Colombia: sexual violence, an unattended medical emergency

On the International Day for the Elimination of Violence against Women, MSF alerts on the need for an emergency focus across all institutions involved in the response
Sexual violence should be treated as a medical emergency. If we want the survivors to receive the comprehensive medical attention they need, guaranteeing that this is available and accessible should be a priority for the government, says Médecins Sans Frontières (MSF) on the International Day for the Elimination of Violence against Women. 
"Sexual violence against any person is totally unacceptable. To survive, it is essential to look for medical and psychological attention as soon as possible," explains Pierre Garrigou, head of mission for MSF in Colombia. "The health institutions have to ensure that the response to the sexual violence survivors is comprehensive and adequate. Today, the institutional response is not sufficient and comes late," he adds. 
Eighty per cent of the survivors of sexual violence attended by MSF between June 2012 and August 2013 hadn't looked for help in the local health structures. The obstacles to their seeking health and psychological help were: the lack of awareness that it requires a visit to the hospital (61%); not considering they had suffered sexual violence; threats by the perpetrator, and shyness, among others.
"The health staff has to be trained to actively find cases so that the response is adequate and the mental health service has to be available in the health structures at the first level of attention," says Garrigou. "But it doesn't have to be limited to the health sector, the emergency focus has to be across all institutions involved in the response to sexual violence," he concludes.
The importance of early assistance
If the survivor goes to the doctor in the first 72 hours, it is possible to give prophylaxis for HIV/AIDS and antibiotics that will help prevent some infections such as chlamydia, gonorrhea or syphilis, besides emergency contraceptives to avoid an unwanted pregnancy.  
Apart from the physical consequences, sexual violence has a devastating psychological impact for its victims. Almost all the survivors show symptoms as a result of the aggression, such as aggression, sadness, excessive fear, irritability or anger, and anxiety or stress. However, less than one in every three women that attended an MSF consultation looked for help and were provided with psychological support after the violent event. 
Médecins Sans Frontières attends hundreds of sexual violence survivors every year in its health and mental health programmes in Cauca, Nariño and Caquetá (Colombia). 223 cases were attended between June 2012 and August 2013.
"The 13-year-old girl was brought by her mother to the consultation room. The violent incident happened three years ago. According to the mother, the girl received good quality medical attention in Barbacoa. However, there were some flaws: she didn't receive any documents (report, medical treatment received, consultations for follow-up). Besides, the attention was not comprehensive as she didn't receive mental health support. The girl shows depressive symptoms and post-traumatic stress that make her unable to establish adequate social relations, especially with adult men, as well as daily activities."
- Testimony of an MSF doctor in Nariño  
"We identified the case of a 24-year-old patient who survived sexual violence that resulted in an unwanted pregnancy. She went to legal entities to file a complaint. However, she didn't go to any health institution until she had to give birth. She tried to interrupt her pregnancy several times and tried unsuccessfully to end her life. Her family expelled her from the house. Today she is fleeing from the perpetrator, who is out of jail."
- Testimony of an MSF psychologist in Caquetá