Three-quarters of public health facilities in South Africa – designated to provide medical or forensic care – are unable to provide comprehensive care to survivors of sexual violence.

This is a key finding in a new report by Doctors Without Borders (MSF), titled Untreated Violence: Critical gaps in medical and clinical forensic care for survivors of sexual violence in South Africa.

The report, to be presented on Tuesday morning at an event hosted by MSF, Health e-News, Sonke Gender Justice, Shukumisa Coalition and Thohoyandou Victim Empowerment Programme (TVEP), investigated gaps in the provision and availability of comprehensive medical and forensic care for survivors of sexual violence.

In October 2017, MSF conducted a nationwide telephonic mapping overview of designated facilities to see what service provision gaps existed at these facilities, the organisation said in a statement. The purpose was to inform recommendations on how to improve care in future.

Out of 265 designated facilities, 167 (63%) participated in the survey.

According to the report:

• Only 43 facilities (26,7%) provide the full medical component of the comprehensive package of care;
• Only 68 facilities (42%) reported all medical examination and treatments were available;
• 12 facilities (7%) reported they did not provide any services for survivors of sexual violence;
• Where clinical forensic services are available, they are provided exclusively by doctors in 74 of these facilities;
• Counselling and social assistance was reportedly not widely available on site. Only 27% of facilities provide access to a psychologist, while 28% are unable to provide access to a social worker;
• Some 20% do not provide the clinical forensic services that enable survivors to pursue a case in a court of law.

Medical co-ordinator Dr Amir Shroufi said providing a comprehensive package of care to sexual violence survivors was a “medical imperative”.

Mitigating the effects

According to the report, providing comprehensive services for those who suffer sexual violence can mitigate the risks and damage they suffer.

Survivors can suffer physical trauma, injuries, HIV or STI infections, unwanted pregnancy, tetanus and/or hepatitis, mental health disorders, safety concerns and other social issues.

Although a comprehensive care package is not a silver bullet, it can help survivors to take the first steps toward coping with the trauma and any and impact on their physical health, the report notes.

Assistance for these after-effects can be provided through a comprehensive medical assessment, including forensic examination in case of opening a case with the SAPS; first aid; emergency contraception or referral to choice on termination of pregnancy; vaccinations; crisis intervention and longer-term counselling; and social work assistance. Prophylactic treatment for HIV can also be administered.

“National findings and MSF experience in North West (Province) suggest a need for more health care workers to be trained in caring for survivors of sexual violence,” said Cecilia Lamola, MSF forensic nurse and nurse mentor in Rustenburg. “Nurses should be trained to conduct forensic examinations with standard clinical care, and lay counsellors can be given skills to offer longer-term support for survivors.

“Survivors of sexual violence should not have to travel forever and pay a lot of money to receive emergency care,” she added.

According to Lamola, under-staffing is a serious challenge. “Often it is just one professional nurse ensuring the availability of services in a facility, and when this individual goes, those services collapse,” she said.

For survivors, the provision of comprehensive care after a sexual assault can make a life-altering difference. “I would be dead today if it wasn’t for the counselling I received after I was raped. We need to be able to get these services… and we need to use them,” says rape survivor Luleka*.

According to survivor Constance*, the care she received at Brits Hospital after a gang rape at her home in 2015 was a lifeline. Had she not received counselling, she would have committed suicide, she says.

Sexual assault in South Africa

The South African Police Services (SAPS) reported 42,496 rape cases for 2015/2016, but it is estimated that many sexual assaults still go unreported.

Suspected under-reporting means the extent of sexual violence in South Africa is unclear. A 2016 report by Africa Check, which focused on rape, debunked many of the older statistics as outdated.  

There has been an overall decline in reported rapes per 100,000 people in recent years. This, however, is also subject to reporting data. In 2017, official crime statistics released in March showed sexual offences across the country decreased by more than 2,500 cases for the period under review (April – December 2016). Documented cases of rape decreased from 32,161 to 30,069, or just under 110 cases per day. Gauteng had the highest incidence of rape, with over 5,900 cases reported in nine months.

Data regarding sexual assault of adults (taking into account lack of clarity due to under-reporting) is still sketchy at national level, despite several smaller regional studies having been conducted. The data on child sexual assault suggests high rates in comparison to global averages.

The Shukumisa Coalition, meanwhile – a network of NGOs, community-based organisations, research institutions and legal services working to change attitudes towards sexual violence – has said the slow-motion roll-out of sexual offences courts in South Africa exacerbates a shortage of data and support. Dedicated legal support for victims of sexual violence, they say, reduces survivor trauma, speeds up the processing of cases, makes for more sound judgements because of specialised legal expertise, higher conviction rates, and higher levels of reporting as survivors see more promising results.

MSF believes one person who does not receive help is too many, and that the facilities that are available in theory should be available in practice – year-round, not just during the 16 Days of Activism. “MSF is calling on the Department of Health to urgently address issues of access to health care for hundreds of thousands of people who each year experience sexual violence in South Africa,” the organisation’s statement said. DM

* Indicates alias

Read more: Why a third of South Africa’s children are sexually abused – study

Photo by Aimee Vogelsang/(Unsplash).