As for any woman exposed to sexual violence, without appropriate care this can lead to sexually transmitted infections, HIV, unwanted pregnancy and psychological trauma. The consequences are often far worse for younger women because may fear that they will not be believed when they disclose the assault; or they may lack the confidence or even the language to explain what happened. The sense of guilt too can be overwhelming.
Sexual assault can also change the life course of a girl who wished to complete school, seek financial independence, or be able to plan her first pregnancy.
In many settings where MSF works sexual violence care for children is non-existent, yet the youngest victims need the most robust support. In Mathare, Kenya, for example, one in four of our patients are under 12 years of age. Without early psychological care it can be difficult for children to recover from the experience, presenting a significant setback to their growth and development. But like adolescents, accessing care relies on their own bravery in speaking up, and a sensitive guardian responding to their plight.
MSF is rare in offering care for children in addition to adults in a number of contexts. The consultation environment, tools and processes have been carefully adapted: child-friendly rooms; adapted questionnaires; child-centred techniques such as play therapy. But there are many challenges to overcome for the children and the care providers. Many children are related to their abuser. Some are homeless, or orphaned, which has increased their vulnerability. Can they return home, or do they need a refuge? The issue of protection looms large for these young victims.
With a majority of patients under 18 years of age, Médecins Sans Frontières continues to refine its services to address the complexity of their needs.