NAIROBI– Survivors of sexual violence in Kenya face barriers to quality mental health services in their communities, according to a new assessment co-published today by Physicians for Human Rights (PHR) and the Survivors of Sexual Violence in Kenya Network (SSVKenya), which is convened by the Wangu Kanja Foundation.
The new assessment, Voicing Our Plight: Using Photovoice to Assess Perceptions of Mental Health Services for Survivors of Sexual Violence in Kenya, documents the wide-ranging challenges that survivors of sexual violence in Kenya face related to mental health services. Featuring survivors’ own voices, photos, and perspectives, the assessment shows that there are significant gaps in the availability, accessibility, acceptability, and quality of mental health services being offered to survivors in their communities in Nairobi. Barriers that survivors experience range from costly transportation to stigma to infrastructure challenges to undertrained health workers.
Under national laws and policies, as well as international treaties, Kenya’s government is obligated to provide mental health care for survivors of sexual violence, but the assessment shows clear shortcomings in the implementation of those policies.
The assessment was conducted in 2022 using Photovoice – an inclusive and participatory methodology that mitigates the risk of retraumatizing survivors of sexual violence. PHR worked closely with SSVKenya and other partners to address challenges faced by survivors of sexual violence in Kenya. The assessment team identified ten survivors of sexual violence from across Nairobi who were engaged in their communities as activists, human rights defenders, and volunteers helping other survivors access health services. Using the Photovoice methodology, these ten survivors took a total of 223 photos and 99 WhatsApp voice notes that depicted the experiences of survivors in their communities in accessing mental health services in Nairobi.
“The photovoice research was one of a kind because it enhanced, we the Survivors of sexual violence’s sense of ownership as we went on documenting the state of neglected mental health services in our health facilities,” said Beatrice Karore, a member of SSVKenya who participated in the Photovoice project.
The assessment publishes alongside a new multimedia gallery, which features a series of images, taken by the survivors themselves, that provide an intimate look into the daily lives of these women. Today in Nairobi, the survivors and PHR will present the assessment and photo gallery to community stakeholders, donors, and policymakers.
“Photovoice has given us the platform of realizing and identifying on the factors contributing to mental health issues and how we can give a hand as survivors, stakeholders and the community at large,” said Bonila Sisia, a member of SSVKenya who participated in the Photovoice project.
Sexual and gender-based violence (SGBV), a public health crisis that deeply impacts the lives of survivors, remains underreported and under-prosecuted in Kenya and globally. 34 percent of women and girls between the ages of 15 and 49 in Kenya reported having experienced physical violence at least once in their lifetime and 13 percent reported having experienced sexual violence, with many of these cases going unreported to authorities, according to the Kenya Demographic and Health Survey of 2022.
Often, survivors do not seek medical and psychological care or pursue justice and accountability due to factors such as safety concerns, stigma, and lack of services. In addition, survivors often are not able to physically access health facilities due to distance, cost, physical infrastructure that is difficult to navigate, and high volumes of patients. Many survivors who participated in the assessment reported that mental health services were unavailable in their communities – for instance, some facilities were only open for part of their official office hours – or had concerns about other issues such as the quality of services related to the training of health workers. Survivors also noted the lack of confidentiality and survivor-centeredness of services provided.
“Survivors have the right to mental health care, and the Government of Kenya has an obligation to provide it,” said Naitore Nyamu-Mathenge, head of PHR’s Kenya office. “The government must no longer delay providing high-quality mental health care access for all survivors of sexual violence. There is an urgent need for the government to build capacity in and provide funding to health facilities to provide high-quality, free post-rape care and affordable mental health care – which is required under Kenya’s new Mental Health Amendment Act.”
“We thank our assessment and advocacy partners SSVKenya for their ingenuity, persistence, and courage,” Nyamu-Mathenge added.
Based on the assessment, PHR and SSVKenya are calling on the Government of Kenya as well as donors, civil society organizations, and other stakeholders to support survivors of sexual violence:
- The Nairobi City County Government should allocate county health funds to guarantee no-cost post-rape care and affordable mental health care for priority populations, establish the Mental Health Council as mandated by the Mental Health Amendment Act, and fully implement the National Guidelines on Management of Sexual Violence in Kenya at health facilities that provide post-rape care.
- The Nairobi City County Government’s Medical Services Sub-Sector should allocate more financial resources to mental health service provision, increase the number of staff offering mental health services, and conduct annual capacity development for all health care providers on the provision of mental health services.
- The Nairobi City County Government’s Public Health Sub-Sector should train and engage community mental health workers to offer appropriate first-line mental health services and referrals for survivors of sexual violence and develop new programs to ensure mental health services are more accessible to survivors of sexual violence.
- The Kenya Ministry of Health should fund and implement comprehensive training and awareness building on mental health care for survivors of sexual violence for all health care workers, including training on mental health counseling and documentation of psychological evidence of sexual violence.
- All stakeholders, including donors and civil society organizations, should ensure support to survivors’ groups and adoption of measures to engage survivors’ perspectives and voices in all processes to improve mental health services for survivors, as well as promote and fund participatory methods for engaging survivors like Photovoice to understand survivor priorities.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.