“It is our job as health care providers to help survivors”
Nurse Arzo took part in the WHO gender-based violence training in Bamyan province. Photo: WHO/S.Ramo
Kabul 4 August 2016 – Sarbaland, a man from the Ashkamis district of Takhar province, cut off parts of his pregnant wife’s genitals and beat her so severely that she lost her unborn baby last week. A day before this attack, a woman was shot dead by her in-laws in Faryab province. Earlier this year, 20-year-old Reza Gul’s husband cut off her nose with a kitchen knife.
“I see so many cases of violence against women in my area. Last year, I saw a beheaded 22-year-old woman outside my village. There are so many types of violence, there are these types of “honour killings”, there are women who have been beaten by their husbands, women who have been raped. I also witness a lot of psychological violence,” says Zahra, a midwife working in a basic health centre in Bamyan province.
These unspeakable, horrific acts of violence against women, rooted in pervasive gender inequality, are common in Afghanistan. Around 87% of Afghan women experience at least one form of gender-based violence in their lifetime. More than 5000 cases of violent acts against women were registered in 2015, including 241 murders, according to the Afghanistan Independent Human Right Commission. However, since GBV often goes unreported due to fears of retribution, shame and stigma, the real figures are likely to be many times higher.
This is why WHO is working with the Ministry of Public Health in Afghanistan to strengthen the role of the health sector in addressing gender-based violence and ensure that all those who experience violence receive the medical treatment they need.
Gender-based violence – an urgent public health priority
“Gender-based violence is a violation of human rights and a serious public health issue with consequences for physical, psychological and reproductive health. This is an issue that the health sector needs to take seriously. GBV mainly affects women and girls but men and boys can also experience it,” said Ms Farzana Akbari, Director of the Gender Directorate of the Ministry of Public Health of Afghanistan.
An assessment carried out by WHO Afghanistan in 2015 showed major weaknesses in health service provision to GBV survivors: only 10% of facilities are well prepared to address GBV. Only a quarter of the 280 health facilities surveyed in 7 provinces had private examination rooms and only 2% of facilities had a protocol in place for GBV care. The assessment also showed major gaps in health care providers’ knowledge and attitudes regarding gender-based violence, its health consequences and the role of health care providers in helping survivors.
“Strengthening health sector response to gender-based violence is one of WHO’s core priorities,” says Dr Richard Peeperkorn, WHO Country Representative in Afghanistan. “We are working to ensure that all survivors of gender-based violence receive the care they need and deserve and that health care providers follow safe and ethical practices guided by a survivor-centred approach.”
Ensuring better care for GBV survivors
WHO, with the support of USAID and the Italian Development Cooperation, is training over 6500 health care providers in all 34 provinces on how to properly manage cases of GBV, including physical, sexual and psychological violence. A GBV treatment protocol for health care providers, developed by the Ministry of Public Health and WHO with the support of UN Women, is being implemented across Afghanistan’s health facilities.
Health care providers are currently trained in Badakhshan, Balkh, Bamyan, Herat, Kabul, Nangarhar and Parwan provinces by WHO’s partner organization Youth, Health and Development Organization. All 34 provinces will be covered within the next 5 years.
Baz Mohammad, nurse at the Bamyan Provincial Hospital, arranges patient files in a lockable cabinet. Photo: WHO/S.Ramo“The majority of those who have experienced GBV do not come to the health facility and they won’t talk about it to anyone because of the shame and stigma associated with it. This needs to change,” says Arzo, a female nurse at a comprehensive health centre in Kahmard district of Bamyan. “This training has taught me so much. Before I didn’t really know that GBV is a health issue and that we play a role in helping survivors. I have learned about basic psychosocial support, how to provide treatment for rape survivors, how to refer cases and how to advise survivors about their options,” she adds.
Abdul Khalil is a medical doctor from Uruzgan province, currently working at a district hospital in Bamyan. “Everything has been new to me in this training,” he says. “Before, I didn’t know where to refer GBV survivors. Now I know the signs of GBV and I know how to take a complete patient history. I learned about the importance of informed consent, privacy and confidentiality. This training has helped me and I can now treat GBV survivors in a better way.”
“We shouldn’t be judgemental; we need to listen to survivors”
WHO trains health care providers on basic psychosocial support for survivors, how to properly identify gender-based violence, how to maintain key principles of confidentiality, safety and privacy and how to conduct physical and genital examinations and provide clinical care for rape survivors.
“If health workers are not trained on these issues, they don’t take GBV seriously,” says Baz Muhammed, a nurse working at the Bamyan Provincial Hospital. Baz attended WHO’s training a month ago. “I learned about the importance of communicating with survivors in a proper way, listening to them and the importance of being empathetic and respectful.”
“We shouldn’t be judgmental, we must listen to the survivors and show our support,” says midwife Zahra. Photo: WHO/S.Ramo“Active listening is important. We shouldn’t be judgemental, we need to listen to the survivors and show our support,” adds Zahra.
Training of healthcare providers is not enough. Health facilities must provide an environment where proper care can be provided to survivors. WHO provides basic medical equipment and medicines to support care and strengthens privacy measures at health facilities by installing separation curtains to ensure visual privacy where private rooms are not available.
“The main problem we are facing in the health facility is the lack of a private room or calm, quiet areas,” says Baz Muhammad. “We also need to have more staff trained on GBV so they understand that it is a health issue and something healthcare providers need to address.”
WHO is expanding the GBV treatment protocol project to further 14 provinces by 2017 with the support of USAID to scale up treatment received by GBV survivors.
“All human beings are the same, we are all equal. Everyone who has experienced violence needs to get the best support that is available,” says medical doctor Abdul Khalil as he picks up his pen, folder and GBV notes before walking back to the training room.
Related links
Gender-based violence treatment protocol for healthcare providers in Afghanistan
WHO Afghanistan gender, equity and human rights programme
