A first step in breaking the silence surrounding rape as a weapon of war and its destructive impact is to provide victims with the right to quality holistic services, which are indeed a right rather than a luxury.
We promote a four pillar healing model, the so called one stop centre where survivors can access medical care, psychosocial services, legal aid, and can choose to participate in activities aimed at gaining socio-economic power and building women’s leadership. Having all services in one place prevents survivors from having to repeat their story over and over, and enables them to choose from the services when they feel they are ready.
Read on to find out more about the four pillars of holistic services.
1. Medical care
Medical care is the first and most urgent step in a rape survivor’s journey to healing. Survivors of rape should have access to both clinical care and advanced surgery, when needed.
Clinical care starts with discussing confidentiality and patient rights with the survivor. Doctors and nurses obtain detailed information about the incident in a compassionate way, and gain consent for conducting a medical examination and documenting the findings. A survivor should never be pressured to undergo a medical examination or treatment: they must make their own decisions. Medical care includes treatment for injuries, providing presumptive treatment for sexually transmitted diseases, providing post-exposure prophylaxis (PEP) to prevent HIV-infection and emergency contraception to prevent pregnancy. Furthermore, services include the collection of clinical evidence to support a criminal investigation and referral to other services if requested by the survivor.
When rape is used as a weapon of war, it often involves brutal violence, mass rape and the forced insertion of objects, and it may target young girls whose bodies have not fully developed. This can cause traumatic gynaecological injuries, including fistula. Fistula is a painful condition that causes an abnormal opening between the vagina and rectum or bladder. Women with fistula suffer from incontinence and are unable to control the constant flow of urine and/or faeces that leak from the tear. Each and every woman or girl suffering from fistula should have access to safe surgery.
2. Psychosocial support
Besides painful injuries, rape survivors suffer from intense emotional and psychological trauma. As a first prerequisite to healing, all survivors and their dependents should have access to food and clothes, and to a safe place, such as community-based care or a shelter.
All professionals working with survivors of rape, including doctors, nurses and lawyers, must have a sound understanding of the psychological needs of a rape survivor, and provide their services in a compassionate, culturally appropriate and confidential way.
Family and community support are also crucial for survivors’ psychosocial well-being. This may require (1) working with local leadership (for example women, men, young people) in community-awareness actions to reduce stigma and (2) providing recreational activities to minimize social isolation and increase social cohesion.
For those survivors who have significant difficulties functioning, specialized mental health care needs to be available to prevent or treat persistent mental health problems. Trained mental health workers including psychologists and psychiatrists should provide these services. Services may include psychotherapy, group therapy and the provision of medication.
3. Legal aid
One of the main drivers in healing and reintegration into society the access to justice. Rape devastates victims’ integrity and leaves them feeling wronged and dejected. The pursuit of justice helps a victim regain her rights, which may be a big step in emotional and psychological healing. Yet, reporting rape, pursuing the legal process and testifying in court takes extreme courage and perseverance. All victims should have access to free legal aid throughout the judicial process, until judgment is handed down and enforced. Legal aid can include covering expenses, providing transport and translation, and the supply of all legal services including representation in court.
4. Socio-economic power and women’s leadership
Rape is associated with intense social stigma and isolation. Women are often exiled from their communities and families, left to take care of themselves. Socio-economic support can make an important contribution to the healing process. This type of support may take several forms ranging from a livelihoods cash grant to vocational training, or access to business development services or loans. Assistance may also involve supporting victims as they continue their education. Livelihood programmes should also provide access to practical skills training such as financial management, as well as general life-skills training in areas such as conflict management, negotiation, leadership, reproductive health and self-esteem. Such development allows victims of rape to activate the power that is within them, to become leaders in their community and fight for rights and justice.