Sexual and gender-based violence is a medical emergency, but there is often a dire lack of healthcare services for victims.
In 2023, the number of projects supporting victims of sexual violence increased dramatically in places where MSF works around the world, particularly in Democratic Republic of Congo. There, ongoing and escalating conflict as well as dire conditions in camps for displaced people have heightened the risk of sexual violence, resulting in unprecedented numbers of survivors seeking care from our teams.
Sexual and gender-based violence encompasses many different acts of violence against women, children and men, ranging from rape to genital mutilation.
In conflict, rape is often used as a weapon or as a reward for soldiers. Rape and other forms of sexual abuse are also used as a means of torture or, in some cases, as a strategy to spread HIV/AIDS within a community.
Sexual and gender-based violence can have a wide variety of medical consequences affecting 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 sexually transmitted infections (STIs), such as HIV. STIs are more likely to be transmitted by forced sex as vaginal or anal tears to provide an entry for the virus.
Another medical consequence can be unintended pregnancies. According to the World Health Organization, women who have suffered sexual violence are twice as likely to have an abortion. Abortions performed under unsafe conditions often have further consequences for reproductive health.
Survivors of sexual and gender-based violence often suffer from severe and varied psychological effects.
It is common for a person 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 by clinical conditions such as depression, post-traumatic stress disorder and anxiety.
The mental health of someone who has suffered sexual violence can be further deteriorated by stigmatisation. In some cultures, survivors are rejected by partners and family members, with some communities even humiliating rape survivors
Post-exposure prophylaxis is given to victims of rape within 72 hours to prevent HIV in case of exposure. Emergency contraception should also be given promptly to be the most effective. Antibiotics are given to prevent sexually transmitted infections such as syphilis and gonorrhoea, and vaccinations for tetanus and hepatitis B. The treatment of physical injuries and psychological support are also part of the package of care.
Sexual violence against men and boys includes rape, sexual torture and sexual slavery. Men and boys are even less likely to report sexual violence than women for fear of stigmatisation and because of the enormous taboo around the topic. As a result, sexual violence committed against men remains particularly invisible and under-reported, and how to adequately meet the needs of male victims poses a particular challenge for us.
Rape and other forms of sexual violence are often widespread in conflict settings, where they can be used to humiliate, punish, control, injure, inflict fear, and destroy communities. They may also be used to reward or remunerate combatants, to motivate the troops. But millions of people living in stable contexts are also affected by sexual violence. In these cases, the perpetrators are often acquaintances or family members of the victims.
Medical care is crucial in the 72 hours following rape to prevent the transmission of HIV and unwanted pregnancy. Stigma and fear of the aggressor and of others finding out are some of the reasons victims may hesitate to seek care and often do not pursue follow-up care. The prevention and management of unwanted pregnancy is often their biggest concern and is part of the care MSF provides. Emergency contraception is allowed in almost all countries; however, termination of pregnancy is – for a variety of reasons – more complicated.
As sexual and gender-based violence can occur anywhere at any time, MSF ensures that all of its projects are equipped to handle sexual violence cases.
However, in some countries, such as Colombia, Kenya and Democratic Republic of Congo, for example, we have projects that are set up specifically to provide treatment to victims of violence, including sexual violence. In these situations, we:
Our medics urge people to seek treatment within three days of an attack, to not only treat physical injuries but also to prevent disease.
Survivors of rape are given post-exposure prophylaxis to try and prevent possible infections, such as HIV. The sooner the drugs are given the more effective they are.
Antibiotics, vaccinations and emergency contraception can also be provided.
As well as treating physical injuries, MSF also provides psychological support to victims of sexual and gender-based violence.
We provide initial counselling to help patients deal with shock, as well as counselling and follow up care to prevent the development of post-traumatic stress.
Awareness and access to careMedical care is central to MSF’s response to sexual violence, but stigma and fear may prevent many victims from coming forward.
A proactive approach is necessary to raise awareness about the medical consequences of sexual violence and the availability of care.
Where MSF sees large numbers of victims – especially in areas of conflict – advocacy aims to raise awareness among local authorities, as well as the armed forces when they are involved in the assaults.
Were it not for her loud screams, he would have been successful! I said enough is enough!Mary, an internally displaced person in Kenya
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