Violence in the Fields

In the Kimbi-Lulenge and Kamambare health zones, MSF works with 50 focal points. These community focal points are identified by MSF and the local village leaders. Most are female as the majority of survivors of sexual and gender based violence (SGBV) are women and girls. The focal point is often the first point of contact for survivors so discretion and confidentiality are vital. Their role is to listen to survivors, provide support and inform them of the medical and psychosocial care they can receive in health facilities supported by MSF. The focal points also provide some of the outreach work in the community with health education on sexual violence and sensitisation regarding stigma.

"It's hard to listen to the stories of these women. It affects me. I relive their experiences a second time with them. But as my advice is heard and welcomed, suddenly I feel good,” says one 30-year-old focal point. “All the injustices that women face make me feel sick. Today, they are afraid to go to work in the fields. Yet, they must feed their families. They have no other choice and have to choose between going to the field and risk being sexually abused, or starving.”

Survivors of sexual violence tell MSF that they are often attacked when they work in the fields, usually by several armed men. The attacks are often brutal, with the victim tied up by their hands and feet, blindfolded and raped by several men, sometime for hours.

Many survivors tell MSF that they were pregnant at the time of the attack. Family members who accompany the woman are often forced to witness the act or, if male, forced to sexually abuse their own mother, sister or daughter. According to the survivors', after the assault the attackers sometimes travel to their home to steal their personal belongings.

Identifying survivors

Survivors mostly visit a health facility or go directly to an MSF focal point voluntarily. MSF then transports them to the health centre or the hospital for treatment. As sexual and gender based violence is often stigmatised in communities, many prefer to be cared for outside their village or community.

"It is difficult to address the subject of sexual violence, because it is always taboo and accompanied by many judgments. This is why community health workers organise awareness-raising activities within the communities," explains the MSF supervisor and focal point for the sexual violence case management service at the Jamaa health centre.

Stigma is also addressed during community awareness sessions on various topics related to reproductive and sexual health. At such events, many survivors, the vast majority of whom are women and girls, open up about an abuse or rape committed by relatives or within the community. Often they are faced with an unwanted pregnancy and sometimes do not want to keep the child.

Five Essential Services

MSF is treating survivors free of charge with five essential services. These include: post-exposure HIV prophylaxis, prevention and treatment of sexually transmitted infections, prevention of unwanted pregnancy, vaccination (Hepatitis B and Tetanus), treatment of injuries and finally delivery of a medical certificate.

Following a significant increase in SGBV cases in the first three months of 2019, MSF deployed mobile clinics to reach survivors and also meet with local leaders to facilitate access to care as quickly as possible, so to avoid sexually transmitted infections and unwanted pregnancies.

Beyond the physical suffering and impact, there is also the psychological suffering that has a major impact on the lives of survivors. As such, psychosocial support is offered at all MSF supported health centres. These essential medical and psychosocial services are available seven days a week, 24 hours a day and are entirely confidential.