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close this bookClinical Management of Survivors of Rape - A Guide to the Development of Protocols for Use in Refugee and Internally Displaced Person Situations (United Nations High Commissioner for Refugees (UNHCR) / Alto Comisionado de Naciones Unidas para los Refugiados (ACNUR) - WHO - OMS, 2001, 46 p.)
View the document(introduction...)
View the documentPreface
View the documentAcknowledgements
View the documentAbbreviations and acronyms used in this guide
View the documentIntroduction
View the documentSTEP 1 - Making preparations to offer medical care to rape survivors
View the documentSTEP 2 - Preparing the survivor for the examination
View the documentSTEP 3 - Taking the history
View the documentSTEP 4 - Collecting forensic evidence
View the documentSTEP 5 - Performing the physical and genital examination
View the documentSTEP 6 - Prescribing treatments
View the documentSTEP 7 - Counselling the survivor
View the documentSTEP 8 - Follow-up care of the survivor
View the documentAnnex 1 · Information needed to develop a local protocol
View the documentAnnex 2 · Sample consent form
View the documentAnnex 3 · Sample history and examination form
View the documentAnnex 4 · Pictograms
View the documentAnnex 5 · Protocols for treatment of STIs
View the documentAnnex 6 · Protocols for post-exposure prophylaxis of HIV infection
View the documentAnnex 7 · Protocols for emergency contraception
View the documentAnnex 8 · Minimum care for rape survivors in low-resource settings
View the documentAnnex 9 · Additional resource materials

Introduction

This guide describes best practices in clinical management of people who have been raped. It is intended for adaptation to each situation, taking into account national policies and practices, and availability of materials and drugs.

This guide is intended for use by qualified health care providers (health coordinators, medical doctors, clinical officers, midwives and nurses) in developing protocols for the management of rape survivors, based on available resources, materials, drugs, and national policies and procedures. It can also be used in planning care services and in training health care providers.

The document includes detailed guidance on the clinical management of women, men and children who have been raped. It explains how to perform a thorough physical examination, record the findings and give medical care to someone who has been penetrated in the vagina, anus or mouth by a penis or other objects. It does not include advice on standard care of wounds or injuries or on psychological counselling, although these may be needed. Neither does the guide give guidance on referral procedures to community support, police and legal services. Other reference materials exist that describe this kind of care or give advice on creating referral networks; this guide is complementary to those materials.

Note: It is not the health care provider's responsibility to determine whether a person has been raped. That is a legal determination. The health care provider's responsibility is to provide appropriate care, to record the history and other relevant information and, with the person's consent, to collect any forensic evidence that might be needed in a subsequent investigation.

While it is recognized that men and boys can also be raped, most individuals who are raped are women or girls; feminine pronouns are therefore used in the guide to refer to rape survivors, except where the context dictates oherwise.

The essential components of medical care after a rape are:

· collection of forensic evidence,
· evaluation for sexually transmitted infections and preventive care,
· evaluation for risk of pregnancy and prevention,
· care of injuries,

· counselling and follow-up.

How to use this guide

This document is meant to be used by health care professionals who are working with refugees or internally displaced persons (IDPs), or in other similar settings to develop specific protocols for medical care of rape survivors. In order to do this a number of actions have to be taken. Suggested actions include (not necessarily in the following order):

1 Identify a team of professionals and community members who are involved in caring for people who have been raped.

2 Convene meetings with medical staff and community members.

3 Create a referral network between the different sectors involved in caring for rape survivors (community, health, security, protection).

4 Identify the available resources (drugs, materials, laboratory facilities) and the relevant national policies and procedures relating to rape (standard treatment protocols, legal procedures, laws relating to abortion, etc.). See Annex 1 for an example of a checklist for the development of a local protocol.

5 Develop a situation-specific medical care protocol, using this guide as a reference document.

6 Train providers on use of the protocol, including what must be documented during an examination for legal purposes.

Steps covered in this guide

1 Making preparations to offer medical care to rape survivors.

2 Preparing the survivor for the examination.

3 Taking the history.

4 Collecting forensic evidence.

5 Performing the physical and genital examination.

6 Prescibing treatments.

7 Counselling the survivor.

8 Follow-up care of the survivor.

Special considerations needed when caring for children, men, and pregnant and elderly women are also described.

Rape is a traumatic experience, both emotionally and physically. Survivors may have been raped by any number of people in a number of different situations; they may have been raped by soldiers, police, family members, friends, boyfriends, husbands, fathers or uncles; they may have been raped while collecting firewood, using the latrine, in their beds or while visiting friends. They may have been raped by one, two, three or more people, by men or boys, or by women. They may have been raped over a period of months or this may be the first time. Survivors can be women or men, girls or boys; but they are most often women and girls.

Survivors may react in any number of ways to such a trauma; whether their trauma reaction is long-lasting or not depends, in some part, on how they are treated when they seek help. By seeking medical treatment, the survivor is acknowledging that physical and/or emotional damage has occurred. She most likely has health concerns. The health care provider can address these concerns and help survivors begin the recovery process by providing compassionate, thorough and high-quality medical care, and by centring this care around the survivor and her needs and being aware of the setting-specific circumstances that may affect the care provided.

Center for Health and Gender Equity (CHANGE)