SGBV Report 2011-2017 UNTREATED VIOLENCE: Breaking down the barriers to sexual violence care in Harare, Zimbabwe 2011-2017 REPORT 1 Médecins Sans Frontières Charter Médecins Sans Frontières (MSF) is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principles: Médecins Sans Frontières provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, religion, creed or political convictions. Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions. Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic, or religious powers. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them. “In my picture there is also hope for the future. Can you see the house and the dog that I will have one day? I painted myself happily running in a beautiful garden. Like a bird I will fly high and fulfill my dreams. Hopefully with time the pain in my heart will subside and the rest of the picture will take over my life” “If you find some happiness inside yourself, you’ll start finding it in lot of other places too” Gladiola Motana Cover photo credit: Charmaine Chitate This project was implemented by MSF in collaboration with the City of Harare and it summarizes the key findings and lessons learned after seven years of the project. Photos inside: MSF Zimbabwe and Charmaine Chitate 2 SGBV Report 2011-2017 FOREWORD Violence often blights people’s lives for decades, leading to alcohol and drug addiction, depression, suicide, school dropout, unemployment and recurrent relationship difficulties. The costs of violence are enormous for the survivors, their families, communities and the nation as a whole. Sexual and gender based violence represent one of the most prevalent forms of violence amongst women and children. 37% of women worldwide and 46% in Africa have experienced physical and/or sexual violence in their lifetime. In Zimbabwe, 27% of women aged between 15 - 49 years have experienced sexual violence. In 2011 Médecins Sans Frontières (MSF) in collaboration with Harare City Health services opened a sexual and gender based violence (SGBV) clinic in Edith Opperman Polyclinic, Mbare, which offers comprehensive care to the survivors of sexual violence. During the last seven years, SGBV services have been scaled to 9 polyclinics in Harare (Glenview, Budiriro, Kuwadzana, Mabvuku, Hatcliff, Highfields, Rujeko, Warren Park and Rutsanana). More than 120 nurses have been trained on SGBV management and more than 70 nurses were attached to the clinic for on-the-job practical training. Between 2011 and 2017 more than 8200 survivors of sexual violence received care, 2 out of 3 survivors were children and in most cases the perpetrators were known by the child and the family. The MSF SGBV programme in Mbare would not have achieved the successes outlined in this report without the continuous efforts and dedication of Harare City Health staff, partners and MSF staff working towards one goal: making a positive difference in the life of the sexual violence survivor. Most importantly thanks are due to the many survivors of sexual violence and their families testifying their experiences and trusting in the care we are providing. “Many who live with violence day in and day out assume that it is an intrinsic part of the human condition. But this is not so. Violence can be prevented. Governments, communities and individuals can make a difference.” Nelson Mandela, World Health Organization’s 2002 World report on violence and health. Dr Daniela Garone, MD, Infectious Diseases and DTM&H Country Medical Coordinator, MSF Zimbabwe. Dr Clemence Duri Acting Director, Harare City Health Services, Harare. 3 CONTENTS Foreword 3 I have a Future 6 Executive Summary 7 Chapter 1 Sexual Violence in Zimbabwe 8 The Legal Framework for Sexual Assault in Zimbabwe 10 10 Mbare Suburb 11 Perception Study Prior and after the Opening of SGBV clinic, Mbare12-13 Chapter 2 Model of Care for Survivors of Sexual and Gender Based Violence 14 Nurse - Based Care 15 Basic Principles of SGBV Care Programme 16 14 Health Promotion 17 Health Promotion Messages 18 Collaboration with other Partners to Disseminate Information on SGBV 20 Social Work 21 Decentralization of Sexual Violence Services to other Polyclinics 23 Decentralization Strategy 25 21 Advocacy 26 Chapter 3 SGBV Programme Outcome 28 Scaling up Access to SGBV Services 29 Sex and Age Distributions 29 Types of Aggressors 34 Mitigations of Medical Consequences of Sexual Violence 38 28 Scaling up Legal and Social Support 