Each incident of sexual violence must be examined and assessed for the required action in each of the following areas:
KEY POINTS TO REMEMBER
* Ensure the physical safety of the victim.
* Prevent any further suffering by the victim
* Be guided by the best interests of the victim.
* Respect the victim's wishes in all instances.
* Guarantee confidentiality.
Strict confidentiality is essential. Wherever possible a victim's anonymity should be maintained. Written information on the victim must be kept locked and secure from others.
If confidentiality is breached it could bring grave consequences for the victim, particularly if adequate protection is not in place. It may discourage others from coming forward.
* Be sensitive, discreet, friendly and compassionate when dealing with the victim.
* Ensure same-gender interviewer/interpreter/doctor.
Recommends that refugee victims of sexual violence and their families be provided with adequate medical and psychosocial care, including culturally appropriate counselling facilities, and generally be considered as persons of special concern to States and to UNHCR with respect to assistance and the search for durable solutions;
Executive Committee Conclusion No. 73 (XLIV) (1993), paragraph (f)
Refugee Protection and Sexual Violence
Acts of sexual violence violate basic human rights. Therefore, UNHCR staff have an obligation to intervene whenever cases are reported or suspected. The immediate physical and emotional consequences of sexual violence require a quick response. However, careful handling is required due to the extreme sensitivity of sexual issues in general and of sexual violence in particular. It is important to try to provide an environment in which refugees feel they can report protection problems privately, secure in the knowledge that there will be no retribution, and that confidentiality will be assured. The victim's immediate or long-term vulnerability must be taken into consideration, and the victim's own decisions must be respected.
Problem of association
Experience has shown that a "problem of association" may result if one specific person is tasked to work only with victims of sexual violence. Anyone coming to see this person might be branded as a "rape victim" and be stigmatized. Staff should take every precaution not to draw attention to women who have been subjected to sexual violence. Similarly, separate projects for such women should be avoided.
The link of UNHCR staff and medical personnel
It is important that the community services officers, protection officers, field officers, resettlement officers and medical personnel work together as a team.
UNHCR staff dealing with a victim of sexual violence are encouraged to share their interview notes with each other in order to make a second interview unnecessary. No more information about the incident than absolutely necessary should be sought (see Obtaining relevant information in 3.4 below).
3.2 The Rights of the Accused
Where the accused is a refugee, UNHCR has a responsibility towards him also.
Fair trial and humane treatment
The accused is entitled to be treated with the rights accorded to a person whose guilt is not proven. UNHCR has an obligation to him to ensure that he has a fair trial and is subjected to humane treatment in the course of interrogation and incarceration.
Until such time as a court of law has found an accused guilty of the sexual violence for which he is charged, the accused should be properly referred to as the "alleged perpetrator" or the "accused", rather than as "the rapist" and the like.
3.3 Identifying Incidents of Sexual Violence
* One of the most effective ways of "tapping" the refugee information network to identify cases of sexual violence is to facilitate the establishment of women's groups and associations, thereby giving individual women a channel to report attacks. Experience has shown that an effective mechanism is a women's health clinic which deals with women's physical health, and thus offers a "safe" environment for revealing attacks. (However, care should be taken not to set up such groups merely as "cover" for detecting sexual violence). Other groups could be in relation to recreational, leisure or income-generating activities. These groups have significant additional benefits such as providing a network for communication and information flow and a structure for community support in the aftermath of sexual violence, as well as reinforcing preventive action.
* Keep close contact with community members and leaders to discover whether a young girl or woman is being held in isolation or whether people talk about her in a disapproving way. This might indicate that she is a victim of sexual violence. In the case of male victims, the taboos are so strong that it is extremely unlikely that an incident will be revealed or acknowledged even to this limited extent.
* Look for signs of trauma, such as reports of pains, nightmares, loss of appetite, headaches, sadness, fear, confusion, loss of memory, attention problems, isolation and talk of suicide.
* Discreetly look for signs of physical violence.
* Collect and study background materials and refugee stories describing the circumstances of flight. Such information can indicate situations where sexual violence is likely to occur or has occurred.
