Hostname: page-component-7479d7b7d-t6hkb Total loading time: 0 Render date: 2024-07-10T00:39:23.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Sexual violence, health and humanitarian ethics: Towards a holistic, person-centred approach

Published online by Cambridge University Press:  18 August 2015

Paul Bouvier
Get access Rights & Permissions [Opens in a new window]

Abstract

Sexual violence and rape in armed conflicts are widespread phenomena, with devastating consequences. Over the last thirty years, our understanding of these phenomena has significantly improved. Today humanitarian and health professionals understand better the reality, scale and impact of sexual violence on the personal, physical, social and mental health of individuals and communities. Rape is recognized to have a dehumanizing effect, as much as torture or mass violence. Major efforts are put into providing an effective and ethical response, with respect and sympathy to the survivors. Health and humanitarian assistance contribute to the healing and resilience of survivors and communities. Looking forward, programmes must be centred on the person, promoting their autonomy and dignity, and integrating medical, psychosocial and socio-economical responses.

Keywords

sexual violencearmed conflictshumanitarian ethicshumanitarian assistanceaccess to health care
Type
Addressing/Responding to sexual violence in armed conflict
Information
International Review of the Red Cross , Volume 96 , Issue 894: Sexual violence in armed conflict , June 2014 , pp. 565 - 584
Copyright
Copyright © icrc 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 See Keith Burgess-Jackson's Introduction in Keith Burgess-Jackson (ed.), A Most Detestable Crime: New Philosophical Essays on Rape, Oxford University Press, New York, 1999, p. 3.

2 Georges Vigarello, Histoire du viol, XVIe-XXe siècle, Seuil, Paris, 1998, pp. 73, 292–293.

3 Marianna G. Muravyeva, “Categorising Rape in the Military Law of Modern Russia”, in Raphaëlle Branche and Fabrice Virgili, Rape in Wartime, Palgrave Macmillan, London, 2012, pp. 17–33.

4 Keith Burgess-Jackson, “A History of Rape Law”, in K. Burgess–Jackson (ed.), above note 1, p. 24.

5 Quoted in Susan Brison, Aftermath: Violence and the Remaking of a Self, Princeton University Press, Princeton, NJ, 2002, p. 6.

6 Keith Burgess-Jackson, “A Theory of Rape”, in K. Burgess–Jackson (ed.), above note 1, p. 93.

7 Patricia Smith, “Social Revolution and the Persistence of Rape”, in K. Burgess-Jackson (ed.), above note 1, pp. 38–39.

8 The Elements of Crimes of the International Criminal Court explicitly use the wording “coercion” and “coercive environment” to define rape and sexual violence as a war crime and a crime against humanity: “The invasion was committed by force, or by the threat of force or coercion, such as that was caused by fear of violence, duress, detention, psychological oppression, or abuse of power, against such person or another person, or by taking advantage of a coercive environment or the invasion was committed against a person incapable of giving genuine consent” (emphasis added). See e.g. Elements of Crimes of the International Criminal Court, The Hague, 2011, Arts 7(1)(g)-1, 7(1)(g)-6, 8(2)(b)(xxii)-1, 8(2)(b)(xxii)-6, available at: www.icc-cpi.int/NR/rdonlyres/336923D8-A6AD-40EC-AD7B-45BF9DE73D56/0/ElementsOfCrimesEng.pdf (all internet references were accessed in October 2014).

9 For the elements of the crime of rape as a war crime or crime against humanity, see ibid., Arts 7(1)(g)-1, 8(2)(b)(xxii)-1, 8(2)(e)(vi)-1. For a detailed discussion of law and sexual violence in armed conflicts, see the article by Gloria Gaggioli in this issue of the Review.

10 Etienne G. Krug, Linda L. Dahlberg, James A. Mercy, Anthony B. Zwi and Rafael Lozano, World Report on Violence and Health, WHO, Geneva, 2002.

