Health Services for Survivors of Gender-Based Violence in Northern Uganda: A Qualitative Study

2008 ◽  
Vol 16 (31) ◽  
pp. 122-131 ◽  
Author(s):  
Mirkka Henttonen ◽  
Charlotte Watts ◽  
Bayard Roberts ◽  
Felix Kaducu ◽  
Matthias Borchert
2019 ◽  
Vol 11 (3) ◽  
pp. 198-211 ◽  
Author(s):  
Michelle R. Kaufman ◽  
Graziele Grilo ◽  
AshlieM. Williams ◽  
Christina X. Marea ◽  
Fasil Walelign Fentaye ◽  
...  

2020 ◽  
Vol 16 (4) ◽  
pp. 389-414
Author(s):  
Helen Jane Liebling ◽  
Hazel Rose Barrett ◽  
Lillian Artz

Purpose This British Academy/Leverhulme-funded research (Grant number: SG170394) investigated the experiences and impact of sexual and gender-based violence (SGBV) and torture on South Sudanese refugees’ health and rights and the responses of health and justice services in Northern Uganda. Design/methodology/approach It involved thematic analysis of the narratives of 20 men and 41 women refugees’ survivors of SGBV and torture; this included their experiences in South Sudan, their journeys to Uganda and experiences in refugee settlements. In total, 37 key stakeholders including health and justice providers, police, non-government and government organisations were also interviewed regarding their experiences of providing services to refugees. Findings All refugees had survived human rights abuses carried out in South Sudan, on route to Uganda and within Uganda. Incidents of violence, SGBV, torture and other human rights abuses declined significantly for men in Uganda, but women reported SGBV incidents. The research demonstrates linkages between the physical, psychological, social/cultural and justice/human rights impact on women and men refugees, which amplified the impact of their experiences. There was limited screening, physical and psychological health and support services; including livelihoods and education. Refugees remained concerned about violence and SGBV in the refugee settlements. While they all knew of the reporting system for such incidents, they questioned the effectiveness of the process. For this reason, women opted for family reconciliation rather than reporting domestic violence or SGBV to the authorities. Men found it hard to report incidences due to high levels of stigma and shame. Research limitations/implications Refugees largely fled South Sudan to escape human rights abuses including, persecution, SGBV and torture. Their experiences resulted in physical, psychological, social-cultural and justice effects that received limited responses by health and justice services. An integrated approach to meeting refugees’ needs is required. Practical implications The authors make recommendations for integrated gender sensitive service provision for refugees including more systematic screening, assessment and treatment of SGBV and torture physical and emotional injuries combined with implementation of livelihoods and social enterprises. Social implications The research demonstrates that stigma and shame, particularly for male refugee survivors of SGBV and torture, impacts on ability to report these incidents and seek treatment. Increasing gender sensitivity of services to these issues, alongside provision of medical treatment for injuries, alongside improved informal justice processes, may assist to counteract shame and increase disclosure. Originality/value There is currently a lack of empirical investigation of this subject area, therefore this research makes a contribution to the subject of understanding refugees’ experiences of SGBV and torture, as well as their perceptions of service provision and response. This subject is strategically important due to the pressing need to develop integrated, gendered and culturally sensitive services that listen to the voices and draw on the expertise of refugees themselves while using their skills to inform improvements in service responses and policy.


2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Anna Chiumento ◽  
Theoneste Rutayisire ◽  
Emmanuel Sarabwe ◽  
M. Tasdik Hasan ◽  
Rosco Kasujja ◽  
...  

