"The trauma is intense"

Pascale Pynson, a psychologist working in Médecins Sans Frontières' programme at Lavender House Clinic in Mathare Slum in Nairobi, sees a considerable number of young children in the clinic.

Trigger Warning: this story contains information about sexual assault and/or violence which may be triggering to people who have similar experiences.

“Our programme offers comprehensive care to victims of sexual violence, including access to a 24-hour hotline and pick-up by ambulance. We see about 200 people at the clinic every month, most of whom are under 18. Of this number, 25 per cent are children under the age of 12.

In my work, children the under 12s are a really important focus of the program.  They need to receive specific support using different techniques like play therapy; we also check their main symptoms with questionnaires adapted for their lower age. When you are under-12 and you have this kind of trauma, your psychological needs are different to an older child or an adult, and psychological care is mandatory to recover.

Here, in 80 per cent of cases, the assault is committed by somebody the child knows. So the trauma is intense because it was a person that this child was used to associating with in a certain way. 

Sometimes the trauma is not a rape—there is no physical violence noted, it’s more like sexual abuse. But for a child, this can have a big effect; they withdrawal from their usual social life as a child.  For instance, when the child is going to school they won’t focus on their homework or school issues and they won’t be joking with their friends. There will be a lot of pain, it’s a disturbance for them, and sometimes they won’t tell the parents immediately either, which means they keep everything secret.

This is connected to the fact that most of the time the perpetrator will threaten the child. At the same time they give some rewards, they will give sweets, they will give the child something to eat, a little toy, or let them watch a television show, and so the offending can go on and on. In ten per cent of cases the perpetrators are immediate family members such as the father, step-father or sometimes the cousin or brothers. It’s something that happened to the child in a normally trustful environment, and suddenly trust doesn’t exist anymore.”

In Mathare most of the children have the support of a guardian and where not, the MSF clinic has developed strong links with children’s and social services for external support.