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center000What responses, approaches to treatment, and other supports are effective in assisting refugees who have experienced sexual and gender-based violence?Karen Block, Hala Nasr, Cathy Vaughan, Claire Sullivan and Sara AlsarafIRiS WORKING PAPER SERIES, No.30/2019birmingham.ac.uk/irisIRiS Working Paper SeriesIRiS Working Paper Series The Institute for Research into Superdiversity (IRiS) Working Paper Series is intended to aid the rapid distribution of work in progress, research findings and special lectures by researchers and associates of the Institute. Papers aim to stimulate discussion among scholars, policymakers and practitioners and will address a range of topics including issues surrounding population dynamics, security, cohesion and integration, identity, global networks, rights and citizenship, diasporic and transnational activities, service delivery, wellbeing, social exclusion and the opportunities which superdiverse societies offer to support economic recovery. The IRiS WP Series is edited by Dr Nando Sigona and Dr Aleksandra Kazlowska at the Institute for Research into Superdiversity, University of Birmingham. We welcome proposals for Working Papers from researchers, policymakers and practitioners; for queries and proposals, please contact: n.sigona@bham.ac.uk. All papers are peer-reviewed before publication. The opinions expressed in the papers are solely those of the author/s who retain the copyright. They should not be attributed to the project funders or the Institute for Research into Superdiversity, the School of Social Policy or the University of Birmingham. Papers are distributed free of charge in PDF format via the IRiS website. Hard copies will be occasionally available at IRiS public events.right3810left36639500Institute for Research into SuperdiversityUniversity of BirminghamEdgbastonB15 2TT Birmingham UKbirmingham.ac.uk/iris11738177874000This Working Paper is also part of the SEREDA Working Paper Series (No.4/2019)For more information on SEREDA: to sexual and gender-based violence (SGBV) need to adapt to varying contexts and needs across the refugee journey, however there is no comprehensive evidence base for understanding how these needs evolve at different points for people on the move. This working paper is a critical overview of the current state of knowledge on responses to SGBV for refugees, asylum seekers and internally displaced persons across all stages of the refugee journey. The review demonstrates that recommended responses to SGBV tend to converge across the settings of conflict, displacement and resettlement. Available evidence suggests that intersectional and ecological principles need to underpin interventions. Thus, individual health and psychosocial responses should be supported by engagement with families, community leaders and communities, and by addressing underlying risk factors including harmful gender norms and social and economic marginalisation. These recommendations for multilevel and multisectoral responses are based on practice-based expert opinion and primary data collection with SGBV survivors and service providers but more research is needed to evaluate the impacts and effectiveness of such multi-faceted interventions. Suggested citationBlock, K., Nasr, H., Vaughan, C. Sullivan, S. and Alsaraf, S.? (2018), What responses, approaches to treatment, and other supports are effective in assisting refugees who have experienced sexual and gender-based violence? IRiS Working Paper Series, No.30/2019, Birmingham: Institute for Research into Superdiversity.The authorsDr Karen Block*, Hala Nasr, Dr Cathy Vaughan, and Claire Sullivan are based at The Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne. Sara Alsaraf is based at the School of Social Policy, University of Birmingham*Corresponding author: keblock@unimelb.edu.auContents TOC \o "1-3" \h \z \u Introduction PAGEREF _Toc15309900 \h 5Scope and methods for review PAGEREF _Toc15309901 \h 5Definitions PAGEREF _Toc15309902 \h 5Scope PAGEREF _Toc15309903 \h 6Method for literature search PAGEREF _Toc15309904 \h 7Structure of this report PAGEREF _Toc15309905 \h 8Humanitarian guidelines for responses to SGBV in the field PAGEREF _Toc15309906 \h 9Individual level guidelines PAGEREF _Toc15309907 \h 9System level guidelines PAGEREF _Toc15309908 \h 10Literature review findings PAGEREF _Toc15309909 \h 13Key findings and recommendations from evidence reviews and commentaries PAGEREF _Toc15309910 \h 13Studies with recommendations for response based on primary data collection PAGEREF _Toc15309911 \h 16Studies that evaluated responses to SGBV PAGEREF _Toc15309912 \h 21Discussion and Conclusion PAGEREF _Toc15309913 \h 26References PAGEREF _Toc15309914 \h 28IntroductionViolence, insecurity, persecution, and human rights violations have led to the forced displacement of an estimated 68.5 million people as of 2018 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"40v7xq5e","properties":{"formattedCitation":"(UNHCR, 2018a)","plainCitation":"(UNHCR, 2018a)","noteIndex":0},"citationItems":[{"id":162,"uris":[""],"uri":[""],"itemData":{"id":162,"type":"webpage","title":"Figures at a glance","container-title":"United Nations Commissioner for Refugees","URL":"","author":[{"family":"UNHCR","given":""}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (UNHCR, 2018a). Of those 68.5 million, 25.4 million are refugees - the highest number ever recorded; 3.1 million are asylum seekers; and 40 million are internally displaced ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"szLOXrIN","properties":{"formattedCitation":"(UNHCR, 2018a)","plainCitation":"(UNHCR, 2018a)","noteIndex":0},"citationItems":[{"id":162,"uris":[""],"uri":[""],"itemData":{"id":162,"type":"webpage","title":"Figures at a glance","container-title":"United Nations Commissioner for Refugees","URL":"","author":[{"family":"UNHCR","given":""}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (UNHCR, 2018a). Humanitarian emergencies exacerbate the unequal power relations and structural inequalities that underpin the sexual and gender-based violence (SGBV) experienced by girls and women, as well as boys and men ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VGj33rpX","properties":{"formattedCitation":"(UNOCHA, 2016)","plainCitation":"(UNOCHA, 2016)","noteIndex":0},"citationItems":[{"id":3571,"uris":[""],"uri":[""],"itemData":{"id":3571,"type":"webpage","title":"Unseen but not unheard: sexual and gender-based violence in humanitarian crises","container-title":"United Nations Office for the Coordination of Humanitarian Affairs","URL":"","author":[{"family":"UNOCHA","given":""}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (UNOCHA, 2016). In some humanitarian emergencies, more than 70 percent of women have experienced gender-based violence and an estimated one in five displaced women will experience sexual violence ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"f2LAMa5i","properties":{"formattedCitation":"(UN Women, 2017)","plainCitation":"(UN Women, 2017)","noteIndex":0},"citationItems":[{"id":160,"uris":[""],"uri":[""],"itemData":{"id":160,"type":"webpage","title":"Facts and figures: Humanitarian action","URL":"","author":[{"family":"UN Women","given":""}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} (UN Women, 2017). Conflict-related sexual violence against men and boys has been documented around the world, though data to determine prevalence are limited ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lzUuJvbE","properties":{"formattedCitation":"(Solangon & Patel, 2012)","plainCitation":"(Solangon & Patel, 2012)","noteIndex":0},"citationItems":[{"id":3554,"uris":[""],"uri":[""],"itemData":{"id":3554,"type":"article-journal","title":"Sexual violence against men in countries affected by armed conflict","container-title":"Conflict, Security & Development","page":"417-442","volume":"12","issue":"4","ISSN":"1467-8802","journalAbbreviation":"Conflict, Security & Development","author":[{"family":"Solangon","given":"Sarah"},{"family":"Patel","given":"Preeti"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} (Solangon & Patel, 2012). Following displacement, and even after permanent resettlement, different kinds of insecurity such as breakdown of family and community networks, shifting gender roles, and limited access to resources can also increase the risk of SGBV. Responses to SGBV need to adapt to varying contexts and needs across the refugee journey, however there is no comprehensive evidence base for understanding how these needs evolve at different points for people on the move. This working paper is a critical overview of the current state of knowledge on responses to SGBV for refugees, asylum seekers and internally displaced persons across all stages of the refugee journey.Scope and methods for reviewDefinitionsRefugeesFor the purposes of this working paper, refugees, asylum seekers and internally displaced people are defined as people who are or have been displaced within or outside their home country due to persecution or conflict. Gender-based violence (GBV) and Sexual and Gender-based violence (SGBV)The ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ofpMnj4P","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015, p. 5)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015, p. 5)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}},"locator":"5"}],"schema":""} Inter-Agency Standing Committee (IASC) 2015 Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery defines GBV as an “umbrella term for any harmful act perpetrated against a person based on socially ascribed gender differences between males and females. It includes acts that inflict physical, sexual or mental harm or suffering, threats of such acts, coercion and other deprivations of liberty” (p. 5). While some guidelines separate GBV and sexual violence, for this review we use the term SGBV as encompassing this definition and including, but not being limited to, different forms of sexual violence (such as sexual harassment, rape and sexual