AGAINST WOMEN ON THE MOVE TO AND WITHIN EUROPE

The Image 1. The western Balkan Migration Route (18). Europe has encountered a refugee crisis in recent years due to continuing conflicts and violations in many countries. This has led to the displacement of millions of people, who seek ­refuge in Europe (1). The major- ity of these arrive in Greece or Italy and mainly originate from Syria, Afghanistan and Iraq (2). Since January 2016 women and children account for more than 55% of people travelling on the migration route, attempting to reunite with their families in Europe (2, 3). The objective of this overview is to present the issue of sexual violence (SV) against refugee women and girls and to discuss countermeasures that have been ­measures due to their increased vulner- Risks on the journey to Europe suggested or initiated by the Member ability. Women are particularly vulner- In 2015 and early 2016, most refugees States of the WHO European Region and able in camps, when shelters are not have travelled by sea from Turkey to national nongovernmental organizations secure and when they have to walk long Greece and then continued overland (NGOs) between January 2015 and May distances to find basic items like firewood through the western Balkans into their 2016. A literature review was undertaken (9). Moreover, economic insecurity and destination countries, particularly Ger- using Google scholar, the WHO pub- lack of male protection increases the risk many and Sweden (see Image 1). Women lication database and a cross-search of for SV (10). A study in 2014 estimated and girls, travelling alone or female journal databases. that around 21% of women in 14 conflict headed households with children are countries reported SV (11). Refugee particularly vulnerable to SV (3, 12). The issue of SV for refugee women women are affected by SV not only in According to reports, women and girls The refugee crisis is particularly challeng- areas of conflict but also on their jour- have been forced to marry to obtain male ing for women and girls and becomes ney to and once they arrive in Europe. protection or to engage in ‘survival’ sex increasingly difficult as tightened im- While various reports call for action to in exchange for documents or transport. migration policies and border controls address SV against refugee women, no However, humanitarian and government in Europe and along the western Balkan comprehensive data on prevalence is interventions often did not adequately route, overcrowded reception centres, available as much abuse is not reported focus efforts against SV as it was not delayed processing times for asylum ap- by women or recognized by aid workers perceived as a priority due to lack of data plications and restricted family reunifica- (12). SV against refugees often occurs in (12). In transit countries like the former tions further increase their vulnerability combination with physical, emotional Yugoslav Republic (FYR) of Macedonia to SV. Men and boys can also be subjected or socio-economic violence. Both men and Serbia, the registration system for 26 to SV (2-3, 7-8). However, vulnerability and women seeking refuge in Europe are refugees has been found to be inad- differs between men and women due to susceptible to different kinds of violence. equate in identifying vulnerable women , which usually stems Nevertheless, women are more likely to be and girls. Moreover, weak coordination from traditional gender roles and be­ subjected to SV compared to men (13). between government and humanitarian haviour expectations of men and women According to a study conducted in 2012, actors challenge a comprehensive and in societies, disadvantaging one gender 69.3% of female migrants, including gender-sensitive response and referral over the other. For instance, women often refugees, have experienced SV since they system (16). Lack of information and un- have a lower status than men in many have entered Europe and acts were often necessary detention also puts women at societies (7). Therefore, a gender-sensitive perpetrated by European profession- increased risk for SV during their entire response by European Member States and als or citizens. This is in stark contrast journey (8). NGOs is needed (3). to the 11% lifetime prevalence of SV in Since the border closure in March European girls and women aged over 15 2016, over 45 000 refugees remain Burden of Sexual Violence and indicates the possible magnitude of stranded in Greece without adequate ac- Women living and fleeing from con- the issue of SV against refugee women in commodation, facilities, medical care and flict areas require targeted intervention Europe (14, 15). information about their rights. Moreover,

Gianna Gunta Dinesh Robbers­ Lazdane­ Sethi

Text Box 1. Key Facts about refugees in Europe. • Protection from further harm; • Timely referral to appropriate services KEY FACTS like psychosocial support; • 55% of refugees on the move are female. • Provision of emergency contracep- • Women and girls are at increased risk of SV. tion and STI prevention e.g. HIV • The border closure of countries along the western Balkan route has further put female post-exposure prophylaxis; ­refugees at risk of SV. • Follow-up care and support plan; • Denying female refugees protection against SV is a human rights violation. • Confidential, supportive and non- • More data and research is needed to estimate SV prevalence. judgmental services; • A gender-sensitive care training for health care providers; and • Sexual assault care service provision the identification and referral of vulner- volunteers, complicating the situation. integrated with other health care able refugees remains problematic due to This has been documented at various services. a lack of guidelines and operating proce- accommodation centres. The language dures (17). Consequently, many women barriers also contribute to a lack of infor- Women subjected to SV require immedi- and girls are unable to find protection, a mation on basic rights, available services ate emotional and physical health services safe passage to Europe and cannot reunite and support (3). Therefore, multiple risks and ongoing support in regard to safety with families. This further increases their are present and increase the likelihood and . Health care providers risk to SV as they become vulnerable to of women and girls to be subjected to SV have a vital role in the recognition, treat- exploitation by traffickers andsmugglers­ (13). ment and referral of SV victims. as they try to reach Europe by other routes illegally (8, 17) (see Text Box 1). Consequences SV guidelines specific for refugees SV can result in unintended pregnancy According to the guidelines on preven- Risks within Europe and sexually transmitted infections (STIs) tion and response to SV against refugees Sweden and Germany have been accept- including HIV. In addition, it can ad- provided by the UN Refugee Agency (20), ing most refugees. However, the incoming versely affect the mental health of women confidentiality, providing safety and pro- refugee population has overwhelmed and lead to post-traumatic stress disorder, tection from further suffering, as well as, both countries and accommodation anxiety and depression (4). Moreover, acting in the best interest and according and support services are inadequately stigma and shame associated with in to the wishes of the victim are crucial. equipped to respond to gender-sensitive many cultures can lead to underreport- Further recommendations include: issues. Moreover, essential European ing of cases, social rejection, suicide or • Private consultations with vulnerable ­Union Directives for the protection of murder of women and girls by family or refugee women by a social or health vulnerable people have been hard to community members (9). Women and workers if SV is suspected; implement in Germany to date. There girls who have been subjected to SV in • Creation and facilitation of women’s are also no standardized procedures their lives are also prone to subsequent groups and associations as an effec- present to identify and support victims exposure to SV, which further aggravates tive and safe channel for women to of SV. Therefore, support and help is only health outcomes for women and girls report SV cases; provided according to the judgment of long-term (14). • Provision of same gender medical 27 the individual aid care worker. Although staff; Sweden and Germany have ratified the • Ensuring a gender and cultural sensi- Istanbul Convention, which provides Best Practice and tive conduct with SV victims; and details on how to protect refugees, accom- Recommendations • Informing refugee women about their modation centres have often failed to pro- rights. Response vide basic security measures like separate lockable rooms. The large influx of new General guidelines against SV The WHO document, “Preventing and arrivals has further led to overcrowded 1. The WHO clinical and policy guide- addressing intimate partner violence reception centres, which challenges the lines: “Responding to intimate partner vio- against migrant and ethnic minority ­ability to provide safe, private and sepa- lence and sexual ” women” (21) also recommends: rate spaces for female refugees, increasing recommends (19): • A multi-level and multi-sectoral the risk for violence. Perpetration of SV • A comprehensive medical examina- approach to address the inequities in has been reported, not only by fellow tion; access to care and services in relation refugees but also by security guards and • First-line support; to SV;

