseling can also prevent the development of post-traumatic stress disorder at a later stage.
Issuing legal certificates
MSF issues medical-legal certificates to victims of sexual violence. When a patient wishes to press charges against a perpetrator, the certificate can constitute important evidence in court.
Sometimes it is a father, an uncle, a friend, or a neighbor, but seldom a stranger. In poverty-stricken Khayelitsha, near Cape Town, South Africa, it happens in a home, rather than in a deserted field. In Khayelitsha, the result is always the same: rape followed by silence. It is the silence that becomes a prison because of the overwhelming fear and the reality of continued violence for the victim. To help address the problem, Doctors Without Borders/Médecins Sans Frontières (MSF) coordinated the establishment of the Simelela Center in Khayelitsha, a place where victims of sexual violence can be heard.
“[The rapists] will threaten the victim after the rape: ‘If you tell, I will kill you. I will kill your mother,' There is fear and the victim does not want to talk about it. And, if they keep it inside, it destroys them,” says Sis-Ntutu Ntwana, a MSF nurse and Simelela Center project coordinator.
Simelela, meaning “to lean on” in the indigenous Xhosa language, was established in September 2003. It initially started out as a follow-up center for sexual violence victims. It quickly developed into a full-fledged post-rape care center offering integrated health and social services, as well as the option of legal intervention.
Violence strikes inside the home
The Simelela center was set up in order to offer medical care and the collection of forensic evidence, as well as counseling and follow-up care all under one roof. The center is open 24 hours a day, seven days a week, for victims of sexual violence in the rape-ravaged township of Khayelitsha, near Cape Town, South Africa.
Simelela is the outcome of a joint venture between MSF and the South African Government’s Provincial Department of Health, civil society groups, Rape Crisis, Treatment Action Campaign, the City of Tygerberg Health, the Department of Social Development, and South African Police Services.
MSF fulfilled a coordinating role until July 1, 2009, when MSF handed over management and administration of the Simelela Center to the South African NGO Mosaic Training, Service, and Healing Center for Women.
Outreach a key to success
An exceptionally high percentage of rapes, 31 percent, occur in victims’ homes and the perpetrators are often known to the victims. An alarming 66 percent of the cases seen at the Simelela Center involved victims younger than 19 years. These young victims, and adult women alike, share homes with husbands, partners, fathers, uncles, or breadwinners who are abusers or rapists.
Much of the success achieved by Simelela has depended on the outreach activities to educate Khayelitsha residents about dedicated services within their community, which they would otherwise not know about.
Six years ago, before the establishment of Simelela, if a woman or child was raped in Khayelitsha, there were virtually no options to escape the prison of silence while she tried to pick up the pieces of her shattered life. The nearest rape treatment facility was nine miles away, close by some standards, but incomprehensibly far for those who have no means to pay for transport. Today, the center is trusted by countless Khayelitsha community members because they know that their voices will be heard.
Last year, 392 women and children in Khayelitsha found the courage to report to police that they had been raped. But during the same year, a total of 693 sexual violence victims sought help at Simelela. During the first five months of 2009, 229 new cases were recorded at the center, suggesting that the actual extent and level of abuse is far more alarming, despite victims increasingly speaking out.
“We did a lot of work to raise awareness,” says Ntwana. “We went door-to-door, held marches, and put on puppet shows for children at schools and crèches. We told them, ‘Speak up and break the silence about rape’. Married women or girlfriends who had been imprisoned in their own bedrooms told us what happened to them. They knew what their husbands and boyfriends were doing was wrong, but it is always difficult to speak out, especially, when it is someone close to you, a family member, or a neighbor, or if the perpetrator is a breadwinner.
“These women just need someone to believe their stories,” she says. “If you hesitate to believe what they tell you, they will not tell anyone ever again—this is especially true of the children. Victims of sexual violence need for you to believe them when they disclose.”
Simelela’s outreach activities have changed thousands of lives in Khayelitsha. Between August 2005 and May 2009, a total of 6,330 women and children have turned to the clinic for support. And in the four years since its establishment, the center has seen 2,548 new cases of sexual violence recorded. More than 80 percent of rape cases are treated within 72 hours of the incident, meaning more and more victims are coming forward sooner after rapes occur.
A greater need indicated
Dr. Eric Goemaere, medical coordinator for MSF in South Africa, says the rate of attendance at Simelela clearly indicates a great need for services to victims of sexual violence in the high rape-incidence communities where they live.
“The value of such proximity to services, the ongoing community information drives, and the importance of access to treatment within 72 hours in a one-stop service center, which includes medical and forensic service, is evident,” says Goemaere. “This is a project which has proved effective, and provincial health authorities would do well to replicate the model of integrated service clinics in high rape-incidence settings, and then roll it out across South Africa where the needs are greatest.”
Tara Appalraju, Mosaic project manager and the former MSF coordinator, says the outreach activities are crucial for the success of the project in the future. “It is just as important as it is to do the medical work at the center. It was this and the strong partnerships that set Simelela apart.”
Although MSF’s involvement with Simelela has come to an end, the strength of the partnerships lives on. “I can see the change Simelela has brought," says Ntwana. ”Now, if someone is raped, people know where to go to report it and how to get help when they speak up.”