Abstract Background Refugees fleeing conflict often experience poor mental health due to experiences in their country of origin, during displacement, and in new host environments. Conditions in refugee camps and settlements, and the wider socio-political and economic context of refugees’ lives, create structural conditions that compound the effects of previous adversity. Mental health and psychosocial support services must address the daily stressors and adversities refugees face by being grounded in the lived reality of refugee’s lives and addressing issues relevant to them. Methods We undertook a rapid qualitative study between March and May 2019 to understand the local prioritisation of problems facing Congolese refugees living in two refugee settings in Uganda and Rwanda. Thirty free list interviews were conducted in each setting, followed by 11 key informant interviews in Uganda and 12 in Rwanda. Results Results from all interviews were thematically analysed following a deductive process by the in-country research teams. Free list interview findings highlight priority problems of basic needs such as food, shelter, and healthcare access; alongside contextual social problems including discrimination/inequity and a lack of gender equality. Priority problems relating to mental and psychosocial health explored in key informant interviews include discrimination and inequity; alcohol and substance abuse; and violence and gender-based violence. Conclusions Our findings strongly resonate with models of mental health and psychosocial wellbeing that emphasise their socially determined and contextually embedded nature. Specifically, findings foreground the structural conditions of refugees’ lives such as the physical organisation of camp spaces or refugee policies that are stigmatising through restricting the right to work or pursue education. This structural environment can lead to disruptions in social relationships at the familial and community levels, giving rise to discrimination/inequity and gender-based violence. Therefore, our findings foreground that one consequence of living in situations of pervasive adversity caused by experiences of discrimination, inequity, and violence is poor mental health and psychosocial wellbeing. This understanding reinforces the relevance of feasible and acceptable intervention approaches that aim to strengthening familial and community-level social relationships, building upon existing community resources to promote positive mental health and psychosocial wellbeing among Congolese refugees in these settings.


BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017296 ◽  
Author(s):  
Naeemah Abrahams ◽  
Soraya Seedat ◽  
Carl Lombard ◽  
Andre P Kengne ◽  
Bronwyn Myers ◽  
...  

IntroductionSouth Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care.Methods and analysisThis longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied.Ethics and disseminationThe South African Medical Research Council’s Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.


Author(s):  
Kristina Lindvall ◽  
John Kinsman ◽  
Atakelti Abraha ◽  
Abdirisak Dalmar ◽  
Mohamed Farah Abdullahi ◽  
...  

Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts.


2018 ◽  
Vol 68 ◽  
pp. 208-212 ◽  
Author(s):  
Amaia Maquibar ◽  
Anna-Karin Hurtig ◽  
Carmen Vives-Cases ◽  
Itziar Estalella ◽  
Isabel Goicolea

2019 ◽  
Author(s):  
Keneth Opiro ◽  
Francis Pebolo Pebalo ◽  
Neil Scolding ◽  
Charlotte Hardy

Abstract Abstract Background Sexual and gender-based violence (SGBV), including rape and child sexual abuse, remains a significant challenge in post-conflict northern Uganda, including within refugee settlements. Many victims have never sought help from health-related services. Consequently, the scale of the problem is unknown, and SGBV victims’ injuries, both psychological and physical, remain undetected and unaddressed. We hypothesized that health workers in rural Reproductive Health Services could provide a valuable resource for SGBV screening and subsequent referral for support. Methods Our project had three elements. First, Reproductive Health Service workers were trained in the knowledge and skills needed to screen for and identify women who had experienced SGBV, using a questionnaire-based approach. Second, the screening questionnaire was used by reproductive health workers over a 3-month period, and the data analysed to explore the scale and nature of the problem. Third, victims detected were offered referral as appropriate to hospital services and/or the ActionAid SURGE (Strengthening Uganda’s Response to Gender Equality) shelter in Gulu. Results 1656 women were screened. 778 (47%) had a history of SGBV, including 123 victims of rape and 505 victims of non-sexual violence. 1,254 (76%) had been directly or indirectly affected by conflict experiences; 1066 had lived in IDP camps. 145 (9%) were referred at their request to Gulu SGBV Shelter under SURGE. Of these, 25 attended the shelter and received assistance, and a further 20 received telephone counselling. Conclusion Undetected SGBV remains a problem in post-conflict northern Uganda. Reproductive Health Service workers, following specific training, can effectively screen for and identify otherwise unreported and unassisted cases of SGBV. Future work will explore scaling up to include screening in hospital A&E departments, incorporate approaches to screening for male victims, and the impact of taking both screening and support services to rural communities through local clinics with mobile teams.


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