Where Sexual Violence is Suspected but the Person is Reluctant to Discuss
* Where sexual violence is suspected but the person is reluctant to report the incident, it is advisable for a social worker, health worker, community services officer or protection officer to meet privately with the suspectedvictim either alone or with a trusted person of her choice. In such a situation it is vital that the officer, and any interpreter, be of the same gender as the person. However, there may be cases where a person requests to speak to someone of the opposite gender, e.g. male victims may prefer discussing sexual violence with females.
* There is no hard and fast rule for dealing with situations where sexual violence is suspected to have occurred but the person is unwilling to discuss the issue. Staff dealing with this should take a very delicate approach, being extremely careful not to push the person. Being forceful with the individual may cause retraumatization and further suffering.
* If the family is sympathetic towards the suspected victim, and where it is culturally appropriate to do so, it may be helpful to meet with the family to find out whether they have noticed a problem and give advice on how to handle it.
3.4 Steps to Take in Response
Once an incident of sexual violence has been revealed the following steps should be taken:
* Staff handling the victim of sexual violence must always be sympathetic yet professional. The victim should immediately be provided with privacy and be reassured about her safety. She should not be pressured to talk nor be left alone for long periods.
* If the incident has occurred recently, the victim may require immediate medical care and should be escorted to the appropriate medical facilities. Post-coital contraception may be available to prevent a rape victim from becoming pregnant.
See 3.8 Medical Response below.
Contacting the police
* In addition, it may be necessary to contact the police immediately, if the victim so decides, in order that they investigate the case, particularly where there is the possibility of apprehending the perpetrator(s). The victim should be advised as to the likely course of events following police notification in order to make her decision about whether the authorities should be contacted.
See chapter 4 on Legal Aspects.
Obtaining relevant information
The staff member should seek no more information about the incident than absolutely necessary to establish what took place, where, and by whom.
* When an interview is possible, and with the consent of the victim, relevant information should be obtained about the-circumstances of the incident details about the victim, the perpetrator(s); when the incident(s) occurred; where, and who, if anyone, witnessed the occurrence. See the sample sexual violence information form in Annex 2.
* The focus should be on trying to clarify the circumstances sufficiently to determine what, if any, further action should be taken. It is not a test of the victim's credibility nor should it be seen as an opportunity for building a court case against the alleged offender.
* Staff should strive to ensure that only one interview is conducted to establish the events.
See 3.6 Conducting an Interview below.
Same gender and continuity of staff involvement
* A trained staff member of the same gender must always conduct related interviews with the victim, unless the victim requests otherwise. The same staff member(s) should remain involved in the case throughout to avoid the victim being handed from one person to another and having to repeat the same painful information.
Exchange of information
* With full respect for confidentiality, UNHCR staff (field officers, protection officers, community services officers, resettlement officers) should exchange information available on cases in order to avoid retraumatizing the victim by obliging her to repeat her story.
* The information must be treated as strictly confidential, unless the victim decides otherwise.
* At the conclusion of the first or subsequent interview, the interviewer should determine whether the victim requires (further) medical help, legal advice and/or counselling, and make the necessary referrals.
Ensure physical safety of victim
* If the victim's living situation is unsafe, measures should be taken to ensure safety. This may include those such as removal to a safe house or an emergency room, or immediate transfer from a camp, while ensuring at all times the victim's privacy.
* If the victim is unaccompanied, it may also be helpful to house her with female friends to support and assist her during this critical time.
Where the alleged perpetrator is a member of the police or military, or another government officer
* Immediate measures are necessary where the alleged perpetrators are amongst those who are responsible for the safety of the refugees, e.g. the police guarding a refugee camp.
* Depending on the wishes of the victim, immediate measures may involve bringing the incident to the attention of high level government officials by convening a meeting to present the allegations and decide on an appropriate course of action. It may also be useful to give the government officials at the meeting, or subsequent to it, a letter written by UNHCR outlining the allegations and UNHCR's expectation of a speedy and thorough investigation. It may be particularly useful to forward a copy of the correspondence to superiors of the local officials, e.g., where refugee camps are in remote areas and there is a general breakdown of law and order, or a lack of discipline among the security personnel.
* Where appropriate, an identification parade should be arranged as soon as possible through the highest local authorities/police/military officials present. In such circumstances extreme caution should be taken to ensure the safety and protection of the victim and any refugee witnesses. For instance, in some situations, if the alleged sexual violence occurred in a refugee camp it may be necessary to evacuate the victim, refugee witnesses and any accompanying family members as soon as possible, with interim protection measures being made.