exploitation), intimate partner violence, forced and early marriage, occurring in both private and public domains. Included in this definition is gendered violence against women and girls, men and boys, and lesbian, gay, bisexual, transgender and intersex (LGBTI) persons. Responses to SGBVIn this working paper, ‘responses to SGBV’ refers to actions that provide survivors with specialist care, support or assistance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iZ7ZZw18","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (IASC, 2015). These responses differ depending on the type of SGBV being targeted, the level of intervention - which can include anything from basic services and security to specialised support - and the refugee context. Stages of ‘refugee journey’Given the importance of context for determining what is possible in terms of SGBV response, and possibly also for determining survivors’ priorities and needs, we have described responses as occurring during one of three different phases of the ‘refugee journey’. These are categorised as:Conflict or immediately post-conflict settingsDisplacement in countries of first asylum or following internal displacement e.g. within refugee camps or urban sites. These are typically resource-poor settings and/or settings hosting large numbers of refugees with few prospects of long-term settlement or integrationResettlement, typically in relatively resource-rich countries such as those within Europe, North America or Australasia where refugees have been given either temporary or permanent protection status.ScopeInclusion criteriaAn iterative approach was taken, whereby the search terms were refined during the process of research ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vRkAQjCL","properties":{"formattedCitation":"(Boell & Cecez-Kecmanovic, 2014)","plainCitation":"(Boell & Cecez-Kecmanovic, 2014)","noteIndex":0},"citationItems":[{"id":157,"uris":[""],"uri":[""],"itemData":{"id":157,"type":"article-journal","title":"A hermeneutic approach for conducting literature reviews and literature searches.","container-title":"CAIS","page":"12","volume":"34","journalAbbreviation":"CAIS","author":[{"family":"Boell","given":"Sebastian K"},{"family":"Cecez-Kecmanovic","given":"Dubravka"}],"issued":{"date-parts":[["2014"]]}}}],"schema":""} (Boell & Cecez-Kecmanovic, 2014). Publication types were limited to peer-reviewed journal articles and service delivery evaluation reports, and technical reports in English.The inclusion criteria were studies that referenced responses to SGBV in refugee populations in the abstract or overview, and/or studies that provided recommendations for responses to SGBV in refugee populations in the abstract or overview. Inclusion of the relevant literature was based on their relevance to the search frame, thus a small number of included studies focus on SGBV responses in (refugee-producing) conflict settings rather than following displacement. A small number of included studies also describe their sample as ‘immigrant’ rather than ‘refugee’ but are focused on immigrant groups likely to have had a refugee experience (e.g. West African migrants in the U.S. or Ethiopian immigrants in Israel).Exclusion criteriaThe review does not include studies that were attempting to assess the prevalence or describe the causes and types of SGBV experienced by refugees without reference to specific responses. Studies focused on responses to generalised trauma (rather than SGBV) and responses to SGBV experienced by people who were primarily victims of trafficking (rather than refugees) or people affected by other humanitarian emergencies (such as natural disasters), were not included within the scope of this review. For the purpose of this review, responses are also taken to be distinct from prevention (taking action to stop SGBV from first occurring) and mitigation (reducing the risk of exposure to SGBV) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YVNfWqGs","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (IASC, 2015). Prevention and mitigation generally involve targeting the root causes of SGBV, including gendered social norms and gender inequality. This requires longer-term approaches focused on structural and behavioural change, which are outside the scope of this working paper. Despite this distinction, we recognise that response and prevention are part of a continuum. Responses to SGBV may also work to prevent further violence and many authors focusing on response emphasise the importance of prevention. While we have not conducted an exhaustive search of the prevention literature, where papers addressed both they have been included. Method for literature searchGuidelines for responding to SGBV were sourced from the websites of prominent United Nations (UN) and international non-governmental organisations (INGOs) such as the United Nations High Commissioner for Refugees (UNHCR), United Nations Population Fund (UNFPA), and the World Health Organisation (WHO). The databases – Medline (Ovid), PsycINFO, PubMed, Scopus, and Google Scholar were searched using the search strategy outlined in Table 1. The abstracts/overviews of the located literature were reviewed using the exclusion criteria, and those which remained were further reviewed using both the inclusion and exclusion criteria. Reference lists of relevant literature were also examined. Finally, the remaining literature was read in-depth using a data extraction tool developed to support the recording of key information, including research design, intervention levels, type of SGBV targeted, location, key findings and methodological quality. Table 1. Search StrategySearch framesTermGender-based violencesexual harassment OR sexual abuse OR sexual exploitation OR sexual violence OR sexual assault OR trafficking OR gender-based violence OR violence against women OR domestic violence OR intimate partner violence OR forced marriage OR child marriage OR early marriage OR survival sex OR rapeResponsesevaluation OR evidence OR best practice OR good practice OR intervention OR trauma-informed care OR therap* OR treatment OR responseRefugeeRefugee* OR forced migra* OR asylum seeker*Structure of this reportWe begin with a brief overview of the content focus of the most widely-referenced humanitarian guidelines which provide standards for responses to SGBV by humanitarian actors in complex emergency and displacement settings. These guidelines can be broadly categorised as providing recommendations for response primarily focused on individual survivors or on systems and settings.In addition to these guidelines, a total of 54 journal articles and reports met the inclusion criteria. Included papers reflected three basic study designs:Evidence reviews, summaries and commentaries (19 papers);Primary data collection with SGBV survivors and/or service providers leading to recommendations for response (20 papers); and Evaluation of SGBV responses (15 papers). The remainder of the review is structured in line with these study designs as each gives rise to a different type of evidence. Papers that report on evaluations of interventions will be discussed in greatest detail. Given the importance of context for determining what is possible in terms of SGBV response, and possibly also for determining survivors’ priorities and needs, within each study design section we have categorised responses according to their setting: 1/ conflict settings; 2/ countries of first asylum or following internal displacement, within both refugee camps or urban sites; or 3/ resettlement.The review concludes with a discussion of the key findings and recommendations. Humanitarian guidelines for responses to SGBV in the field There have been a number of guidelines on responses to SGBV in humanitarian settings that have been produced by UN agencies and international non-governmental organisations. For the purposes of this review, we have conceptualised the most widely referenced guidelines from the Inter-Agency Standing Committee (IASC), WHO, Gender-based Violence Information Management System Steering Committee, the Inter-Agency Working Group on reproductive health in crises (IAWG) and UNFPA as either individual or systems level guidelines. The terms ‘GBV’ and ‘sexual violence’ are sometimes used distinctly in the guidelines, but we will use the umbrella term of SBGV. The guidelines are a product of a cyclical process, both shaping and shaped by the experiences of SGBV practitioners and experts across the humanitarian sector over time. However, insufficient evidence exists about the effectiveness of the application of these guidelines in practice.Individual level guidelinesThe major guidelines at the individual level are the Guidelines for Medico-Legal Care for Victims of Sexual Violence ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"RRk8GnJ3","properties":{"formattedCitation":"(World Health Organisation (WHO), 2003)","plainCitation":"(World Health Organisation (WHO), 2003)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":156,"uris":[""],"uri":[""],"itemData":{"id":156,"type":"webpage","title":"Guidelines for medico-legal care for victims of sexual violence","URL":"","author":[{"family":"WHO","given":""}],"issued":{"date-parts":[["2003"]]}}}],"schema":""} (WHO, 2003), Clinical Management of Rape Survivors: Developing Protocols for Use with Refugees and Internally Displaced Persons ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yifIwR2f","properties":{"formattedCitation":"(World Health Organisation (WHO), 2004)","plainCitation":"(World Health Organisation (WHO), 2004)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":159,"uris":[""],"uri":[""],"itemData":{"id":159,"type":"webpage","title":"Clinical Management of Rape Survivors: Developing protocols for use with refugees and internally displaced persons","URL":"","author":[{"family":"World Health Organisation (WHO)","given":""}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (WHO, 2004), and, published almost 15 years later, the Inter-Agency GBV Case Management Guidelines, published by the ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"G7GJ4u6m","properties":{"formattedCitation":"(Gender-based Violence Information Management System (GBVIMS) Steering Committee, 2017)","plainCitation":"(Gender-based Violence Information Management System (GBVIMS) Steering Committee, 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":164,"uris":[""],"uri":[""],"itemData":{"id":164,"type":"report","title":"Inter-Agency Gender-based Violence Case Management Guidelines","URL":"","author":[{"family":"Gender-based Violence Information Management System (GBVIMS) Steering Committee","given":""}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} Gender-based Violence Information Management System (GBVIMS) Steering Committee (2017). The initial focus of the two early WHO guidelines is sexual violence, specifically through the lens of improving clinical care practices. Female survivors are prioritised, though the WHO (2003) guidelines do point to specific issues that might arise with male and child survivors. Sexual violence is framed as both a human rights and public health issue, with the WHO (2004) guidelines defining survivors’ rights through the principles of the right to health, human dignity, non-discrimination, self-determination, information, privacy, and confidentiality. The WHO (2004) guidelines are designed specifically for humanitarian settings, while the WHO (2003) guidelines are generally applicable to both humanitarian and non-humanitarian settings with a particular regard for settings with severe contraints on the capacity to provide comprehensive health services and as such has become a useful tool for sexual violence responses in refugee settings. The WHO (2004) guidelines are more comprehensive, providing context to sexual violence, examining trends and consequences, as well as confronting rape myths and unconscious bias that practitioners may hold. Nevertheless, the two sets of guidelines complement each other, providing step-by-step recommendations for the preparation, forensic and physical examination and follow-up care of survivors of sexual violence. The Inter-Agency GBV Case Management Guidelines, on the other hand, provide a step-by-step guide for SGBV case management in humanitarian settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eJmLd7Bh","properties":{"formattedCitation":"(Gender-based Violence Information Management System (GBVIMS) Steering Committee, 2017)","plainCitation":"(Gender-based Violence Information Management System (GBVIMS) Steering Committee, 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":164,"uris":[""],"uri":[""],"itemData":{"id":164,"type":"report","title":"Inter-Agency Gender-based Violence Case Management Guidelines","URL":"","author":[{"family":"Gender-based Violence Information Management System (GBVIMS) Steering Committee","given":""}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} (GBVIMS Steering Committee, 2017). This includes the following steps:Engaging with the survivor to build trust and rapport, assessing risk, and gaining informed consent Assessing the survivor’s situation and needs, providing psychological first aid and information, and determining whether a survivor requires further case management services Developing a case action plan, making referrals, and documenting plans Assisting and advocating for survivors in implementing the case action plan, and leading case coordinationMonitoring case progress, revising and reassessing needs if necessary Closing the case Case management is a focused non-specialised method of support that links survivors to basic needs, mental health and psychosocial support services and resources. In line with the WHO guidelines, it is recommended that case management be approached through the principles of the right to safety, confidentiality, dignity and self-determination, and non-discrimination – now referred to as the ‘survivor-centred’ approach. The theoretical and practical foundations justifying this approach are linked to the learnings from social work case management, trauma theory and practice, women’s movements, and evidence from survivors. Most significantly, this guideline is uniquely inclusive, detailing the specific case management needs of LGBTI, men, and people with disabilities, as well as women and girls. System level guidelinesThe major guidelines at the system-level are the IASC Guidelines for GBV ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"RjiSCZx5","properties":{"formattedCitation":"(IASC, 2005)","plainCitation":"(IASC, 2005)","noteIndex":0},"citationItems":[{"id":"fNlRhSZX/yCFWJgEt","uris":[""],"uri":[""],"itemData":{"id":6410,"type":"report","title":"IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings: Focusing on Prevention and Response of Sexual Violence in Emergencies","URL":"","author":[{"family":"IASC","given":""}],"issued":{"date-parts":[["2005"]]}}}],"schema":""} (IASC, 2005), its updated republished version, Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"AQOCDUio","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (IASC, 2015), and The Minimum Standards for Prevention and Response to Gender-based Violence in Emergencies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"T8khZZjr","properties":{"formattedCitation":"(UNFPA, 2015)","plainCitation":"(UNFPA, 2015)","noteIndex":0},"citationItems":[{"id":1078,"uris":[""],"uri":[""],"itemData":{"id":1078,"type":"webpage","title":"Minimum standards for prevention and response to gender-based violence in emergencies","container-title":"United Nations Population Fund","URL":"","author":[{"family":"UNFPA","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (UNFPA, 2015). In addition, the Inter-agency Working Group on reproductive health in crises specifically addresses reproductive health needs and prevention of sexual violence through the Minimum Initial Service Package (MISP) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dVmt2fDC","properties":{"formattedCitation":"(IAWG, 2011)","plainCitation":"(IAWG, 2011)","noteIndex":0},"citationItems":[{"id":7039,"uris":[""],"uri":[""],"itemData":{"id":7039,"type":"report","title":"Minimum Initial Service Package","publisher":"IAWG on Reproductive Health in Crises","URL":"","author":[{"family":"IAWG","given":""}],"issued":{"date-parts":[["2011"]]},"accessed":{"date-parts":[["2019",7,18]]}}}],"schema":""} (IAWG, 2011). Overall, the guidelines advocate for multi-sectoral collaboration and coordination, and the mainstreaming of gender and SGBV into humanitarian responses. The Minimum Standards for Prevention and Response to Gender-based Violence in Emergencies specify operational standards to support multisectoral support services for survivors of SGBV (UNFPA, 2015). These responses include specialised health care with an emphasis on clinical management of rape, mental health and psychosocial support, safety and security, legal aid, socioeconomic empowerment, and mainstreaming across sectors, as well as referral systems to manage disclosures. While the Minimum Standards for Prevention and Response to Gender-based Violence in Emergencies makes mention of men and boys, as well as LGBTI, pregnant women and adolescent girls and children, it does not elaborate on the diverse needs of specific groups within SGBV responses. The 2005 IASC Guidelines for GBV are structured around a series of action sheets for coordination, assessment and monitoring, protection, human resources, water and sanitation, food security, shelter, health, education and communication ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"N7qpm4Ff","properties":{"formattedCitation":"(IASC, 2005)","plainCitation":"(IASC, 2005)","noteIndex":0},"citationItems":[{"id":"fNlRhSZX/yCFWJgEt","uris":[""],"uri":[""],"itemData":{"id":6410,"type":"report","title":"IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings: Focusing on Prevention and Response of Sexual Violence in Emergencies","URL":"","author":[{"family":"IASC","given":""}],"issued":{"date-parts":[["2005"]]}}}],"schema":""} (IASC, 2005). Notably, it is in these guidelines that the language of GBV is first introduced as an umbrella term for different forms of gendered violence. In line with the individual-level guidelines of the time, the central focus is sexual violence and women and girls. In 2015, the UNHCR published an evaluation of the implementation of the 2005 IASC Guidelines for GBV, through analysis of interventions in humanitarian settings in Syria. The evaluation found that the guidelines were not being incorporated in programming or sector strategy documents and that sectors were not being held accountable for failing to meet minimum standards ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aI4o2f1Z","properties":{"formattedCitation":"(UNHCR, 2015)","plainCitation":"(UNHCR, 2015)","noteIndex":0},"citationItems":[{"id":7037,"uris":[""],"uri":[""],"itemData":{"id":7037,"type":"report","title":"Evaluation of Implementation of 2005 IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings in the Syria Crisis Response","publisher":"UN High Commissioner for Refugees (UNHCR)","abstract":"Refworld is the leading source of information necessary for taking quality decisions on refugee status. Refworld contains a vast collection of reports relating to situations in countries of origin, policy documents and positions, and documents relating to international and national legal frameworks. The information has been carefully selected and compiled from UNHCR's global network of field offices, Governments, international, regional and non-governmental organizations, academic institutions and judicial bodies.","URL":"","language":"en","author":[{"family":"UNHCR","given":""}],"issued":{"date-parts":[["2015",10,15]]},"accessed":{"date-parts":[["2019",7,18]]}}}],"schema":""} (UNHCR, 2015). The updated and republished version, the 2015 Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action (“2015 IASC guidelines”), provide guidance and tools for humanitarians across all sectors to coordinate, plan, implement, monitor and evaluate actions related to the prevention and mitigation of GBV