Supporting Survivors of Wartime Gender-Based Violence: Upholding Rights, Addressing HIV, and Support Systems

In the Refugee Settlements and post-conflict environment settings, survivors often do not access the full comprehensive care partially due to late diagnosis, poor health seeking behaviors and inadequate services. The lack of access to comprehensive health care not only perpetuates the trauma of violence but also impedes survivors’ abilities to reintegrate into their communities and rebuild their lives. To effectively support the survivors, a comprehensive intervention that integrates medical care, psychosocial support, protection services, and long-term strategies for empowerment is required. This article focuses on an experience of an anonymized refugee living with HIV as result of wartime sexual violence and the need for a robust support system that can aid survivors in rebuilding their lives

When the war started in 2013 rebels raided Akech’s village and Akech[1] fled South Sudan amidst the ongoing conflict, seeking refuge in Uganda. Her journey was marred by profound loss and trauma, beginning with the murder of her husband who was forcibly removed from the house by the rebels and shot dead in front of her and the children. In the chaos that followed, Akech was subjected to a violent assault by multiple perpetrators who beat and raped her, leaving her with physical injuries and deep psychological wounds.

The assault left Akech with unexplained and persistent pain in her lower abdomen, chest and general body with the symptoms worsening due to the lack of immediate medical care upon arrival in Uganda in 2013. Akech reported to have experienced persistent gynecological complications, headaches, fever, severe abnormal pain, being tired all the time, body ache, infections, pelvic pain, back pain and joint pain when she arrived in Uganda.

Only after visiting the health center in Kiryandongo Refugee Settlement she was diagnosed as HIV positive. She questioned herself where this could have come from but linked it to the sexual violence she encountered during the war in her country of origin South Sudan. She struggled to accept her new condition even rejecting medical care due to the fear of the stigma associated with HIV. She was unable to perform even basic tasks due to the pain and fear of rejection. Notably, survivors of GBV-related abuse often experience a range of health issues ( as well as HIV), depression, anxiety, post-traumatic stress disorder (PTSD), and physical injuries[2].

Survivors of conflict-related sexual violence living with HIV face a complex journey toward seeking help, compounded by multiple barriers to accessing essential services. This creates a cycle of trauma, stigma, low self-esteem and marginalization, further worsened by systemic violations of human rights. Without comprehensive support that acknowledges these intersecting challenges, survivors often find it difficult to reintegrate into society and go about their lives with dignity.

While seeking help is a critical first step in recovery, many survivors of conflict-related sexual violence encounter numerous short term and long term obstacles. These include the absence of safe spaces for disclosure, fear of disclosing their war-related trauma, language barrier, shame and the stigma associated with sexual violence and HIV infection. Furthermore, basic needs such as food, shelter, education for children, and clean water are often unmet, with survivors also facing inadequate healthcare services, sexually transmitted diseases, late diagnosis, and a lack of intentional psychological support.

The inadequate protective measures and environment in the Refugee Settlements leaves many survivors isolated and unable to seek care due to the fear of discrimination, re-traumatization and isolation. The lack of access to services perpetuates their trauma and marginalization, preventing them from accessing the resources needed for recovery and healing. In many instances, refugees living with HIV also experience violations of fundamental human rights, including the right to safety, healthcare, and justice.

To address these challenges, a survivor-centered, rights-based approaches and intentional protection services to survivors living with HIV is essential. For example, with the reduction in food availability, special initiatives to access food and provide nutritional supplements are critical for better health for refugees living with HIV. In addition, survivors should have guaranteed access to all healthcare, including HIV treatment, hepatitis B screening and treatment, psychological support, safety services, and social reintegration programs. Upholding the human rights of survivors, including their right to health, dignity, and justice, is key to helping them regain control over their lives and to begin the recovery and healing process.

Akech’s story highlights the transformative impact of such support. When she visited the reception center in Kiryandongo Refugee Settlement, she encountered Refugee Law Project (RLP) staff who were raising awareness about community support programs for survivors of wartime violence. Through RLP’s intervention, Akech was screened for war-related harms and enrolled in a specialized medical rehabilitation program. She also received ART support, and a scan revealed an abdominal wound requiring Immediate medical attention. She was subsequently referred to St. Mary’s Hospital Lacor, Gulu district for further medical assessment and treatment.

The support Akech received, from both Refugee Law Project and the health center in the Settlement, played a key role in initiating and improving her psychological and bodily functionality. As a result of her treatment and emotional support, Akech found relief from the abdominal pain and began to manage the psychological effects of the trauma, including nightmares, Post Traumatic Stress Disorder and flashbacks.

RLP applies trauma informed services during counselling so that survivors are able to live a healthy life and endure life’s challenges. With undergoing medical and psychological care, she gradually recovered, particularly from her gynecological complications, and gained the ability to perform light tasks such as doing household chores and caring for her children. Although her physical capabilities remain limited, the progress she has made is a significant improvement in her overall well-being and rebuilt sense of self and confidence in life. Beyond physical injuries, RLP emphasizes the importance of addressing the psychological trauma that many refugees endure due to war. This psychosocial support is critical in helping refugees cope with the emotional scars of their experiences.

