One in three women has experienced intimate partner violence (IPV) or sexual violence in their lifetime. For WHO in Cox’s Bazar, responding to gender-based violence (GBV) is integral to the sector’s comprehensive service during the displacement crisis.
That’s why health partners have been working to improve service provisions for survivors of IPV and rape in Cox’s Bazar.
Under the leadership of WHO, the health sector collaborated with the Sexual and Reproductive Health Working Group to conduct training on the clinical management of rape and intimate partner violence in May 2022.
These sessions are part of a range of training aimed at building the capacities of health workers to respond to cases. They help workers better understand the barriers that survivors face, as well as how to provide compassionate, competent and confidential services.
Critically, the training will help workers better identify cases of intimate partner violence and respond to rape cases. They also enable the health sector to improve the confidential health systems to support and protect Rohingya women and girls.
Clinical Management of Rape and Intimate Partner Violence training sessions took place from 22 to 25 May 2022 in Cox’s Bazar.
“Healthcare providers are the front line of support for survivors,” says Samrawit Assefa Melles, WHO Emergencies Specialist in GBV, “they play a significant role in providing life-saving services and making the necessary referrals.”
The training provides a much-needed opportunity to workshop best practices and builds a framework for rapid service support. It equips front-line workers with the knowledge they need to respond correctly.
“These services, when accessed in a timely manner, can provide life-saving interventions for survivors of GBV. It’s essential that they know where to go for help.”
In humanitarian settings, a survivor of GBV may also face stigma and rejection from her community and family. Photo credit: WHO Bangladesh/Irene Gavieiro Agud
Displaced women are more at-risk
WHO has recognised that violence against women is a global health concern. The impacts of gender-based violence, however, can be more severe for displaced women and girls.
A 2014 study estimated that around 21% of women from conflict-affected countries are victims of sexualised violence. As a result of IPV and GBV, displaced women and girls may experience serious physical injuries, unintended or unwanted pregnancies, and sexually transmitted infections. The impact on mental health can be equally dangerous, leading to depression and PTSD.
Incidents of GBV commonly go under-reported by survivors and unrecognised by aid workers. Stigma, shame and the attitudes of service providers contribute to low reporting rates. Many women also struggle to find the services they need.
Despite challenges in reporting, there is clear evidence that the COVID-19 pandemic has increased the prevalence of GBV in Cox’s Bazar. An IRC analysis found that incidents of violence against women were increasingly committed by intimate partners during the pandemic.
Co-ordinating multiple solutions
Survivors of gender-based violence have a range of needs and health responses play a vital role in care. However, such challenges can’t be solved through the health sector alone. They require a coordinated response, aligning a range of solutions within the sector and further afield. UNFPA is the lead agency of the GBV sub-sector in Cox’s Bazar. It plays a key role in coordinating services, ensuring the availability of the GBV response systems, GBV prevention and mitigation services. WHO collaborates with UNFPA and SRH Working Group as the health-sector lead to build the capacities of providers.
Both agencies also coordinate awareness-raising actions that empower women to seek health care and speak out against violence.
For Mst. Rezwana Khanam, these communications campaigns are a critical part of the solution to rape and IPV. In her role as Program Supervisor on Sexual Violence for Médecins Sans Frontière, she sees first-hand how awareness campaigns impact health outcomes.
“If we conduct quality community engagement-related sessions—sensitise the community people, community leaders, Maji, for the community dialogue—if we include this in our training sessions, it will be better.”
This kind of engagement helps to break down barriers to health care.
“Religious barriers, social stigma, shame—that’s why [survivors] are not always interested to arrive at health facilities within 72 hours. However, if we work properly on the community level on sexual violence-related issues, more and more, it will be better for every survivor.”
Monitoring and assessment are also crucial ingredients to ensuring best practice. The sector conducts quarterly health facilities monitoring and plans to conduct quality assurance assessments to identify gaps in GBV care.
Health workers attend the Clinical Management of Rape and Intimate Partner Violence training sessions. Photo credit: WHO Bangladesh/James Carmichael
A future without gendered violence
WHO continues to strive towards a world with equitable health outcomes for all. That means providing care for survivors whilst working to undermine the causes of inadequate health-seeking behaviours. There are, however, no easy solutions.
Rezwana believes that the next step in supporting women and girls lies in improving the process of confidential filing for rape and IPV cases.
“If there is not quality documentation,” she says, “then other actors aren’t able to offer support and can’t give cases their proper importance. So it is very important [for health workers] to fill out medical documentation correctly.”
WHO is also collaborating with health-sector partners to strengthen the confidential referral process. This helps to ensure survivors get the best possible treatment without any unwanted consequences of seeking care.
In the meantime, health-sector workers continue to provide the best possible care for survivors of rape and IPV. Dr Jorge Martinez, Head of the WHO Sub Office in Cox’s Bazar, has testified to the progress made so far.
“Development and gender equality are intrinsically linked. Until women around the world have access to the health services and protections they need, the potential of the global community can never be fully realised. Here in Cox’s Bazar, we have made huge strides in improving access for survivors of gender-based violence. But there is still much work to be done.”
For more information on the issues covered in this article, please contact [email protected].