40 Knowledge, Attitudes, Practices and Perceptions Study (2015) 42 Knowledge on SGBV 42 Perceptions on SGBV 43 Patterns of Assistance Seeking Behaviour 44 Role of Decentralization in Increasing Access to SGBV Services 46 Chapter 4 Challenges 48 No Increase in Uptake of SGBV Services for Specific Groups of Survivors 49 First Entry Point of Reporting Sexual Violence 49 Decentralization 53 Delays in Launch and Roll-Out of SGBV Services due to HR Challenges 54 Provincial Roll-Out of SGBV Services throughout Zimbabwe 54 Voice to Survivors of Sexual Violence 57 Concept Artists Against SGBV in Solidarity with Survivors 57 Income Generating Initiatives 57 56 Conclusion 58 4 SGBV Report 2011-2017 TABLES AND GRAPHS Table 1: Perceptions Study Results 2010 12 Table 2: Flowchart of care for survivors of sexual violence 17 Table 3: Survivors of sexual violence reporting within 72 hours and 120 hours in 18 Mbare clinic Table 4: Health Promotion Strategy 20 Table 5: Percentage of survivors according to origin coming to Mbare clinic 24 from 2011 - 2017 Table 6: Proportion of different types of sexual assault per age group reported in Mbare 32 clinic from 2011 - 2017 (out of 8200 survivors) Table 7: The definitions of different crimes utilized in this study are outlined and 33 the difference in relation to Zimbabwean law is also described Table 8: Types of aggressors per age group reported in Mbare clinic from 2011 - 2017 35 (out of 8200 survivors) Table 9: Percentage and age group of survivors reporting within 72 hours in 36 Mbare clinic from 2011 - 2017 Table 10: Overall percentage reporting within 72 hours according to referral system in 37 Mbare clinic from 2011 - 2017 Table 11: List of main service providers for psychological, social and legal support for 41 survivors of sexual violence within Harare (not exclusive) Table 12: To show what information had been received on rape 43 Table 13: To show assistance seeking behaviour: If someone in your family was raped, what would you do? 45 Table 14: Referral pathway to report sexual violence in Mbare clinic from 2011 - 2017 50 Graph 1: Number of new visits per quarter in Mbare clinic from 2011 - 2017 29 Graph 2: Proportion of gender/age groups reported from 2011 - 2017 in Mbare clinic 32 Graph 3: Percentage of reporting time within 72 hours and 120 hours from 2011 - 2017 36 in Mbare clinic Graph 4: Perceptions of SGBV in 2010 and 2015 44 Graph 5: Number of survivors accessing SGBV services in decentralized sites 46 from 2015 - 2017 5 I HAVE A FUTURE When my parents passed away, I was left in who always had been kind to me. Together the care of my grandmother. I can remember we reported the matter to the police and they the whispers at my mother’s funeral that it was referred me to MSF for medical treatment. My fortunate the old lady was still alive, so I had case was dropped from the courts due to what a close relative that would take care of me. they called ‘lack of merit’. I still believe that I won. If I had not gathered the courage to run Little did they know within few weeks my away and speak out, I would still be one of the grandmother would be spreading rumours many wives of the prophet. May be already that I was possessed by evil spirits. I was with children, though I am a child myself. only fifteen, but everyone believed her. Why, otherwise, would an old woman say something At least now I have a chance of a brighter so evil about her own daughter’s child? Then future. I am going to school and my ambition under the guise of this story, she married me is to become a hair dresser and to open a pre- off to a prophet who she claimed would be able school. I now have a more positive image of to exorcise my demons. What she wanted from myself and am able to write that I love myself. all this was the bride price and to get rid of me This is not as easy as it looks. It has taken as a responsibility that she did not want. time and counseling, to start feeling positive about myself. I believe my future is bright and Everything inside of me refused to succumb I wanted to use bright colours to show that ‘I to this arrangement. After a few days at the have a Future’. prophet’s house, I ran away to my paternal aunt Photo credit: Charmaine Chitate 6 SGBV Report 2011-2017 EXECUTIVE SUMMARY Definition of sexual violence (WHO 2002): “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work.” Sexual violence is a global concern with 37% of sexual violence (33%).