What is the relationship between sexual violence in conflict and the right to health?
Sexual violence in armed conflict situations violates the sexual and reproductive health rights of women and girls and their right to prevent infectious and sexually transmitted infections (STIs) such as HIV. It also jeopardises gender equality by putting the lives of many girls and women at risk. The absence or lack of secure and reliable health services in conflict zones deepens the impact of sexual violence on the victims, who are often unable to access professional medical aid and services such as post-exposure prophylaxis (short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure) or safe abortions in case of pregnancy. Conflict-related sexual violence endangers maternal and child health and increases mortality rates as a result of infectious diseases.
Examples of the substantial physical and psychological health implications of sexual violence on the victims include: unwanted pregnancy, traumatic genital injuries, sexual dysfunction, sexually transmitted infections, rape trauma syndrome, post-traumatic stress disorder, depression, feelings of guilt, shame and hopelessness, and withdrawal.[1]
Which forms of sexual violence in conflict are there?
The UN Security Council resolution 1820 (2008) on sexual violence during wars [2] states that women and girls are particularly targeted by the use of sexual violence as a weapon of war. However, also boys and men can be the targets of forms of wartime sexual violence. The purposes are to humiliate, dominate, cause fear, or forcibly relocate civilians who are members of a community or ethnic group. The United Nations distinguish between eight forms of sexual violence in wars: rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, forced sterilization, forced marriage, and any other form of sexual violence of similar gravity.[3]
What are the rights of victims of wartime sexual violence?
The Security Council resolution 1880 of 2009 reaffirms the statements of resolution 1820 and classifies rape and other forms of sexual violence as a crime against humanity.[4] It acknowledges the rights of the victims through a variety of justice and reconciliation mechanisms, such as international and local criminal courts and commissions that deal with cases of sexual violence in conflict zones. The resolution requests the implementation of a policy of zero tolerance of all forms of sexual violence. It recommends financial and technical support to assist the victims through access to healthcare, psychosocial support, legal assistance, and socioeconomic reintegration services, particularly for women and children in rural areas.
On April 23, 2019, the Security Council adopted the most recent resolution (2467) on sexual violence in conflict. It calls for a victim-centred approach in all UN actions and stresses the importance of providing healthcare and psychological support to the victims and vulnerable groups.[5] The resolution condemns the world’s slow progress in addressing this issue, which has become systematic and widespread, and urges for the implementation of sanctions against perpetrators. However, according to Plan International, a major weakness of this resolution is the general disregard for the right of victims to sexual and reproductive health services, including safe abortion.[6]
What can medical professional organizations and NGOs do?
Professional organizations of health workers and NGOs can create a suitable environment to address the issue of sexual violence in conflict through research, advocacy, policy dialogue, and capacity building. Their role could be to gather data through methodical population surveys, communicate it to the higher authorities, and liaise between the medical and legal sectors within the prosecution process to achieve justice for the victims.
In 2010, the World Medical Association adopted the WMA Resolution on Violence against Women and Girls, in which it stressed the need to document and report cases of sexual violence, and encouraged a “legislation that classifies gang rape used as a weapon of war as a crime against humanity that is eligible for litigation through the jurisdiction of the International Criminal Court system.”[7]
Physicians for Human Rights (PHR) has developed the Program on Sexual Violence for Conflict Zones to standardise forensic data collection for more accurate health examinations of the victims and a better understanding of the circumstances of their experience.[8] To support the victims, the Dr. Denis Mukwege Foundation implements national and international advocacy strategies and measures ensuring accountability for sexual violence.
What are the roles and responsibilities of individual health workers?
The Guidelines for Medico-legal Care for Victims of Sexual Violence (WHO, 2003) state that medical personnel must be aware of the protocols on emergency humanitarian interventions and prioritise the health of victims of sexual violence over legal and forensic procedures.[1] They must provide health services such as treatment for any injuries and take measures for the prevention of pregnancy or an infection with an STI. Collection of forensic evidence may be useful in criminal proceedings.
Health workers should have optimal access to these services to be able to respond to the needs of the victims. Their care should be ethical, compassionate, and free of bias. Security and privacy are also a priority for the provision of health services.
In addition to the medico-legal procedures, medical personnel should be aware of the psychological consequences of sexual violence on the victims and offer, or refer to, psychological counselling and social support to decrease feelings of isolation, depression and stigma.
The provision of professional training for health staff, the deployment of female health workers for data collection and documentation of incidents of sexual violence, and the allocation of sufficient human and financial resources for advocacy, monitoring, and evaluation can further improve the humanitarian response to sexual violence in conflicts. Also, stronger cooperation between professional organizations, health professionals in conflict and safe regions, and the United Nations Security Council can facilitate transnational justice processes.
This page was written by Somaya Bahji in June 2019.
Notes
[1] Guidelines for Medico-legal Care for Victims of Sexual Violence (2003). World Health Organisation (WHO).
[2] United Nations Security Council Resolution 1820 (2008). Published on 18 June 2008.
[3] Forms of Wartime Sexual Violence. Webpage Dr. Denis Mukwege Foundation.
[4] United Nations Security Council Resolution 1888 (2009). Published on 30 September 2009.
[5] United Nations Security Council Resolution 2467 (2019). Published on 23 April 2019.
[6] UN Resolution on Sexual Violence in Conflict Disregards Girls’ Rights (2019). Plan International.
[7] WMA Resolution on Violence against Women and Girls (2010). Adopted by the 61st WMA General Assembly, Vancouver, Canada.
[8] The Program on Sexual Violence in Conflict Zones was launched by Physicians for Human Rights (PHR) in 2011. The program has offices in the Democratic Republic of the Congo, Kenya, and the United States.