11 See ibid., Chapter 6, “Sexual Violence”, p. 149, available at: www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf.

12 Ibid., p. 149.

13 See the WHO web page, available at: www.who.int/reproductivehealth/topics/violence/sexual_violence/en/.

14 WHO, Health Consequences: Understanding and Addressing Violence against Women, WHO/RHR/12.43, Geneva, 2012.

15 WHO, Mental Health and Psychosocial Support for Conflict-Related Sexual Violence: 10 Myths, WHO/RHR/HRP/12.17, Geneva, 2012.

16 Kelly, Jocelyn et al. , “‘If Your Husband Doesn't Humiliate You, Other People Won't’: Gendered Attitudes Towards Sexual Violence in Eastern Democratic Republic of Congo”, Global Public Health, Vol. 7, No. 3, 2012, pp. 285–298CrossRefGoogle ScholarPubMed.

17 Josse, Evelyne, “‘They Came with Two Guns’: The Consequences of Sexual Violence on the Mental Health of Women in Armed Conflicts”, International Review of the Red Cross, Vol. 92, No. 877, March 2010, pp. 177–195CrossRefGoogle Scholar.

18 J. Kelly et al., above note 16.

19 Richard Mollica, Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World, Harcourt, Orlando, FL, 2006, p. 230.

20 R. Charli Carpenter, “War's Impact on Children Born of Rape and Sexual Exploitation: Physical, Economic and Psychosocial Dimensions”, in R. C. Carpenter, Born of War: Protecting Children of Sexual Violence Survivors in Conflict Zones, Kumarian Press, Hartford, 2007.

21 Mari Mikkola, “Dehumanization”, in Thom Brooks (ed.), New Waves in Ethics, Palgrave Macmillan, Basingstoke, 2011, pp. 128–149, 141.

22 S. Brison, above note 5, p. 8.

23 Ibid., p. 9.

24 R. Mollica, above note 19, p. 66.

25 Ibid., p. 63.

26 Françoise Sironi, Psychopathologie des violences collectives, Odile Jacob, Paris, 2007, pp. 59–62.

27 Jonathan Glover, Humanity: A Moral History of the Twentieth Century, Pimlico, London, 2001, p. 383.

28 Paul Ricœur, Soi-même comme un autre, Seuil, Paris, 1990, p. 223.

29 WHO, “Do's and Dont's in Community-Based Psychosocial Support for Sexual Violence Survivors in Conflict-Affected Settings”, WHO/RHR/HRP/12.16, Geneva, 2012.

30 WHO, Guidelines for Medico-legal Care of Victims of Sexual Violence, Geneva, 2003.

31 Paul Ricœur, “La prise de décision dans l'acte médical et l'acte judiciaire”, in Paul Ricœur, Le Juste 2, Esprit, Paris, 2001, pp. 245–255.

32 Kelly, J. T., Betancourt, T. S., Mukwege, D., Lipton, R. and VanRooyen, M. J., “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo: A Mixed-Methods Study”, Conflict and Health, Vol. 5, No. 25, 2001, pp. 2–8Google Scholar.

33 R. Mollica, above note 19, p. 236.

34 Luthar, Suniya S., Cicchetti, Dante and Becker, Bronwyn, “The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work”, Child Development, Vol. 71, No. 3, 2000, pp. 543–562CrossRefGoogle ScholarPubMed.

35 Personal communication with Boris Cyrulnik on resilience, Paris, December 2010.

36 Boris Cyrulnik, Un merveilleux malheur, Odile Jacob, Paris, 1999.

37 Boris Cyrulnik, “Children in War and Their Resilience”, in Henri Parens, Harold P. Blum and Salman Akhtar, The Unbroken Soul: Tragedy, Trauma and Resilience, Jason Aronson, Lanham, MD, 2008.

