Abstract
BackgroundOutcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).MethodsA retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.ResultsIn Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.ConclusionThis study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Highlights
Sexual violence is a devastating problem worldwide, having a major impact on the medical and psychological wellbeing of its survivors [1]
Data were collected from January to December 2012 in two Medecins Sans Frontieres (MSF) programmes offering care to sexual violence survivors: one in an active conflict zone in the remote Masisi Health Zone in North Kivu province, and one in the remote, post-conflict Niangara Health Zone in Orientale province in northern Democratic Republic of Congo (DRC)
Sexual violence care is managed as an integrated component in both projects, following national and MSF guidelines. These are in accordance with the WHO guidelines on medical management of sexual violence survivors: only post-exposure prophylaxis (PEP) as done by MSF is more up-to-date than the current WHO protocols [11,12,13]
Summary
Sexual violence is a devastating problem worldwide, having a major impact on the medical and psychological wellbeing of its survivors [1]. In particular in unstable areas such as conflict and post-conflict zones, certain (sub-)populations are highly vulnerable to sexual violence. In post-conflict zones, social destabilization due to population displacements and past traumatic experiences tied to conflicts can lead to high levels of abuse within families and communities [3]. Sexual violence can lead to mental and physical problems, and psychological post-traumatic reactions or disorders such as anxiety or depressive disorders, suicide attempts, and substance abuse. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We set out to compare the Medecins Sans Frontieres sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uele)
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