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India: Sexual and gender based violence - Invisible medical emergency
SGBV is a major public health problem. Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime. In 2017, MSF has treated over 18,800 victims of sexual violence which highlights the seriousness of the emergency.
A SGBV survivor’s story: “He would come home drunk, beat me, urinate on my face and threaten to abuse me in worse ways.”
A thin-framed Kamla* looked around, unsure whether she was at the right place, and hesitating whether to share her experience or not. This was the first time she was visiting MSF’s Umeed ki Kiran (Ray of Hope) clinic on the recommendation of a MSF health educator. Reassured by the friendliness of the counsellor, who promised her complete privacy, Kamla felt able to share her story of abuse with the staff there.
Kamla’s aunt brought her to Jahangirpuri, Delhi, from another city when she was five years old. She was forced to work in her aunt’s house, do other menial jobs and hand over her earnings to her aunt. Then she was forced into an abusive child marriage. Her husband repeatedly assaulted Kamla sexually, emotionally, physically and verbally for the next 15 years.
Kamla felt unable to share her story with anyone, thinking it was a private family matter. Seeking medical care wasn’t something she considered at all. But the absence of family and friends exacerbated her isolation. “The issue of sexual and gender-based violence here is multi-pronged,” explains Huzaifa, Kamla’s counsellor. “Sometimes the victims don’t even realise they are being abused and accept it as a way of life. Sometimes they are too scared to reach out for help, fearing it will aggravate the problem or that the services won’t be private and confidential. We have had victims who had no idea where to go for help. The Umeed Ki Kiran clinic in Delhi, through its patient-centered approach, not only provides medical and psychosocial help, but also educates the community on sexual and gender-based violence and the need for timely medical help.”
Injuries are common consequences of physical and sexual violence, but psychological wounds can be just as detrimental. Kamla’s abuse led to suicidal thoughts. “She looked drained and hopeless the first time I saw her,” Huzaifa says. “She was prepared to take her own life and those of her three children. To help her out of that state, she needed not only treatment for her physical injuries but also counselling.”
As with all the survivors that come to MSF’s Umeed ki Kiran clinic, Kamla was examined for physical injuries and assigned a counsellor who she sees regularly. “Sometimes I felt she just wanted someone to vent to, someone to listen and tell her she wasn’t alone, to show her hope. In that sense, I sometimes think to myself how Umeed ki Kiran actually lived up to its name for Kamla,” Hazaifa says.
After a number of counselling sessions, Kamla decided to leave her husband and move elsewhere with her children. Umeed ki Kiran also links patients to other services, such as specialized medical care, legal services and shelters, so Kamla and her children were able to move into a shelter.
Kamla now lives in the shelter, works, and is raising her three children away from abuse. She wants them to grow into gentlemen. “I met her at the shelter the other day, brimming with life! It made me so happy to not just witness this transformation but play a role in it,” says Huzaifa.
* Some names and identifying details have been changed to protect the patient’s privacy.