Title : Understanding the gaps in delivering comprehensive sexual, reproductive health and rights services for sexual and gender based violence survivors in humanitarian
Abstract:
Background: Studies have shown that Sexual and Gender Based Violence (SGBV) exacerbated during conflict. During such times, the tendency to report and seek care decreases due to insecurity, displacement and the inability of the health system and other services to address these situations. This study aimed to understand the existing gaps in disclosure and formal reporting of SGBV and barriers for care seeking and SGBV care delivery to survivors exposed to violence during conflict or forced displacement from conflict.
Methods: From May to July 2022, the research was carried out in four Ethiopian regions: Amhara, Oromia, Afar, and Somali regional states, and Addis Ababa city administration. In-depth interview was conducted with 19 survivors of SGBV. Before and after the data collection, a desk review of relevant literature was conducted to supplement the findings from the primary data. The audio data was transcribed verbatim and translated into English before being entered into the Dedoose software for content analysis. The data was coded using the codebook created by the research team.
Results: All the survivors included in the study had been the victims of rape except one. The majority of those who were assaulted during an active conflict also reported experiencing physical assaults, abductions, and forced detention. Almost all survivors of sexual violence had experienced social stigma after the violence. Following the assault, the survivors faced a range of consequences, including physical injury, pregnancy, and psychological effects. Most survivors found disclosing the assault and seeking care difficult for different reasons. The major barriers identified were stigma, social norms, lack of awareness about SGBV services and where to seek assistance, lengthy process to get the necessary health care and legal protection, and poorly designed health care system that can provide comprehensive care.
Conclusions and Recommendations: Women and girls have suffered from chronic reproductive health, mental and psychological problems because of SGBV. Most SGBV survivors hardly accessed legal and health care services. Few sought health care but they were late in deciding to seek care as victims because of fear of stigma/shame; not having the information where to obtain the required service; delay in reaching care as they had to travel far to seek care; delay in receiving care which is attributed to unavailability of trained health providers or shortage of supplies to render care. There is a lack of clarity in the pathway in accessing care. There is no standard care and support as the role of each of the service delivery points and health professionals is not clearly defined.
Comprehensive SGBV services which include medical care with forensic exam, psychosocial and legal services should be readily available to survivors. The health facilities should be equipped with the necessary trained manpower and medical supplies to deliver essential SGBV care. Having the service closer and immediate would help survivors’ benefit from the immediate medical care such as clinical management like emergency contraception, HIV PEP, STI treatment and safe abortion care.
