Nurse-led care for survivors of sexual violence in humanitarian settings
On 19 June, we will mark the 6th International Day for the Elimination of Sexual Violence in Conflict. As part of our IND Case Study series we look here at nurse-led care for survivors of sexual violence in humanitarian settings.
Sexual violence affects millions of people, brutally shattering the lives of women, men and children. It is a medical emergency, but there is often a dire lack of healthcare services for victims. Shame, fear, stigmatisation and many other obstacles prevent an unknown number of victims from receiving, or even seeking, treatment. In addition, the global shortage of trained health workers, the under-utilization of the scope of practice of nurses, and laws restricting forensic examinations to medical doctors present challenges to provision of care for SV survivors. The World Health Organization and ICN support task shifting and the expansion of the roles of nurses, and the provision of health care to survivors of sexual violence by nurses has been promoted widely.
Getting immediate health care after sexual assault is critical in order to limit the potential consequences. Survivors of sexual violence need access to immediate, comprehensive and quality health care as well as psychosocial support. Health care is crucial in the 72 hours following rape to prevent the transmission of HIV and an unwanted pregnancy. In some countries, the COVID-19 outbreak has forced private health facilities to close because of the risk of contamination and lack of personal protective equipment, making access to care even more difficult.
In order to ensure that survivors have access to the much-needed care, MSF has implemented survivor-centred nurse-led models of care supported by nurse-led leadership for survivors of sexual violence.
With support from both a field and a headquarters-based expert adviser on sexual violence, MSF nurses working in humanitarian settings conduct the history, interview and examination of the survivors, and conduct HIV testing and provide HIV post-exposure prophylaxis, emergency contraception pills, abortions, and prophylaxis for sexually transmitted infection. Nurses ensure care is based on survivor-centred principles of informed consent, privacy, confidentiality, respect, compassion, and is non-discriminatory.
Nursing-led models of care have been implemented in Afghanistan, Sierra Leone, South Sudan, Papua New Guinea, Bangladesh and Ethiopia. In Afghanistan, for example, there is a lack of highly trained health workers, in particular female doctors and nurses. Despite the many challenges in implementing health care and psychosocial support in conflict areas in Afghanistan, building the capacity of the national staff, especially nurses, had the large role to play in the success of the program.
MSF’s experience shows that nurse-led model of care for survivors for sexual violence, implemented with a combination of training and expert support, could allow for a fully utilized scope of nurses and the expansion of access to health care for survivors of sexual violence in humanitarian settings with a shortage of trained health workers.
In a 2017 MSF report on critical gaps in health and clinical forensic care for survivors of sexual violence in South Africa, recommendations to the South African government included “ task-shifting to professional nurses could ensure that quality clinical services are more widely accessible to survivors”