Sexual violence is a worldwide public health and human rights problem, affecting women in every country. Despite this, responses to sexual violence are inadequate, particularly in emergency settings, when risks may increase, response and prevention mechanisms may be weakened and access to services may be disrupted. This article reviews recent initiatives aimed at addressing the problem of sexual violence in emergencies.
The scale of the problem
Violence against women, including sexual violence, has been increasingly documented in crises including armed conflicts. The use of rape and other forms of sexual violence to humiliate and terrorise civilians is now recognised as an international crime. Landmark judgements by the International Criminal Tribunal for the former Yugoslavia and the International Criminal Tribunal for Rwanda have established that sexual violence may be considered an instrument of genocide, torture, a crime against humanity and a war crime. Sexual violence is also included in the Statute of the International Criminal Court. Nonetheless, women and girls continue to face particular risks of sexual violence during emergencies. Conflicts such as those in the former Yugoslavia, Rwanda, West Africa and the Democratic Republic of Congo have demonstrated that sexual violence causes serious immediate and long-term physical and psychological harm. Possible physical consequences include genital and other injuries, sexually-transmitted infections including HIV/AIDS, pelvic pain and pelvic inflammatory disease, urinary tract infections, unwanted pregnancy, unsafe abortion and even death, including from suicide. Psychological consequences may include depression and post-traumatic stress disorder. Women who experience sexual violence may also face social pressure not to report their experience, and may be ostracised or rejected if their experience becomes known.
Sexual violence is generally under-reported. The shame and stigma often associated with it, the feelings of self-blame it can generate, and fear of reprisals make many women reluctant to come forward. This under-reporting can also be a barrier to identifying and addressing the problem. What little data are available come largely from reports by health workers and the police, but these probably represent only a small fraction of cases. The silence around sexual violence makes it difficult to know how many people are affected, and to identify those in need of support and help. Often, sexual violence in emergencies reflects womens subordinate status in society and the discrimination and violence they face in times of relative peace, including in their homes. These aspects of womens status, coupled with political issues, are frequently also barriers to addressing sexual violence during and following emergencies.
The humanitarian community has recognised that it has a role to play in preventing and responding to sexual violence in crises. Over the past decade, humanitarian agencies have developed programmes to offer medical and psychosocial care, as well as education and skills training to survivors of sexual violence, particularly in refugee settings. Their experiences, and those of international organisations working to prevent and address sexual violence, have informed current thinking about what roles actors in different humanitarian sectors can play in preventing and addressing this problem.
Guidelines on the Clinical Management of Rape Survivors in Emergency Settings
In March 2001, 160 representatives of refugee groups, NGOs, governments and intergovernmental organisations came together to document what had been done and what still needed to be done to prevent and respond to sexual and gender-based violence against refugees. At a conference in Geneva hosted by the UN High Commissioner for Refugees (UNHCR), they shared their experiences and lessons learned. This resulted in a set of guidelines developed by UNHCR and WHO on the clinical management of rape survivors in emergency settings. The revised and updated version of the guidelines, published in 2005, is the result of a collaboration between UNHCR, WHO, the UN Population Fund (UNFPA) and the International Committee of the Red Cross (ICRC). The guidelines address the physical and psychological aspects of care, and identify best practices in the clinical management of women, men and children who have been raped in emergencies.
The guidelines are intended to be used by qualified health care providers (health coordinators, doctors, clinical officers, midwives and nurses), and can be adapted to different legal, policy and resource contexts. They include the most recent technical information on the various aspects of care for people who have been raped, including: making preparations to offer medical care to rape survivors; preparing the survivor for examination; taking the history; collecting forensic evidence; performing a physical and genital examination; prescribing medication to prevent pregnancy and sexually transmitted infections including HIV; counselling; and follow-up care. The guidelines also include special considerations when caring for children, men and pregnant or elderly women.
