Fieldset
Caring for survivors of sexual violence in the Central African Republic

Luciano Canchelara is a psychologist who has been working at MSF’s sexual violence clinic in Bangui for the past three months.

In some societies, sexual violence is overwhelmingly frequent. Women, men, girls, and boys are sexually assaulted in different environments, both in conflict situations and also in the course of daily life.

That’s why, in the Central African Republic, Médecins Sans Frontières/Doctors Without Borders (MSF) is taking a holistic approaching to treat survivors of rape and other forms of sexual violence. In December 2017, MSF opened a clinic to support victims of sexual violence and has treated nearly 800 people since then. Of these, the majority were women, and a quarter were children.

Treating victims of sexual violence is truly a complex problem, with people affected by their ordeal in three key ways: at physical, psychological and social levels.  

If, as the World Health Organisation (WHO) states, health can be understood as "a state of perfect physical, mental and social wellbeing, and not only the absence of disease", then we must tackle this problem from these three angles in order to bring our patients back to as healthy a state as possible.

Treating trauma

In Bangui, the capital of the Central African Republic, we meet people who come to our clinic with clear physical consequences of aggression, for example with different injuries or gynaecological complications. These patients are also at serious risk of contracting sexually transmitted diseases such as HIV and Hepatitis B, among others.

Treating victims of sexual violence is truly a complex problem, with people affected by their ordeal in three key ways: at physical , psychological and social levels.  

The trauma of the experience also leaves traces at the psychological level. In the case of boys and girls, in particular, there are psychological symptoms such as behavioural disorders, feelings of deep sadness, and paralyzing fear. All of these are signs that something is wrong, and behind these, we often find an episode of sexual violence.

Adult patients, too, frequently show signs of post-traumatic stress or severe alterations in mood that can prevent them from continuing with their daily lives.

Social stigma

Unfortunately, there is also a lot of stigma here surrounding sexual violence. Some children stop going to school, while some are rejected by their peers and even – in the case of both children and adults – cast out by their own families.

It is also common to find people who, due to the armed conflict, have had to move from their homes to other towns and as a result are living in very poor conditions. Many of these people have already suffered sexual assaults at another time and have also lost family members due to conflicts and disease.

This is the complexity of the problem we are facing in the Central African Republic.

A holistic approach

For these reasons, my colleagues have designed a model of care for patients covering medical, psychological and social assistance. This means treating any injuries while taking action to prevent the sexually transmitted diseases that sexual violence can entail.

Our objective is to recognise suffering in all its dimensions and support patients with humane treatment.

At the same time, we have a mental health service to reduce the impact and alleviate the symptoms of the survivors. We have a special room for children and another room for adults.

Finally, our team of social workers is responsible for supporting the reintegration of survivors into the community. They can provide patients with information on the legal implications of the attack, as well as assess different needs and refer the patient to services that can help, such as for education, food, and legal support.

Our objective is to recognise suffering in all its dimensions and support patients with humane treatment.

We try to respond to all of the forms of human suffering that are connected to sexual violence. The results that we are seeing with this holistic approach are much better than we would see if these departments weren’t linked.

We believe that by doing this, we can do what we are here in Bangui to do:  to serve and treat survivors, and support them as they start their life again.