* Punishment of one official for sexual violence may deter others in authority from committing further acts.
Replacement of clothes and non-food items
* It may be necessary to replace the victim's clothes so that she does not wear those worn during the attack. If essential non-food items belonging to the victim, such as shelter or blankets, were looted, these should bereplaced immediately upon verification. The community service workers may be able to perform the necessary verification.
* Where clothes are replaced, care must be taken so that women cannot be identified as victims of sexual violence by particular clothing characteristics (e.g., do not give victims cloth of the same fabric).
* It is up to the victim to decide about criminal prosecution or the initiation of a civil suit, depending on the legal system. The victim should be advised of all relevant information, including possible consequences, before she makes the decision whether to bring the incident to the attention of the authorities. UNHCR, NGO or adequate legal support should be available throughout any court procedures if the victim so desires.
See 4.1 National Law.
* Depending on the security situation and the victim's mental and û physical condition, consideration may be given to resettlement on emergency or nonemergency grounds. It is emphasized that resettlement is rarely a "solution" under these circumstances.
b) Specific Situations
i) Where sexual violence has resulted in pregnancy (and termination of pregnancy is medically viable).
See 3.8 Medical Response.
ii) Where sexual violence has resulted in pregnancy and the victim is unable or unwilling to legally terminate the pregnancy or the situation does not come to the attention of staff until it is too late to terminate the pregnancy.
* All options, e.g., keeping the child, foster care and adoption, should be discussed with the woman concerned, regardless of the individual beliefs of the counsellors, medical staff or other involved persons, in order to enable the woman to make an informed decision at a later stage.
* Close medical monitoring is necessary.
* Counselling and support are essential.
iii) Children Born as a Result of Rape
Children who are born as a result of rape may be mistreated, or even abandoned by their mothers and families. These children may become malnourished and may lack the necessary care and attention.
This is an extremely sensitive area with no simple answers. However, the following points are stressed:
* The situation will require very close monitoring.
* Extreme care must be taken not to stigmatize the mother or the child.
* The situation should be dealt with to the extent possible by the ordinary community support structures and existing systems of child welfare.
* Additional support to the mother, in relation to assistance and psychological help, may be needed.
* The welfare of the child may warrant consideration of options such as foster placement and, later, adoption. A cautious approach should be taken.
3.5 Sexual Violence in Domestic Situations
There are no easy responses to sexual violence against refugees when it is committed in a domestic environment. The following general guidance is provided based on a common sense approach that should be borne in mind at all times.
Extreme caution should be exercised before any intervention is made. Concerned staff should be aware of the possible difficulties that may arise following intervention. In some situations, more harm may be caused to the victim and other relatives by becoming involved than had the matter been left alone.
Awareness of repercussions and limits of UNHCR intervention
* While intentions may be good, give careful forethought to the possible repercussions of any proposed action.
* Be attentive to the fact that the victim may decide to return, or may have no alternative but to return, to reside with the abuser at the end of the day.
* Retaliation against the victim or relatives may result if the abuser learns that the victim or other family members have brought the incident to the attention of others.
* UNHCR staff should be aware of the limits of the action able to be taken by the Office in this context.
* Before any intervention is made each situation must be carefully assessed on an individual basis with due regard to the particular cultural context.
Close Liaison with Colleagues
* Before taking any action discuss possible approaches with relevant colleagues, such as the field officer, protection officer and community services officer, in order to benefit from their expertise, share strategies and points of view. They may also have additional information on the case which is not known by you.
* Following a careful assessment, and where intervention is determined as the most appropriate response, it may be useful for colleagues to act together, such as, for example, the protection officer teaming up with the community services officer.
* One approach may be to identify the possible root causes of the aggression and examine ways to redress them.
* Where appropriate, refer the matter to a disciplinary committee or other mechanism in place or, if the offence is of sufficient gravity, the authorities may have to be contacted.
Suspected Domestic Violence
* Where sexual violence is suspected in domestic situations, very discreet advice to the suspected victim on any options available to her may be appropriate.
Possible types of action to be taken in advance:
* Inform refugees of different forms of assistance that may be available to persons subjected to domestic violence (e.g., counselling services, options for safe alternative accommodation).
