Spotlight on Sexual Violence

Picture © MSF-E Sexual Violence and Migration Report

Every year, millions of people are affected by sexual violence.  It is a pervasive problem that is not confined to specific religious, cultural or ethnic groups and although women comprise the majority of those affected, sexual violence can happen to anyone; women, children and men.  Sexual violence can include many types of violation, from rape and forced pregnancy to sexual slavery and genital mutilation. 

Despite variation in the form that sexual violence can take, the need to protect and provide medical care to those affected is universal and imperative.  Sexual violence has a profound impact on the physical and mental health of survivors and can also have devastating effects on the families and communities of those affected.  Survivors of sexual violence require immediate care following an assault.  In order to prevent HIV, treatment has to start within three days and emergency contraception must be taken within five.  Survivors may have other acute needs, from administration of the tetanus vaccination to the treatment of potentially life threatening physical injuries.  Sexual violence may cause survivors to experience long-lasting emotional effects and thus may require psychological support.  Beyond these medical needs, survivors may also require recourse to legal help, to bring their perpetrator to justice, as well as economic or social support.

Despite its global prevalence, sexual violence is often an invisible problem.  One of the major issues is that the extent of sexual violence is not fully known due to low reporting rates.  Survivors often feel that they are alone or worse, that the violence they endure is their fault or acceptable.  Furthermore, survivors may fear stigmatisation or face retributive acts of violence for speaking out.  They may be forced out of their homes or communities, may be forced to marry their perpetrators or be abandoned by their partners.  Societies may blame the survivor for the attack or the survivor may not be protected under the legal system.[1]  Males or children may not be recognised as survivors and excluded by health care provisions for sexual violence.  Speaking out about the violence they endure therefore takes great courage on the part of the survivor.  Ultimately these barriers to reporting exacerbate the impact that these violations have on survivors. 

Sexual violence can be particularly evident during times of instability.  While sexual violence need not and should not be inevitable during conflict situations, the vulnerability of civilians, the erosion of social norms and the culture of impunity enables sexual violence to occur on a widespread scale.  Sexual violence may also be used as a weapon of war in order to inflict fear, hatred or destroy the social fabric of particular groups or alternatively used as a means to reward or pay combatants.  While providing treatment is challenging in most contexts, the treatment of those living in war-torn countries can be even more exigent due to limited or non-existent health services.  The disruption of police and health services as well as the displacement of civilians not only impacts the ability to provide treatment to survivors, but creates additional barriers to reporting. 

However, sexual violence does not only affect people living in conflict zones but those living in stable settings.  In these instances, sexual violence is often perpetrated by intimate partners, relatives or individuals known to the survivor.[2]  In many cases the perpetrator is the head of the household and the survivor is forced to endure the situation as they are economically dependent on them.  These circumstances can make speaking out even harder for survivors and enables the continuation of abuse by their perpetrators. 

As demonstrated, sexual violence permeates through all spectrums of society indiscriminately of gender, ethnicity, religion or age.  Providing comprehensive support to survivors as well as creating better access and awareness is an imperative, albeit, challenging task.  In many societies there are enduring myths of sexual violence; that survivors are to blame, that sexual violence is an inevitable part of conflict or that males are not affected by sexual violence.  These entrenched perceptions of sexual violence combined with the low reporting rates are just a few of the challenges we face in addressing the problem. 

While the prevention of sexual violence may be beyond the scope of MSF, speaking out about what we see and giving a voice to survivors, by offering medical support, is one step in a long process to tackling the problem.  The current lack of adequate care and support should not and need not be this way.  Survivors must be able to access free, quality, confidential and integrated medical care without stigmatisation during the process.  This is something that with time MSF can achieve.

Written by: Romy Rehfeld

If you wish to read more about the topic you can find interviews and research on sexual violence in the December 2013 issue of the Association newsletter.

[1] I RIN (2005). Broken bodies. Broken dreams. Violence against women exposed: http: //

[2] WHO (2005) Multi-country study on women’s health and domestic violence:


By: Association Intern