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State of World Population 2010

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Chapter Three

Women on the front lines of recovery

The sign at the door of Judge Evelina Quaqua’s chambers says only “Court E.” She hears cases in camera—without a public or media audience—in a light and airy courtroom where witnesses and survivors can testify in booths with one-way glass so that they can watch proceedings but cannot be seen by an alleged criminal or the jury. Quaqua presides over a unique Liberian court, purpose-built for handling crimes of sexual and gender-based violence.

Women returning from a farm with vegetables to be sold in a market on the outskirts of Monrovia, Liberia. The market, built with support from UNFPA, is a safe haven for the women and their children.
©VII Photo/Marcus Bleasdale

In a conversation in her chambers, Quaqua said that since the end of the civil war and the return of democratic government, she has noticed a marked increase in the number of people willing to report rape and other gender crimes because they now know their rights. The court is new; six cases have gone to jury trials over the course of a year. Jury selection is rigorous, she said. Fifty “credible men and women” are empanelled in a pool, from which 15 jurors are drawn for each case. Quaqua has the power to sentence offenders convicted in the jury trials from a minimum of 10 years to life, depending on the gravity of the case.

Quaqua says that children are particularly vulnerable to sex crimes—she has tried a case involving a five-year-old—and that the offender is almost invariably a relative or someone else the child knows. “Those who rape are not strangers,” she says.  She said that she still does not see many cases of sexual abuse among men, although research shows that many men were abused during the civil war, perhaps as high as nearly a third of the male population. As in other countries, counsellors in Liberia say it can take much longer for a man to seek help.

Liberia should have had a head start in post-conflict recovery because women had amassed considerable political influence in the early years of this decade. Liberian women, many of them from among the market stallholders who are the backbone of much West African commerce, demonstrated in 2003 that the seemingly impossible could be achieved by a mass peace movement that relied heavily on broad solidarity, persistence, song and prayer, but almost no money. Their story, told in the dramatic documentary Pray the Devil Back to Hell shows how women were able to demand an end to civil war.

More widely in West Africa, women have been very active in organizing themselves. Even before the passage of resolution 1325, the Mano River Women’s Peace Network had brought together activists from the West African nations of Guinea, Liberia and Sierra Leone to work for the restoration of peace across the region. The Mano River network, which won the United Nations Human Rights Prize in 2003, was at the forefront of opposition to the Government of Guinea when, in September 2009, soldiers in service of a military leader opened fire in a stadium in Conakry, the Guinean capital, where the regime’s political opponents had gathered for a rally. In the chaos of the deadly assault, many women were seized and sexually abused.

Women police officers teach self-defense to young Liberian women in Monrovia.
©VII Photo/Marcus Bleasdale

Still, despite the strength of women’s movements, domestic violence remains a major problem in Liberia. Touching Humanity in Need of Kindness—THINK—is a Liberian non-governmental organization founded in 2003 to counsel women and girls who survived sexual abuse in war time, including some young women who had been military combatants and many others who had been caught in raids by brutal, undisciplined gunmen on all sides. “As fighters moved through villages, they collected girls—girls as young as seven or nine,” said Rosana Schaack, Executive Director. “They were used as sex slaves, and after the war they were shunned by their families. Communities did not want the girl or the girl’s rebel child,” she said. “We had to insure that the rebel child would not be hurt.”

Post-conflict, THINK goes on helping girls, young women and a few young men and boys through nine-month-long counselling and training courses. Sexual and gender-based violence has shifted from the scenes of conflict and rampaging rebel militias to streets, homes, schools and other familiar places. Schaack and her counselors concur with Evelina Quaqua in saying that in this environment, the victims usually know their attackers.

Three very traumatized girls of 14 told their stories, individually and in the company of a counsellor, in the child-friendly environment of the small THINK headquarters in Monrovia. Stuffed animals were scattered on beds where children and adolescents could rest during counselling; the atmosphere was serene. One girl, from Lofa County in northern Liberia, had been raped by her pastor, who found her home alone one day, invited her to his parsonage, locked her in and told her that if she ever reported the rape he would kill her. Her family pursued the case in the courts, despite threats, and the rapist has gone to jail. Such cases, sometimes involving rape by other trusted figures such as teachers, make a powerful statement to those who have become accustomed to assuming that a victimized girl has little chance of winning in court. The courage of those who go to the police or to court does not pass unnoticed, and each victory helps chip away at impunity.

