Family and Sexual Violence in Papua New Guinea: a Medical Emergency

Family and Sexual Violence in Papua New Guinea: a medical emergency The Australian Government Inquiry into the human rights issues confronting women and girls in the Indian Ocean – Asia Pacific region Submission by Médecins Sans Frontières (MSF) Family and sexual violence (FSV) is widespread across Papua New Guinea (PNG) both within and outside the family. Women and children are particularly vulnerable. And despite the alarmingly high statistics we see in the few studies that exist and in Médecins Sans Frontières’ (MSF) own clinical data, this is thought to be only the tip of the iceberg. The full magnitude of the problem of FSV in PNG is not understood due to the lack of disaggregated data available and the challenges survivors face in coming forward. Family and sexual violence is a medical emergency and must be treated as such. FSV survivors can suffer both acute and long-lasting medical and psychological consequences. If they do not receive adequate and timely care, there can be grave ramifications for the individual and potentially also the community. Médecins Sans Frontières has been working with FSV survivors in PNG since 2007 and promotes the provision of ‘5 essential services1’ to all FSV survivors in one session as a minimum level of care. While the national and provincial governments have made improvements in the medical care of FSV survivors, there is still a very long way to go. Currently, due to the scarcity of Family Support Centres (FSCs) across the country, access of FSV survivors to all of the essential services in a timely manner is not assured. This can lead to unnecessary further suffering, illness and even death. All of which is preventable. This paper looks at the medical and psychological needs of FSV survivors, what the PNG government and other actors are currently doing to address these and the priority actions that must be taken in order for more FSV survivors to receive needed care. Finally, MSF identifies six steps the Australian government could take to best support the provision of much-needed medical and psychological support to FSV survivors across PNG. These recommendations are in line with, and thus complementary to, the Australian government’s current and planned activities. We believe they would not necessarily require a great amount of additional financial resources or personnel, yet could have significant benefits for FSV survivors. We urge the Australian government to leverage its influence, knowledge and experience from its decades of support in PNG to provide even greater help to FSV survivors. 1 As discussed in section 3. 1 1. Médecins Sans Frontières (MSF) in Papua New Guinea Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, healthcare exclusion and natural or man-made disasters. In PNG MSF aims to improve access to integrated basic health care and mental health services for survivors of Family and Sexual Violence (FSV), and to improve access to emergency medical and surgical care to survivors of both FSV and general violence where necessary. MSF nurses and doctors began treating PNG survivors of FSV in December 2007. Since then, our medical teams have done close to 19,000 consultations to provide emergency medical and psychological care in Lae2, Tari, Maprik and Port Moresby. These are women, children and men who have been raped, beaten and otherwise physically or sexually assaulted by family members, spouses or intimate partners and unknown assailants. In addition to treating patients directly, MSF staff working at Lae’s Angau Memorial Hospital trained staff from more than 28 provincial and district hospitals and health centres around the country between 2010 and 2012. MSF also works in partnership with PNG’s Family and Sexual Violence Action Committee (FSVAC) supporting them to ensure the National and Provincial governments move forward with agreed strategies for planning and implementing FSCs throughout the country. 2. Family and sexual violence (FSV) in PNG Family and sexual violence (FSV) is a global problem, with 35% of women worldwide experiencing some form of sexual violence (SV) or intimate partner violence (IPV) at some time in her life3. But in Papua New Guinea, the rates of FSV are significantly higher. Early government- commissioned nationwide studies from the 1980s found that 66% of husbands interviewed in PNG said they beat their wives, while 67% of women interviewed in PNG said they had been beaten4. A 2008 study of sexual violence documented rates of reported rape at 44%5 across PNG. Cultural practices of polygamy, early marriage, customary justice, as well as high levels of criminality mean that women and girls (and to a lesser but unknown extent men and boys) can expect to experience sexual violence at some time in their lives. In a landmark study in the Lancet of male experience of sexual violence in ten countries in South East Asia, one in four men admitted to committing rape and nearly half to committing some form of violence against their partner. In Bougainville, Papua New Guinea, the figures were particularly concerning, with around 80% of men admitting to committing some form of violence against their partner6. The study found that in Bougainville one in five women’s first experience of sex was rape. 2 This project was handed over to the National Department of Health in mid 2013. 