A guest blog by Mihoko Tanabe, senior program officer, sexual and reproductive health program, Women’s Refugee Commission

Community health workers (CHWs) forge a river to cross from Thailand into Myanmar (Burma), laden with rape kits and several months of medical supplies. They trek through the dense jungle for two or three days before finally arriving in isolated villages, where decades of conflict have left the ethnic minority communities without doctors, nurses or permanent health facilities.

In Mogadishu, the capital of war-torn Somalia, women toting bags full of medical supplies navigate the dangers of the city and the camps for internally displaced people, providing community-based care to survivors of sexual violence.

At a workshop in mid-May, I met with the Somali CHWs who told me how truly inspired they were by the work of their Burmese counterparts because of the challenges they have to overcome, delivering care in such far-flung, and hard to reach locations. I have no doubt the Burmese CHWs would be equally inspired by their Somali peers who live and work in a city plagued by their country’s long-term anarchy. It’s a testament to courage and resilience.

It’s those qualities that we see in refugees and displaced women around the world that drove us to find a way to ensure women in even the most dangerous places would not have to accept whatever heath care was left to them. We thought there should be a way for even these women to have quality care.

In 2008, the Women’s Refugee Commission (WRC) set into motion an initiative to provide post-rape care to women caught in some of the world’s most dangerous circumstances.

Our first pilot project trained women in Thailand to provide minimal clinical care in Myanmar based on the World Health Organization’s post-rape care protocol. A local NGO told us, “before, health workers and community members were not interested in gender-based violence because they thought it was a normal occurrence. The health workers wanted to run away from the topic. Now they are very interested.”

UNICEF adapted our model and is currently piloting it in Somalia and South Sudan. UNICEF’s partner in Somalia sees some 70 cases per month, 12 percent of which are rape and sexual violence survivors. In the past three months, two survivors were treated entirely by CHWs since they did not wish to be referred to health facilities.

In a country where stigma and shame associated with sexual violence are the norm, providing alternative options for survivors can increase their ability to receive medical care.

CISP, UNICEF’s partner in Somalia, is using the adapted WRC model to care for survivors of sexual violence. Here, a community health worker visits clients in a displaced persons’ camp.

We hope to expand our pilots to areas such as Shan and Kachin states in Myanmar, where access to health care is heavily compromised. Ultimately, we hope to collect enough evidence to change policy around post-rape care to include community-based options. This will make a significant difference in the lives of sexual violence survivors.

Related Papers and Documents

Mullany LC, Lee CI, Paw P, Shwe Oo EK, Maung C: The MOM project: delivering maternal health services among internally displaced populations in eastern Burma. Reproductive Health Matters 2008, 16:44-56.

Tanabe M, Robinson K, Lee CI, et al. Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma. Conflict and Health. 2013;7:12. doi:10.1186/1752-1505-7-12.

Global Health Workforce Alliance, WHO, IFRC, UNICEF, UNHCR. 2011. Scaling-up the Community-Based Health Workforce for Emergencies: Joint Statement by the Global Health Workforce Alliance, WHO, IFRC, UNICEF, UNHCR.

WHO Recommendations: Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions Through Task Shifting, 2012.

IPPF Medical Bulletin: IMAP Statement on Task Sharing in Sexual and Reproductive Health, 2013.

RHM47 Call for Papers on gender-based violence – coming soon