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SEXUAL VIOLENCE AGAINST REFUGEE WOMEN ON THE MOVE TO AND WITHIN EUROPE (CONTINUED)

• Policies affecting refugee women Text Box 2. Key actions to prevent SV against refugees. require a gender perspective; • Involvement of stakeholders, funding KEY ACTIONS and a reduction of barriers to health • Implement relevant Directives and apply best practice guidelines. care and service access; • The European Member States, NGOs and women’s organizations need to cooperate more • Involvement of migrant communities to protect female refugees as best as possible. to allow for empowerment; • Create legal passages and safe environments. • Cooperation and network building • Collect more specific data and invest in research to investigate SV against female refugees. between health sector, NGOs and the civil society to allow for stronger coordination; • Targeting the socioeconomic, cultural awareness about GBV and SV have been benefit from the engagement of men and and environmental determinants of suggested (22). boys as gender inequality cannot be ad- the health of refugees; The risk of SV increases with large dressed without their participation (25). • More investment in research due to a accommodation centres. Therefore, pre- limited evidence base; and vention measures need to include smaller Relevant Policy Frameworks • Removal of institutional discrimina- accommodation centres with lockable • European parliament resolution calls tion and barriers to access of services rooms and separate sanitary facilities for a gender-sensitive adoption of (21). and a gender balanced staff team, which asylum policies and procedures (26). should be trained in culture and gender- • The draft Strategy and Action Plan Prevention sensitivity and violence prevention and for Refugee and Migrant Health in the To avert SV, health care providers could response. Moreover, information sessions WHO European Region 2016–2022 also play an important part in the to refugees that support integration and addresses the vulnerability of refugees coordination and implementation of the provision of women-only spaces to violence (27). SV prevention measures against refugee in reception centres have further been • The Global plan of action to strengthen women. Nevertheless, effective prevention recommended (23). the role of the health system to address will also require the involvement of dif- interpersonal violence, in particular ferent stakeholders including legal, social, Legal Passage against women, girls and children health organizations and civil society Ensuring greater access to legal passage ­advocates for a multi-sectoral, (21). Guidelines for the prevention and into Europe is a crucial step to prevent evidence-based and comprehensive response of gender-based violence (GBV) refugee women from being exploited by response and prevention strategy can also be useful for the prevention of smuggling networks. It also aids to secure (28). SV against refugee women. the fundamental rights of refugee women. • The draft Action Plan for Sexual and The following options could be used to for the fulfillment create legal passage: of the 2030 Agenda for Sustainable Creating Safe Environments • Granting temporary protection; Development in Europe will protect Current recommendations for the • Support resettlement or humani­ta­ against SV with a rights-based and primary prevention of GBV and SV rian aid programmes; life-course approach (29). 28 include measures that address the causes • Find alternative channels to speed up and contributing factors of GBV and family reunification i.e. humanitarian Several NGOs are also committed to SV in refugee settings, aim to transform visa; providing appropriate response meas- sociocultural norms through the creation • Granting a labour or study visa; and ures. Medica Mondiale for example, has of employment opportunities for refugee • Offer medical evacuation pro- established vast partnerships with other women and rebuild family and commu- grammes (24). grassroots organizations in several coun- nity structures. In addition, provision of tries and provides protective services in safe and effective services and facilities Refugees’ engagement response to SV victims across the Syrian- like creating safe and well lit accommoda- Last but not least, a greater engagement Turkish border. Women in Exile, another tion centres and the cooperation with the and participation of refugee women in NGO in Germany, supports asylum legal system to prosecute perpetrators are any decisions or activities that aim to seeking women, living in social housing crucial and mentioned in most guidelines protect them against SV is encouraged by engaging and empowering them in of international organizations. Moreover, to better address concerns and improve the struggle against SV. Consequently, monitoring, proper documentation of in- protection. Activities, campaigns and pro- a stronger cooperation with NGOs has cidents and education campaigns raising grammes against GBV, including SV also been suggested to respond to the needs of

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