3 World Health Organisation (WHO), Violence Against Women. http://www.who.int/mediacentre/factsheets/fs239/en/ 4 Toft, S & Bonnel, S. (1985), “Marriage and Domestic Violence in Rural Papua New Guinea,” issue 18 of Occasional Paper, Law Reform Commission of Papua New Guinea. 5 Lewis. I., Maruia, B. & Walker, S. (2008), “Violence against women in Papua New Guinea,” Journal of Family Studies, 14(3),183 - 197. 6 The Lancet Global Health. (2013) “First multi-country study of rape and partner violence finds that nearly a quarter of men report having committed at least one rape” September 10th 2013. 2 MSF’s experience of treating patients in PNG and its data confirm that there is a high level of need for medical care for FSV survivors. Close to 19,000 FSV consultations have been provided in MSF-supported clinics since 2007. Between the three current projects in Tari, Maprik and Port Moresby, MSF treats an average of 130 cases of family and sexual violence per month, 57 of which are for rape. These studies, combined with MSF’s experience, highlight the alarmingly high levels of FSV in PNG. However, the true extent of FSV across the country is not understood due to the serious lack of FSV-specific statistical information and data collection tools. This is a major problem that hinders any attempts to support FSV survivors, and will be discussed later in this paper. Although data is limited, MSF’s experience suggests that an alarmingly large number of SV survivors are children. The rate of children below 18 years seen by MSF in the Regional Treatment and Training (RTT) supported facilities in the National District Capital was 53% of all rape survivors in February 2014 and 65% of all rape survivors in March. Patient testimonies show that the perpetrator is generally a relative or known person. According to MSF psychologist Cindy Scott: “this often means that it is not a one-time traumatic event, but goes on for years, chipping away at the basic core of the developing child’s ability to trust, learn, regulate emotions and solve problems. Additionally, in many cases, parents may be reluctant to come forward because this may create conflict in the family or community”. MSF trains the FSC nurses to provide child friendly, appropriate medical care and psychological first aid, and engages the guardians in understanding the impact that the abuse has had on the child and how to support the child’s recovery. There is still a long way to go for all Family Support Centres to have child-friendly services available, with active links to effective social welfare, child protection and police services, to ensure that child survivors are not returned to a situation in which they are assaulted again. 3. Family and sexual violence: a health emergency “29% of women had been forced into sex when pregnant and 17% had been beaten, with the result that one in five had lost their pregnancy. Two thirds of women who experienced physical violence had been injured, usually on multiple occasions. Depression, suicide and post-traumatic stress disorder were much more common among women who experienced partner violence than other women. They were also much more likely to have a miscarriage, a sexually transmitted infection and to have been prevented from using contraception than women who had not experienced violence.”7 Family and sexual violence survivors may have both acute and long-lasting medical and psychological needs. They require immediate medical and psychological care to treat what are often serious injuries and to treat or prevent diseases and other medical and psychological conditions. This care is time critical. If a woman does not get the medical attention she needs immediately after rape, her chances of contracting a disease, in particular HIV, increase substantially. And, as we have seen in many international contexts, HIV prevalence can, and does, destroy the social and productive fabric of a country and its workforce. 7 Rachel Jewkes, Emma Fulu Yandisa Sikweyiya, (September 2013) “Family Health and Safety Study, Bougainville, Papua New Guinea.” 3 Treating FSV as a medical emergency ensures not only that the survivor is cared for immediately, but also that the longer term health and economic consequences of family and sexual violence on the broader society is mitigated. Médecins Sans Frontières defines five essential services that should be available immediately following any incident of FSV.

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