Reducing Violence Against Women: Health Care Providers Can Help

Darfur, Sudan: "The soldiers and Janjawid [militia] arrived by car, camels, and horses. Some 15 women and girls who had not fled quickly enough were raped in different huts in the village. The Janjawid broke the limbs of some women and girls to prevent them from escaping. After the rapes, they looted the houses."
   —A female refugee interviewed by Amnesty International (1)

Northern Uganda: "I was taken under a tree. They told me to lie upside down. I refused. One of the rebels told me I was stubborn, and they would teach me a lesson I would never forget. Two rebels spread my legs and tied them with ropes. Then they started piercing my private parts with a knife and cut the area open up to my anus. They beat me and left me unconscious."
   —A female refugee interviewed by Isis-Women’s International Cross-Cultural Exchange (120)

Putting water supply points in well-lit,well-traveled locations, as in this Ghanaian refugee camp, helps women stay out of remote parts of the camp where they might be attacked. (Photo Credit: © Nell Kussian, Courtesy of Photoshare)

Violence against women is a serious and common problem in crisis situations. What can health care providers do? Awareness is the first step. Providers who are unaware, indifferent, or judgmental often miss opportunities to help their clients (34). Providers need to become more aware of the situations in which violence against women occurs and learn what they can do to help protect women (112).

Caring for survivors of violence. The best way to determine if a female client has been abused is to ask her about it. Women who have experienced violence may be willing to discuss their experience. They typically do not disclose such information on their own, however, but might if someone they trust raises the issue, such as a counselor, health care provider, or close friend or relative. Women are more likely to disclose violence and other abuse to a female health care provider than to a male provider (34).

Health care providers often do not ask women about violence, however, because they feel unprepared to address clients’ needs. Humanitarian and local health care providers need training in counseling women subject to violence and abuse. They should be alert to physical injuries, health conditions, and clients’ behavior that may indicate trauma from sexual violence or other abuses.

If a woman discloses abuse, providers can take the following steps to support her (17, 34, 94, 112, 113):

• Provide appropriate care. If a woman has been sexually assaulted, appropriate medical care includes a medical exam, treatment of any injuries, preventing unwanted pregnancy by providing emergency contraception (EC), treatment for STIs, including post-exposure prophylaxis against HIV/AIDS, and counseling. Providers should also refer women for other levels of care needed, such as referral to hospital for surgery, and offer transportation when needed. In addition, providers should offer information about other available services, such as counseling, economic assistance, or legal advice, and refer as requested by the survivor. (For further information see the WHO report, “Clinical Management of Rape Survivors” )

• Document the woman’s condition. Documenting a woman’s injuries and symptoms helps medical staff to follow up. Documentation also can help providers to understand the types and extent of sexual violence and to monitor and evaluate care.

• Support women’s self-esteem. Health care providers can reaffirm to each client that the violence against her was not her fault and that no one deserves to be beaten, raped, or assaulted under any circumstances.

Preventing violence in camps. Health care providers in refugee camps can take several steps that help prevent violence against women (4):

• Work with camp management. To reduce vulnerability among refugees, providers can help camp management committees to locate water collection points and latrines in places that are well-traveled and well-lit.

• Work with refugee health care providers. Providers should try to locate health care providers within the refugee population. Refugees who are providers may already be aware of the violence and could be trained how to handle it.

• Advocate leadership by women. Providers can support female representation on governing councils for refugees in camps or communities.

• Work with security forces. Providers can work with security forces to create awareness of women’s needs for protection in and around camps.

• Involve the community. Community-based strategies can reduce emotional and social harm and promote community support for survivors. In the long term, sexual violence can be reduced by reaching out to community leaders and men to change attitudes that permit abuse of women. These kinds of community-based strategies for social change are most feasible in the recovery phase, when communities no longer face immediate disruption.

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