Transcript Screening for sexual violence amongst refugee populations

Screening for sexual violence amongst
refugee populations: An exploration of
Process and an examination of Results
Chris Dolan
Workshop for Global Summit to
End Sexual Violence in Conflict
12 June 2014
History
• 1996 interview with former RENAMO Combatant in
Mozambique
• 1999 research in northern Uganda, sexual violence against
men the most hidden topic
• 2006-2009 isolated individuals at RLP… no response for
men at risk
• 2009 launch of ‘Gender Against Men’ and decision to work
systematically on the issue, workshop on ‘SGBV for men’
(150 participants: Congolese group say ‘this happened to all
of us’)
• 2009 – 2012 ‘snowball’ effect of working with individuals,
encouraging group formation, rapidly escalating numbers…
Men of Hope: from 6 to 60 members in less than six months, currently 120
Men of Courage:
from a handful to
more than 40 in 2
years
Men of Peace: from 1 to 20 in one week, up to 45 in one month, 80 in
six months, to 240 members in the space of one year
2012
WORKING WITH
MEN AND BOY SURVIVORS
OF SEXUAL AND
GENDER-BASED VIOLENCE
IN FORCED DISPLACEMENT
CE
4
I DA N
ED TO
OW
GU
KN
NE
3 big questions:
What is the real extent of the problem in the
populations we are working with?
Where do we situate this work within
existing action on violence against women?
How do we demonstrate it?
The enquiry by Johns Hopkins School of
Public Health about whether we would be
interested in collaborating in the
development of the first screening tool for
male victims for use in humanitarian
situations came at just the right time: we
had the big questions we needed
answering, and we already had
a) staff
with extensive experience of working
with male victims
b) a large network of
engage
survivors
willing to
c) credibility in the refugee community
Objectives of the screening
Primary: Routine use of screening method to
confidentially identify unreported cases of GBV and refer
to appropriate services
– 1st GBV screening tool of its kind for male
refugee/displaced populations (Systematic literature
review - No screening tool exists)
– Increase access to services by GBV survivors in
displaced settings
Spin-offs:
– Change norms related to discussing/disclosing GBV
– May assist with data collection to assess trends
Development of the Screening Tool
Formative Phase (Jan-Feb 2013)
Kampala & Nakivale refugee
camp
- Survivors
- Service providers
UGANDA
Validation Phase (April – July
2013)
Kampala & Nakivale refugee
camp
- Survivors
- General refugee population
Generalizability Phase (August –
October 2013 )
Kampala & Rwamwanja refugee
camp
- Screening during registration
Kampala
Rwamwanja
Nakivale
Formative Research: Results
• Participants revealed multiple and diverse types of GBV
– Rape, other sexual violence, forced perpetration of sexual
violence, detention, and psychological violence.
• Locations of GBV occurrence:
– Town prior to displacement, during conflict, rural areas, new
setting of displacement
– Within home, in captivity, in camp
• Perpetrators:
– armed actors, strangers, other trusted individuals (e.g. family
members, neighbors)
• Barriers to reporting: stigma; low access to services
Validation Phase
• Kampala & Nakivale
– Tested among 95 self-identified survivors of GBV
and 249 adult men in the general refugee
population
• Validity tests:
– Compared to other violence and trauma screening
tools used in non-conflict/displaced settings
– Compared results of those previously self-reported
to those who screened positive
Implementation/Generalisability Phase
The Depth of the Issue: Results from Systematic
Screening of Male Refugees from eastern DRC
• The Johns Hopkins–Refugee Law Project study
screened 447 male refugees aged 18 years and older, residing in
a refugee settlement in western Uganda (26 Aug - 4 Oct 2013).
• Participants were recruited during registration
and during attendance at the settlement medical
centre. 99% originated from DRC and had lived a median of
less than one year in the settlement (range: 0– 17yrs).
• 13.4% had experienced an incident of sexual
violence in the preceding 12 months rising to
38.5% if looking at their whole lives.
•
Those screened ranged from 18–78 years, with a median age of
30, and 73% were married.
