MSF started sexual and gender-based violence (SGBV) activities in Bidibidi refugee settlement in March and in Imvepi refugee settlement in May to respond to the increasing need for holistic SGBV care among South Sudanese refugees in Uganda. Marie-Anne Henry, is a midwife activity manager for MSF who has been working in Bidi Bidi and Imvepi since April 2017.

Why did MSF start its SGBV activities?

Many of the refugees from South Sudan have gone through high levels of violence, including sexual violence. They were raped or sexually assaulted and many also witnessed their family being killed or raped. Some people have been raped several times. It’s very important for them to get first aid and psychological support as soon as possible but many survivors do not find it easy to talk about what they have experienced. Many of them are traumatised and scared. MSF started SGBV activities to ensure a safe and neutral space where survivors of sexual violence can access timely medical and psychological care. Before MSF started its activities, when survivors were identified, cases were reported to the police and people had to go through a long and uncomfortable process before getting treatment and support. As an independent humanitarian medical organisation, MSF does not take cases to the police unless our patients want to do so, and we prioritise providing treatment before it becomes too late.

What SGBV care does MSF provide?

At our SGBV clinic in Imvepi refugee settlement, where new arrivals are taken for registration, we provide first aid treatment and psychological care. In the consultation, we test for HIV and if the assault happened within 72 hours, we give post exposure prophylaxis (PEP) to prevent an infection, as well as the emergency pill to prevent unwanted pregnancies.
If she is found to be pregnant and wishes a termination, we refer to a regional clinic when it’s less than 16 weeks of pregnancy. If it’s over 16 weeks, we refer to the antenatal care clinic we run in Bidi Bidi. We have midwives specifically trained for SGBV care, as well as psychologists and counselors. We also closely collaborate with the MSF mental health clinic in Bidi Bidi, as many of our patients need mental health support for symptoms such as PTSD (post-traumatic stress disorder) and depression. We have female and male patients and male clinical officers are available if the male patients prefer them. We refer complicated cases and children to Bidi Bidi, our central referral centre.
As it’s important for victims to get treatment as soon as possible, we also provide training to other medical actors working in the transit centres where buses depart for the refugee settlements. We donate such medicines as emergency pills and PEP and train health workers on how to screen, identify and handle counseling before referring cases to Imvepi.
What we are doing is making a pathway for people from their arrival in Uganda to their relocation in refugee settlements so that they receive the necessary care.

How many patients have we treated so far? Who are the patients?

So far we have treated 49 patients, including 3 men and 20 children under 18 years old. The youngest patient we saw was a 5 year old boy raped and physically assaulted several times sexually assaulted multiple times in South Sudan multiple times. Among our patients, 33% experienced sexual violence in South Sudan, 23% during the journey to Uganda, 19% at the border area, and 18% in the refugee settlement or reception centre. This indicates that even though SGBV is one of the reasons people flee South Sudan, there are significant numbers experience it on their journey to Uganda and in the refugee settlements.
You said that it’s not easy for the survivors to speak out.

How does MSF find survivors?

At the reception centre in Imvepi, we are doing a sample survey to collect information on where refugees are from, why they fled, and if they witnessed or experienced violence. It’s possible to identify survivors of SGBV through this survey. We also do a daily round with other actors to see if they have encountered any SGBV cases. Another way is word of mouth. Those who visit our clinic tell their community about us. We also implement bi-weekly community awareness activities to sensitize key people in the community so they can help spread the word about our services.
We also work closely with the health surveillance teams who to gather medical information about malnutrition, morbidity and mortality. In Bidi Bidiour clinic we received a woman who had disabilities and couldn’t speak. She wasgot pregnant from rape and it was already too late for abortion. But Oone day she stopped coming to the clinic and it was not possible to find out where exactly she was living. and wWe were worried about her. The other day, our surveillance team found out that she gave had given birth in a regional hospital after she started labour and a community health leader alerted it to the regional hospital. She is now admitted in our clinic for further follow-up., which is good but we don’t know how she ended up giving birth in a hospital far from the settlement. We are trying to follow up on her case now.

What are the main challenges that MSF is facing?

One of the challenges is to treat patients within 72 hours after the assault to prevent HIV and unwanted pregnancies. If people were raped in South Sudan or at the border, those 72 hours easily pass as they make their journey or while they go through registration and screening. Even once they arrive to the reception centre, they have to queue for registration, food and non-food item distribution. In these desperate circumstance, going to the SGBV clinic isn’t always seen as the priority.
Another challenge is following up with patients after they are settled. The refugee settlements are vast and because some people move from one zone to another, it is difficult to figure out who is settled where. We are now working with the surveillance team on how to solve this issue. Regardless of the urgent needs for SGBV care given the high levels of sexual violence South Sudanese refugees have gone through, we are seeing a lack of sufficient services available for them. An increased focus and additional capacity should be allocated for protection and essential psychological and medical care for sexual violence.