Sixteen-year-old Florence was an orphan doing domestic work when the January 2010 earthquake hit Haiti. She moved with the family she worked for to a displacement camp, where her employer raped her. The rapist threatened to harm her even more if she told anyone, so she didn’t see a doctor. Besides, she didn’t have the money, the means, or the information she needed to get care. She discovered she was pregnant.
Months into her pregnancy, Florence decided to press charges. But the lack of a post-rape medical exam not only affected her health; it also prevented her from pursuing justice for this horrible crime.
In Haiti, the justice system relies on certificates from care practitioners after a post-rape examination as foundational evidence for prosecuting rape. Without this medical certificate, rape charges will not proceed successfully; and because significant numbers of rape victims cannot or do not seek medical attention following rape, many attackers are never charged or punished.
There are few instances in which the health and human rights of women and girls intersect in such an immediate way as after violence. Ending violence against women and girls, like that endured by Florence, is a public health imperative.
Sexual violence causes physical injury, disability, and even death. It can result in sexually transmitted disease, poor reproductive health, unwanted pregnancies, unsafe abortions, and depression. The public health community, including local and international health providers active in Haiti, needs to be prepared to handle the health and social consequences of violence against women, and to work to prevent this violence. Playing a role in successful prosecutions, including by issuing medical certificates after rape, is only one of many ways health professionals can take an active role in ending violence against women.
In Haiti, where I interviewed more than 120 women and girls about sexual violence and access to health care in 2010 and 2011, the government is doing little to inform the public about access to post-rape care, and few health providers are trained to address gender-based violence. Professional schools for doctors and nurses do not include instruction on treating gender-based violence as part of their core curricula or continuing learning programs. Doctors and nurses may not necessarily know how important medical certificates are for rape prosecutions. So even when girls like Florence are able to overcome obstacles in getting to a health facility, they may still not receive appropriate medical services, or the correctly completed medical certificate they need.
November 25 was the 30th anniversary of the International Day for the Elimination of Violence Against Women. Over these 30 years, enormous gains have been made in some countries in passing laws against sexual and domestic violence and in developing guidelines for health providers to identify, treat, and refer victims of gender-based violence to appropriate services. In Haiti, these gains are just now starting to be made—slowly—with the criminalization of rape in 2005 and new legislation addressing violence against women being discussed. But these gains mean little to women like Florence when the reality of seeking health services or justice is a far cry from the laws and guidelines.
Health professionals may not know that the women and girls they treat have experienced sexual violence and about the resulting trauma. Naomi, 25, didn’t tell anyone that a man had raped her, but she had an already-scheduled family planning appointment at a clinic shortly after. “I didn’t tell them I had been raped, because I was ashamed,” she told me. Unlike Florence, she had reached medical care—she was there in front of a health professional—and still Naomi slipped through the system.
Health professionals’ ability to recognize, treat, and work to prevent violence against women can have a significant impact on the human rights of women everywhere, and is especially critical in disaster or displacement situations with high risk of sexual violence, like Haiti.
In Haiti, and indeed in many other countries, public health authorities should take immediate steps to inform the public about where victims can go for post-rape care, as well as steps necessary for legal redress, such as obtaining medical certificates. Public health officials should work with medical and nursing schools to ensure that providers have proper training and the ability to recognize signs of violence if a patient is reluctant to speak.
Public health officials should also work with the many nongovernmental organizations operating in Haiti to make sure health professionals know what services are available for psychosocial support, legal assistance, or relocation to safe housing for women victims of violence. Without this, appropriate health care and legal redress will remain out of reach for women like Florence and Naomi.
