International Day for Elimination of Sexual Violence in Conflict - Theme: Attacks against Healthcare in Conflict areas impacts negatively on Survivors

This year we focus on the central importance of healthcare. Hospitals and other healthcare facilities support victims and survivors of conflict-related sexual violence. As the UN Secretary-General rightfully put it in his annual message in commemoration of the day, health facilities should be beacons of safety, security and healing for all those injured in conflict, including the survivors of sexual violence.

Uganda with its open-door policy currently is hosting 1.7 million refugees (UNHCR 2024), many of whom have suffered conflict-related sexual violence (CRSV). Many live-in fear and silence due to the stigma and limited access to appropriate healthcare services. Survivors of sexual violence experience numerous short-term and long-term negative physical and mental health outcomes, including physical injury, sexually transmitted infections (STIs), unwanted pregnancy, unsafe abortion, anxiety, shame, posttraumatic stress, and depression. In many cases, victims and survivors of sexual violence suffer with problems that are not necessarily medical emergencies yet real and impactful on their lives, relationships and livelihoods for self-reliance. For example, the psychological consequences of sexual violence can affect the career, social, emotional, and sexual activity of victims and survivors and may lead to an increased use of health services in order to cope with the physical and mental health vulnerabilities and harms suffered. We do acknowledge that there have been major financial investments made in the healthcare sector that target refugees. At the same time, these investments have not been very specific enough in addressing issues with which victims and survivors of conflict-related sexual violence grapple.

This year's focus on medical health facilities underscores the need and demand for our collective action to improve health services and ensure the deployment of adequate skilled personnel to handle survivors and victims of conflict-related sexual violence. There is a need to budget for and prioritize access to appropriate health services and ensure that survivors and victims’ get the much-needed specialized support so they can heal, return to work, and resume normal life.

Partners’ limited investment in appropriate medical responses to conflict-related sexual violence continues to impact negatively the victims and survivors. Health facilities are critically important for victims of conflict-related sexual violence for several reasons:

1. Victims often require urgent medical attention due to physical injuries, sexually transmitted infections (STIs), prolapses, and potential pregnancy resulting from CRSV. Health facilities need to be able to provide the necessary expertise and resources to treat these immediate health needs.
2. Health facilities need to be capacitated with resources, human and material, to be able to conduct forensic examinations to document injuries, collect evidence for legal purposes, and potentially identify the perpetrators. This documentation is crucial for legal proceedings, truth-seeking and accountability. Many health facilities already work closely with legal and social service organizations to help victims access legal assistance, protection, and social support. This coordination is vital for comprehensive care and recovery.
3. Victims of sexual violence often suffer from psychological trauma, including depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideations. Health facilities can offer counseling and support services to address these emotional and mental health needs.
4. Health facilities have a role to play in educating survivors about preventive measures against STIs, unwanted pregnancies, and other health risks. They can also provide information about available support services and resources.
5. Some injuries from sexual violence may require long-term medical care and monitoring. Health facilities, when supported, can ensure the continuity of the provision of care and the well-being of the survivors.

At the Refugee Law Project (RLP), we have witnessed the profound impact of sexual violence on refugees and internally displaced persons (IDPs). We have had the opportunity to work with survivors (both female and male) who have shared harrowing stories and showed us the harms that have resulted from Conflict-Related Sexual Violence. We have over time provided comprehensive support to survivors which includes legal assistance, psychosocial support, and medical care. Our efforts are aimed not only at healing and restoring normal functionality of individual survivors and also advocating for justice and accountability.

Through the Gender and Sexuality Programme, RLP has over the years, developed the Screen Refer, Support Document (SRSD) model with which it works to support victims and survivors. The model enables survivors to disclose their war-harm experiences and promotes the multi-survivor programming approach that recognizes the importance of working with not only the victims but also their families and the communities around them. RLP has noted that the effects of conflict-related sexual violence go far beyond the victim; they also affect families and communities.  More so, healing for victims depends on how supportive families and communities are to the survivors.

RLP further works with survivors through peer support groups that foster a sense of community belonging amongst survivors. Through these support groups, survivors share their experiences, offer each other emotional support, take care of each other, and build functional and sustainable solidarity. This can be particularly empowering in contexts where survivors often feel isolated or stigmatized as has been the case of most of the survivors RLP works with.

With support from the Royal Netherlands Embassy and other key partners, our programming around conflict-related sexual violence has over time grown to include the following interventions:

1. Awareness creation on the vice and its impact on the survivors, encouraging them to seek support (medical, psychosocial, and legal) to enable them to overcome the trauma and live dignified lives.
2. Training of Medical Students from the public universities of Gulu University Medical School and MUK College of Health Science to enhance their capacities to be able to respond to war-related harms sustained by the patients they will be attending to during their training practice and thereafter. To date a total of 412(150f,262m) students have benefitted from the capacity-building sessions.
3. Training of Medical/health workers from refugee hosting areas to build their capacities to respond to conflict-related injuries: to date a total of 187(107f,80m) health workers from the three refugee hosting districts of Adjumani, Lamwo, and Kiryandongo have so far benefitted from the training which aims at enhancing their capacity to respond to war-related harms sustained by the refugees and hosts who visit their health facilities.
4. Skilled medical doctors sponsored and placed in government hospitals: RLP works with different facilities to address war harms and has long-running MoUs with district local governments of Adjumani, Kiryandongo, and Lamwo whose district hospitals provide the first assessment and treatment in the spirit of promoting the localization agenda of service provision. Referrals for RLP beneficiaries are frequently made to St Mary’s Hospital Lacor in Gulu, CORSU in Entebbe, and Mulago National Referral Hospital in Kampala for specialized care.  Challenges encountered in the delivery of this service include government hospitals not having enough personnel (health workers) to handle both RLP clients and regular hospital patients. As stipulated in the signed MOUs and within the context of local capacity building objective, the relevant districts recruited 3 additional health workers per district through their district service commission and RLP pays their monthly salaries for the project duration. Over time, these health workers have been very supportive of all patients who access the hospitals and not only RLP clients. It is envisaged that over time after the project these staff will be absorbed by local government public service.
5. Support medical expenses for the victims: We continue to support and treat for war-related harms. Clients undergo comprehensive examinations and can access laboratory, x-ray, and scan services to determine their ailments. Services offered through the package include physiotherapy, orthopedic appliances like corsets, knee braces, elbow clutches, pelvic binder, and orthopedic mattresses among others.

 Important to note is that in all our training with state and non-state actors, a session on CRSV is included to create awareness among the different actors as well.

A lot more still needs to be done to support victims and survivors of sexual violence in conflict. Some of the gaps that still need to be addressed include:

1. Limited Specialized Training: There is a need to train more healthcare providers in handling CRSV cases, including understanding trauma, providing psychological support, and collecting forensic evidence.
2. Limited Mental Health Services: There is still limited mental health services provision availability to address the psychological trauma experienced by CRSV victims.
3. Holistic Care: There is a need to advocate for and promote integrated care approaches that combine physical, psychological, and legal support to avoid fragmented and incomplete care for victims.
4. Research Gaps: More research is needed to understand the long-term health impacts of CRSV and to develop evidence-based interventions.
5. Advocacy: There exists the urgent need for more partners to join this field of supporting survivors of CRSV as wars continue to cause havoc and suffering that affect people’s social fabric. When partners collectively put in place interventions that support survivors and victims of conflict-related sexual violence they play positive and constructive role in enabling them to disclose their war harm experiences and be able to access the necessary support and recovery their wellbeing.