[15] Women, youth and gender-based violence

Gender-based violence occurs more frequently where poverty and social instability are prevalent—for instance, in crises and early recovery situations. Gender-based violence reflects and reinforces gender and social inequities and compromises the health, security, autonomy and dignity of its victims.

Conflicts and natural disasters destabilize social infrastructure, leaving many young people, particularly young women, vulnerable to sexual violence, exploitative labour and trafficking. Minimal services and support are available to gender-based violence survivors and limited law enforcement can result in impunity for perpetrators. In addition, young people are also at a formative time in their transition to adulthood when harmful experiences can have long-lasting physical, psychological and social effects. The damage of gender-based violence to young people is profound and requires attention across sectors to assess and implement preventative mechanisms and provide appropriate services.

At least one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime. The abuser is usually someone known to her. Between 50,000 and 64,000 internally displaced women in Sierra Leone reported experiencing sexual violence by armed combatants. Half of internally displaced women who had direct contact with combatants reported experiencing sexual violence. In the province of South Kivu, Democratic Republic of Congo, local health centres report that 40 women are raped daily on average.

Gender-based violence, especially against young people, is characterized by underreporting because of survivors’ fear of reprisals and the limited availability of services such as health care and justice. Lack of accurate and reliable information on trends and patterns also makes it more difficult to take action and to prevent gender-based violence from happening.

In most contexts, survivors lack access to emergency contraception to prevent pregnancy, post-exposure prophylaxis to minimize HIV transmission, treatment for sexually transmitted infections, counselling and other psychological support, collection of forensic evidence, and referrals to legal and social support services within the community.

Source: Youth Zones, by Governess Films in association with UNFPA and the Women’s Refugee Commission

The second girl was raped by an uncle. A third 14-year-old girl had been raped by a friend of the aunt with whom she was living. This last case demonstrated that police responses are changing. The girl’s uncle found the young man involved and took him to a police station, where he was arrested. In all cases, THINK can provide a safe place for young people to live while in rehabilitation—and after, if their lives are endangered. The organization also has a juvenile transit centre for troubled children, some of whom will be found new homes.

Numerous Liberian organizations, and non-governmental groups in other countries, have begun programmes for young people—often also run by young people—to educate teenagers about sex, the need to be vigilant and the development of positive attitudes. The young, now living in peace, are advised by their peers to reject the behaviour of men and boys who had learned to employ sex and the abduction of girls as tactics of war, while living with a gun and a machete. At the Family Planning Association of Liberia, Comfort Dunbar Kollie, a young woman who heads the youth education and information centre, said that her messages to adolescents are about safe sex, condom use, abstinence and respectful relationships. Psychological counselling is also offered. “We empower the young with information,” she said. “Adolescents want to do everything on their own. If they have the right information, they will do what is right.”

[16] The making of a minister of gender and development

In Liberia, women have won a major role in national politics through persistent, coordinated action in both a peace movement and campaigns to ensure that women can exercise their rights as citizens, starting with voter registration. The political participation of women was no small factor in the election in Liberia of Africa’s first female president, Ellen Johnson Sirleaf. In this environment, the creation of the Ministry of Gender and Development would seem a logical step. But it did not happen overnight.

“The ministry actually came about from years of advocacy by gender activists,” said Vabah Kazaku Gayflor, Minister of Gender and Development and a woman who has seen life from the depths of rural poverty to the heights of international recognition. “We began with the establishment of a coordination unit in the Ministry of Planning. Following the conflict, we found there were a lot of women and women’s organizations all over the place, and they were looking around for some attention.”

The early days were almost comic. “We used to sit on Coca-Cola crates,” Gayflor said. “We used a manual typewriter. I remember distinctly how we had one of the first International Women’s Day celebrations. And do you know what the budget was for that? Three hundred dollars.”

After the Fourth World Conference on Women in 1995, the Liberian women received support from UNIFEM to establish a task force and begin the push for a full-fledged ministry. “Women spearheaded a bill in parliament,” she said. “The ministry was then established in 2001. I became minister later in 2003.” At the time, Gayflor was completing a graduate degree in the Netherlands on women, gender and development. “I was elected in my absence,” she said.

