One Size Fits All? Standardised Provision of Care for Survivors of Sexual Violence in Conflict and Post-Conflict Areas in the Democratic Republic of Congo

Abstract

BackgroundOutcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).MethodsA retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.ResultsIn Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.ConclusionThis study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.

Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece

“…A surprisingly high proportion of survivors (28%) were male, comparable with another survey by MSF which showed that 17% of all male refugees underwent sexual attacks in their efforts to leave from Central America [29]. Other facility-based studies in non-migration contexts present lower proportions of male survivors, including in an urban slum in Kenya (8%) and in post-conflict settings such as Liberia (2%) and eastern DRC (3%) [11][12][13]. However, our findings echo other studies in conflict areas of DRC, showing that 24% of adult males had experienced sexual violence at some point of their life [30], and in Lebanon with 20% of survivors being men and boys [31].…”

“…A number of studies have focused on sexual violence in unstable contexts; of those, most were conducted in conflict or post-conflict zones [4,[11][12][13]. A more limited number of studies have focused on sexual violence among people in transit (this includes refugees, migrants, and asylum seekers); often in specific contexts, such as among migrants in transit in South and Central America [14][15][16] and among refugee populations during/following conflict [17,18].…”

Sexual violence in conflict: a global epidemic

“…Unfortunately, studies have found the success of this programme to be mixed, with poor documentation of its activities, thus further ongoing service evaluation and improvements are required. Other programmes in place include those offered by non‐government organisations, but again these are challenged by low numbers of women presenting to services, as well as loss to follow‐up . Local community initiatives have been shown to have a positive impact on the psychological wellbeing of survivors in certain settings, such as the DRC, suggesting that one size does not necessarily fit all in our response to these crimes .…”

“…Other programmes in place include those offered by non‐government organisations, but again these are challenged by low numbers of women presenting to services, as well as loss to follow‐up . Local community initiatives have been shown to have a positive impact on the psychological wellbeing of survivors in certain settings, such as the DRC, suggesting that one size does not necessarily fit all in our response to these crimes . Of course, international action on CRSV is delicately intertwined with political sensitivities, as well as ease of access to the affected population.…”

The impact of support programmes for survivors of sexual violence: micro-level evidence from eastern Democratic Republic of the Congo

“…The few studies that focus on assistance to survivors that exist (e.g. Bolton 2009;Bosmans 2007;Douma and Hilhorst 2012;Roka et al 2014;Steiner et al 2009) call into question the effectiveness of some of these programmes and highlight the need for further research and critical evaluation. However, there is an acute lack of data that can be used to critically and systematically assess the focus and impact of the programmes designed to assist survivors of sexual violence.…”