Inter-Agency Standing Committee guidelines on GBV in emergencies
In 2005, the Task Force on Gender of the Inter-Agency Standing Committee (IASC) published Guidelines for Gender-based Violence Interventions in Humanitarian Emergencies: Focusing on Prevention and Response to Sexual Violence. These aim to meet the need for a comprehensive, coordinated and participatory approach to addressing sexual violence in emergencies. The guidelines provide practical information, sector by sector, on how to ensure that humanitarian protection and assistance do not place women at increased risk. They also provide guidance about how to respond to the needs of survivors in emergency settings. Their primary purpose is to enable humanitarian actors and communities to plan, establish, and coordinate a set of minimum multisectoral interventions to prevent and respond to sexual violence.
While the guidelines cover the preparedness and post-crisis phases of a response, their primary focus is on the early phase of an emergency. Each of the actions identified as comprising part of minimum prevention and response is elaborated in an action sheet, which includes specific guidance on key actions and who bears responsibility for these actions. The sheets also list the resources which may be used to support key actions.
The guidelines cover interventions in the following sectors: protection, water and sanitation, food security and nutrition, shelter and site planning, non-food items, health and community services and education. There is also information on cross-cutting functions that require action by multiple sectors, including coordination, assessment and monitoring, protection, human resources and information, education and communication.
Sexual exploitation and abuse by aid actors
As well as addressing sexual violence by external actors, humanitarian responses must also ensure that aid workers themselves do not perpetrate abuse, and that such abuse is adequately punished if it happens. In times of crisis and desperation, women and girls may submit to sexual abuse to obtain basic necessities such as food. In response to a growing recognition that sexual exploitation and abuse are committed by humanitarian workers charged with protecting and assisting affected populations, codes of conduct have been promulgated by individual humanitarian organisations, and the issue has been included in the Sphere standards.
The IASC Guidelines address sexual exploitation and abuse by providing specific guidance, including on implementing human resource policies that minimise the likelihood of sexual exploitation and abuse, such as reference checks during the hiring process, coordination and information-sharing with other organisations about people dismissed for engaging in abuse, the dissemination of binding codes of conduct and developing systems of accountability, confidential reporting and enforcement.
UN staff, and organisations or individuals entering into cooperative arrangements with the UN, are bound by the Secretary-Generals Bulletin (SGB) on special measures for protection from sexual exploitation and sexual abuse. This clarifies that such acts, particularly when perpetrated against beneficiaries of United Nations protection or assistance, constitute serious misconduct and are therefore grounds for disciplinary measures, including summary dismissal. In addition, the SGB obliges all staff to report concerns or suspicions of sexual exploitation and abuse and places the onus on managers at all levels to support and develop systems that maintain an environment that prevents sexual exploitation and abuse, including through the appointment of senior focal points responsible for receiving complaints.
Much remains to be done to achieve effective prevention of sexual violence in emergencies, and to provide appropriate support and assistance to survivors. The tools described above represent positive steps to increase attention to sexual violence in emergencies, and to consolidate best practice to improve responses in the field. They also recognise that lasting solutions require cohesive and coordinated action by all key stakeholders. More, however, needs to be done on the ground, including in building capacity to respond to the problem at all levels.
Chen Reisis Programme Officer with the Sexual Violence Research Initiative at the World Health Organisation. Her email address is: firstname.lastname@example.org.
Clinical Management of Rape Survivors (revised edition, 2005), http://www.who.int/reproductive-health/publications/clinical_mngt_survivors_of_rape/index.html.
IASC, Guidelines for Gender-Based Violence Interventions in Humanitarian Settings (2005) http://www.humanitarianinfo.org/iasc/taskgender.asp.
Sphere Humanitarian Charter and Minimum Standards in Disaster Response (2004), http://www.sphereproject.org/handbook/index.htm.
OCHA, Protection from Sexual Exploitation and Abuse, http://ochaonline.un.org/webpage.asp?Site=sexex.The Secretary-Generals Bulletin on Special Measures for Protection from Sexual Exploitation and Sexual Abuse (ST/SGB/2003/13).
Rome Statute of the International Criminal Court http://www.icc-pi.int/library/about/officialjournal/Rome_Statute_120704-EN.pdf
Unifem web portal on Women, War and Security: http://www.womenwarpeace.org
The Sexual Violence Research Initiative: http://www.who.int/svri.