38 R. Molica, above note 19, p. 223.

39 Ibid., p. 234.

40 For more information about the “listening houses”, see, for example, ICRC, ” Democratic Republic of the Congo: Taming One's Fear, by Helping Others”, 2009, available at: www.icrc.org/eng/resources/documents/feature/2009/congo-kinshasa-feature-220509.htm.

41 Paul Ricœur, “Justice et vengeance”, in P. Ricœur, Le Juste 2, Esprit, Paris, 2001, p. 261.

42 Denis Salas, “L'inceste, un crime contre la filiation”, in Gérard Neyrand, Le cœur, le sexe, et toi et moi, Panoramiques-Corlet, Paris, 1998, p. 34.

43 Paul Ricœur, “Sanction, réhabilitation, pardon”, in Paul Ricœur, Le Juste, Éditions Esprit, Paris, 1995, pp. 198–199.

44 Ibid.

45 Ibid.

46 R. Mollica, above note 19, p. 212.

47 J. T. Kelly et al., above note 32.

48 Ibid.

49 WHO, “Safe Abortion Care: The Public Health and Human Rights Rationale”, in Safe Abortion: Technical and Policy Guidance for Health Systems, 2nd ed., Geneva, 2012, pp. 17–21.

50 United Nations, “World Abortion Policies 2013”, Department of Economic and Social Affairs, Population Division, UN Doc. ST/ESA/SER.A/329, 2013, available at: www.un.org/en/development/desa/population/publications/policy/world-abortion-policies-2013.shtml.

51 WHO, above note 49.

52 Sedgh, Gilda et al. , “Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008”, The Lancet, Vol. 379, No. 9816, 2012, pp. 625–632CrossRefGoogle ScholarPubMed.

53 Teklehaimanot, K. I. and Smith, C. Hord, “Rape as a Legal Indication for Abortion: Implications and Consequences of the Medical Examination Requirement”, Medicine and Law, Vol. 23, No. 1, 2004, p. 91Google ScholarPubMed.

54 WHO, above note 49.

55 WHO, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, 6th ed., Geneva, 2011, p. 27.

56 World Medical Association (WMA), WMA Declaration on Therapeutic Abortion, Pilanesberg, South Africa, 2006.

57 Rosamond Rhodes, “The Professional Responsibilities in Medicine”, in Rosamond Rhodes, Leslie P. Francis and Anita Silvers, The Blackwell Guide to Medical Ethics, Blackwell, Oxford, 2007, pp. 71–87.

58 FIGO, “Rights-Based Code of Ethics: FIGO Professional and Ethical Responsibilities Concerning Sexual and Reproductive Rights”, October 2003, available at: www.figo.org/figo-committee-and-working-group-publications.

59 R. Rhodes, above note 57.

60 Savulescu, Julian, “Conscientious Objection in Medicine”, British Medical Journal, Vol. 332, 2006, pp. 294–297CrossRefGoogle Scholar.

61 James, Scott, “Good Samaritans, Good Humanitarians”, Journal of Applied Philosophy, Vol. 24, No. 3, 2007, pp. 238–254CrossRefGoogle Scholar.

62 Cook, Rebecca J., Bernard Dickens and Monika Arango Olaya, “Healthcare Responsibilities and Conscientious Objection”, International Journal of Gynecology & Obstetrics, Vol. 104, 2009, pp. 249–252CrossRefGoogle ScholarPubMed.

63 See Colombia, Corte Constitucional [Constitutional Court], Sentencia T-388/09, 28 May 2009.

64 UN Human Rights Committee, KL v. Peru, Communication No. 1153/2003, CCPR/C/85/D/1153/2003, 22 November 2005.

65 WMA, Medical Ethics Manual, Ferney-Voltaire, 2005, p. 6.

66 F. Sironi, above note 26, p. 61.

67 For examples of effective programmes based on vulnerability and resilience, see Suniya S. Luthar, Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities, Cambridge University Press, Cambridge, 2003.

68 See the opening section “Voices and Perspectives” in this issue of the Review.