* Educate refugees as to their basic human rights as defined by international norms. See 2.4 Preventive Measures Involving Information, Education and Training and 4.2 International Law for more detail.
* Where domestic sexual abuse of refugee children is involved, intervention may be crucial to ensure their physical and psychosocial well-being.Remember that children are more vulnerable than adults on whom they depend for protection.
"[UNHCR] must act when the safety and liberty of refugee children is at risk, either directly or indirectly".
UNHCR Guidelines on Refugee Children at page 81.
For additional information, refer to UNHCR Guidelines on Refugee Children, chapter 4 on "Psychosocial Well-being" and chapter 7 on "Personal Liberty and Security".
3.6 Conducting an Interview
Where the victim is unable or unwilling to discuss the incident
* If the victim is unable or unwilling to discuss the matter, the staff member should ask discreet and indirect questions. If she is still unwilling to share her problem, the staff member should not force the issue, but assure the person that staff are always available to assist her once she is ready to talk about the problem. She should not be left alone but a close relative or friend should be found to keep an eye on her.
* If the victim is under the age of majority of the host country (commonly 18 years) then the consent of his or her parents or legal guardian should first be obtained. A child may feel more comfortable being interviewed in the presence of his or her parent, another family member or a trusted adult. The child should be consulted on this.
* Where a child is involved, interviewing techniques should be adopted accordingly, using simpler language, spending more time establishing rapport with the child and developing a trusting relationship. In addition, if an interpreter is being used he or she should be specifically trained to work with children, e.g., a child welfare worker, or a teacher.
See also the sections on "Interviewing Skills" and "Preparing and Conducting an Interview" on pages 28-39 of the UNHCR Manual Working with Unaccompanied Minors in the Community.
Opening the interview
* The first step should be to establish a basic rapport with the victim. The interviewer should take the time to introduce him/herself and the interpreter, explain clearly what his or her role is and the exact purpose of the interview.
* The victim should be informed that she does not have to be interviewed, can refuse to answer any questions that she does not feel comfortable with, and can stop the interview at any time.
* The victim should be assured of confidentiality vis-a-vis her immediate family, the extended family, the refugee community, and, where requested by her, the camp authorities and police. Confidentiality can be TOTAL if the victim insists that nothing should be done.
Demeanour of interviewer
* It is essential that the interviewer remain neutral, compassionate, sensitive and objective during the interview.
* With an assurance of absolute confidentiality, notes should be taken contemporaneously and in a discreet manner. The individual should know that the conversation is being documented. Post facto notes are likely to be erroneous.
Irrelevance of previous sexual history except in relation to past sexual attacks
The previous sexual history of a victim is irrelevant for UNHCR interviewing purposes and should not be asked of the victim, except in relation to any previous sexual attacks.
Knowledge of any previous sexual (or other) attacks is relevant to both protection of the victim and her psychosocial well-being. Regarding protection, knowledge of a previous attack may suggest that the victim has been specifically targeted rather than chosen at random and may thus need more urgent and drastic protection measures to be taken. Regarding her psychosocial well-being, an individual who has already experienced sexual violence may be more psychologically vulnerable and more prone to retraumatization requiring additional efforts and sensitivity.
* The interviewer should be extremely careful not to cause retraumatization. This occurs when a "triggering" event causes the victim to be overwhelmed by memory and feelings from the previous trauma. As such, questioning should be done gently and discreetly and at the victim's own pace. On no account should she be pressured to speak if she is unwilling to do so. (See Retraumatization in 3.9 for more detail).
Shock or psychic numbing
* Remember that a victim may at the time of the interview be experiencing shock or psychic numbing due to trauma with the consequence that her emotions are significantly muted. (See "Psychic Numbing" in 3.9 for more detail).
Where an interpreter is being used
* The interpreter should be the same gender as the victim.
* The interviewer and the interpreter should be aware of difficulties in interpreting. For example, words such as "rape" or "assault" may have different meanings or connotations in the victim's language.
* As with all other interviews involving an interpreter, the interviewer should ask all questions directly to the interviewee. Recall at all times that the primary role of the interpreter is to facilitate communication, and in no way should the interpreter control or direct the interview.