across all stages of humanitarian response – from preparedness to recovery ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tpElqquG","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (IASC, 2015). Expanding on the 2005 IASC guidelines, the definition of GBV includes reference to violence against LGBTI people and a greater emphasis on gendered violence that is experienced by men and boys. The underlying approaches taken in the 2015 IASC guidelines are human-rights based (sustainable solutions addressing human rights through systemic change); survivor-centred (survivors’ rights, needs and desires are prioritised); community-based (affected populations lead strategies related to their assistance); and a systems-based (macro-level analysis and solutions) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hY9AbekN","properties":{"formattedCitation":"(Inter-Agency Standing Committee (IASC), 2015)","plainCitation":"(Inter-Agency Standing Committee (IASC), 2015)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":163,"uris":[""],"uri":[""],"itemData":{"id":163,"type":"report","title":"Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery","URL":"","author":[{"family":"Inter-Agency Standing Committee (IASC)","given":""}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (IASC, 2015). The 2015 IASC guidelines comprehensively detail the responsibilities of different humanitarian sectors for integrating SGBV prevention and mitigation actions into their respective programs and services, and how sectors can coordinate measures across sectors (sectors include: camp coordination and management; child protection; education; food security and agriculture; health; housing, land and property; mine action; livelihoods; nutrition; protection; shelter, services and recovery; water, sanitation and hygiene; and humanitarian operations support services). The 2015 IASC guidelines also make recommendations for different sectors regarding the specific needs of at-risk groups (such as child survivors, LGBTI survivors, people with disabilities) in different contexts. As well as sector-specific guidance, the guidelines outline essential actions to be undertaken by various key actors (such as governments and humanitarian coordinators) in respect of planning, mobilization of resources, implementation, coordination, monitoring and evaluation of measures to address SGBV.Although the focus of the 2015 IASC guidelines is primarily on prevention and mitigation, they do include recommendations for response programming in some sectors, such as health and protection. Recommendations for the health sector include programming that builds the accessibility of health facilities that include SGBV-related services; builds capacity of health providers to deliver SGBV-related care; and implements strategies that maximise the quality of care available to survivors at health facilities. Strategies include the provision of appropriate clinical care to sexual assault survivors, private consultation rooms, appropriate supplies, training, and supporting and supervising health providers to identify forms of SGBV and provide quality care to survivors. The guidelines also recommend standardised data collection and ethical documentation, specific measures to meet the needs of at-risk groups, and multi-sectoral coordination and support. Recommendations for the protection sector include the implementation of programming that enhances the capacity of security to respond to SGBV incidents through protocols and procedures for assisting survivors (e.g. investigating and collecting evidence for prosecution if possible and if the survivor chooses to pursue legal action); supports legal aid, clinical and judicial processes; supports the development of specialised prosecution units for SGBV crimes; advocates for training for all actors who are part of the justice system; coordinates responses with SGBV specialists and actors in other sectors; and ensures clear referral pathways for multi-sectoral support. The 2015 IASC guidelines recommend that personnel have the capacity to provide information to SGBV survivors in a survivor-centred manner, which is presented as a cross-cutting responsibility across all humanitarian sectors. This requires having up-to-date information on support services, referral pathways, coordination with other sectors, options to report risk, and critically, the capacity to conduct psychological first aid. Psychological first aid (PFA) is a supportive response to a human being who is suffering, in distress or in need of support. It is stated that PFA requires a respect for safety, dignity, and rights, cultural sensitivity, being aware of emergency response measures and self-care. The guidelines adapt guidance from other NGOs ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ka9D9LPb","properties":{"formattedCitation":"(WHO, 2012; WHO, War Trauma Foundation, & World Vision International, 2011)","plainCitation":"(WHO, 2012; WHO, War Trauma Foundation, & World Vision International, 2011)","noteIndex":0},"citationItems":[{"id":"fNlRhSZX/AavvKrur","uris":[""],"uri":[""],"itemData":{"id":6431,"type":"report","title":"Mental health and psychosocial support for conflict-related sexual violence: 10 Myths","URL":"","author":[{"family":"WHO","given":""}],"issued":{"date-parts":[["2012"]]}}},{"id":"fNlRhSZX/TJPrvrkf","uris":[""],"uri":[""],"itemData":{"id":6430,"type":"report","title":"Psychological First Aid: Guide for field workers","URL":"","author":[{"family":"WHO","given":""},{"family":"War Trauma Foundation","given":""},{"family":"World Vision International","given":""}],"issued":{"date-parts":[["2011"]]}}}],"schema":""} (WHO, 2012; WHO, War Trauma Foundation, & World Vision International, 2011), presenting three steps: Look (checking for safety, basic needs, and serious distress); Listen (approaching, asking and listening to people’s needs and concerns); and Link (support access to information, basic needs and services, loved ones, and social supports) (Figure 1). Figure SEQ Figure \* ARABIC 1 Psychological First Aid, IASC, 2015Literature review findingsAs noted above, the following is arranged according to type of evidence (evidence reviews; studies reporting findings from primary data collection with recommendations for response; and evaluations of SGBV responses). Within each of these major sections, studies are organised by setting (conflict settings; displacement settings; and resettlement settings). The extent to which evidence concerns individual or system level responses is also discussed. Key findings and recommendations from evidence reviews and commentariesArticles and reports included in this section range from systematic reviews of published evidence to commentaries based on authorial experience and opinion. As with the guidelines discussed above, publications in this section generally do not differentiate between conflict, post-conflict and displacement settings so these subheadings are merged for this section (13 papers). Articles focused on resettlement settings are discussed separately (6 papers). Conflict and displacement settingsSeveral evidence reviews that focused on responses to SGBV in conflict and post-conflict settings serve primarily to highlight a lack of evidence in this area (Asgary, Emery, & Wong, 2013; Murphy et al., 2016; Schopper, 2014; Tol et al., 2013). A systematic review of prevention and management strategies for the health consequences of gender-based violence in refugee settings conducted by Asgary and colleagues (2013) located no articles that met their inclusion criteria. The authors concluded that ‘there is a dire need for accessible research that evaluates the efficacy and effectiveness of various GBV prevention and management strategies in displaced populations’ (Asgary et al., 2013, p. 89). They note further, that all the guidelines for response emphasise the need for data collection, monitoring and assessment. If such data is being collected however, they note that it has not been published in readily retrievable forms (Asgary et al., 2013). A systematic review published by Tol and colleagues (2013) with a similar focus, located seven relevant studies, which they described as limited, though tentatively suggesting the beneficial effects of mental health and psychosocial interventions, with more rigorous research urgently needed. An evidence brief for the flagship DFID ‘What Works to Prevent Violence Against Women and Girls’ programme has the promising title, What works to prevent and respond to violence against women and girls in conflict and humanitarian settings?, but concludes there is a lack of reliable prevalence data and robust evidence on what does work to prevent and respond to SGBV during conflict and humanitarian emergencies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"W7gzBBeG","properties":{"formattedCitation":"(Murphy et al., 2016)","plainCitation":"(Murphy et al., 2016)","noteIndex":0},"citationItems":[{"id":3103,"uris":[""],"uri":[""],"itemData":{"id":3103,"type":"report","title":"Evidence brief: What works to prevent and respond to violence against women and girls in conflict and humanitarian settings?","collection-title":"What Works to Prevent Violence against Women and Girls","abstract":"Women and girls are at increased risk of violence in conflict and humanitarian crises due to displacement, the breakdown of social structures, a lack of law enforcement, and a culture of impunity. This briefing paper provides a succinct overview of violence against women and girls (VAWG) in conflict and humanitarian emergencies. It reveals that little is known about the prevalence of VAWG in humanitarian emergencies. In addition, there is little robust evidence on what works to prevent and respond to VAWG in humanitarian emergencies. What evidence does exist suggests that the types of VAWG prevalent in humanitarian emergencies are not dissimilar to VAWG in non-emergency settings. As such, approaches that have been successful decreasing forms of VAWG such as intimate partner violence, and target underlying unequal gender norms