Clinical management of sexual violence Sexual and genderbased

Clinical management of sexual violence Sexual and gender-based violence: Core concepts If the guiding principles are integrated into health care services, access to care for sexual violence survivors will be improved.

Barriers to care and support • Do you think all survivors report to your facility? • Why or why not?

Human Rights • “All human beings are born free and equal in dignity and rights. ” (Universal Declaration of Human Rights) • Human rights are universal, inalienable, indivisible, interconnected, and interdependent. • Everyone is entitled to all the rights and freedoms, without distinction of any kind, such as race, gender, religion, political opinion, etc. • Prevention of and response to gender-based violence is directly linked to the protection of human rights.

GBV and Human Rights GBV violates a number of human rights principles: • Life, liberty, and security of the person • Freedom from torture or cruel, inhuman, or degrading treatment or punishment • Freedom of movement, opinion, expression, and association • Entering into marriage with free and full consent and the entitlement to equal rights to marriage, during marriage, and at its dissolution • Equality, including to equal protection under the law, even during war • Human dignity and physical integrity • Freedom from all forms of discrimination • Equality in the family • The highest attainable standard of physical and mental health

Attitudes that contribute to the problem • “Wife beating is an accepted custom…we are wasting our time debating the issue. ”– Papua New Guinea member of Parliament during debate on wife battering • “. . If it's a legitimate rape, the female body has ways to try to shut that whole thing (becoming pregnant) down“ -US member of Congress • “… through questions related to her sexual life it is possible to tell if the woman is responsible for the attack, because in most cases, it is the woman who provokes the aggression”– Agent from the Mexico City Attorney General’s Office • “If my daughter or sister… allowed herself to lose face by doing such things, I would most certainly take (her) to my farmhouse and in front of my entire family, I would put petrol on her and set her alight”– Perpetrator's defense lawyer in India

GBV Tree Verbal abuse Domestic violence Examples of GBV Sexual abuse Rape Dowry abuse Contributing factors Poverty Lack of education Conflict Root causes FGM Isolation Abuse of power • • • Sexual Physical Emotional Economic Harmful practices Disrespect for human rights Forced marriage Alcohol and drug abuse Lack of police protection Gender inequality

Prevention To prevent sexual violence you need to understand root causes and contributing factors that put people at risk in all sectors q Food security q Human resources q Protection q Health q Education q Community q Water sanitation q Non-food distribution q Camp management Response To develop an appropriate response to sexual violence you need to understand the possible consequences of sexual violence

Definitions and Terminology • There is no consensus on terminology or definitions among agencies or individuals. • UNHCR: Sexual and Gender-Based Violence • IASC: Gender-Based Violence • WHO: Violence Against Women • ICRC: Sexual Violence

Definitions of (S)GBV • IASC definition for GBV ‘An umbrella term for any harmful act that is perpetrated against a person’s will, and that is based on socially ascribed differences between males and females’ There also different types or forms of violence: (1) sexual (2) physical; (3) harmful traditional practices; (4) socio-economic; and (5) emotional and psychological • UNHCR definition for SGBV … gender-based violence is violence that is directed against a person on the basis of gender or sex. It includes acts that inflict physical, mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty

Definition of sexual violence • WHO/IASC: “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed against, a person’s sexuality, using coercion, threats of harm or physical force, by any person regardless of relationship to the victim, in any setting, including but not limited to home and work” World Report on violence and health, WHO, 2002 Page 8, IASC GBV Guidelines

Types of sexual violence • • • Rape Sexual slavery and/or trafficking Sexual harassment, indecent assault Sexual exploitation and/or abuse Forced pregnancy, abortion, or sterilization Strip searches Incest Forced marriage, levirate marriage, early marriage Female genital mutilation

Why focus on clinical care of sexual violence? • Sexual violence is immediately life-threatening • Sexual violence has serious negative consequences at all levels • Effective response to sexual violence can prevent further violence • It is feasible and possible to prevent some negative consequences of sexual violence Providing clinical care for survivors of sexual violence is a priority intervention in emergencies

International definition of rape “Invasion of the body of a person by conduct resulting in penetration, however slight, of any part of the body of the victim or of the perpetrator with a sexual organ, or of the anal or genital opening of the victim’s body with any object or any other part of the body … committed by force, or by threat of force or coercion… …or by taking advantage of a coercive environment, or committed against a person incapable of giving genuine consent…” -International Criminal Court (ICC)

Definition of rape in national laws • Legal definitions differ for each country, but always include: • Rape occurs without consent of the victim • Some kind of force was used • What is the legal definition of rape in your setting?

Legal definition of rape • <Update this slide with information prior to the training>

Victim or Survivor Victim q Suggests passivity rather than resilience q Reinforces stigmatization q But: Important status for legal purposes Survivor q Empowering q Right to self-determination

Key messages • Sexual violence is a violation of human rights • Abuse of power and gender inequality are root causes of GBV • Various stakeholders must collaborate to develop comprehensive sexual violence prevention and response activities • There is no common terminology amongst actors • Agree on the same definitions when responding to survivors • Guiding principles: • Safety • Confidentiality • Respect • Non-discrimination