Sexual Violence in Conflict Settings_Christelle Moussallem
1. Sexual violence in conflict settings:
A health-system response to victims in
Lebanon
CHRISTELLE MOUSSALLEM
MSC GLOBAL HEALTH STUDENT
MAASTRICHT UNIVERSITY & THAMMASAT UNIVERSITY
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2. Objective
What are the barriers in establishing a comprehensive health-
response to conflict-related sexual violence?
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3. Sexual violence in conflict settings
One in 5 will
experience sexual
violence and rape
(WHO, 2016)
Conflict settings
Health
system
http://www.concernusa.org/story/lebanese-artist-illustrates-stories-of-women-refugees-from-syria/
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4. 4
Methods
Literature review
What is the needed
health-system response to
sexual violence in conflict
settings?
&
Experience
of Lebanon
Barriers
6. Slow progress of health-system response in
low-resource and conflict-affected settings
(García-Moreno et al., 2015)
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7. Case example of Lebanon
Onset of the Syrian crisis and massive influx
of refugees to Lebanon
Sexual Violence in Syria
21% GBV: Rape and Sexual
Assault in Lebanon
(McRobie, 2015)Health-system unable to
respond
Stigma and reluctance
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8. Healthcare providers reluctant to give care
“If a rape survivor
came here, I would
call the rapist himself
and tell him to come
here to the hospital.
Then I would lock her
alone with him in a
room.”
(Ouyang, 2013)
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9. Aid and governmental officials also….
“When I was in Lebanon incredibly,
a few officials even accused NGOs
of concocting this sexual violence
myth and creating drama where it
didn’t actually exist.”
(Ouyang, 2013)
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10. Initiation of the response and progress
Capacity
Building
Half-day training
Three-day training
Pre and post-
assessments
Health-facility
based trainings
Training manual in
local language
On-the-job
coaching
Coordination
International and
national
organizations
Technical task force
Passive role of
MOPH
Further
involvement of
MOPH
Treatment PEP only available
centrally
Post rape
treatment pre-
packed kits
Short expiry dates
Reproductive
health national
commodity
strategy
Policy level
No national protocol
Mandatory reporting
Restrictive abortion law
Marital rape not
criminalized
Advocacy efforts Advocacy efforts
National CMR
protocol
Reporting abolished
2011 2015
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12. Conclusion and Recommendations
Despite available evidence, it is clear that many socio-cultural and institutional barriers can stand in the
way in establishing a proper response to conflict-related sexual violence.
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13. Conclusion and Recommendations cont.
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Recommendations
Involvement and advocacy by the
international community
National action plan and budgets
Integration of sexual violence in medical
curricula
Data generation
is important to integrate medico-legal
services in the existing health-care services.
In settings affected by conflict, it is also important for national systems to engage with
international actors such as the United Nations and international nongovernmental
dividuals, agencies and organizations must not discriminate against victims
nderstand the importance of working in a multidisciplinary way to deliver
services that minimize harm in the short term and longer term
seek the victim’s informed consent to document
Written medical report, access to medication and supplies
Refer the victim to other centres/services when more specialized interventions
are required.
t provides an opportunity for clinical management, the
documentation of findings and the collection of material required to assist a criminal
investigation. By its very nature, the examination is time consuming, intrusive,
possibly traumatizing to the victim, and often challenging. Careful explanation and
consent to the procedure, and a compassionate and sensitive health-care worker are
the cornerstones of a good service
Adequate budget allocation in required in close collaboration with the international community that should be committed to provide continuous financial and technical support. More involvement of the MOPH is needed to start a national action plan. National interventions should include integration of sexual violence response in the curricula of medical schools, expansion of trainings to cover private and public hospitals in high-population refugee areas but also other regions, ongoing support and capacity building, full coverage for national victims, in addition to ensuring sustainable supply of post-rape treatment. The law on abortion should be revised as to include a new indication: pregnancy from rape or incest. More awareness raising, data generation and research will be required to identify the magnitude of sexual violence among national and refugee communities.