Concluding an interview
* At the conclusion of the interview, the victim should be reassured of her safety, and any follow-up action explained. She should also be given the opportunity to ask any questions.
Some additional practical tips:
* The place of interview should be in a confidential and quiet setting, one which makes the victim feel comfortable, safe and at ease and one that would not lead others to assume that she is a rape victim. In a camp, this could be at the UNHCR offices, at offices where eligibility interviews take place, or a room at the hospital. Care should be taken not to draw attention to the person being interviewed.
* Avoid any interruptions or distractions during the interview, such as telephone calls or others coming into the office during that time. In the same way, switch off any walkie-talkies, unless they are crucial for security purposes.
* Have drinking water and some tissues at hand.
For more detail refer to the UNHCR Training Module Interviewing Applicants for Refugee Status.
3.7 Reporting Requirements
* General reporting on the situation of sexual violence against refugees should be done from each field office to the head UNHCR office in each country. This is usually through the weekly situation reports ("sitreps"). It is also expected that this information will form part of the regular sitreps from each head UNHCR office in the field to Headquarters.
Particularly Serious Cases
* As with any protection problem, UNHCR Headquarters intervention can be sought on cases of a particularly serious nature. Advice can also be requested from Headquarters on any case.
3.8 Medical Response
Same-gender medical personnel
* A doctor (or a health worker if a doctor is not available) of the same gender as the victim should always conduct the initial medical examination(s) and follow-up. This is considered essential for cultural, psychological and security reasons. In many cultures it is taboo or extremely embarrassing for a person to be touched or examined by a doctor of the opposite gender. This is particularly so in the case of women and could significantly add to the trauma which has already been experienced. In such instances, examination by a male doctor would be perceived as highly distressing and even threatening and is therefore to be avoided. If however, there is no option, the situation should be discussed with the victim and she should be prepared for a referral to a male doctor.
Local doctors to conduct medical examination where possible
* In refugee camps, medical practitioners from the host country, rather than international doctors, should conduct examinations and write medical reports since they will be in a better position to give evidence in any later legal proceedings if they occur. For example, by the time the case has reached the courts, a foreign doctor may have left the country and it may not be possible for him/her to return. In some situations, however, local doctors may not be prepared to testify if local agents are the alleged perpetrators.
Preparing the victim
* It is advisable that the victim be prepared for the physical examination which will follow since sometimes medical procedures themselves are traumatic. Therefore, the staff member must be familiar with the examination procedures, and be able to explain them to her in non-technical language.
* In certain situations it may be advisable for this staff member to accompany the victim to the examination.
* In-patient treatment or out-patient treatment may include: tests for sexually transmitted diseases (VDRL); analgesia; post-coital contraception; antibiotics; tetanus toxoid/immunoglobulin injection; blood investigations; hepatitis B tests.
The following medical procedures should be taken
* A counsellor, nurse or physician should document a detailed history of the attack including force or threats used, the nature of any penetration which took place, and whether ejaculation occurred. Essential elements also include whether the victim bathed, urinated, excreted or changed clothes following the attack; any symptoms following the assault, recent menstrual and contraceptive history.
* Obtaining information about the past sexual history is, generally, neither necessary nor relevant. The mental state of the individual should be assessed and noted.
* A medical examination should be made including documentation of the witnessed examination, condition of the clothing, any foreign material adhering to the body, any evidence of trauma however minor, and results of a pelvic examination. This clinical examination should entail a complete physical examination which should not begin immediately with the sexual sphere or be limited thereto.
* Observation of external signs, such as the condition of clothes and a collection of material which might serve as evidence should be made. Material which the medical staff might collect for evidence (where forensic pathology laboratories exist), includes plucked hair, fingernail scrapings, combing from the pubic area, clothing, fluid and swabs from the vaginal and/or anal vaults for sperm, saliva and blood samples. It is necessary to obtain the consent of the victim for the collection of such evidence and its conveyance to the law enforcement authorities.
Vulnerability of pregnant women
* Women who are pregnant at the time of the sexual violence are physically and psychologically more vulnerable. In particular, they are susceptible to miscarriages, hypertension and premature births.
Post-coital contraception ("Emergency Contraception")
* In countries where the "morning-after pill" (or "day-after pill"), or other forms of post-coital contraception, are legal and available, it should be offered to a rape victim, once its effects have been fully and carefully explained to her. Trauma can be reduced by preventing a rape victim from becoming pregnant.
