2. Materials and Methods
3.1. Nature of Refugee SGBV and Torture Experiences
3.1.1. SGBV and Torture
“The fighting in South Sudan is very complex. Sexual harassment and SGBV is rife in South Sudan; SGBV is used as a weapon of war, even small girls are gang raped and as a result are crying. Children, women and men are raped. It causes lots of emotional distress and the whole family is affected. Survivors are often raped in front of family members. To those forced to witness it is psychological torture.”
“Most refugees have been captured and tortured in South Sudan and held in military barracks. There is extensive torturing and robbing and anyone could be a rebel. Most of us were threatened with our lives and experienced atrocities, for instance removing our finger nails, tying penises, being shot; even girls were tortured and shot.”
“I was selling beer in Juba…. The attackers wanted to kill me so they could take away my children. They tied my legs up, head down, and beat me between legs, the head and left me unconscious thinking I was dead. I was left there until morning. Then, my husband took all [the] children. The neighbours came, helped me down, gave me water, and took me to the health centre in Juba.”
“…when I was in South Sudan, the soldier services have arrested me, they tortured me, they bite me, and now I am feel in pain, my neck here is in pain, and even my head, I just feel in pain. I was put inside the throne for one week (tied to a chair), outside under the sun.”
3.1.2. Child Abduction and Marriage
“Children are being abducted: somebody is trying to take the 13-year-old daughter of my deceased sister. My sister stated in her Will that her child should be looked after by me. My sister married a Dinka (a different father to the 13-year-old girl) and had a son by him who subsequently died. Her husband killed my sister in revenge as he blamed her for the son’s death. Now her husband in South Sudan wants to take the 13 year-old-girl. I think it is for marriage. Such situations are common in South Sudan. There are lots of refugee children in the protection unit in Adjumani. I feel insecurity is caused by ourselves as habits from South Sudan are brought into the settlement including abducting children as revenge. This is a characteristic that takes time to change and there is a big need for education.”
“Refugees must live within Ugandan Law. In Uganda girls cannot marry before 18 years of age but in South Sudan it is 12 years. It is contradictory. If a girl is married under the age of 18 years in Uganda then fathers will be charged. This can cause conflict. Hence many girls are taken to South Sudan to be married under the age of 18. Lutheran World Federation is educating the South Sudanese refugees regarding the differences in the laws in Uganda”
3.1.3. Family Conflict and Domestic Violence
“My understanding is and what I have found out from South Sudanese refugees is that when women beat men and you come to report it degrades like you are not a man. I always advise that when it happens you have to report and it is not that all the cases should be taken to Court as we also do counselling”.
3.2. Service Provision
“If you go to reception points, they do an incredibly shallow kind of screening and it’s just absolutely hopeless. So, you know we would still advocate for across the board screening and recognising that the dynamics are extremely complex and that what works at month 1 might be different to 6 months and what works 5 years after”.
3.2.2. Health Services
“The treatment is not very good here because the health system is out of date. I was taken to the clinic as one of my ribs was broken and nothing was done. Now it is pointing the other way. There is no proper medication. I am requesting to be taken to another hospital or for doctors to be sent to help me”(Male refugee, Bidi Bidi)
“We need specialists including gynaecologists and midwives needed to deal with our health problems and treat them. We also need psychological counselling and peer support.”
“Transit centres with medical teams attending to new arrivals. Identification of serious cases and treatment is provided. There is documentation of some health-related issues and violations”.
“Women are informed regarding referral pathways for basic counselling. Those survivors who have mental health trauma or reproductive health needs are referred to our partners including Real Medical Foundation, Transcultural Psychosocial Organisation, and Medicines Sans Frontiers etc…”
“There is a Health Centre 2 and 3 in Adjumani but the Health Centre 2 here has no admission facilities. The Health Centre 3 cannot manage the health needs of refugees as they are over-stretched and for survivors of torture and SGBV we really need to go to Adjumani, Gulu or Kampala and UNHCR are supposed to pay. However, sometimes refugees are transferred for treatment and we are told the money has not been paid. There is no psychiatric clinical officer, no HIV+ medication. Language barriers are also a problem and sometimes health staff demand for money.”
3.2.3. Justice Services
“The only problem is when I reported to the police, they asked for money, saying if I don’t have money they are not going to investigate this issue”.
“When they commit offences here they run to Sudan because they fear to be arrested or detained, so they first run to Sudan. The challenges we also face is when a person commits an offence, when he is aware this has been brought to the attention of the police he becomes very arrogant and fights the police. When you go for the arrest, parents can refuse for the perpetrator to be arrested and sometimes they are serious cases, the offences they have committed, and they say that they have their local court.”
3.2.4. Other Services Provided
“Resources are limited 7% of the refugees needs are met but 93% of refugees needs are not funded and we cannot meet their needs and the environment is being destroyed. There are no adequate health services and the refugee population puts a lot of pressure on our existing services and facilities including lack of treatment for HIV infection”.
3.3. Gender Issues
3.3.1. Lack of Gendered Understanding
“There are several factors triggering gender-based violence including the selling of goods by men, women gaining their rights, the accumulation of problems, stress and distress, the inability to send children to a good school, loss of properties and businesses and an inability to receive treatment for a chronic illness.”
3.3.2. Need for Gender-Informed Specialist Services
“Men fear to open up and many are tortured by women.”