“I began by sitting on a broken chair that had three legs and a brick,” she said. “You could see the sky from in the building because a rocket had fallen on the roof. I shared my office with insects and birds. We didn’t have staff. At the time women didn’t even know they had a ministry of gender.” Gayflor began an information campaign. “And then elections came. I made noise that women had to go and register.” The early registration numbers were disappointing. “I had been invited to go to Harvard for a fellowship, but something told me not to go,” she said. She closed the ministry and told the staff to go on a mission to register women across the country. “I told my staff to get to work putting women on the voter rolls,” she said. “I told them we have to get out and tell women to register, otherwise we’re finished.” Then she raised the money for the registration campaign and hit the road herself, sleeping on floors and eating as they went, filling the van with dirty dishes. “One or two weeks later, I got a call from the United Nations Mission in Liberia, saying, ‘Vabah, you did it.’ And I said, ‘What?’ They said, ‘The women are now 51 per cent of the electorate.’”

“Registration and voting were not gender-sensitive,” Gayflor said. “Women working in the market could not leave the market because they did not want to leave their goods. And so we got women to go and sit at their stalls, and they would go and register and come back. If there had been registration in the market where women work, they would not have had to go through all of that.” The subsequent election was historic in Africa.

“We did not just stop at 1325 implementation with the development of a plan of action,” Gayflor said. “We’ve gone far. This is why you have a female president here. We had like 20 per cent of women in the security forces even before we developed our 1325 plan of action. So what we’re going to do now is to make it measurable.”

Gayflor has learned from life every step of the way to her ministerial office. Her mother died when she was eight years old. But her father sent her to school, where she outshone her brother. “I graduated at the top of my class from high school. So my father was getting good news of me. Oh, she’s a girl-boy. Now they appreciate their girl children. You find that many families are finding that not just boys support the family.”

Gayflor became a market woman during the civil war, when her father lost his job in a hospital. “The money we had was finished, down to $2,” she said. “From the house I saw the market women going up and down, so I said, where they are going I am going to go there too.” She learned to buy and sell to feed her family. She awoke at 5 a.m. to fry plantains to sell as treats to people coming to the hospital to take their medication. She sold whatever she could buy to make a profit. In two years, she said, she earned enough money to leave her father $2,000 for household expenses. She took $1,000 and went to Monrovia, where a new life began.

Across the Atlantic in Haiti, feminist leaders were campaigning before the earthquake struck for better protection from their government, said Olga Benoît, head of the Solidarity of Haitian Women, or SOFA from its initials in the Haitian Kreyol language. The city of Port-au-Prince itself was dangerous, she said. “There were no controls on building, no city plan,” she added, contributing to the destruction of so many homes, schools, hospitals and businesses during the earthquake. “In the first 24 hours we had no one to help us but each other,” she said. “There was no disaster plan, no administration in the early days.” The Security Council and its resolutions may seem very far away, but Haitian women know instinctively why such measures are needed.

Carine Exantus, a student of journalism at the University of Haiti—before it was badly damaged and closed by the January 2010 earthquake—watched life around her and kept a journal of what she saw. Women have been particularly powerless in the months following the disaster in and around Port-au-Prince, the capital, where at least 200,000 people were killed and more than a million were left homeless or in need of survival support. Exantus learned this when she and her middle class family, their home destroyed, fled to a squalid, congested encampment at Place Pigeon, a city plaza near the now-ruined Presidential Palace. By day, and more so by night, the powerlessness of women was on display, she said.

“In the first 24 hours we had no one to help us but each other.”

At Place Pigeon, she witnessed abuse and neglect of women and girls that could not be missed or ignored at such close quarters. She saw women work hard through the day to survive, to find food and water and ways to keep themselves and their children clean and healthy. At night, many got no rest in their makeshift homes. “Many women and girls are housed at the camp,” Exantus wrote in her diary. “They are victims of all forms of violence, physical, moral or psychological. The biggest problem of young girls at the camp is taking their showers in public and exposing their bodies to the gaze of strangers. Some boys take advantage of this situation to denigrate their bodies, assaulting them verbally with foul language. Almost every night, we heard screams of women or girls. Their husbands or partners beat them, whip them violently. They are often abused; sometimes they are forced to flee to escape torture.” Predatory strangers roam the camps, Exantus wrote, reporting that after International Women's Day on 8 March, a young man was arrested for attempted rape. “The problem is the status of women,” she wrote.

