THEMATIC REPORT 2017 SEXUAL TORTURE By inviting family members, particularly partners, to join some sessions, concerns like the complex effects of sexual trauma on intimate partner life can be processed together. Parents can better understand the unfairness of the powerful stigmatisation with which their child is labelled after sexual abuse. This way, their rejection might be avoided and replaced with support. Medical treatment is another critical part of rehabilitation. Physical injuries usually require prompt and often also long-term medical treatment. In addition, they have been found to intensify psychological disorders and to hinder mental recovery as they serve as constant reminders of the torture. Helping survivors to recover from their injuries not only improves their physical health but also promotes their wellbeing as a whole. It may enable them to return to work or to have functioning sexual relations with their partners. Often, the public health sector is inaccessible for victims of sexual torture or not able to meet their needs. An expert from CTV Bosnia and Herzegovina notes: “My colleagues in the public health system, the doctors working in our hospitals, are overwhelmed by the number of patients they have to treat every day. They do not have enough time to really talk with them and to establish a good level of trust. Many victims of sexual torture are going through the public health system without saying anything about the sexual torture they experienced, and without mentioning the consequences they suffer from. They go through that system completely unrecognised, and their specific needs for treatment remain unidentified, which means that they are not treated properly at all.” Therefore, in many countries, the existence of health-based NGOs is crucial for the rehabilitation of survivors of sexual torture. It is important that all medical professionals are sensitised to the specific needs of victims of sexual torture. They also need to receive training in how to look out for physical signs of possible sexual torture, as survivors may not disclose this information themselves. Clear referral pathways between rehabilitation centres, hospitals, private practitioners and the police must be set up and maintained. Doctors, psychiatrists and psychologists, treating patients who are survivors of sexual torture may prescribe pharmacological treatments alongside talk therapy. Medication, for both medical injuries and psychological disorders, may be a very important part of rehabilitation and the high costs involved in most countries may be prohibitive to many survivors. Access to free or highly subsidised medicines is another challenge in the rehabilitation process. Key Action 4: Apply special approaches for women, promote gender equality and tackle stereotypes of femininity and masculinity Some centres believe it is important to create a specialised approach for female victims of sexual torture. According to their view, women and girls are more likely to experience sexual torture since they are generally discriminated against and sexual and gender-based violence is rife in many countries. This becomes particularly clear in contexts of armed conflict, when women and girls are often the targets of systematic rape as a weapon of war. In the view of these centres, women and girls have also special rehabilitative needs that must be addressed separately. This requires not only additional services, such as group therapy for women who experienced rape, but also gender mainstreaming across all general services. This ranges from securing access to female doctors, counsellors and translators to providing victims of rape with immediate antiretroviral medication, as MATESO Kenya notes. Applying approaches tailored to the needs of women is one step that centres have adopted. However, many experts in the field of sexual violence believe that more far-reaching action is necessary. They have called for broad rehabilitation programmes, which have a transformative effect to counteract the underlying problem of discrimination of women and girls that puts them at higher risk of becoming victims of sexual violence and, hence, also of sexual torture. In practical terms, this could involve services or collaborations that improve the socio-economic situation of female survivors and challenge gender roles within their families. Instead of sewing courses, women could be offered computer courses or training on agriculture. Finally, it is also important to remember that trauma, stigma and rehabilitation have proven to be as strong and difficult for men as they are for women. The case studies of male victims collected for this report clearly show that a similar approach also needs to be devised for men and boys. Special attention should therefore also be paid to a discussion of gender roles and the implications of sexual violence against men. Patriarchal gender roles and ideals of virility often restrain men and boys from admitting their abuse. The rehabilitation services they may have access to would benefit from creating an atmosphere that allows victims to disclose their torture and need for help. page 28