Clinical Management of
Sexual Violence/Rape Survivors
In Tigray
ROMADI Hotel
AKSUM
11/06/2025 1
Clinical Management of
Sexual Violence/Rape Survivors
In Tigray
Mebrahtu.H
(Assist. Professor in Maternity &RH )
11/06/2025 2
Introduction
Full Name
Organization
GBV Experience
Expectations
Ground Rules
Pre-test
CMR Training Objective
• Develop understanding and skills in responding to rape survivors
• Understand the role of health care providers in providing first line support to
survivors
• Provide guidance in using working guidline on;-
- Obtaining consent, history taking, examination and treatment protocol for rape
survivors (including child survivors)
• Become familiar with cirtification and how and when to refer for follow up support
Do we have a Reference Manual for CMR?
• Clinical management of Rape have a unique service delivery approach and
setting
• It requires a standard operation manual that could harmonize
• Treatment and prophylaxis protocols , history and physical examination, consent
and registration form, follow up, and referral mechanisms.
• However, there is no contextualized standard management protocol
• This questions service provider’s competency in approach and delivery method.
Information needed to develop a local protocol
Identifying where appropriate care can be provided
• Six one stop centers
• 68 health additional health care facilities are under way to provide
a primary care for survivors
• In cases of severe injury or other complications, survivors may
need to be referred to near by one stop center.
Preparing the facility
1. Protocol
2. Setting
3. Person
4. supplies
5. Drug
6. Administration
Developing a protocol
• World Health Organization (WHO), United Nations Population Fund
(UNFPA), United Nations High Commissioner for Refugees (UNHCR).
Clinical management of rape and intimate partner violence survivors:
developing protocols for use in humanitarian settings. Geneva: WHO;
2019. Licence: CC BY-NC-SA 3.0 IGO
• The above guide used as a reference
document to develop Tigray CMR protocol
for managing sexual violence
CORE CONCEPTS:
GENDER-BASED VIOLENCE
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What is Gender-based violence?
What is Sexual violence?
ፍታሕ GBV & SV ብትግርኛ
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ስርዓተ-ፆታ መሰረት ዝገበረ መጥቃዕቲ
ፆታዊ ጥቅዓት
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List four important
words to define GBV Power
Use of
Gender
Force
Define GBV using
the five words Human Informed
Rights Consent
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GENDER-BASED VIOLENCE
It is an umbrella term for any harmful act that is
perpetrated against a person’s will, and that is
based on socially ascribed (gender) differences
Gender-based between males and females.
Violence GBV can be sexual, physical, psychological
and economic in nature, and includes acts,
attempted or threatened, committed with force,
manipulation, or coercion and without the
informed consent of the survivor.
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When to use the term? ብትግርኛ?
Victim
Client
Survivor
Patient
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Victim v’s Survivor
Victim ግዳይ/ሰለባ
• Suggests passivity rather than resilience
• Reinforces stigmatization
• But: Important status for legal purposes
Survivor ? ? ?
• Empowering
• Right to self-determination
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Types of GBV
Six types of GBV and their definitions (GBVIMS,2017) (UNFPA, IRC, UNHCR, UNICEF and
WHO)
1. Rape: non-consensual penetration (however slight) of the vagina, anus, or mouth
with a penis, other body part or object
2. Sexual Assault: any form of non-consensual sexual contact that does not result in or include
penetration. Rape attempt and FGM
3. Physical Assault: an act of physical violence that is not sexual in nature.
4. Forced Marriage: the marriage of an individual against her or his will.
5. Denial of Resources, Opportunities or Services:
6. Psychological/Emotional Abuse: infliction of mental or emotional pain or injury.
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• Rape
• Sexual slavery and/or trafficking
• Sexual harassment, indecent assault
• Sexual exploitation and/or abuse
Types of sexual • Forced pregnancy, abortion, or sterilization
• Incest
violence
• Forced marriage, levirate marriage, early
marriage
• Female genital mutilation
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Forms of GBV
• Abuse
• Physical Assault • Humiliation
• Trafficking, Slavery • Confinement/Isolation
• Infanticide • Intimidation/Threats
• Honor Killing • Social Exclusion, ostracism
based on sexual orientation
PHYSICAL EMOTIONAL
ECONOMIC SEXUAL • Forced Marriage
• Sexual Exploitation/Forced
• Discrimination, and/or denial of Prostitution
opportunities • Survival Sex
• Forced Marriage/Early Marriage • Rape and Marital Rape
• Denial of Education for Women • Child Sexual Abuse, Defilement
and Children
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Perspectives of GBV Definition
• Factual Perspective
• Physical, emotional/psychological, Sexual, Social-economical
• Relational Perspective
• Domestic, Intimate partner, Opportunistic, as a weapon of war by enemy
• Socitital Perspective
• Interpreted by societal Context, to Relation and reaction
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Conflict and GBV
• In many countries in conflict, rape is being used as a weapon of war to
demoralize and weaken the population
• The first, well-documented occurrence ensued in World War II (WWII)
during the rape of Nanking
• Bosnia-Herzegovina, genocide in Rwanda’s, Indonesia’s, Sri Lanka,
Lebanon, Syria, Colombia, DRC, Liberia, South Sudan
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• Tigray 67% preliminary study 29
How is GBV exacerbated in emergencies?
• Lack of privacy; overcrowding; lack of safe access to basic needs
• Separation from family members; lack of documentation; registration
discrimination
• Breakdown of protective social mechanisms and norms regulating behaviour
• Introduction of new power dynamics, as enemy, with humanitarian actors
• As a weapon of war: demoralization, humiliation, degrading
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GBV Tree Verbal abuse
Domestic
Female
Examples violence Isolation
genital
of GBV cutting
Sexual abuse
Dowry abuse Rape Forced
marriage
Contributing Poverty Alcohol and
drug abuse
factors Lack of
education Lack of police
protection
Conflict
Abuse of Disrespect for Gender Root causes
power human rights inequality 31
Consequences of GBV
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Closing
•QUESTIONS?
•CONCERNS?
•REFLECTIONS?