Leaders of women’s organizations say that Haitian women, who are the heads of almost half of Haitian families, are extremely vulnerable in a disaster, since fathers are often absent, leaving women to support children. When alone with their children in the cramped camps sprawled over acres of muddy earth, they cannot easily find sources of income, and police protection has been scant. Benoît was confident, however, that the situation would change. “Women in the camps should—and will—get organized,” she said at the end of April. “First came the needs for food, health…. We have to let the dust settle.” In the meantime, SOFA and others have been documenting cases of gender-based violence in the camps and offering some medical services in its clinic to earthquake survivors. Some hopes are pinned on the all-female Bangladeshi and Indian United Nations Police units, which may be able to improve the security environment in some of the camps where displaced people live.

Haitians clean the rubble and debris from the streets as part of a UNDP “cash for work” programme in the Carrefour Feuille of Port-au-Prince.  ©MINUSTAH/Sophia Paris

Benoît said that her organization had been working since the 1980s to change the condition of women and help them find their place in Haitian society. “At that time, no one talked about the place of women,” she said. SOFA advocated successfully for a ministry of women’s affairs, raising women’s issues to a higher level. “Twenty-five years later you can see the difference,” she said. Working with the ministry, advocates for women were able to win a decree classifying rape as a criminal act, though prosecutions are said to lag behind numbers of reported cases. It is evident that there is still work to be done. “We have to transform the attitudes of judges, the police and health officials,” Benoît said. “We have to change the idea that the girl or woman is to blame when a crime occurs.”

The earthquake was devastating to SOFA, which works with CONAP, the National Coordination of Advocacy for Women’s Rights. Both organizations lost influential members who died in the disaster. The Ministry of Women’s Affairs was flattened, just as a high-level meeting of gender activists was taking place. The women who died included two well-known feminist leaders, Myriam Merlet and Magalie Marcelin, as well as the Director-General of the Ministry of Women Affairs, Myrna Narcisse Theodore. In late spring, the ministry’s staff were still working under tents on open space cleared of the rubble of ruined buildings. “The whole movement was beheaded,” Benoît said.

Among the causes that the women who died had been fighting for was the establishment of special sections or separate quarters for interviewing survivors of gender-based violence. Thirteen police stations had these facilities before the earthquake. In Port-au-Prince only one survived, and it was taken over by police officers whose offices had been destroyed. In 2009, a combined effort by the Haitian national police academy, Haiti’s National Coalition Against Violence Done to Women and UNFPA—the first United Nations agency to work with the Haitian police on issues of gender-based violence—trained 770 police recruits in dealing with abused women. Some of these initiatives benefited from a collaboration between Haiti and Brazil, a country with good experience in creating police posts dedicated to women, as well as well-established reproductive health clinics. Brazil commands the United Nations peacekeeping force in Haiti, and its soldiers have been involved in community work there as well as in organizing visits of Haitian police to Brazil.

Haiti is only one example of how extreme poverty and development gaps complicate the response to crises and hamper the advancement of women in many countries and make their recovery from crisis extremely difficult. Inadequate political focus on women’s issues will often mean little interest in spending more to improve and expand programmes for women, especially in education and reproductive health. At the village level, girls and women who can read and work with numbers are often easy to spot, as they readily join in conversations about development and the needs of women.

[17] Reproductive health in emergencies

Women do not stop getting pregnant or having babies when a disaster strikes. In a crisis or refugee situation, one in five women of childbearing age is likely to be pregnant. Conflicts and natural disasters put these women and their babies at risk because of the sudden loss of medical support, compounded in many cases by trauma, malnutrition or disease, and exposure to violence.

Women fleeing war may have to give birth on the run, without even the most basic items for clean delivery. Natural disasters can wipe out medical facilities, and push many women into premature labour. Even in relatively stable refugee or displacement settings, lack of family planning and maternal care can put countless women at risk. Women who die in childbirth leave behind devastated families. Their other children are more likely to die before reaching adolescence. Even those who survive are less likely to complete their education. Urgent safe motherhood interventions can mean the difference between life and death for pregnant women and their newborns, and for other children and relatives under their care

In places where skilled birth attendance and emergency obstetric care are not available, an unplanned pregnancy can be fatal. Many couples would prefer not to risk pregnancy or have a baby during a crisis but lack the means to postpone pregnancy when family planning services become unavailable. Neglecting family planning can have other serious consequences, including unsafe abortions resulting from unwanted pregnancies. Restoring access to safe, effective contraception protects the lives and well-being of women and children and enables crisis-affected couples to manage scarce family resources more effectively.

Prenatal care can save lives and keep expectant mothers and their babies healthy. Prenatal care helps to identify general health problems that need to be treated and educates women and their communities to recognize danger signs during pregnancy. Prenatal care should also address the special nutritional needs of pregnant women.

