Susannah Sirkin is Deputy Director at Physicians for Human Rights, an organisation that uses medicine and science to stop mass atrocities and severe human rights violations against individuals. She has organised investigations in Sudan, former Yugoslavia, Rwanda, Afghanistan, Somalia and Bosnia and many other countries. In this guest article, she discusses physical and psychological consequences of sexual violence in conflict.
Women and girls as well as men and boys subjected to sexual violence in conflict often also suffer the traumas of the death of family and friends, exile and dislocation, and the loss of everything familiar, from homes and possessions to traditions and routines.
Rape is a violent act, and victims may incur broken bones, concussions, and wounds. Rape victims also suffer from bruising or tearing of the genitalia, tearing of the perineum and damage to the bladder and rectum. If the assault is extremely violent, the victim may suffer traumatic fistula which leads to chronic incontinence of urine and feces, and sometimes ostracism from the community.
Rape victims are at risk of contracting HIV/AIDs and other sexually transmitted infections (STIs). They may develop pelvic inflammatory disease, which could cause long-term infertility. A woman who contracts an STI while pregnant is at high risk of miscarriage, spontaneous abortion and even death.
Many women who become pregnant as a consequence of rape may attempt to induce abortion, often at great risk to their own health. Women who conceive as a result of rape may not seek pre- or ante-natal care, and children they deliver are often neglected, stigmatized, or worse.
In the immediate aftermath, a victim may suffer from shock, denial, fear and a sense of loss of control over his or her own life. Victims may manifest the psychological distress in physical symptoms including headaches, chest and pelvic pain. In the longer-term, male and female victims can suffer from depression, suicidal ideation and post-traumatic stress disorder (PTSD). Victims are sometimes unable to continue with their daily routines.
Rape in war frequently entails more than one traumatic occurrence. In many conflicts women have been captured and held captive for weeks, months or even years as sex slaves, and raped repeatedly.
The husbands and partners of women raped in war may experience profound shame, feeling that the act has brought dishonor to them and the family. This can lead to divorce or verbal and physical abuse.
Widespread rape has profound consequences for communities, rupturing social cohesion. Entire communities feel vulnerable and traumatized collectively by the sexual violence.
The best programs to support survivors of sexual violence are holistic and comprehensive, providing immediate medical care for injuries, post-exposure prevention that includes emergency contraception, testing and immediate treatment for STIs, and psycho-social support. A component of medical care should also include forensic documentation by doctors and nurses to assure the survivor has necessary medical evidence for access to justice if desired and possible.
Photo: Healing hut at Panzi hospital, Democratic Republic of the Congo.