“Amongst the 30% that we screen who need to go to hospital we will find the woman who was gang raped 20 years ago and is still oozing god knows what because she never got the right treatment, so she has infections that have never cleared up, literally. And then open wounds and somehow it’s all interconnected. All oozing to the point where she stinks and her own family can’t have her in the same hut as them. Why is that happening? I mean it’s just unbelievable. But it’s true.”
3.4. Involvement of Civil Society Organisations (CSOs) and Local NGOs
3.4.1. Provision of Emotional Support
“Samaritan’s Purse is a church organisation which provides Bible based trauma healings, spiritual and counselling services. Samaritan’s Purse provides the survivors’ host communities with a package from the Bible Society of Uganda and America. They conduct training for adults and children on Bible based trauma”.
“We work closely with traditional leadership structures in the villages including the community leaders and faith-based leaders for our interventions. We train refugee mobilisers in the communities and use Biblical principles. We are a Christian organisation but we also work in Muslim communities.”
3.4.2. Instil Hope
“I didn’t receive any help from any organisation but the neighbours consoled me. There were also some tapes provided by the Baptist church, which, preach New Testament Bible in my local language. When the images flashbacks of torture come, I just switch on the tapes and this helps me. As family, we also listen together and go to the Catholic Church on Sundays”.
“There is an overwhelming demand for the services by SGBV victims and inadequate resources and understaffing. Due to cultural sensitivities there is a failure to share the problems affecting both men and some women. It is hard for us to access some locations as there are large zones with inadequate transport. Zone 5 had new arrivals in 2016 and therefore has a high demand for medical treatment. There is a lack of urgently required drugs in Health Centres 2 and 3; particularly Post-Exposure Prophylaxis (PEP) and medication for unwanted pregnancies”.
“The types of mental health and psychosocial problems among South Sudanese refugees in Northern Uganda were diverse and the burden appears to be considerable, yet there are currently few available services. The assessment indicates the need for a range of services addressing social concerns as well as varied types of mental conditions.”
- Screening Which Integrates Health and Justice Issues:
- A Culturally Sensitive Gendered Approach:
“International partners need to work closely with local civil society to contextualise sexual violence and locate areas of compatibility between local cultures and customs and international human rights frameworks as entry points for programming that aims to empower and protect girls and women”.
- Involvement and Empowerment of Refugee Survivors:
- Need for Integrated Approach:
“Sexual violence was experienced simultaneously as a violation of the survivors’ body and rights. It left the survivor in need of both a health and a justice response. As the two are connected in the experience of the survivor so they go hand in hand in terms of service responses required. We therefore argue that there is real value in promoting increased collaboration between local health and justice services”.
4.1. Improving Health and Justice Responses
4.1.1. Comprehensive Screening and Treatment for SGBV and Torture
- Organisations supporting refugees must ensure that there is routine and regular screening and documentation of SGBV and torture, that is sensitive to age, gender and access to justice.
- Development of effective support systems for service providers, including stronger links between health and justice providers and referral mechanisms. We support other research with South Sudanese refugees that supports developing accountability mechanisms that cater to all everyday experiences of injustice, as an important way of ensuring that refugee survivors of sexual violence and torture can seek redress, through interrupting the cyclical relationship between impunity and continued violence [11,13].
- Provision of the integrated services should include physical and psychological health and justice services, as well as education and viable livelihood opportunities. This approach would ensure that refugee’s feel validated, helping them to use their own resilience and agency to continue the process of recovery [14,15,23].
4.1.2. Improved Health Responses
- Better clinic resources and effective referral processes including justice mechanisms for the recording and reporting of abuse.
- Responses need to ensure that there is adequate physical and psychological healthcare staff, and that services are extended, and sensitive to men in particular, who find it difficult to come forward to discuss their SGBV and torture experiences, due to stigma and shame and a lack of specialist medical and psycho-social service provision to respond to their specialist needs.
- The team also advises that CSOs be involved in informing services, to include traditional approaches to recovery building on refugees own skills , provision of psycho-social groups where required for refugees and their children, whilst also involving the healthcare teams and community-based organisations.
4.1.3. Improved Justice Responses
- Increased knowledge regarding the South Sudanese customary court processes and challenging their structures to provide better gendered accountability for SGBV crimes with referral on to higher courts where required could be a positive way forward alongside survivor-focused local justice provision, contextualisation of violence and campaigning through community-based and women’s organisations [11,13].
- The authors argue that it is imperative that governments and international partners, including service responders, listen to the voices of refugee survivors of SGBV and torture as a form of social justice through narration, and their view that integration between services is needed for recovery, restoration of dignity and building resilience.
4.1.4. Further Research
“The Government of Uganda get no funding to support refugees and bad publicity ‘kills’ refugees. There is a lack of water points and infrastructure gaps including poor roads, offices, bridges and accommodation for staff, some of whom travel over 10 kilometres to get to work. Livelihoods are poor and the soil is infertile. Registered refugees survive on about £20 a month which is not sufficient.”
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|Nature of refugee sexual and gender-based violence (SGBV) and torture experiences||Sexual and Gender-Based Violence and torture|
|Child abduction and marriage|
|Family conflict and domestic violence|
|Other services provided|
|Gender issues||Lack of gendered understanding|
|Need for gender-informed specialist services|
|Involvement of civil society organisations (CSOs) and local non-governmental organisations (NGOs)||Provision of emotional support|
|Improving health and justice responses||Comprehensive screening and treatment for SGBV and torture|
|Improved health responses|
|Improved justice responses|
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