* The "morning-after pill" can be effective up to 72 hours post-coitally; the sooner it is used, the more effective it is likely to be. This form of contraception prevents pregnancy by stimulating the process of early menstruation before egg implantation. According to the World Health Organization it does not constitute an abortion.
Increased risk of contracting HIV
* The tearing injuries and open wounds of the women's genital tract from force used in rape increases the risk of contracting HIV from an infected man.
High risk of STD transmission in situations of armed conflict
* Army recruits have been recognized as a category tending to show higher rates of STDs (sexually transmitted diseases) than the general population. In situations of rape during armed conflict a high risk of STD transmission should be assumed. Prophylactic therapy (i.e. without making a clinical diagnosis), using appropriate antibiotics, should be considered to cover the major treatable infections, particularlygonorrhoea, chlamydia and syphilis, that could otherwise have long-term consequences.
Vulnerability of girls to the effects of STDs
* Girls who have not completed puberty are particularly vulnerable to the effects of STDs because the lining of the genital tract has yet to take on its adult character. STDs contracted at this age entail a greater risk of permanent damage such as infertility or ectopic pregnancy (where pregnancy occurs in the Fallopian tube) later in life.
Risks of HIV and other STDs and pregnancy
* The individual should be advised of the risks of contracting HIV and STDs. The risk of pregnancy should be discussed with female victims. HIV and pregnancy tests should be offered.
* UNHCR and the World Health Organization have finalized guidelines in connection with HIV. These Guidelines for Early HIV Intervention in Emergency Settings should be referred to, particularly in relation to counselling and maintaining confidentiality.
Where sexual violence has resulted in pregnancy
* All options. e.g., keeping the child, adoption and abortion, should be discussed with the woman concerned, regardless of the individual beliefs of the counsellors, medical staff or other involved persons, in order to enable the woman to make an informed decision.
* It should be noted that in some countries abortion is illegal or is only permitted under limited circumstances. In some countries, for example, it may be necessary to obtain special permission from the authorities, or abortion may only be permitted for medical reasons. It is noted that in many countries abortion is legal in situations where a woman is pregnant as a result of rape. The counsellor must be aware of the legal situation with regard to abortion in the country of asylum or return, and this must be explained to the woman.
* Following comprehensive counselling, if the woman decides to terminate her pregnancy, this should be carried out under appropriate medical and psychological conditions.
See also 3.4 under b) Specific Situations.
* Follow-up visits should be arranged according to the necessity of each case. Repetition of HIV test should be offered in appropriate circumstances.
* The importance of maintaining strict confidentiality is stressed.
3.9 Psychosocial Response
This section provides an overview of psychological reactions experienced by victims of sexual violence and action required to address their psychosocial needs.
Each person will experience and cope with the traumatic incident differently. See also 1.5 Effects of Sexual Violence.
a) Common Psychological Reactions
* The victim most commonly experiences fear, helplessness and humiliation. She is likely to experience a loss of trust and a loss of sense of safety and security.
* The victim will probably feel guilt or shame from a sense that perhaps she provoked or in some other way was responsible for what happened to her (also referred to as "classic rape syndrome").
* The victim's trauma may also lead to aggressiveness or destructiveness, anger, hatred or revenge, taking an outward direction instead of being internalized or assuming the blame.
* The experience of sexual violence often makes the victim feel unclean and unworthy. Virginity, modesty and female chastity define the value of girls and women in many cultures, and consequently sexual abuse is perceived as devaluing a woman and making her 'unclean'.
* Similarly. men are defined in many cultures in terms of their manhood and virility and therefore the experience of sexual violence against a man or boy can have a devastating psychological impact.
* "Psychic numbing'': it is commonly thought that someone who has been sexually violated will be hysterical and cry uncontrollably, but in fact this is not the most common response. A victim can respond to sexual violence trauma by "psychic numbing". This is a defensive reaction that significantly mutes the person's emotions. She may feel numb, show little feeling, speak slowly and inaudibly and may appear very calm.
* Understanding this reaction is particularly important because that is how many victims appear during initial interviews and in their daily lives post-trauma. Victims of trauma commonly adopt strong defence mechanisms which include forgetting, denial and deep repression of the events during the immediate aftermath of the trauma, when the victim is still operating in "survival mode".