and practices, may also be applicable in humanitarian settings.","URL":"","author":[{"family":"Murphy","given":"Maureen"},{"family":"Arango","given":"Diana"},{"family":"Hill","given":"Amber"},{"family":"Contreras","given":"Manuel"},{"family":"MacRae","given":"Mairi"},{"family":"Ellsberg","given":"Mary"}],"issued":{"date-parts":[["2016",9,20]]}}}],"schema":""} (Murphy et al., 2016). A review by Robbers and Morgan synthesised published literature on the effectiveness of interventions to prevent and respond to SV against female refugees and similarly found a lack of rigorously evaluated interventions in displacement settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"wbKObVYm","properties":{"formattedCitation":"(Robbers & Morgan, 2017)","plainCitation":"(Robbers & Morgan, 2017)","noteIndex":0},"citationItems":[{"id":3161,"uris":[""],"uri":[""],"itemData":{"id":3161,"type":"article-journal","title":"Programme potential for the prevention of and response to sexual violence among female refugees: a literature review.","container-title":"Reproductive health matters","page":"69-89","volume":"25","issue":"51","abstract":"Continuing international conflict has resulted in several million people seeking asylum in other countries each year, over half of whom are women. Their reception and security in overburdened camps, combined with limited information and protection, increases their risk and exposure to sexual violence (SV). This literature review explores the opportunities to address SV against female refugees, with a particular focus on low-resource settings. A systematic literature review of articles published between 2000 and 2016 was conducted following PRISMA guidelines. Databases including Medline (Ovid), PubMed, Scopus, PsychINFO, CINAHL and the Cochrane Library. Grey literature from key refugee websites were searched. Studies were reviewed for quality and analysed according to the framework outlined in the UNHCR Guidelines on Prevention and Response of Sexual Violence against Refugees. Twenty-nine studies met the inclusion criteria, of which 7 studies addressed prevention, 14 studies response and 8 addressed both. There are limited numbers of rigorously evaluated SV prevention and response interventions available, especially in the context of displacement. However, emerging evidence shows that placing a stronger emphasis on programmes in the category of engagement/participation and training/education has the potential to target underlying causes of SV. SV against female refugees is caused by factors including lack of information and gender inequality. This review suggests that SV interventions that engage community members in their design and delivery, address harmful gender norms through education and advocacy, and facilitate strong cooperation between stakeholders, could maximise the efficient use of limited resources.","DOI":"10.1080/09688080.2017.1401893","ISSN":"1460-9576 0968-8080","note":"PMID: 29214917","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Robbers","given":"Gianna Maxi Leila"},{"family":"Morgan","given":"Alison"}],"issued":{"date-parts":[["2017",11]]}}}],"schema":""} (Robbers & Morgan, 2017). Nonetheless, recommendations based on each of these reviews, which focused on both response and prevention, converge. Murphy and colleagues (2016) contend that the evidence that is available suggests that the most successful programs are multifaceted, address underlying risk factors, and actively engage all community members - not only survivors and/or perpetrators; while Robbers and Morgan suggest that programs emphasising engagement/participation and training/education have the potential to target underlying causes of SV. They argue that interventions that engage community members in their design and delivery also have the potential to address harmful gender norms through education and advocacy and facilitate cooperation between stakeholders (Robbers & Morgan, 2017).Several publications urge a ‘comprehensive’ health approach to SGBV violence in conflict settings although recommended responses often lack detail. In some cases a comprehensive response is conceptualised quite narrowly, as responding to the full range of reproductive health needs of survivors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"feKGIFGb","properties":{"formattedCitation":"(Jewkes, 2007)","plainCitation":"(Jewkes, 2007)","noteIndex":0},"citationItems":[{"id":2689,"uris":[""],"uri":[""],"itemData":{"id":2689,"type":"article-journal","title":"Comprehensive response to rape needed in conflict settings.","container-title":"The Lancet","page":"2140-2141","volume":"369","issue":"9580","abstract":"Comments on an article by Paul B. Spiegel and colleagues (see record 2007-10917-006). The authors draw together a substantial amount of data for prevalence of HIV infection in conflict and refugee settings to empirically test the assumption about HIV spread in conflict areas. Their conclusion that there are insufficient data to support assertions that conflict and forced displacement increase HIV prevalence challenges the conventional wisdom. Their conclusions are a salient reminder of the value of interrogating assumptions about the HIV epidemic that are often taken as common knowledge. They remind us of the need for nuance in our understanding of the dynamics of sexual behavior and HIV transmission. They provide a further reminder of the need for rape services to be situated within comprehensive sexual and reproductive health-care services, rather than overly emphasizing prevention of HIV infection. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1016/S0140-6736%2807%2960991-X","ISSN":"0140-6736","author":[{"family":"Jewkes","given":"Rachel"}],"editor":[{"family":"Jewkes","given":"Jewkes","suffix":"Nduna, Spiegel, Vlachova"}],"issued":{"date-parts":[["2007"]]}}}],"schema":""} (Jewkes, 2007), or focusing on providing a variety of ‘safe shelter types’ ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7mFOLypz","properties":{"formattedCitation":"(Freccero, 2015)","plainCitation":"(Freccero, 2015)","noteIndex":0},"citationItems":[{"id":625,"uris":[""],"uri":[""],"itemData":{"id":625,"type":"article-journal","title":"Sheltering displaced persons from sexual and gender-based violence","container-title":"Forced Migration Review","page":"55","issue":"50","ISSN":"1460-9819","journalAbbreviation":"Forced Migration Review","author":[{"family":"Freccero","given":"Julie"}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (Freccero, 2015). Other authors recommend a broader approach. Critiquing intrapersonal interventions to address Syrian refugee women’s health needs, Yasmine and Moughalian ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6nPPslUO","properties":{"formattedCitation":"(2016)","plainCitation":"(2016)","noteIndex":0},"citationItems":[{"id":3229,"uris":[""],"uri":[""],"itemData":{"id":3229,"type":"article-journal","title":"Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions.","container-title":"Reproductive health matters","page":"27-35","volume":"24","issue":"47","abstract":"Since the uprising in Syria in March 2011, over 4.3 million Syrians have fled to neighboring countries. Over a million have sought refuge in Lebanon, constituting almost a quarter of the Lebanese population and becoming the largest refugee population per capita in the world. With inequitable health coverage being a longstanding problem in Lebanon, Syrian refugee women's health, and specifically their sexual and reproductive health, is disproportionately affected. An increase in gender-based violence and early marriage, a lack of access to emergency obstetric care, limited access to contraception, forced cesarean sections, and high cost of healthcare services, all contribute to poor sexual and reproductive health. In this commentary, we conceptualize violence against Syrian refugee women using the ecological model, exploring the intersections of discrimination based on ethnicity, gender, and socioeconomic status, while critiquing interventions that focus solely on the intrapersonal level and ignore the role of microsystemic, exosystemic, and macrosystemic factors of negative influence. These social determinants of health supersede the individual realm of health behavior, and hinder women in taking decisions about their sexual and reproductive health.","DOI":"10.1016/j.rhm.2016.04.008","ISSN":"1460-9576 0968-8080","note":"PMID: 27578336","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Yasmine","given":"Rola"},{"family":"Moughalian","given":"Catherine"}],"issued":{"date-parts":[["2016",5]]}},"suppress-author":true}],"schema":""} (2016) argue that systemic violence must be tackled using an ecological and intersectional approach. Designing interventions that target microsystemic, organisational, institutional, environmental, economic, and policy levels, plays a pivotal role in enhancing individual refugee health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"OTDxROon","properties":{"formattedCitation":"(Yasmine & Moughalian, 2016)","plainCitation":"(Yasmine & Moughalian, 2016)","noteIndex":0},"citationItems":[{"id":3229,"uris":[""],"uri":[""],"itemData":{"id":3229,"type":"article-journal","title":"Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions.","container-title":"Reproductive health matters","page":"27-35","volume":"24","issue":"47","abstract":"Since the uprising in Syria in March 2011, over 4.3 million Syrians have fled to neighboring countries. Over a million have sought refuge in Lebanon, constituting almost a quarter of the Lebanese population and becoming the largest refugee population per capita in the world. With inequitable health coverage being a longstanding problem in Lebanon, Syrian refugee women's health, and specifically their sexual and reproductive health, is disproportionately affected. An increase in gender-based violence and early marriage, a lack of access to emergency obstetric care, limited access to contraception, forced cesarean sections, and high cost of healthcare services, all contribute to poor sexual and reproductive health. In