Caring for Rwanda’s Survivors of Gender-Based Violence

How health impacts go beyond physical healing

USAID
USAID
Dec 1, 2017 · 4 min read
A midwife records medical data for an expectant mother in the maternity unit of Nemba Hospital, Rwanda. / Kate Holt/Jhpiego

Martine’s* parents brought her to one of Rwanda’s Isange One Stop Centers that provide health services for survivors of gender-based violence (GBV). It was there that GBV officers trained by USAID — physicians, nurses, social workers, psychologists and police — discovered that the young girl had a fistula as a result of sexual assault.

Fistula is an abnormal opening in the birth canal resulting in uncontrollable, constant leakage of urine and/or feces, a relatively rare condition that can cause permanent incontinence and serious health complications. Typically, fistula is a complication of prolonged, obstructed labor, but it can also result from sexual violence (traumatic fistula). High rates of sexual violence against children and adolescents not only increase their risk of fistula, but also of death, disability, unintended pregnancies, miscarriage, HIV and mental health issues.

In Rwanda, USAID partners with the Ministry of Health to make system-wide improvements to all aspects of reproductive, maternal, newborn and child health service delivery. This includes addressing the serious health impacts of GBV, which about 40 percent of all Rwandan women have experienced. Key to the success of these efforts is ensuring that services are talking to each other and working in coordination.

“I would like for you to share my story with others so that they can support their daughters in these situations instead of being ashamed.”

After Martine had been discharged, the GBV officers continued their outreach through home visits focused on her recovery. They also provided support to her family to cope with the assault, which has meant a tremendous amount to her parents.

USAID-trained GBV officer Alice Mukundwa at the Ruhengeri Isange One Stop Center / Evariste Bagambiki/MCSP

“I would like for you to share my story with others so that they can support their daughters in these situations instead of being ashamed,” her father said.

USAID has trained 640 Rwandan health providers on basic post-GBV care, counseling and referrals, and 172 GBV officers to provide comprehensive health services. USAID has reached almost 10,000 GBV survivors with care since 2015, and is currently assisting the Ministry of Health to revise its national GBV training materials.

After completing a training on responding to GBV, Valerie Musengimana, who works at the USAID-supported Ngarama Isange One Stop Center, said she can “easily identify and manage” GBV cases. “[I can] work as a team with my colleagues at the hospital to provide all necessary support and care to victims,” she added.

According to the World Health Organization, one in three women in the world has experienced GBV in her lifetime.

Ruhengeri Isange One Stop Center / Evariste Bagambiki/MCSP

We’re also training providers and facilities in seven countries to deliver high-quality, compassionate health care to GBV survivors. In Rwanda, Nigeria, Madagascar, Liberia, Guinea, Ghana and Haiti, we’re strengthening pre-service education to ensure providers learn about GBV from the get-go, starting in school, and throughout their on-the-job training and mentoring.

According to the World Health Organization, one in three women in the world has experienced GBV in her lifetime. Even when high-quality services are available, stigma, victim-blaming, and a lack of awareness of help can block women from getting the care they need.

One provider and one survivor at a time, we’re reversing these trends and helping women and girls like Martine address their trauma and move forward to live healthy and productive lives.

*Name changed to protect identity.

About the Authors

Joya Banerjee, Marie Rose Kayirangwa and Mamy Ingabire Muziga are communication and gender advisers for USAID’s flagship Maternal and Child Survival Program.

From Nov. 25 through Dec. 10, we’re highlighting stories as part of the 16 Days of Activism Against Gender-Based Violence. Join the conversation via #16days.

Follow USAID Global Health @USAIDGH, on Facebook

U.S. Agency for International Development

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