Where Médecins Sans Frontières is present, we contribute to prevention through community liaison, by raising awareness about sexual violence and its consequences, and identifying who is most vulnerable. In settings such as displacement and refugee camps, we can also contribute through physical design, carefully considering risk factors such as distance to latrines and showers, separation of male and female facilities, and lighting, amongst others.
Once a sexual assault has occurred, there are multiple, practical ways that Médecins Sans Frontières’ work can contribute to the immediate need for safety. For longer term solutions, however, we must connect with other organisations and authorities working under a protection mandate.
Practical protection measures include:
- round-the-clock services, including public holidays
- toll-free hotline
- ambulance pick-up
- strong linkages with the police
- safe houses
Reducing logistical barriers
By reducing logistical barriers, a victim can receive care as soon as she can reach us. But night-time can be a risky time for travel; transport may also be less available, and more costly. For this reason in Mathare, Nairobi, we have incorporated an ambulance that can be dispatched in response to a call to a free hotline. The ambulance has a route of designated pick-up points that have been chosen to be as accessible to as much of the community as possible, and has been influential in increasing the number of victims reaching us within 72 hours.
The police also play a vital role in linking us to victims; in many cases women come to us because the police have referred them.
In the clinic, our medical care is accompanied by a variety of measures to avoid our patient being assaulted again. Our objectives are:
- to place a sexual violence victim out of danger, and
- help them to defend themselves against the perpetrator/s.
Removal from danger
To place someone out of danger our staff investigate, with the individual, or the individual and their guardian, for the most appropriate solution, given the environment and available resources. In Tari, in Papua New Guinea, the Family Support Centre has a short-stay ward, where victims can stay overnight before the next steps are undertaken the following day. In Mathare, links have been established with short-stay shelters and spare clothes are available too. Longer-term shelter solutions rely on networks developed with other actors.
Legal action
Only the victim of the assault can decide (or not) on the timing and manner of filing a complaint with the authorities, and legal proceedings should only be suggested if a reliable legal system exists which would make a legal procedure possible. Médecins Sans Frontières will never make the decision to pass on information to the police, the UN High Commissioner for Refugees, or other organisations. This includes the medical certificate, completed at the first consultation, and then available whenever the victim decides. If she wishes to have it presented in court, Médecins Sans Frontières staff will attend to verify it. This is a common occurrence in Nairobi and Harare.
Best interests of children
Where the victim is a minor, and the perpetrator a member of their family still living in close proximity, Médecins Sans Frontières must protect the best interests of the child. This requires specific attention from the medical practitioner, and the timely involvement of external services for protecting minors.
Protection needs support from community and government
Without a doubt there are large gaps in longer-term protection services in many places where Médecins Sans Frontières work, but In the contexts where we work we have seen improvements, such as in Papua New Guinea where there has been growing recognition that violence, both within and outside the family, is a national problem to be tackled across all levels of society. The government has progressively taken steps to try to better address the high rates of family and sexual violence. In recent years there have been notable initiatives and improvements, with authorities identifying gender-based violence as a public health and social emergency and a major threat to the country’s development. However, though encouraging, deeper acknowledgement of the problem has not always translated into the urgent, robust action required to safeguard the lives, health and dignity of survivors.
Working closely with the community and authorities at all levels is the key to increasing awareness about sexual violence; improving access to services; expanding the offer of care; and developing important protection mechanisms for women and children at their most vulnerable. Without protection, our patients will remain physically and psychologically at risk—victims both of a brutal assault and of failures in society as a whole.