* After the initial shock and trauma of the incident, the victim might go through a period of thinking frequently about the incident, about the attacker, and re-experiencing the trauma. This may occur in connection with preparations for court proceedings or in preparation for eligibility interviews and will require careful monitoring and counselling.
* From the psychological point of view the reactions can range from minor depressions, grief, anxiety, phobia, somatic problems to serious and chronic mental conditions.
* Extreme reactions to sexual violence may result in suicide, or in the case of pregnancy, physical abandonment/elimination of the child.
* Retramautization: the concept of "retraumatization" is important to understand. This occurs when a "triggering" event causes the victim to be overwhelmed by memory and feelings from the previous trauma. It has been described as the psychological equivalent of having a scab torn off. It is painful, and can deplete what little emotional resources the victim has built up. The incident of sexual violence may in itself trigger retraumatization due to a previous trauma the person has experienced. Further, retraumatization may occur as a consequence of being interviewed in relation to a sexual attack.
Children are more vulnerable to trauma and to retraumatization than adults. This is because children are developing. They grow in developmental sequences, each sequence depending on the one below it. Serious delays interrupting these sequences can severely disrupt development. All children are at developmental risk in situations of violent displacement, but sexual abuse, especially if it is ongoing, can have very harmful long-term psychological and psychosocial consequences.
The child as a direct victim
* The effects on a child resulting from personally suffering sexual violence will be mediated by age, gender and developmental level, and particularly by the capacity of the child's caregivers to give the child the necessary nurture and support.
* Who perpetrated the sexual attack will be a matter of significance: a stranger, a family member, and whether the abuse was ongoing or an isolated event. If there is an ongoing sexually exploitative relationship in a camp situation, for example, it would have very negative implications for the child's capacity to develop and maintain normal social relationships and age and gender appropriate behavior.
"Secondary" impact of sexual violence on a child
* A child may suffer as a result of sexual violence experienced by another person, most frequently the child's mother. Experiencing one traumatic event can compromise a mother's ability to care for her children. It may cause her to mediate the negative effects of sexual violence on her children's well-being and development. For example, in some cultures a woman may brake a number of cultural taboos if seen naked in front of her male children, or if they witness her engage in sexual activity. Should she be sexually attacked in front of her male children, her response may be to withdraw social and emotional contact from them as a result of her feelings of guilt and shame.
c) Care of Victims
Every child has the right to "such protection and care as is necessary for his or her well-being".
Every child who is a victim of "any form" of abuse or neglect has the right to "physical and psychological recovery and social reintegration".
The Convention of the Rights of the Child: Article 3(1) and Article 39.
UNHCR staff are required to make their best efforts both to prevent risk to refugee children and to take additional action to ensure the survival and safety of refugee children at particular risk.
UNHCR Policy on Refugee Children, paragraph 26 (g).
For specific guidance on how to help refugee children in relation to their psychosocial well-being, refer to Chapter 4: "Psychosocial Well-being" in UNHCR's Guidelines on Refugee Children (pages 37-51). This chapter explains why psychosocial well-being is important and contains guidance on how to help refugee children directly, by helping the family and by helping the community. The need for some children to receive specialized services or treatment due to havingexperienced damaging effects of trauma is dealt with on pages 48-49. Suggested age-appropriate activities for refugee children are also included.
It is important to know what the response to sexual violence is according to the culture and traditions of the refugees. Victims should be treated with acceptance, care and support.
Support of family and friends
* In the long term, and in most cultural settings, the support of the victim's family and friends is likely to be the most important factor in overcoming the trauma of sexual violence. Efforts should therefore be made to encourage and maintain good relations with family and friends or to facilitate speedy family reunion where possible. For example, family and friends should be encouraged to accept a victim's apparent disorganization and/or uncustomary passivity and give support in managing daily activities and responsibilities. They may also need to provide help in making decisions.
Community support groups
* Efforts to relieve trauma suffering for the majority of cases are most appropriately handled through community-based activities which address psychosocial needs generally, rather than focusing specifically on sexual violence.
