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This paper explores whether a systematic approach to screening for experiences of violence (sexual, physical and psychological) is possible in a range of humanitarian settings (just arrived and longer-term, rural and urban) and, if so, what kinds of levels of disclosure are found, what are some of the factors influencing disclosure positively and negatively, and what might be the cost of addressing the most urgent needs.
1 RESEARCH SUMMARY
Present humanitarian practice is to wait for survivors of conflict-related sexual violence to come forward for assistance. Most do not, resulting in prolonged suffering and unwarranted obstacles to individual and household recovery and self-reliance in the medium term, and obstacles to peace-building and post-conflict recovery in the longer term.
This project explored whether a systematic approach to screening for experiences of violence (sexual, physical and psychological) is possible in a range of humanitarian settings (just arrived and longer-term, rural and urban) and, if so, what kinds of levels of disclosure are found, what are some of the factors influencing disclosure positively and negatively, and what might be the cost of addressing the most urgent needs.
The fieldwork, conducted in five different sites hosting south Sudanese refugees, sampled a total of 938 adult South Sudanese refugees (46% male, 54% female), with data captured directly on electronic tablets and daily uploaded to a centralized database. Acholi and Madi were the largest group of respondents, followed by Nuer and Dinka.
The study found that systematic screening is possible and is welcomed by survivors and seen as a positive departure from existing practice of no stakeholders asking them what happened to them before they ever reached Uganda. Questions are particularly welcome when linked to adequate referral mechanisms for complex conditions arising from violence.
Access in humanitarian settings require careful negotiation, and the screening process itself is labour and time intensive and reliant on skilled and trained personnel. Given the sensitivity of the experiences touched on, screening cannot be rushed, should explore the full range of experiences of violence rather than only sexual violence, and should include questions on physical functionality, pain and scarring, as well as psychological and social functionality. These cross-reference and thereby enhance possibilities of disclosure. Screening should not be conducted unless counselling support is in place, together with basic referral options.
Levels of physical and sexual violence disclosed in this project (e.g. 22% of women and just under 4% of men disclosed experience of rape), are high although they still do not reflect full disclosure. Patterns of violations are also quite gender specific. 20% of those screened were referred for further support, with 6% referred for private medical investigations and treatment through RLP.
If extrapolated to the refugee population as a whole, they suggest that in the current refugee crisis of approximately 1 million South Sudanese refugees in Uganda, a minimum of 22,000 adults could be identified and in need of medical support if the harms from these largely untreated injuries are to be minimized.
Even these relatively high disclosure levels almost certainly still reflect under-reporting insofar as disclosure is undoubtedly still influenced and qualified by a number of factors, including the time and timing of screening, the skill level of the interviewer and the language used, the ethnic composition of the settlement, the plausibility of referral options, the time-gap between incidence and disclosure. Reporting levels would almost certainly increase once the connection between disclosure during screening and subsequent medical support became clear. The average costs of screening can be brought down through further development of the screening tool and full integration into referral processes.
Screening is thus a critical step in significantly reducing under-reporting of existing experiences and conditions. It offers an important starting point in understanding incidence and prevalence patterns. It suggests that humanitarian actors need to increase their attention to the response to existing conditions, even as they work to prevent further violations in the humanitarian setting. To maximise on this potential, screening should be combined with more effective and widely publicized treatment options as well as community level work to maximise support to identified survivors.