Abstract
Sexual violence is recognised as a widespread consequence of armed conflict and other humanitarian crises. The limited evidence in literature on interventions in this field suggests a need for alternatives to traditional review methods, particularly given the challenges of undertaking research in conflict and crisis settings. This study employed a realist review of the literature on interventions with the aim of identifying the mechanisms at work across the range of types of intervention. The realist approach is an exploratory and theory-driven review method. It is well suited to complex interventions as it takes into account contextual factors to identify mechanisms that contribute to outcomes. The limited data available indicate that there are few deterrents to sexual violence in crises. Four main mechanisms appear to contribute to effective interventions: increasing the risk to offenders of being detected; building community engagement; ensuring community members are aware of available help for and responses to sexual violence; and safe and anonymous systems for reporting and seeking help. These mechanisms appeared to contribute to outcomes in multiple-component interventions, as well as those relating to gathering firewood, codes of conduct for personnel and legal interventions. Drawing on pre-existing capacity or culture in communities is an additional mechanism which should be explored. Though increasing the risk to offenders of being detected was assumed to be a central mechanism in deterring sexual violence, the evidence suggests that this mechanism operated only in interventions focused on gathering firewood and providing alternative fuels. The other three mechanisms appeared important to the likelihood of an intervention being successful, particularly when operating simultaneously. In a field where robust outcome research remains likely to be limited, realist methods provide opportunities to understand existing evidence. Our analysis identifies the important potential of building in mechanisms involving community engagement, awareness of responses and safe reporting provisions into the range of types of intervention for sexual violence in crises.
Highlights
Sexual violence is well recognised to be a consequence of armed conflict [1,2,3,4,5,6,7,8,9], with a recent global summit convened by the British Foreign Secretary attended by delegates from 123 countries
We identify seven types of intervention: i) provision of care for survivors of sexual violence; ii) initiatives to enhance livelihoods of women and so provide protection from sexual exploitation and abuse; iii) community mobilisation strategies to increase awareness and mutual protection; iv) initiatives directed at personnel providing services or protection; v) systems and security responses; vi) legal interventions; and vii) multiplecomponent interventions which integrate two or more of these strategies
We build on our earlier narrative analysis of identified studies [18] and report here on the realist analysis where we aimed to answer the question: what are the underlying mechanisms by which these interventions appeared to bring about reduced risk or incidence of sexual violence? Recognising the effectiveness of multiple-component interventions, we focus first on the mechanisms that seem to underpin these, and those evident in stand-alone interventions, where sufficient data exists
Summary
Sexual violence is well recognised to be a consequence of armed conflict [1,2,3,4,5,6,7,8,9], with a recent global summit convened by the British Foreign Secretary attended by delegates from 123 countries. Twenty one per cent of female refugees and internally displaced people in complex humanitarian emergencies have experienced sexual violence according to a recent review across 14 countries [10]. Sexual violence during armed conflict is a public health as well as a security and justice issue [14] with significant leadership being demonstrated by the World Health Organization [14, 15]. Its intervention recognises the significant short and long-term health effects, which include injury, HIV, sexually transmitted infections, unwanted pregnancies, traumatic fistulae, depression, post-traumatic stress disorder, anxiety, stigma and social rejection
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