this commentary, we conceptualize violence against Syrian refugee women using the ecological model, exploring the intersections of discrimination based on ethnicity, gender, and socioeconomic status, while critiquing interventions that focus solely on the intrapersonal level and ignore the role of microsystemic, exosystemic, and macrosystemic factors of negative influence. These social determinants of health supersede the individual realm of health behavior, and hinder women in taking decisions about their sexual and reproductive health.","DOI":"10.1016/j.rhm.2016.04.008","ISSN":"1460-9576 0968-8080","note":"PMID: 27578336","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Yasmine","given":"Rola"},{"family":"Moughalian","given":"Catherine"}],"issued":{"date-parts":[["2016",5]]}}}],"schema":""} (Yasmine & Moughalian, 2016). Similarly, a number of authors conclude that humanitarian organisations must attend to the medical, psychological and social impacts of sexual, violence with multi-sectoral and multi-level interventions. These include health and legal responses, physical design for increased safety, increased leadership, data collection and evidence-based programming. Social and service delivery barriers to reporting and documenting cases and accessing care must also be addressed ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kd5WgBW4","properties":{"formattedCitation":"(Marsh, Purdin, & Navani, 2006; Samari, 2017; Shanks & Schull, 2000)","plainCitation":"(Marsh, Purdin, & Navani, 2006; Samari, 2017; Shanks & Schull, 2000)","noteIndex":0},"citationItems":[{"id":3006,"uris":[""],"uri":[""],"itemData":{"id":3006,"type":"article-journal","title":"Addressing sexual violence in humanitarian emergencies.","container-title":"Global public health","page":"133-146","volume":"1","issue":"2","abstract":"Sexual violence is a by-product of conflict commonly seen, but poorly addressed, in humanitarian emergencies. Reports reveal that extraordinary numbers of women and girls suffer physical, psychological, and social consequences of sexual violence during conflict, when fleeing conflict, and during displacement. All sectors of the humanitarian community have a role to play in the prevention of and response to sexual violence. Improvements are needed: in the short-term to meet the needs of survivors of sexual violence; in collecting data related to sexual violence in humanitarian emergencies; and, perhaps most importantly, to address the widespread tolerance for high rates of sexual violence in humanitarian settings.","DOI":"10.1080/17441690600652787","ISSN":"1744-1706 1744-1692","note":"PMID: 19153902","journalAbbreviation":"Glob Public Health","language":"eng","author":[{"family":"Marsh","given":"M."},{"family":"Purdin","given":"S."},{"family":"Navani","given":"S."}],"issued":{"date-parts":[["2006"]]}}},{"id":548,"uris":[""],"uri":[""],"itemData":{"id":548,"type":"article-journal","title":"Syrian Refugee Women's Health in Lebanon, Turkey, and Jordan and Recommendations for Improved Practice.","container-title":"World medical & health policy","page":"255-274","volume":"9","issue":"2","abstract":"Since 2011, an estimated nine million Syrian refugees have fled to neighboring countries, and over four million have fled to neighboring countries of Lebanon, Turkey, and Jordan. Seventy five percent of Syrian refugees are women and children. In times of conflict, women's health disproportionately suffers. Based on an assessment of academic literature and international policy and development reports, this study explores the vulnerabilities of Syrian women and girls in Lebanon, Turkey, and Jordan, and how these countries approach Syrian refugee women's health care. In all settings, sexual and gender-based violence, reduced use of modern contraceptives, menstrual irregularity, unplanned pregnancies, preterm birth, and infant morbidity are ongoing issues. Recommendations for improved practice include taking a multilevel approach to eliminate social and service delivery barriers that prevent access to care, conducting thorough needs assessments, and creating policy and programmatic solutions that establish long term care for Syrian refugee women.","DOI":"10.1002/wmh3.231","ISSN":"2153-2028","note":"Samari, Goleen. Population Research Center at the University of Texas at Austin.","journalAbbreviation":"World med. health policy","author":[{"family":"Samari","given":"Goleen"}],"issued":{"date-parts":[["2017"]]}}},{"id":3087,"uris":[""],"uri":[""],"itemData":{"id":3087,"type":"article-journal","title":"Rape in war: the humanitarian response.","container-title":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","page":"1152-1156","volume":"163","issue":"9","abstract":"Women and children are vulnerable to sexual violence in times of conflict, and the risk persists even after they have escaped the conflict area. The impact of rape goes far beyond the immediate effects of the physical attack and has long-lasting consequences. We describe the humanitarian community's response to sexual violence and rape in times of war and civil unrest by drawing on the experiences of Medecins Sans Frontieres/Doctors Without Borders and other humanitarian agencies. Health care workers must have a keen awareness of the problem and be prepared to respond appropriately. This requires a comprehensive intervention protocol, including antibiotic prophylaxis, emergency contraception, referral for psychological support, and proper documentation and reporting procedures. Preventing widespread sexual violence requires increasing the security in refugee camps. It also requires speaking out and holding states accountable when violations of international law occur. The challenge is to remain alert to these often hidden, but extremely destructive, crimes in the midst of a chaotic emergency relief setting.","ISSN":"0820-3946 0820-3946","note":"PMID: 11079062 \nPMCID: PMC80250","journalAbbreviation":"CMAJ","language":"eng","author":[{"family":"Shanks","given":"L."},{"family":"Schull","given":"M. J."}],"issued":{"date-parts":[["2000",10,31]]}}}],"schema":""} (Marsh, Purdin, & Navani, 2006; Samari, 2017; Shanks & Schull, 2000). A review specifically focused on the rehabilitation needs of girl child soldiers - whose experiences have commonly included SGBV - makes a similar range of recommendations with a focus on prevention as the priority through legal responses and coordinated advocacy at local, national and international levels. The review also recommends provision of viable alternatives to enlisting through education and income generating activities. This study also highlights the importance of indigenous forms of mental health therapy and the need to work with families and community leaders to improve reintegration and acceptance post-conflict ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"s9EmJIIp","properties":{"formattedCitation":"(Stevens, 2014)","plainCitation":"(Stevens, 2014)","noteIndex":0},"citationItems":[{"id":3252,"uris":[""],"uri":[""],"itemData":{"id":3252,"type":"article-journal","title":"The invisible soldiers: understanding how the life experiences of girl child soldiers impacts upon their health and rehabilitation needs.","container-title":"Archives of disease in childhood","page":"458-462","volume":"99","issue":"5","abstract":"There are estimated 120,000 girl child soldiers worldwide. Recruitment makes girls vulnerable to the violence of war, torture, psychological trauma and sexual abuse with huge impact on their physical, mental and reproductive health. Despite this, girl soldiers often remain an invisible and marginalised group frequently neglected from disarmament, demobilisation and reintegration programmes. This is not just a local issue: with former child soldiers seeking asylum as refugees there is an increasing need for health workers in the destination countries to understand their health needs in order to inform appropriate holistic service provision. This review provides an overview of how the duties and life experiences of girl soldiers, including gender-specific abuses, impacts upon their health and concludes with a summary of recommendations as to how their rehabilitation needs can be addressed.","DOI":"10.1136/archdischild-2013-305240","ISSN":"1468-2044 0003-9888","note":"PMID: 24397926","journalAbbreviation":"Arch Dis Child","language":"eng","author":[{"family":"Stevens","given":"Amy Jane"}],"issued":{"date-parts":[["2014",5]]}}}],"schema":""} (Stevens, 2014).A rare paper offering guidance for the care and support needs of male survivors of conflict-related sexual violence raises additional themes describing such violence as intended to produce emasculation, feminisation, ‘homosexualisation’, and demonization resulting in shame, confusion, guilt, fear and isolation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"X5mNmEdv","properties":{"formattedCitation":"(Russell, Hilton, & Peel, 2010)","plainCitation":"(Russell, Hilton, & Peel, 2010)","noteIndex":0},"citationItems":[{"id":3622,"uris":[""],"uri":[""],"itemData":{"id":3622,"type":"webpage","title":"Care and Support of Male Survivors of Conflict-Related Sexual Violence: Background Paper","URL":"","author":[{"family":"Russell","given":"Wynne"},{"family":"Hilton","given":"Alastair"},{"family":"Peel","given":"Michael"}],"issued":{"date-parts":[["2010"]]}}}],"schema":""} (Russell, Hilton, & Peel, 2010) . The authors recommend public information campaigns, establishment of generic drop-in centres for boys, safe spaces, telephone helplines, psychological interventions, service provider training, and different gender translators. ResettlementThree of the six papers included in this section focused primarily on the need to reform legal and policy frameworks in order to improve responses to SGBV faced by refugee women ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Nr6NY7A2","properties":{"formattedCitation":"(Freedman, Jamal, & Euro-Middelhav Menneskerettigheds Netv\\uc0\\u230{}rket, 2008; Keygnaert & Guieu, 2015; Liew, 2015)","plainCitation":"(Freedman, Jamal, & Euro-Middelhav Menneskerettigheds Netv?rket, 2008; Keygnaert & Guieu, 2015; Liew, 2015)","noteIndex":0},"citationItems":[{"id":1044,"uris":[""],"uri":[""],"itemData":{"id":1044,"type":"book","title":"Violence against migrant and refugee women: in the Euromed region : case studies: France, Italy, Egypt & Morocco","publisher":"Euro-Mediterranean Human Rights Network","publisher-place":"Copenhagen","source":"Open WorldCat","event-place":"Copenhagen","ISBN":"978-87-91224-28-7","note":"OCLC: 467137985","title-short":"Violence against migrant and refugee women","language":"en","author":[{"family":"Freedman","given":"Jane"},{"family":"Jamal","given":"Bahija"},{"literal":"Euro-Middelhav Menneskerettigheds Netv?rket"}],"issued":{"date-parts":[["2008"]]}}},{"id":2803,"uris":[""],"uri":[""],"itemData":{"id":2803,"type":"article-journal","title":"What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants.","container-title":"Reproductive health matters","page":"45-55","volume":"23","issue":"46","abstract":"In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply 'tunnel vision'. