Five Evidence-based Approaches that Deliver Results for Survivors of Conflict-Related Sexual Violence and the Clinicians Who Support Them 

An estimated one in three women worldwide have been subjected to physical and/or sexual violence in their lifetime, a traumatizing experience with short- and long-term adverse health consequences that impact individuals and communities. For people who survive sexual violence in the context of war or conflict, the barriers to accessing high-quality services, support, and accountability can be particularly steep.  

Through the Program on Sexual Violence in Conflict Zones, Physicians for Human Rights (PHR) works to confront these challenges and empower multisectoral professionals to offer survivor-centered services and document forensic evidence of injuries sustained to strengthen accountability and access to justice. PHR has a well-established track record of evidence-based interventions that achieve impact for survivors and support for the professionals who provide care and services. Working at the global level as well as in Kenya, the Democratic Republic of the Congo (DRC), Central African Republic (CAR), Iraq, Myanmar/Bangladesh, and Ethiopia, we center survivors and our partners in our conversations and efforts to understand how to drive progress at a systemic level, primarily through capacity building, multisectoral networks, and research. As we mark the International Day for the Elimination of Violence Against Women on November 25, we continue to challenge ourselves to understand what works and what doesn’t, using the following rigorous, scientific, and trauma-informed approaches.  

This International Day for the Elimination of Violence Against Women, PHR will continue fighting for justice for survivors of conflict-related sexual violence, and empowering the clinicians that support them.

Here are five ways that evidence makes change possible for survivors of conflict-related sexual violence: 

1. Multisectoral Trainings and Partnerships with Clinicians and the Legal Sector 

At the heart of PHR’s work to pursue access to justice for survivors of conflict-related sexual violence are the multisectoral networks and partnerships built among healthcare professionals, police officers, forensic analysts, lawyers, and judges. Health professionals are often essential first responders for sexual violence survivors. However, professionals in conflict regions require support to strengthen their capacity to properly collect and document forensic medical evidence, which is a key first step needed to engage with multisectoral partners, including legal services and law enforcement, and to seek accountability for crimes of sexual violence. 

PHR prioritizes trauma-informed, survivor-centered, multisectoral trainings and partnerships, particularly to enhance medical-legal processes for survivors, that have proven effective. A recent article about our work in Kenya found that scaling medical–legal training and strengthening multisectoral networks in areas with high rates of sexual and gender-based violence (SGBV) are promising strategies for increasing collaboration, enhancing the quality of services, and improving justice processes for survivors. These approaches have promoted prosecutions and appeared to have encouraged other survivors to come forward.  

Another recent article about our work in DRC, published in the journal Violence and Victims, found that participants completing PHR’s multisectoral training had improved knowledge and attitudes of health, law enforcement, and legal professionals and, overall, viewed PHR’s training as beneficial. This study suggests that PHR’s training is effective in under-resourced, conflict-affected regions. PHR started developing these trainings in 2011, and we have been consistently refining our approaches ever since to ensure alignment with best practices and in collaboration with our partners and colleagues living and working in the communities where the trainings are taking place. 

2. Innovative Technologies Co-Designed with Colleagues in Kenya and the DRC 

To support the reliable and secure documentation of forensic evidence needed to support sexual violence cases, PHR designed and developed MediCapt, an award-winning mobile application to document forensic evidence of sexual violence. MediCapt provides a digital platform to facilitate the comprehensive collection of evidence, including forensic photography of injuries sustained by survivors. MediCapt also allows forensic evidence to be securely stored in the cloud and safely shared with law enforcement and justice sector officials to inform investigations and prosecutions. To date, MediCapt has been successfully piloted in DRC at HEAL Africa Hospital in Goma, in Kenya at Naivasha Sub-County Hospital in Naivasha, at Nakuru County Referral and Teaching Hospital in Nakuru, and at the Mukuru Health Centre in the Embakasi South Sub-County in Nairobi. MediCapt standardizes and improves the quality of information collected compared to the paper-based form. A report we published in collaboration with the first end-users, who self-describe as the “pioneers,” addresses the effectiveness of MediCapt from their unique perspective. Further information about the extensive process we undertook to collaboratively design and develop the app can be found here and here

3. Survivor-Centered Litigation to Hold Perpetrators Accountable 

These multisectoral partnerships are helping to achieve justice for survivors of sexual violence. One notable example of our work in this area has been in the South Kivu village of Kavumu in the DRC. Over a three-year period, beginning in 2013, more than 42 young girls in DRC, some as young as 18 months, were kidnapped from their homes, raped, and then left in the fields surrounding Kavumu, a small town in South Kivu. To pursue justice for the girls and their families, PHR worked with multisectoral professionals to gather forensic evidence from the survivors, coordinate the investigation, and provide technical assistance to medical, law enforcement, and legal professionals. This work was critical for achieving a landmark conviction in December 2017 of 11 militia members, including a sitting member of parliament, for crimes against humanity for rape and murder. The judgment was upheld on appeal in July 2018. In Kenya, inConstitutional Petition No. 122 of 2013, a group of eight survivor-petitioners and four civil society organizations, including PHR, sought to hold the Kenyan government accountable for sexual violence in the post-election period. In December 2020, the High Court of Nairobi issued a landmark judgment holding the Government of Kenya accountable for failing to investigate and prosecute the cases of survivors who reported to the police or who were violated by government security forces. However, the court failed to acknowledge the government’s responsibility in those cases where survivors were not able to report their cases. To that end, PHR and our co-petitioners filed a partial appeal in January 2022 at the Court of Appeal at Nairobi. While this litigation has wound its way through the Kenyan legal system for nearly a decade, repeatedly subjected to unacceptable delays, PHR and our partners remain committed to seeing justice delivered for the courageous survivors of post-election sexual violence in Kenya. 

4. Research to Document and Corroborate Reports of Conflict-Related Sexual Violence 

PHR also conducts research to document and corroborate reports of conflict-related sexual violence (CRSV). Most recently, our work addressing CRSV has focused on Rohingya refugees from Myanmar who fled to Bangladesh. We have documented patterns of injuries and physical and psychological conditions experienced by the Rohingya related to sexual violence, and examined how the COVID-19 pandemic affected SGBV and the provision of services for Rohingya refugees. Our work has corroborated previous reports that the Rohingya experienced CRSV by the Myanmar military and security forces and documented barriers to providing comprehensive SGBV care services to Rohingya survivors in Bangladesh. This important evidence has been shared with various international fact-finding and accountability processes, supporting the pursuit of justice for the Rohingya. 

5. New Projects to Understand and Communicate Experiences of Survivors 

PHR is also conducting innovative research to better understand the experiences of survivors of sexual violence in Kenya as they access mental health services. These experiences are important as they convey advocacy needs and priorities related to mental health and survivor-centered care, from the perspective of survivors themselves. For this project, PHR will use a visual research strategy consisting of an approach called “Photovoice” to collect data and make a gallery of photos and captions from survivors to advocate for them and influence change. We are also doing this research to understand the impacts of our work and to create stronger strategies that reflect survivors’ experiences and perspectives. Our advocacy in Kenya also helped bring about the Mental Health Amendment Act, which prioritizes ensuring that all people with mental health needs receive the best care they can attain, including survivors of sexual violence.  

This International Day for the Elimination of Violence Against Women, PHR will continue comprehensively fighting for justice for survivors of conflict-related sexual violence and empowering the clinicians and professionals that support them. Through evidence and advocacy, change is possible for survivors of conflict-related sexual violence. 

Photo: A physician at HEAL Africa Hospital in Goma, DRC uses PHR’s MediCapt app

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