Rape victims in Ugandan camps need better health care

The protracted war between the Ugandan Government and Lord’s Resistance Army rebels has forced 1.7 million people to flee their homes. Women living in camps are at risk of forced marriage, sexual harassment and abuse and rape, often by their partners. Services for victims of sexual violence are woefully inadequate. 

In2006 the London School of Hygiene and Tropical Medicine, in the UK, conducted asurvey into health services in the refugee camps of Uganda. Their reportfocuses on services for female survivors of sexual violence.

Thecamps house between 1,000 and 50,000 refugees and suffer from many of theproblems found in poor urban areas. More than half of the inhabitants are underthe age of 15, and a quarter of the children have lost one or both of theirparents. Rates of mortality, illness and mental distress are high in the camps,which are crowded and do not have proper sanitation.

Researchersinterviewed 26 professionals about violence against women (gender-basedviolence) in Gulu district, northern Uganda. Theyinspected the availability of medical supplies such as emergency contraceptionfor victims of sexual violence. The study found that while services for victimsof violence were inadequate there was no money available to improve theservices. Other findings include:

• Seven of the eight health centres surveyed had at least one persontrained in handling violence against women.
• While trained staff felt they were able to identify cases of violence,they did not feel confident in treating or counselling the women victimised.
• There was a shortage of medical supplies such as drugs to prevent HIVinfection following rape. However, clinics did have drugs for sexuallytransmitted infections (STIs).
• The clinics had nowhere to store confidential documents.
• The professionals believed rape by strangers was uncommon but earlymarriages made the girls more vulnerable to rape by their partners.
• In contrast the professionals believed forced marriage,sexual harassment and abuse of young girls, and rape within marriage were verycommon.

Currentinternational guidelines for programmes to deal with gender-based violence inhumanitarian settings focus on rape by strangers. However, other forms of violence towardswomen may be more common in northern Uganda. Such guidelines could excludegirls and women who have suffered from violence not directly related to theconflict from obtaining health care. The study recommends that the guidelinestake a broader view of gender-based violence, and also advocates:

• an increase in the provision of services, in particular youth-friendlyservices, for victims of violence at local health centres
• more training for health workers to support survivors of violence
• greater availability of necessary drugs for treatment of STIs, post-exposureprophylaxis for HIV and emergency contraception at the clinics
• further investigation into the rape and sexual exploitation of men andboys
• campaigns for greater awareness within the community, particularly amongyoung people
• the legalisation of abortion for rape victims who do notget to clinics in time to take emergency contraception.