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants' legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an 'outsider' and 'female only' issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.","DOI":"10.1016/j.rhm.2015.11.002","ISSN":"1460-9576 0968-8080","note":"PMID: 26718996","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Guieu","given":"Aurore"}],"issued":{"date-parts":[["2015",11]]}}},{"id":3010,"uris":[""],"uri":[""],"itemData":{"id":3010,"type":"article-journal","title":"Taking it personally: Delimiting gender-based refugee claims using the complementary protection provision in Canada","container-title":"Canadian Journal of Women and the Law","page":"300-329","volume":"26","issue":"2","archive":"Scopus","abstract":"Random violence and general criminal risk-decision makers evaluating refugee claims are characterizing violence against women in this manner. The reduction of gendered violence, leading to the denial of refugee claims, occurs under the covert operation of Canada's consolidated refugee definition. Canada has received accolades for recognizing gender-related persecution. Since this recognition, Canada has consolidated its refugee definition, legislating a \"complementary protection provision \" in the Immigration and Refugee Protection Act. Prior to 2002, risk assessments done just prior to the removal of persons asked whether persons would be returned to torture or cruel and unusual punishment. In 2002, this assessment was included in the refugee determination process. There has been little evaluation of this provision since then. This article examines the performative functions of Canada 's complementary protection and finds the provision delimits gender-related claims in three ways. First, it does not fill the gaps left by the enumerated grounds system. Second, the provision encourages the production of harmful discourse on violence against women. Finally, it encourages decision makers to conflate the separate analyses (enumerated grounds and the complementary protection schemes), erroneously allowing factors such as the universality of oppression or violence to erode the enumerated grounds regime.","DOI":"10.1353/jwl.2014.0013","author":[{"family":"Liew","given":"J.C.Y."}],"issued":{"date-parts":[["2015"]]}}}],"schema":""} (Freedman, Jamal, & Euro-Middelhav Menneskerettigheds Netv?rket, 2008; Keygnaert & Guieu, 2015; Liew, 2015). Based on case studies of the situation of refugee women in France, Italy, Egypt and Morocco, Freedman and Jamal (2008) recommend that policies and legislation to fight violence against women both at national and at EU levels should include specific measures to tackle violence against migrant and refugee women and enable them to receive appropriate support – employing other migrant and refuge women as interpreters and mediators for example. These measures should consider the specificities of migrant and refugee women’s situation, particularly their legal situation within the country, and should ensure the primacy of basic human rights (protection from violence) over immigration status ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IC9g39zi","properties":{"formattedCitation":"(Freedman et al., 2008)","plainCitation":"(Freedman et al., 2008)","noteIndex":0},"citationItems":[{"id":1044,"uris":[""],"uri":[""],"itemData":{"id":1044,"type":"book","title":"Violence against migrant and refugee women: in the Euromed region : case studies: France, Italy, Egypt & Morocco","publisher":"Euro-Mediterranean Human Rights Network","publisher-place":"Copenhagen","source":"Open WorldCat","event-place":"Copenhagen","ISBN":"978-87-91224-28-7","note":"OCLC: 467137985","title-short":"Violence against migrant and refugee women","language":"en","author":[{"family":"Freedman","given":"Jane"},{"family":"Jamal","given":"Bahija"},{"literal":"Euro-Middelhav Menneskerettigheds Netv?rket"}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Freedman et al., 2008). Keygnaert and Guieu (2015) are also critical of European legal and policy frameworks, which, they argue, apply too narrow a scope regarding sexual violence, focusing solely on female victimisation and ignoring vulnerable groups such as LGBTI, undocumented migrants and sex workers. Policy documents that they analysed, also focused predominantly on sexual violence in countries or cultures of origin (eg. sexual violence in war, torture, trafficking and FGM) while ignoring vulnerability to violence following migration to Europe ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"M8Aiy2wQ","properties":{"formattedCitation":"(Keygnaert & Guieu, 2015)","plainCitation":"(Keygnaert & Guieu, 2015)","noteIndex":0},"citationItems":[{"id":2803,"uris":[""],"uri":[""],"itemData":{"id":2803,"type":"article-journal","title":"What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants.","container-title":"Reproductive health matters","page":"45-55","volume":"23","issue":"46","abstract":"In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply 'tunnel vision'. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants' legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an 'outsider' and 'female only' issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.","DOI":"10.1016/j.rhm.2015.11.002","ISSN":"1460-9576 0968-8080","note":"PMID: 26718996","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Guieu","given":"Aurore"}],"issued":{"date-parts":[["2015",11]]}}}],"schema":""} (Keygnaert & Guieu, 2015).Liew ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ul0ZSdWe","properties":{"formattedCitation":"(2015)","plainCitation":"(2015)","noteIndex":0},"citationItems":[{"id":3010,"uris":[""],"uri":[""],"itemData":{"id":3010,"type":"article-journal","title":"Taking it personally: Delimiting gender-based refugee claims using the complementary protection provision in Canada","container-title":"Canadian Journal of Women and the Law","page":"300-329","volume":"26","issue":"2","archive":"Scopus","abstract":"Random violence and general criminal risk-decision makers evaluating refugee claims are characterizing violence against women in this manner. The reduction of gendered violence, leading to the denial of refugee claims, occurs under the covert operation of Canada's consolidated refugee definition. Canada has received accolades for recognizing gender-related persecution. Since this recognition, Canada has consolidated its refugee definition, legislating a \"complementary protection provision \" in the Immigration and Refugee Protection Act. Prior to 2002, risk assessments done just prior to the removal of persons asked whether persons would be returned to torture or cruel and unusual punishment. In 2002, this assessment was included in the refugee determination process. There has been little evaluation of this provision since then. This article examines the performative functions of Canada 's complementary protection and finds the provision delimits gender-related claims in three ways. First, it does not fill the gaps left by the enumerated grounds system. Second, the provision encourages the production of harmful discourse on violence against women. Finally, it encourages decision makers to conflate the separate analyses (enumerated grounds and the complementary protection schemes), erroneously allowing factors such as the universality of oppression or violence to erode the enumerated grounds regime.","DOI":"10.1353/jwl.2014.0013","author":[{"family":"Liew","given":"J.C.Y."}],"issued":{"date-parts":[["2015"]]}},"suppress-author":true}],"schema":""} (2015) examines gender-based claims for protection by asylum seekers under Complementary Protection provisions in Canadian law. His analysis suggests that this provision erroneously limits successful protection claims as it fails to fill gaps in grounds for protection under the Refugee Convention and simultaneously encourages harmful discourse on violence against women.Three evidence reviews focused on intimate partner violence in resettlement settings and provided recommendations for practice. James ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NwRedPi1","properties":{"formattedCitation":"(2010)","plainCitation":"(2010)","noteIndex":0},"citationItems":[{"id":2691,"uris":[""],"uri":[""],"itemData":{"id":2691,"type":"article-journal","title":"Domestic violence within refugee families: Intersecting patriarchal culture and the refugee experience.","container-title":"ANZJFT Australian and New Zealand Journal of Family Therapy","collection-title":"Australian and New Zealand Journal of Family Therapy, Australian Journal of Family Therapy","page":"275-284","volume":"31","issue":"Health & Mental Health Services [3370]","abstract":"This article examines the stages of the refugee journey and the intersections of domestic violence with culture, trauma, resettlement and masculinity. Arguing that therapists must challenge aspects of culture that promote violations of women's human rights while understanding the unique situation of refugee families, the article concludes by identifying principles for