* It is important to encourage the establishment of community support groups which can counteract tendencies towards the social isolation of victims of sexual violence and problems in relation to friends, family members and the community. Clearly the form and approach of this kind of intervention will vary considerably according to the cultural context in which the violence has occurred. Where feasible, it can be helpful for such support groups to organize activities such as literacy, education, skills training, occupational therapy, music, sports, information, or any other useful daily activity.
Formal and informal women's groups
* Facilitating the establishment of formal and informal women's groups can provide an excellent framework for both preventive and therapeutic assistance. In most situations, keeping the victims active through recreational, psychosocial and/or income generating activities is veryeffective psychological assistance. For example, women s groups or committees can provide a focus for establishing projects which promote useful activities, such as income generating projects, which can assist victims of sexual violence to regain control over some areas of their lives. Such activities can foster normalization of daily life and thereby contribute significantly to restoring or maintaining the mental health of refugee women, including those who have been sexually attacked.
Relocation of victim
* In some refugee camp situations, it may be helpful to discreetly transfer the victim and her family, if they desire, to another camp where refugees do not know about the incident. This may be necessary in situations where the victim would be ostracized by refugees who know about the incident.
* Where relocation occurs, extreme care and discretion should be used at the place of reception so that the transferees are not identified as being victims of sexual violence. Precautions to be taken will depend on the particular circumstances. It may also be necessary to inform the victim and any accompanying relatives not to divulge the real reason for the transfer.
d) Traumatic Effects on Family Members
* Sexual violence can have severe traumatic effects on the victim's family members or those friends who have witnessed the crime without being able to intervene, or who experience guilt for not having been present. This may be particularly the case for husbands who were present and were unable to prevent their wives from being raped, or for children who witnessed their mothers being sexually attacked.
* In such cases, individual and/or family counselling and close follow-up might be needed. In cases of family reunion where family members did not witness the incident, supportive counselling might be needed.
Counselling should be provided only by trained mental health professionals. That is, a trained worker (such as a counsellor, nurse, social worker, psychologist, or psychiatrist), preferably from the same background as the victim.
In situations of continuing conflict it is particularly important to ensure that interviews with victims of sexual violence are conducted only by people with appropriate training and only if follow-up care by mental health professionals is available. Experience has shown that some women have attempted suicide aftertalking to the press and/or a "routine" interview with well-meaning information seekers. They need reassurance and total discretion.
Objectives of counselling
* help victims to understand what they have experienced and to develop a sense of control over their lives and to overcome their feelings of guilt;
* help victims to realize that they are not responsible for the attack, to stop blaming themselves and to understand that they are not alone, and that many other people have overcome such experiences and are leading normal lives;
* help victims to understand that feelings of anger, fear and guilt as well as unusual reactions and activities are common and natural; to encourage them to express anger towards their attacker(s) in order to alleviate feelings of self-blame;
* help in breaking the victim's social isolation and to ensure that they have access to support networks and services that meet their needs;
* help create an awareness in the community so that the victim can be provided with the necessary support, particularly within the family structure and within the larger community;
* help victims to remain or become active in daily activities.
In view of the potentially very serious and long lasting psychological effects of sexual violence, it is essential that the victim receive counselling as early as possible. Such immediate intervention can be very effective in minimizing the severity of psychological trauma in the longer term. On the other hand, if the incident remains unresolved, it may surface at any time in the future and can result in social dysfunction or, at worst, chronic mental disorder.
It is vital to ensure that the victim is ready for counselling. An individual who has experienced sexual violence should never be pressured into counselling as she may have built up psychological defences to deal with the experience. This is particularly important in situations of continuing conflict where the uncertainties of everyday existence may demand the maintenance of such defence mechanisms. It is also critical in situations where provision of ongoing counselling support is not ensured.
Where possible, counsellors should work as part of a team with trained health and welfare workers of the same gender and culture as the victim. The counsellor and refugee workers should work closely with other service providers and members of the community, so that they are able to deal sympathetically and skillfully with victims of sexual violence
In some situations, where telephone services are available, the provision of a telephone counselling and referral service may be feasible and useful, particularly in locations where victims are widely dispersed.
For detailed information on appropriate therapeutic interventions, please refer to UNHCR Guidelines on the Evaluation and Care of Victims of Trauma and Violence. See also UNHCR Community Services for Urban Refugees, in particular pages 49-59 on "Victims of Violence''.