Health care deficit causing fresh trauma to sexual violence survivors in South Sudan
Thirteen-year-old Suzanne begins to weep as she tells the story of how she was raped.
Her ordeal began when armed men burst into her home in Leer in the middle of the night, beating family members, and threatening to shoot them.
“They came and found us sleeping. They woke us with rough kicks. They beat me,” she says through a veil of tears. “One of them snatched me by force and took me away despite my grandmother pleading for him to stop. He even beat my grandmother.”
“My family were wailing and screaming for him to bring me back. But he took me to the bush and raped me. When he let me go, I went home by myself.”
Suzanne is one of thousands of women and girls who have suffered immense harm as the result of the widespread and pervasive sexual violence that has plagued South Sudan throughout its five-year civil war.
Many survivors suffer, not only, from the sexual assault, but also an inability to access the health care they need to physically and emotionally recover.
Esther, a 40-year-old mother of five, was one of many women raped as they tried to flee their village in Leer during fighting in May 2018. Her ordeal did not end when the rape was over.
“The only support I need is to improve my health. Without health, nothing is possible,” she says. “But the health facility is always running out of medicine and I cannot buy medicine when my children are starving. There is no work for me in town. I do not make enough money with the small amount of firewood I am able to collect, and I can’t carry as much firewood now as I did before the rape, because of the pain in my body. We are now forced to depend on others.”
A new report by the Human Rights Division of the United Nations Mission in South Sudan has documented the severe lack of health care for sexual violence survivors. It also tells the story of health workers who work hard to provide what little care they can in a country torn apart by devastating conflict.
The report investigated incidents of conflict-related sexual violence in Unity and the Central and Western Equatorian regions between January 2018 and January 2020. These areas had the highest rates of this violence with 89 percent of the cases documented.
The report found that South Sudan’s Government has consistently failed to prioritise funding of the public health system. For the 2019-20 fiscal year, only 1.2 percent (USD14 million dollars) of the national budget was allocated to the entire public health sector, contrasting with USD20 million allocated for the health care of members of the national legislature during the same period.
This underfunding has effectively resulted in the outsourcing of health care in South Sudan to international organizations and a reliance on funding from international donors. But, despite this major investment, the medical response for sexual violence survivors remains weak.
As a result, the report recommends a substantial increase in Government funding to 15 percent of the annual budget to strengthen the capacity of the health facilities and workers.
“In the longer term, obviously building capacity of doctors and nurses will take some time,” says UNMISS human rights officer, Sara Gibson. “But what we would like to see is for the government to allocate more resources to this, and to see this not as something that is primarily done by the international community, but to really take ownership of that as the duty bearer for the right to health.”
The report identifies three major challenges.
Access to health care facilities is extremely limited. The World Health Organization standard is two facilities per 10,000 people while in South Sudan, the average number is one. With 72 percent of the population living more than five kilometers away from their closest facility sexual violence survivors are forced to travel long distances through insecure areas to seek treatment.
There aren’t enough skilled doctors, nurses and midwives which, combine with the lack of facilities, means survivors often only seek treatment after developing complications like sexually transmitted infections, unwanted pregnancy, and complications from unsafe abortions.
Social barriers also have a significant impact by forcing many to suffer in silence.
“Most of the survivors are developing stigma,” says Helen Merdado from the UNIDOR primary health unit. “They don’t want anybody to know what has happened. One of them told me that she would hang herself because she didn’t want anyone to know. These cases are not easy.”
Health care workers are doing their best. In some areas, specialist post-rape treatment and oral drugs are available. A lucky few can also access trauma counselling.
“The kind of work that I do is to work closely with the survivors to try and give them psychosocial support and bring them together to share what happened to them,” says Elizabeth Salada, a gender-based violence officer with Hope Restoration. “We always have a focus group discussion for women in the centers where they can talk and explain the challenges they are facing in the community or at home.”
The report makes a series of recommendations. In addition to increased government funding for public health care, it calls for offenders to be prosecuted, victims to be given access to immediate and long-term health and psychosocial support, targeting international investment towards improving capacity of the South Sudan system, and increasing efforts to overcome social barriers.