For raped women in Darfur, access to reproductive health services limited

October 26, 2004 - (Refugees International) Janjaweed militias and government police continue to attack and rape women in Darfur. But the few clinics that do have services for rape survivors are not seeing recent cases because women are unable and unwilling to use health services. While clinics are packed with patients seeing treatment of malaria or respiratory illnesses, very few women are coming in for medical treatment after being raped. Many of the women said they did not know that services such as the "morning after pill" were available. Some NGOs say that they do not advertise services to rape survivors because Sudanese law (Article 48) prevents doctors from treating rape victims without a referral from the police department. Doctors and health personnel can be arrested for violating this law and some have been threatened to prevent them from providing services. While the

Government of Sudan has issued an "administrative circular" stating that women that have been seriously injured by rape do not require the police referral, repeal of this provision is essential for women to access medical services.

Ninety percent of all women in Darfur have been circumcised in the most severe manner (pharaonic circumcision, which removes all external genitalia); rape thus often results in extreme trauma and childbirth is difficult without a practiced midwife. The clinics that Refugees International visited differed from camp to camp and from state to state. Most clinics did not provide any specific services for women who were survivors of rape, nor did they stock rape kits including emergency contraception. Some clinics, however, had trained midwives to act as community outreach workers. Other midwives told us of seeking out women themselves during their off hours and performing abortions and delivering babies of rape.

Guaranteeing confidentiality within clinics is essential. The women all feared being gossiped about within their community. While the international community's desire for numbers and data is understandable, there should be less focus on compiling an accurate count of rape survivors and more on getting treatment to all that need it. Rumors that Janjaweed have branded raped women so they will always be stigmatized abound. But even without a physical mark, raped women face stigmatization. Women told us that a raped woman could "probably get married" to a much older man if she were his second or third wife, but her opportunities would be severely limited. Her bride price has decreased; many will never be able to marry. "My daughter has no opportunities left in life," one woman told us. "We have sent her to Khartoum for medical treatment, but she does not want to live." Men told us that a woman who has been raped is like a piece of spoiled meat and no one will marry her. In West Darfur, there were reports of single women being thrown out of their family homes and divorces of married women when it became known that they had been raped.

Because victims of sexual violence are reluctant to go to the clinics, the clinics must come to them and let them know about their services. Very few of the clinics that RI visited offered outreach services to internally displaced persons (IDPs). "One lady reported rape to us in the clinic. She told us that many other girls were suffering from that, too. We told her to bring them back here but she was shy and did not return," one health clinic worker told us. RI interviewed women in Darfur who told us of their sisters and daughters dying due to rape. In addition to their physical injuries, women are susceptible to pregnancy due to rape. This can be prevented by giving women emergency contraception after a rape. Community outreach programs to reach rape survivors must be put in place immediately.

Even if women are able to get to a clinic, there is no guarantee that the clinic will stock emergency contraception or have rape kits available. Emergency contraception must be used within 72 hours of a rape for it to be effective. If a rape survivor is on the move, there is no guarantee that the health clinic she visits will stock emergency contraception. On the 21st of September, a 14-year-old girl, while traveling to the market with her little brother, was gang-raped by seven Government of Sudan soldiers outside of Zam Zam camp in North Darfur. She was treated for medical wounds by an NGO and given the first dosage of emergency contraception, but did not return for follow-up treatment. Luckily, the UN Office of the High Commission for Human Rights (OHCHR) followed up with the medical clinic and tracked the girl down. With their assistance, the girl received further treatment and reported the incident to the police. OHCHR planned to follow-up with a commission of inquiry.

Despite the US government's reluctance to provide funding for or distribute emergency contraception to rape victims, UN Fund for Population Activities (UNFPA) staff told RI that they have adequate funding and supplies of rape kits, which include emergency contraception. Due to distribution problems, however, many of the clinics that RI visited did not stock these kits.

Currently, there are no programs for men to encourage them to change their attitudes towards women who have been raped. In order to help women become reintegrated into the community, men need to address their own feelings of powerlessness for failing to protect their families and to address community attitudes towards survivors of rape. "These men are supposed to protect their families," a Sudanese woman told RI. "Instead; the women are turning against them for failing to help them. They will not respect them."

There are also very few programs to enable rape survivors to overcome the stigma, shame, and fear from this act. More psychosocial or mental health programming is essential to help the communities overcome this trauma. There is still controversy in the relief world about what mental health services are appropriate for IDP and refugee populations, but there are a variety of ways to address this issue - from the MSF art therapy-style programs that bring women together to talk about their hopes for the future to UNFPA's planned "Family Support Programs" that help survivors and their families come to terms with taking care of themselves. Customary practices that are not harmful or dangerous should be incorporated into plans for psychosocial assistance.

Therefore Refugees International recommends that:

* Donor governments increase pressure on the Government of Sudan to repeal Article 48 as soon as possible so that women may receive treatment for rape.
* The Government of Sudan repeal Article 48 as soon as possible.* Humanitarian agencies accelerate community outreach efforts to IDP women to inform them of medical services available in clinics.* UNFPA expedite delivery of rape kits and emergency contraception to all health clinics, both in IDP camps and in villages.* Strict standards of confidentiality be observed in all health facilities. All humanitarian agencies must protect the names of their clients while developing confidential reporting systems. Collecting information should not stand in the way of providing services.
* Donors earmark money for programming for men and ask implementing partners to begin developing programs.
* Donors earmark money for mental health programming and implementing partners begin testing pilot programs immediately.

From: http://www.reliefweb.int/w/rwb.nsf/