In times of crisis, the risk of maternal and infant mortality rises. Women fleeing conflict or displaced by natural disaster are often forced to give birth without access to even the barest essentials for safe child delivery. The most critical interventions for safe child delivery are providing women with skilled care during childbirth and ensuring that women who experience life-threatening complications have prompt access to emergency obstetric care.

Conditions in emergencies increase the risk of exposure to HIV and other sexually transmitted infections. Displacement and the disintegration of families and communities—combined with the breakdown of health and education infrastructure and sudden unavailability of condoms—can lead to a rise in unprotected sex. The possibility of sexually transmitted infection is greater in cases of rape and other forms of coercive sex due to the increased likelihood of vaginal tearing and bleeding. Even in post-conflict settings, a residual culture of violence and shattered legal systems may continue to fuel high levels of sexual violence.

Source: Women Are the Fabric: Reproductive Health for Communities in Crisis, UNFPA

In the Ugandan village of Acowa, in eastern Amuria district, Florence Achan is one of those women. She had joined other women, and a few men, to talk about their experiences in a programme to improve local farming techniques, run by ASB (the initials in German of the Workers’ Samaritan Federation), a large German non-governmental organization, supported here by UNFPA, the United Nations High Commissioner for Refugees and the United Nations Food and Agriculture Organization. Like the others in the group, Achan, who is 35 years old, had been displaced first by violent raids from nomadic cattle rustlers from the neighboring Karamoja region and then by the Lord’s Resistance Army. As others told their stories, the sorrow was so overwhelming that the interpreter broke down in tears. Then Achan stood up and began to speak, in English. She was separated from her husband in the raids and unable to find him until she was able to go home in 2004. It was not a happy homecoming. “He had got another lady,” she said. Achan, with a secondary school education, decided to work through this setback. She learned about loans, and seeds and planting techniques. She persuaded her husband to start over in a farming partnership with her, and he agreed. Together they set out to work their patch of land. He stopped fighting and seeing other women, she said. Agriculturally, everything went wrong in the first year and they had no food. But they stayed together and are planning to start again. “If God brings us water, we can make it,” she said, with her husband sitting beside her. “We are reconciled and have started afresh.”

Achan had been displaced first by violent raids from nomadic cattle rustlers from the neighboring Karamoja region and then by the Lord’s Resistance Army.

International agencies have considerable documentation to support observations that educated women not only have fewer children and send them to school, but also have better economic prospects themselves, among other improvements in family life. Illiteracy, which holds back millions of women, disadvantages them in many ways, including denying them the ability to learn about and seek contraception. Worldwide, there are now estimated to be 215 million women who would like to avoid pregnancy but are not using an effective method of contraception, according to the Guttmacher Institute, a research and advocacy organization. Many, if not most of them, are in poor countries.

In Timor-Leste, Kirsty Sword Gusmão, the founder of the Alola Foundation, a development and educational non-governmental organization, said, “The major challenges that women face today relate to economic independence—or dependence—and the impact of that in terms of the options that are available in resolving issues such as violence in the home. Women are very financially dependent on men and they therefore often do not have the option of pursuing legal channels, and this shuts off access to other things, like education. That is particularly the case of rural women.”

“You have to remember, too, that the women’s movement here is very young,” said Gusmão, the Australian-born wife of Prime Minister Xanana Gusmão, considered a rebel hero in battles against Indonesian occupation, which ended in 1999. “We had only one women’s organization prior to 1999. We operated, obviously, in a very repressive environment, where ‘NGO’ was a dirty word.”

A young woman receives an examination at a clinic in Dili, Timor-Leste.
©VII Photo/Ron Haviv

Kirsty Gusmão said that there is a big interest in and growing demand for family planning, which in a country with one of the highest fertility rates in the world is understood as a way to rein in family expenses. A visit to a village on Timor-Leste’s north coast to talk with local women about this issue led to a debate among them that ended with the consensus that four children was an optimal number. The national fertility rate is well above six births. The women in the village said that government family planning services were often hard to reach and unpredictable in having supplies in stock.

“There are problems in getting the government to roll out services across the country, and to educate nurses and doctors about how to present the options to families,” Gusmão said. “They obviously face opposition from the clergy. It’s a challenging environment but in terms of women’s attitudes I think on the whole there is a great openness to it, and a greater understanding of the link between family size and poverty.” Similar conclusions have been drawn by staff of the Marie Stopes International organization in Timor-Leste and other non-governmental organizations as well as UNFPA.