RLP has strengthened the capacity of health-workers, rule of law stakeholders and civil society actors in refugee settlements across Uganda, including Nakivale, Kiryandongo, Kampala, Adjumani, and Lamwo. Through targeted training, RLP enhances the ability to provide comprehensive care for war-related injuries, addressing both physical and psychological scars from conflict, sexual violence, and displacement, ensuring better support for vulnerable refugee populations. RLP is not only improving healthcare outcomes but also fostering a more supportive environment for refugees. The ongoing training ensures that healthcare professionals are better equipped to address the multifaceted challenges faced by refugees, thereby enhancing the quality of care and contributing to the overall well-being of displaced populations and support systems.

Akech’s journey toward living with HIV is deeply intertwined with her recovery from the impact of gender-based violence (GBV) and the support systems she received. One of the most significant aspects of her positive living has been the unwavering support from her family, particularly her 17-year-old son. His presence during medical appointments and his emotional encouragement have not only helped Akech cope with the trauma of sexual violence but also contributed to her adherence to HIV treatment. Living with HIV requires consistent care, and the emotional strength Akech derives from her family has been essential in helping her stay committed to her health and ART regimen.

As well, the challenges of refugees living with HIV such as the need for lifelong ART, monitoring of viral loads, and managing potential side effects are compounded for survivors of sexual violence. Akech’s healing process has been supported by access to consistent medical care, including ART from health partners, which is crucial for viral suppression and maintaining a good quality of life. Through Refugee Law Project (RLP) and the healthcare service at the Kiryandongo Refugee Settlement, Akech was enrolled in an ART program, and her health was regularly monitored. This medical intervention has enabled her to manage the physical aspects of HIV, preventing progression to AIDS and improving her overall well-being.

In addition to medical care, Akech’s involvement in support groups of survivors of conflict related sexual violence has been vital in creating a safe space for disclosure and emotional healing. The group has not only provided a safe space for her to share her experiences with other survivors, but also helped reduce the isolation that refugees living with HIV face due to stigma. Connecting with others who share similar challenges has fostered for Akech a sense of community and belonging, which has significantly contributed to her mental health recovery and wellbeing.

Akech’s ability to live with HIV also highlights the importance of addressing the broader social and psychological factors that continue to affect refugees living with HIV. The stigma associated with both HIV and sexual violence can prevent individuals from seeking care, adhering to their treatment regimen, and maintaining a healthy lifestyle. However, with the support of her family, community, and organizations like RLP, Akech has been able to overcome some of these barriers. Her story underscores the necessity of creating environments where survivors feel empowered to seek care, adhere to HIV treatment, and lead fulfilling lives.

Her progress further demonstrates that a comprehensive support system which includes medical care, emotional support, and community integration can significantly improve the prospects of HIV-positive individuals. Through ART, her ongoing recovery from impact of GBV, and the unwavering support from her family and community, not only regained her health but has also found a renewed sense of hope and confidence in life. Her children are happier and living a better mother children relationship and her journey serves as a powerful reminder that with the right care and support, refugees living with HIV can live longer, healthier lives while navigating the complexities of trauma, refugee life and displacement.

Akech’s story is a powerful testament and reminder of the need to support migrants living with HIV, because sexual violence survivors face critical needs that require systemic response that involves direct support interventions and advocacy. Humanitarian and development organizations, governments, religious institutions and communities need to work together to ensure that migrant survivors continue to receive comprehensive care and protection. Such interventions need to integrate the following elements:

• Providing psychological support to migrants living with HIV must be intentional and tailored to their unique needs. The refugees living with HIV face compounded trauma from migration and HIV, requiring specialized counseling and sustained mental health services. Mental health support is essential for processing trauma, restoring hope and supporting refugees to rebuild their lives. Community-based support networks like churches have been core in providing additional emotional and spiritual guidance.
• Improving access to healthcare for survivors of sexual violence is essential for their recovery and long-term well-being. Survivors must receive timely and comprehensive medical care, including treatment for physical injuries and immediate access to HIV prevention and care. Quality healthcare services are crucial for managing the long-term impacts of sexual violence and HIV. Access to quality medical care is a fundamental right, not a privilege.
• Access to food and nutritional support among migrants living with HIV/AIDS must be urgently rethought and reprioritized. Adequate nutrition is essential for managing HIV and improving treatment outcomes, yet many migrants face severe food insecurity issues. Governments and aid agencies need to prioritize food assistance and integrate nutritional support into HIV care programs in Refugee Settlements in order to strengthen the health and resilience of the vulnerable refugee population.
• Raising awareness about HIV/AIDS and its impact on migrants is crucial for reducing stigma, isolation, abandonment, strengthening support systems and promoting care access. Public awareness campaigns should prioritize the "nothing about us, without us" approach to ensure migrant voices amplify advocacy efforts and also addressing Hepatitis B in Refugee Settlements. Grassroots participation is key to creating inclusive, supportive environments, empowering survivors but also to seek help and break the cycle of isolation and discrimination.
• Research studies focusing on refugees living with HIV/AIDS is essential to identifying and highlighting the unique barriers refugees continue face in unique circumstances within Refugee Settlements. In addition, there is need to collect, analyze, report HIV surveillance data about refugees living with HIV, prevalence rates among different age groups. Understanding these factors allows for the development of targeted, culturally sensitive and conflict-sensitive support programs. Such research is key to improving HIV care, prevention, and overall health outcomes and wellbeing for migrant population.