Against Their Will: MSF Report on Sexual Violence in Haiti

In Haiti, the number of young people, especially women and girls, who report experiencing sexual and gender based violence (SBGV), is alarmingly high, especially in the highly populated capital city Port-au-Prince. But despite its scale, the issue is still commonly overlooked. SGBV is also likely underreported due to stigma and shame, as well as fear of reprisal from perpetrators or from the community.  The current availability of services for survivors is inadequate to address the problem, especially when it comes to the youngest survivors. Despite ambitious efforts from civil society actors and progress in some sectors, policies and overall capacity still fail to adequately address the needs. Survivors often fall between the cracks of a poorly coordinated system that should be providing them with an integrated package of medical and psychological care as well as social and legal support and protection.

In May 2015, Médecins Sans Frontières/Doctors Without Borders (MSF) joined other agencies serving SGBV survivors in Haiti to open a clinic specialised in providing this type of care in Port-au-Prince. From May 2015 to March 2017, MSF’s Pran Men’m clinic (Haitian creole for “take my hand”) has provided care to nearly 1,300 SGBV survivors.

While people of all ages report experiencing SGBV in Haiti, girls and young women appear to be the most vulnerable. Patients younger than 25 years old represent the majority of survivors treated by MSF since May 2015 (77 percent). Eighty-three percent of all patients are rape survivors, and 83 percent of these patients in turn are younger than 25.

MSF is particularly concerned by the fact that 53 percent of patients seen in Pran Men’m clinic are under 18. Most are survivors of rape and other types of sexual abuse. This high rate of young survivors underscores the urgent need to address the problem of sexual violence against minors, who are particularly vulnerable due to their age.

Four out of five minors treated at the clinic knew their attacker. Most were family acquaintances and sometimes (11 percent) household members. In Port-au-Prince, children and adolescents are often left on their own while their caretakers work or otherwise meet the needs of their household. Most children under 10 (71 percent) were abused in places where they should feel safe. Additionally, one in five minors who came to the clinic after sexual abuse was previously exposed to SGBV.

In addition to its impact on physical and mental health, sexual violence can also transmit HIV and other sexually transmitted infections. It can also lead to unwanted pregnancy. These risks are reduced or eliminated when survivors receive medical care as soon as possible within 72 hours. However, only 58 percent of minors treated at MSF’s clinic arrived within this timeframe. In total, 45 pregnant minors and 30 pregnant adults could not use emergency contraception due to late arrival to the clinic.

There are many obstacles for survivors seeking medical care for SGBV. For example, 38 percent of rape survivors came to Pran Men’m clinic between 6:00 p.m. and midnight, when most other clinics that offer care for sexual and gender-based violence are closed. Additionally, medical care provision in other health structures is often incomplete due to a lack of available supplies. Medicines for the prevention of HIV and other sexually transmitted infections, as well as emergency contraception, must be made available immediately in all health care facilities.

Immediately after sexual attacks, survivors are often in a state of shock. The first objective of psychosocial care for survivors is to help them restore their ability to carry on with their lives. In some cases, initial counselling helps stabilise and prepare them to receive medical care. Timely counselling and adequate follow-up sessions help prevent long-lasting psychological consequences.

The consequences of sexual violence are not just physical and psychological—they are also social and economic. SGBV affects both survivors and their families and communities. Survivors need comprehensive care that includes a range of support services. Coordination of existing services for survivors is one of the biggest challenges and currently fails to address the gaps in service provision in all sectors. MSF works with a network of organisations providing social and protection services in Port-au-Prince. Some provide shelter to minors, women, and families, but procedures for placement are often lengthy. Longer-term, safe, and secure shelter solutions remain one of the greatest and most urgent needs for our patients.]

The most vulnerable patients need to be referred to social services for follow-up and protective care to avoid further exposure to violence or sexual abuse. Sixty-seven percent of MSF’s patients need social support. Forty-nine percent of these need protection (including safe shelter and child protection services), and 28 percent are referred for legal assistance to press charges against perpetrators. Despite the needs, social and protection services are often constrained by a lack of sustainable funding and proper referral mechanisms to ensure comprehensive care.

Sexual and gender based violence in Haiti should be recognised and addressed as a public health issue. Prevention services must be increased at various levels and rapid availability and accessibility of medical and psychological care for survivors—as well as social support and protection services—must be reinforced.

Survivors should have access to adequate and timely medical and psychological care within a system that addresses the specific needs of this particularly vulnerable population. A referral network of service providers for SGBV survivors, efficiently coordinated at national and local levels, is urgently needed to ensure that any survivor seeking assistance is properly referred to a comprehensive range of services. Donors should support organisations providing safe shelter solutions with more sustainable and reliable funding to ensure the protection of the most vulnerable survivors.

It is critical that multidisciplinary services be made available to survivors to address both their immediate needs and the long-term consequences of SGBV. If prevention services are not strengthened, SGBV will remain a critical issue in Haiti—especially for the youngest and most vulnerable.