Utilisation of the Screening Tool
• Mainstreaming into RLP’s Assessment and Intake Process (women
and men) from June 2013
• Betweeen Jan 6 and April 20 2014 this resulted in 524 referrals (184
male (35%) and 340 females (65%))
• Continued screening of men in refugee settlement (Nov – Dec 2013:
1266 screenings) (this allowed in-depth interviews with 140 of those who screened
positive and also referrals of most extreme cases)
Impacts on prevention of and
response to SGBV
• enabled a paradigm shift in community outreaches
and participation (who talks, who is mobilised)
– community policing
– information session
• informed trainings of stakeholders on SGBV
– police and prisons
– medical and legal students and practitioners
– refugee serving agencies
• Informed funding proposals
Provides a model for other areas of
programming: from this one tool we have
developed similar screening tools for
mental health and access to justice related
experiences
Improved documentation of cases and
trends and providing evidence for
prosecution through video follow-ups,
documentation and in-depth interviews
– these also feed into resettlement
referrals
Improved gender inclusive service provision
through creation of a climate of trust where;
1) survivors start to take charge of their own
experience
2) transition from victim to survivor resulting from
combination of;
i. individual medical, psychosocial and legal
support
ii. home based care
iii. participation in peer support groups
evidenced by acquiring an independent
voice on matters of concern (e.g. Men of
Hope)
Change of assumptions about sgbv against
men and boys, challenging the conventional
understanding of male rape as a taboo
across many cultures, enabling robust
understanding
of
perpetrator/victim
dilemmas (community outreaches )
Screening vs Population Based Survey
Where population-based surveys have been conducted in
post-conflict settings, they suggest that levels of sexualised
violence against males during conflict are much higher
than is generally assumed or publically admitted: a
population-based survey conducted in eastern DRC in
March 2010 showed rates of reported sexual violence
were 39.7% among women and 23.6% among men.
(Johnson et al)
This compares with the screening figure of 38% for refugee
men from the same region
Arriving at a workable figure of prevalence
in the male refugee population
Reported prevalence varies depending on the site
where the screening is conducted. In the
Rwamwanja case it went to 38.5% who had a
lifetime experience of sexual violence, and 13.4%
had experienced an incident of sexual violence in
the preceding 12 months
While prevalence varies slightly by location
(reception centre vs clinic vs refugee law project,
it seems safe for planning purposes to work with
a figure of 1 in 4 adult male refugees as victims of
sexual assault of one form or another
Implications of a 1 in 4 figure for GBV
programming in other refugee
situations
In the Ugandan case, if the 1 in 4 calculation is applied to
the adult male refugees, the result is 15,604, equivalent to
5% of the total refugee population of 328,997
According to UNHCR, “A year into the civil conflict in the Central African
No of Adult Male
Males 18+ as %within
of
No of Adult
Male victims
Republic,
some
632,700
people
have
been
displaced
country
and
Females
All Males
Males 18+
victims the
if counting
LOCATION
total pop
if counting 1 in 3
1 in 4
over 326,700 people have fled to Cameroon, the Democratic
Republic of the
Congo, the Republic of Congo and Chad” If the 1 in 4 ratio and 5% calculus is
34,304
29,394
13.90
2,214
2,951.67
Adjumani
applied to those who
have fled,
we could8,855
expect to identify
16,355
adult male
31.93
21,477
24,958
14,827
3,707
4,942.33
Kampala
survivors.
7,751
2,614
16.28
654
871.33
appeal?gclid=CJDHmt_sqb4CFe3JtAod7GwAlQ)
2,785
2,562
Oruchinga
945
17.67
236
315.00
2,634
13.17
659
878.00
Kiryandongo
8,301
According
to the DEC
(Disasters Emergency
Committee)
“An
estimated 1,118
6.5 million people
11,281
11,057
4,471
20.02
1,490.33
Kyaka
II
are displaced inside 19,235
Syria, and 2.5
million people
fled to the 1,881
neighbouring 2,508.33
18,961
7,525 have now
19.70
Kyangwali
29,724 and Iraq”
7,462
12.53
1,866
2,487.33
countries of Jordan,29,833
Lebanon, Turkey
(http://www.dec.org.uk/appeals/syria-crisisNakivale
Rhino
10,341
9,660
If the 1 in 4 ratio and27,823
5% calculus29,550
were applied
only to the
2.5 million who
have fled as
22.80
13,083
3,271
4,361.00
refugees, we would need to plan for 125,000 cases of adult male survivors.
Rwamwanja
Total
165,380
163,617
62,416
15,604
20,805
Partners
Office of the Prime Minister, Refugee section
• Refugee participants in Kampala, Nakivale, Rwamwanja
Geneva, Kampala, Nakivale, Rwamwanja
• Implementing partners in Kampala, Nakivale &
Rwamwanja
• Financial support: US Government: BPRM
Thank you for listening
[email protected]