BACKGROUND
Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.
METHODS
The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.
RESULTS
A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.
CONCLUSIONS
Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.
BACKGROUND
Conflict-related sexual violence (CRSV) is a significant health and human rights issue in humanitarian contexts, but there is a need of further research on differences between sexes in terms of severity of symptoms and improvement. Consequently, we explored the differences in severity and outcomes among male and female survivors of CRSV who received mental health and psychosocial support (MHPSS) in an armed conflict setting.
METHODS
We retrospectively analysed medical records from 3442 CRSV survivors in a MHPSS programme in Borno State, Nigeria, between 2018 and 2019. Patient characteristics, severity (measured with Clinical Global Impression of Severity Scale [CGI-S scale]), and improvement (measured with Clinical Global Impression of improvement [CGI-I] scale) were assessed by an attending counsellor. We assessed predictors for severity and improvement using a multivariable logistic regression analysis and time to improvement by sex using Kaplan Meier (K-M) curves and Cox regression.
RESULTS
We included 3442 patients who had at least one CRSV event in this study (2955 [85.9%] female, 486 [14.1%] male, one unknown). The most prevalent categories of symptoms were depression (49.9%; n = 1716), post-traumatic (25.6%; n = 879), and anxiety (20.3%; n = 697) symptoms. Most patients had mild (59.0%; n = 1869/3170) or moderate (36.4%; n = 1153/3170) symptoms at baseline, with 4.7% having severe symptoms (n = 148/3170). The logistic regression analysis (n = 1106), showed male patients had a 59% higher odds of severe symptoms at baseline than female patients (aOR 1.59; 95% CI 1.04-2.45). Among males, those older than 55 years had three times higher odds of presenting severe symptoms than younger patients (aOR 3.65; 95% CI 1.43-9.34). Women aged 36-55 years were more likely to present improvement than younger female patients (aOR 1.32; 95% CI 1.11-1.58). For both sexes, prompt attention after a CRSV event (≤ 3 days) positively predicted improvement (aOR 13.9; 95% CI 1.48-130 males, aOR 2.11; 95% CI 1.22-3.64 females) compared to late attention. Time to improvement did not differ between sexes, with an average of at least three consultations needed to achieve improvement.
CONCLUSIONS
Our study suggests that psychological attention of survivors within the first 72 h should be a priority. MHPSS programmes addressing CRSV should be inclusive to all patients, and gender-neutral approaches to ensure access, safety, confidentiality, and non-discrimination for all survivors should be developed.
Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence.
OBJECTIVE
The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence.
METHODS
Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014-2018.
RESULTS
Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred.
CONCLUSION
Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.
During the same period, the United Nations sexual and reproductive health agency (UNFPA) documented 14,907 other cases of sexual violence in CAR reported by other humanitarian organisations working in the country, or by state structures.
This report outlines the public health emergency that sexual violence has become in CAR, with recommendations to address the crisis.
Tongolo (“star” in local language Sango), a holistic project opened by MSF at the end of 2017 in the capital, Bangui, accounted for 66% of the cases seen by MSF. The project provides medical treatment and mental health support, as well as guidance to pursue legal action and obtain protection, such as emergency shelter or socio-economic support.
MSF teams also took care of patients for sexual violence at a dozen other locations, in nearly every corner of the Central African Republic. Numerous gaps were noted at different levels in terms of assistance for the survivors as well as huge challenges for them to access care.
This article shares the learnings of Médecins Sans Frontières (MSF)’s experience of adapting its sexual violence care training for its staff and missions in the Middle East and North Africa (MENA) region in 2019. It explores some of the implications of MENA operational and sociocultural specificities for MSF’s training approach, as well as theoretical and practical aspects of working in sexual violence response in specific settings and addressing contextual structural barriers to survivors’ accessing such services. It contributes to sharing knowledge among practitioners about adapting a sexual violence training approach for different contexts.
METHODS
Methods employed included a scoping review of literature; qualitative data collection via consultations with MENA organisations and interviews with MSF experts and staff working in Yemen, Palestine, Syria, Lebanon, Jordan, Turkey and Greece; collaborative content adaptation and issue integration; translation in Arabic and proofreading; testing of training modules in different settings; and feedback integration.
RESULTS
The adaptation work shows the importance of context and suggests that culturally and contextually adapted training bears potential for effectively strengthening staff members’ survivor-centered skills and attitudes, as well as technical knowledge and skills in care provision. The revision process shows that the overall approach of the training is constitutive to its effectiveness since the approach to – in addition to the substance of – most core principles and elements bears the potential to make training more acceptable and effective in encouraging staff reflectivity on local existing social and gender norms and their own beliefs and attitudes.
CONCLUSIONS
The article concludes that capacity-building efforts alone must not be overestimated in their ability to mobilize change in complex settings but highlights their potential to catalyze change if embedded in institutional longstanding efforts involving operational strategies, political advocacy and organizational culture. The process represents a first step which needs to be further tested, evaluated and continuously fed by MSF practice-based knowledge and dialogue with other organizations around response and training approaches and practices