A new initiative in which qualified village nurses and clinical officers provide free medical examinations and counselling services to survivors of sexual and gender-based violence (SGBV) in Uganda could help to speed up the prosecution of such cases, say officials.
“[SGBV] is a big problem eating the society. For long, offenders have been escaping the hands of the law because victims fail to [obtain] medical evidence,” Moses Byaruhanga, the head of the medical service in the Uganda Police Force, told IRIN.
Uganda’s Justice Law and Order Sector has allocated 250 million shillings (about US$92,700) to the 2012-2013 budget for the Uganda Police Force to implement the programme, as well as a programme to facilitate its post-mortem reports; the medical examinations are part of the legal process following reports of sexual assault. Health workers who perform the examinations will be paid 25,000 shillings (about $10). It is hoped the programme will extend access to justice to some 10,000 SGBV survivors.
“Most SGBV survivors avoid reporting the abuse as they cannot afford to meet the cost of medical examinations,” said Byaruhanga. “Without this [medical report], how do you expect [the] court to pass its verdict? Definitely such [a] case, without medical proof, [will be] stashed away.”
According to the Wadeg Mone Women’s Group, an association of SGBV survivors in the village of Koch Ongako, in the northern Gulu District, the initiative will help to protect the rights of impoverished rural women who have limited access to legal support.
“I am victim, and I know what it [means] to undergo such an experience; it’s horrible because you don’t feel free. It dehumanizes,” Vicky*, a Wadeg Mone member, told IRIN. She added that high hospital fees discourage women from reporting such crimes.
“I had a similar experience in 2009, when my daughter was sexually abused by a neighbour. I reported the case to the police, and the police referred us to Gulu Hospital to have my child examined, but a doctor asked for 80,000 shillings [$29] in fees,” Christine* told IRIN in Koch Ongako. “I gave up and it turned out horribly because my daughter tested HIV-positive recently.”
“My daughter’s future is no more. She has to live on drugs all her life, and I don’t know if she will be able to cope,” she added.
Poverty and ignorance increase rural women’s vulnerability, said Henry Barnabas, a principle medical officer and a Ministry of Health trainer on SGBV. He noted that there is a need for SGBV survivors to seek prompt medical care to avoid secondary infections and unplanned pregnancies.
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“We have had patients who come to the clinic weeks after they have been abused. That is very bad because it puts their health at more risk,” said Barnabas. He hopes more survivors will seek out the service now that it is free.
SGBV survivors who seek medical care are provided post-exposure prophylaxis kits - a course of HIV medications that can help prevent infection - and are tested for sexually transmitted infections and pregnancy. “We do this because of its consequences to victims,” he added.
Plans are underway to strengthen and establish SGBV ‘stop centres’ at all regional referral hospitals in Uganda with the required facilities and staff.
NGOs providing care and support to SGBV survivors are also calling for more sensitization and advocacy to ensure that the community knows the dangers of SGBV and that they are aware of the free medical service available.
“We need to focus on deterrent measures to curb the problem. We need to see that these perpetrators are given severe punishments like life imprisonment,” Susan Akello, an official with the Uganda Legal Aid project, told IRIN.
Some families are already accessing the free service.
“My younger sister was sexually abused in the afternoon of Monday last week. I reported the matter to the police and the perpetrator was arrested immediately. They [the sister and the perpetrator] were rushed to Gulu Hospital, where they were examined. The perpetrator was found to be HIV-positive, and my sister was put on post exposure prophylaxis,” said Sarah* from Amuru District.
*Family name withheld