Mario Martins da Cruz is a team leader and education specialist for Marie Stopes in Timor-Leste. “There is a need to improve reproductive health not only for women but also for men and the whole community, and that can best be done through information and education,” he said at the organization’s Dili headquarters, as he and others from the field talked about their work and their impressions. “We are providing information sessions; we start with reproductive health, the organs in the body. We then talk about family planning and sexually transmitted infections. There are very low levels of knowledge in the country. Many people are happy with what we are doing. They know that information can help to improve their lives. But we do still have some women who are scared of their husbands. The reality is that there still is not enough information out there, and the information that many people have is often negative.”

At the Caritas St. Antonio Motael Clinic in Dili, Madre Idalia Taveras, the Carmelite nun who heads Caritas’ Dili office, said that women are coming there to ask for information about contraception even though the Catholic Church is opposed to modern methods of family planning, and people are often unsatisfied with what government clinics offer. More than a decade ago, women were ordered to use contraceptives to limit their families to two children, and the threat of sterilization hung over them if they did not comply, she said. Those days are gone, and the Motael clinic, named for the church on whose grounds it is located, now tells women and their husbands that they are free to make their own choices.

Because this is a Catholic institution, the clinic explains both the church’s moral position on family planning and the modern options available, but it does not dispense modern contraceptives as part of its extensive medical services for men as well as women. The clinic was able to give women the beads that serve as daily reminders of the progression of menstrual cycles, though these are no longer recommended or distributed by most international agencies because they are not considered reliable or effective. However, for Timorese women, who favoured them, they are a family planning method that will not put them at odds with the church. Sometimes the use of beads is also a first step towards modern family planning. The clinic was looking for new sources of supply.

The Carmelite nuns, with their frank reproductive advice, have not escaped the attention of church leaders. But they have explained to them, Madre Idalia said, that the nuns are only helping people exercise their right to information.

[18] Interventions against gender-based violence in humanitarian settings

Gender-based violence is especially problematic in the context of complex emergencies and natural disasters, where civilian women and children are often targeted for abuse, and are the most vulnerable to exploitation, violence, and abuse simply because of their gender, age, and status in society.

During a crisis, such as armed conflict or natural disaster, institutions and systems for physical and social protection may be weakened or destroyed. Police, legal, health, education, and social services are often disrupted; many people flee, and those who remain may not have the capacity or the equipment to work. Families and communities are often separated, which results in a further breakdown of community support systems and protection mechanisms.

Grace returned to her community after having been abducted by the Lord's Resistance Army.
©Panos Pictures/Jenny Matthews

To save lives and maximize protection, a minimum set of coordinated activities must be rapidly undertaken to prevent and respond to gender-based violence from the earliest stages of an emergency. Survivors of gender-based violence may need health care, psychological and social support, security, and legal redress. At the same time, prevention activities must be put in place to address causes and contributing factors. Providers of all these services must be knowledgeable, skilled, and compassionate to help the survivor and to establish effective preventive measures.

Sexual violence is often used as a weapon of war, targeting civilian women and children. Survivors are at high risk of severe and long-lasting health problems, including death from injuries or suicide. Health consequences can include unwanted pregnancy, unsafe self-induced abortion, infanticide, and sexually transmitted infections, including HIV/AIDS. Psychological trauma, as well as social stigma and rejection, is also common. Most societies tend to blame the victim in cases of sexual violence, which increases psychological harm. The exact nature and severity of physical and emotional trauma vary greatly among survivors; not all available response services will be wanted or needed by all. The response to gender-based violence must, however, include a set of available services to reduce the harmful consequences and prevent further injury and harm to the survivor.

In times of crisis, health care services are often severely affected or disrupted. Lack of coordination, overcrowding, security constraints, and competing priorities can contribute to an even greater decrease in available and accessible health services, especially for women and children. Well-functioning and accessible health services also make a difference to women’s ability to reduce risks to their and their children’s health.

Although most survivors of sexual violence do not disclose the abuse to anyone, some will talk with a health provider if health services are physically or geographically accessible, confidential and sensitive; accommodate private consultations; and are of good quality. Health centres may serve as a first “neutral” location to provide information and counselling on women’s and girls’ reproductive health. Women may be more able to access this type of information if it is within the context of basic health care and not provided by specialty or separate programmes.

Source: Guidelines for Gender-based Violence Interventions in Humanitarian Settings, United Nations Inter-Agency Standing Committee

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