SA’s healthcare system is failing survivors of sexual violence

A nurse uses diagrams of the human body as a forensic tool with children who may have been abused in Rustenburg, a large mining town in the so-called Platinum Belt of South Africa. A recent MSF survey showed that 1 in 4 women living in Rustenburg Municipality have experienced rape in their lifetime, but 95% have never told a health professional about it. At the same time fewer than 50% know about getting medical treatment after being raped.

New research by Doctors Without Borders (MSF) on 256 designated public health facilities has found critical gaps in the provision of comprehensive medical care for survivors of sexual violence. The Daily Vox rounds up.

The study found that while some facilities have the resources to provide some services, most facilities could not provide the essential services needed by survivors of sexual violence.

Of the facilities surveyed, 73% were unable to provide at least one of the essential services required; 85% did not have the infrastructure and space required to provide the proper care for the sexual violence survivors. Only 27% of the facilities that reported offering counselling services had a psychologist on their staff.

Most of the facilities provided services for HIV testing, post-exposure prophylaxis (PEP) – which can help prevent a person who has been exposed to HIV from contracting the virus – and pregnancy testing.

However one in five facilities did not provide forensic services. Clinical forensic examinations can provide the survivor with evidence that would be helpful should they choose to pursue a criminal case against their attacker.

But the study found that 20% of the facilities did not provide this service, meaning many of the survivors who went to those facilities would be hindered should they decide to pursue a case.

The report said the lack of this service was partly because staff are not being trained and because there are no government support systems in place to ensure the training of medical professionals in forensic services. Dr Amir Shroufi, an MSF medical coordinator says that: “Providing a comprehensive package of care to survivors of sexual violence is a medical imperative.”

The report also pointed out that many of the facilities were hospital-based, with no separate care units for survivors. Separate care is important, the report says, because hospitals are unevenly distributed and hospital-based facilities do not provide adequate coverage for the population.

The report found that 7% of the faculties (one in 13) said it would refer survivors to another facility as it could not provide the services. Of the 246 designated facilities, more than 85% are hospital-based.

“Often it is just one professional nurse ensuring the availability of services in a facility, and when this individual goes those services collapse.” says Cecilia Lamola, a forensic nurse.

The study was conducted in October, through nationwide telephonic mapping of the the public healthcare facilities which have been designated to provide medical and psychological care to survivors of sexual violence.

The report’s research team phoned as many of the 265 designated facilities as they could and tried to find out whether the facility was able to provide the care for each of the physical and mental health consequences of sexual violence. This includes physical trauma needing medical assessment and a forensic examination, HIV infection needing HIV testing and post-exposure prophylaxis, unwanted pregnancy needing information about choices relating to the termination of pregnancy and mental health disorders needing crisis intervention and long term counselling. In all, 63% of the designated facilities participated.

MSF has called on the South African government to make services for sexual violence survivors more widely available throughout the country, to better train medical staff, to ensure that the best services are provided to survivors and to create greater awareness of the sexual violence services that are available.

Featured image by Siyathuthuka Media/MSF