An open hand holding a whistle for protection from sexual violence in Nigeria.

Nigeria 2023 © Kasia Strek/MSF

Sexual and gender-based violence

Sexual violence is a medical emergency that shatters lives around the world, yet survivors often lack access to vital health care and social support.

Putting sexual and gender-based violence in context

Providing care for victims of sexual violence is a growing part of the medical-humanitarian action of Doctors Without Borders/Médecins Sans Frontières (MSF). Sexual violence can occur anywhere but is often more prevalent in unstable situations, such as during conflicts and mass population displacements. The harms are often compounded by a dire lack of health care services for victims and social stigma that can prevent survivors from seeking care. Since victims of sexual violence need rapid access to emergency health services, we strive to make comprehensive health care available for survivors—whether they are women, children, or men—in all our projects.

In 2023, the number of projects supporting victims of sexual violence increased dramatically in places where MSF works around the world, particularly in Democratic Republic of Congo (DRC). There, ongoing and escalating conflict as well as dire conditions in camps for displaced people have heightened the risk of sexual violence, resulting in unprecedented numbers of survivors seeking care from our teams.

1 in 3

women experiences physical or sexual violence in their lifetime

20%

of women suffer some form of sexual abuse before age 18

62,200

patients were treated for sexual violence by MSF in 2023

Facts about sexual and gender-based violence

Sexual violence includes rape, sexual abuse, and sexual exploitation, as well as forced sterilization and female genital mutilation. Victims are usually women (and often children), but a significant minority are men and boys. Men and boys are even less likely than women to report sexual violence, due to fear of stigmatization and to enormous taboos. Sexual violence committed against men therefore remains particularly invisible and under-reported.

In conflict, rape is often used as a weapon against populations or as a “reward” for soldiers. Rape and other forms of sexual abuse are also used as a means of torture and to humiliate, punish, control, injure, inflict fear, and destroy communities.

Sexual violence can have a wide variety of consequences for physical and reproductive health.

Physical injuries can range from stab wounds, fractures, and bleeding, to vaginal fistulas. People who are sexually abused are also more susceptible to developing a sexually transmitted infection such as HIV. Sexually transmitted infections are more likely to be transmitted through forced sex, since vaginal or anal tears provide an entry for pathogens.

Another medical consequence can be unintended pregnancy. According to the World Health Organization, women who have suffered sexual violence are twice as likely to have an abortion. Unsafe abortions performed in resource-poor settings are a leading cause of maternal mortality worldwide, and for survivors can have other negative reproductive health consequences.

Survivors of sexual violence often suffer from severe psychological effects. It is common for them to feel guilty and to think the incident could have been avoided. A loss of control and trust can also affect a survivor’s ability to form relationships with others. These feelings are often accompanied with clinical consequences such as post-traumatic stress disorder, depression, and anxiety.

Many societies stigmatize sexual violence victims, which can cause additional damage to survivors’ mental health. Survivors may be rejected by partners, family members, and their communities, particularly in places where there is cultural stigma around sexual violence.

A smiling woman in brightly colored dress sits on the lawn in front of a brick building in Central African Republic.

Mending the invisible wounds of sexual violence

Survivors of sexual violence in the Central African Republic share stories of stigma, survival, and community support in a new MSF report.

How MSF responds to sexual and gender-based violence

Since sexual violence can occur anywhere at any time, we strive to ensure that all our projects are able to handle sexual violence cases. In some places with high levels of sexual violence—for example, in Colombia, Kenya, and Democratic Republic of Congo—our projects have dedicated services for sexual violence victims, available around the clock. In all cases, we strive to offer a comprehensive package of care, including medical treatment of injuries, preventive interventions, and psychological care.

Our medics urge people to seek treatment within three days of an attack if possible, not only to treat physical injuries, but also to prevent disease. Our comprehensive care for victims includes the following:

Post-exposure prophylaxis using medicines that prevent sexually transmitted infections, such as HIV, syphilis, and gonorrhea. To be effective these drugs should be given within three days of the attack. Hepatitis B and tetanus vaccines are also given in some cases.
Offer of emergency contraceptives for female victims where allowed by law, to prevent unwanted pregnancy.
Treatment for physical injuries, including surgery, if necessary.
Pregnancy tests for female victims at follow-up visits, to determine if they became pregnant from their attack.
Support to female victims whose attack caused an unwanted pregnancy, to help them manage their care and treatment decisions.
Psychological care (see below).
Medical certificates to survivors, for legal purposes.

Psychological care

Immediately after sexual attacks, victims are often in a state of shock. It is also common for them to feel guilty and believe that they could have avoided the rape. They may feel that they have lost control of their lives and may become unable to perform everyday tasks, or may have nightmares and disturbing flashbacks. Many rape victims also fear for their safety. Where impunity is rife, victims may still encounter their perpetrators and fear further attacks. Rape survivors can also develop depression and post-traumatic stress disorder.

MSF support for the mental health of survivors includes initial counseling to help patients deal with shock, as well as counseling and follow-up care to prevent or manage post-traumatic stress.

Awareness and access to care

A crucial element of any project providing health care to victims of sexual violence is ensuring that they know about the services available, and about the importance of seeking care and of doing so as quickly as possible.

MSF is actively involved in raising awareness of the medical consequences of sexual violence. Talking to people door-to-door, and using theater, radio announcements, and billboard advertisements are among the tools our teams employ to communicate about sexual violence and encourage victims to seek help. We particularly emphasize the urgency of seeking immediate medical care.

In some areas where care is not easily accessible, we have set up ambulance services that transport sexual violence victims to clinics where they can receive care.