therapeutic and community based interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1375/anft.31.3.275","ISSN":"0814-723X","author":[{"family":"James","given":"Kerrie"}],"editor":[{"family":"Almeida","given":"Farmer","suffix":"Jaji, James, Meetoo, Pease, Pittaway, Pittaway, Sokoloff"}],"issued":{"date-parts":[["2010"]]}},"suppress-author":true}],"schema":""} (2010) lists principles that are fundamental to working with refugees in a therapeutic setting as trust, confidentiality, flexibility, self-determination, and empowerment. Community-led approaches that ‘honour cultural differences while challenging abuse’ are also recommended ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yAkyoTGX","properties":{"formattedCitation":"(James, 2010, p. 282)","plainCitation":"(James, 2010, p. 282)","noteIndex":0},"citationItems":[{"id":2691,"uris":[""],"uri":[""],"itemData":{"id":2691,"type":"article-journal","title":"Domestic violence within refugee families: Intersecting patriarchal culture and the refugee experience.","container-title":"ANZJFT Australian and New Zealand Journal of Family Therapy","collection-title":"Australian and New Zealand Journal of Family Therapy, Australian Journal of Family Therapy","page":"275-284","volume":"31","issue":"Health & Mental Health Services [3370]","abstract":"This article examines the stages of the refugee journey and the intersections of domestic violence with culture, trauma, resettlement and masculinity. Arguing that therapists must challenge aspects of culture that promote violations of women's human rights while understanding the unique situation of refugee families, the article concludes by identifying principles for therapeutic and community based interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1375/anft.31.3.275","ISSN":"0814-723X","author":[{"family":"James","given":"Kerrie"}],"editor":[{"family":"Almeida","given":"Farmer","suffix":"Jaji, James, Meetoo, Pease, Pittaway, Pittaway, Sokoloff"}],"issued":{"date-parts":[["2010"]]}},"locator":"282"}],"schema":""} (James, 2010, p. 282). Other authors note that refugee’s experiences of domestic violence is often accompanied by social and economic marginalisation, underscoring their need for social support, information, and culturally competent assistance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"MXqck7fl","properties":{"formattedCitation":"(Bhuyan & Senturia, 2005)","plainCitation":"(Bhuyan & Senturia, 2005)","noteIndex":0},"citationItems":[{"id":1027,"uris":[""],"uri":[""],"itemData":{"id":1027,"type":"article-journal","title":"Understanding domestic violence resource utilization and survivor solutions among immigrant and refugee women: introduction to the special issue.","container-title":"Journal of interpersonal violence","page":"895-901","volume":"20","issue":"8","ISSN":"0886-2605","note":"Bhuyan, Rupaleem. University of Washington, USA.","journalAbbreviation":"J Interpers Violence","author":[{"family":"Bhuyan","given":"Rupaleem"},{"family":"Senturia","given":"Kirsten"}],"issued":{"date-parts":[["2005"]]}}}],"schema":""} (Bhuyan & Senturia, 2005). Bilingual and bicultural services, community outreach and involvement, language classes and male-behaviour-change program are amongst recommendations for provision of culturally appropriate supports in these settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"CPxMUdYM","properties":{"formattedCitation":"(Bhuyan & Senturia, 2005; Taft, Small, & Hoang, 2008)","plainCitation":"(Bhuyan & Senturia, 2005; Taft, Small, & Hoang, 2008)","noteIndex":0},"citationItems":[{"id":1027,"uris":[""],"uri":[""],"itemData":{"id":1027,"type":"article-journal","title":"Understanding domestic violence resource utilization and survivor solutions among immigrant and refugee women: introduction to the special issue.","container-title":"Journal of interpersonal violence","page":"895-901","volume":"20","issue":"8","ISSN":"0886-2605","note":"Bhuyan, Rupaleem. University of Washington, USA.","journalAbbreviation":"J Interpers Violence","author":[{"family":"Bhuyan","given":"Rupaleem"},{"family":"Senturia","given":"Kirsten"}],"issued":{"date-parts":[["2005"]]}}},{"id":730,"uris":[""],"uri":[""],"itemData":{"id":730,"type":"article-journal","title":"Intimate partner violence in Vietnam and among Vietnamese diaspora communities in western societies: A comprehensive review.","container-title":"Special Issue: Innovative approaches to family violence","collection-title":"Australian Journal of Marriage & Family, Australian Journal of Sex, Marriage & Family","page":"167-182","volume":"14","issue":"Social Processes & Social Issues [2900]","abstract":"Informal observations in Australian refuge/shelter services suggest that culturally and linguistically diverse women and children are over-represented in crisis rather than early intervention services. This observation includes Vietnamese women and children escaping intimate partner violence (IPV). There is limited research on the prevalence or characteristics of IPV in Vietnam or their diaspora that sheds light on the role played by immigration, acculturation, gender roles and other factors affecting Vietnamese victims' help-seeking strategies. Such knowledge can inform innovative responses to reduce IPV among Vietnamese families. We searched electronic databases and websites using keyword terms for 'intimate partner/family violence' and 'Viet'*. The review found that Vietnamese victims and perpetrators of IPV share major similarities with those globally, especially the socio-economic determinants and sequelae of IPV. However, immigration and refugee status confer particular stressors. The review highlights the important bridging role of bilingual and bicultural staff and other emerging and promising directions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","DOI":"10.5172/jfs.327.14.2-3.167","ISSN":"1322-9400","author":[{"family":"Taft","given":"Angela J"},{"family":"Small","given":"Rhonda"},{"family":"Hoang","given":"Kim A"}],"editor":[{"family":"Baba","given":""}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Bhuyan & Senturia, 2005; Taft, Small, & Hoang, 2008).SummaryMany of the papers reviewed in this section highlight the lack of evidence for the effectiveness and impact of responses to SGBV experienced by refugee populations either in conflict and displacement settings or in resettlement contexts. Based on the evidence there is however, almost all authors stress the need for provision of multi-sectoral, multi-faceted responses explicitly (or implicitly) based on an ecological and intersectional understanding of the causes and consequences SGBV. Thus, recommended interventions are to provide culturally appropriate individual care and treatment as well as to engage with families, communities, and legal and policy frameworks. Attending to underlying social and economic marginalisation and empowerment of women and girls is also recommended. Studies with recommendations for response based on primary data collectionPublications included in this section are based on studies comprising primary data collection with SGBV survivors and/or service providers that included recommendations for responses. Two studies were carried out in conflict or immediate post-conflict settings; nine studies were concerned with displacement settings; and nine studies were conducted in resettlement settings.Conflict settings Two of the included studies were carried out in (conflict or immediate post-conflict) settings. Mootz and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Ex2W4zHJ","properties":{"formattedCitation":"(2017)","plainCitation":"(2017)","noteIndex":0},"citationItems":[{"id":3188,"uris":[""],"uri":[""],"itemData":{"id":3188,"type":"article-journal","title":"Gender-Based Violence and Armed Conflict: A Community-Informed Socioecological Conceptual Model From Northeastern Uganda","container-title":"Psychology of Women Quarterly","page":"368-388","volume":"41","issue":"3","archive":"Scopus","abstract":"The high prevalence of gender-based violence (GBV) in armed conflict has been documented in various national contexts, but less is known about the complex pathways that constitute the relation between the two. Employing a community-based collaborative approach, we constructed a community-informed socioecological conceptual model from a feminist perspective, detailing how armed conflict relates to GBV in a conflict-affected rural community in Northeastern Uganda. The research questions were as follows: (1) How does the community conceptualize GBV? and (2) How does armed conflict relate to GBV? Nine focus group discussions divided by gender, age, and profession and six key informant interviews were conducted. Participants’ ages ranged from 9 to 80 years (n = 34 girls/women, n = 43 boys/men). Grounded theory was used in analysis. Participants conceptualized eight forms of and 22 interactive variables that contributed to GBV. Armed conflict affected physical violence/quarreling, sexual violence, early marriage, and land grabbing via a direct pathway and four indirect pathways initiated through looting of resources, militarization of the community, death of a parent(s) or husband, and sexual violence. The findings suggest that community, organizational, and policy-level interventions, which include attention to intersecting vulnerabilities for exposure to GBV in conflict-affected settings, should be prioritized. While tertiary psychological interventions with women and girls affected by GBV in these areas should not be eliminated, we suggest that policy makers and members of community and organizational efforts make systemic and structural changes. Online slides for instructors who want to use this article for teaching are available on PWQ's website at . ? 2017, ? The Author(s) 2017.","DOI":"10.1177/0361684317705086","author":[{"family":"Mootz","given":"J.J."},{"family":"Stabb","given":"S.D."},{"family":"Mollen","given":"D."}],"issued":{"date-parts":[["2017"]]}},"suppress-author":true}],"schema":""} (2017) conducted focus group discussions and key informant interviews with girls and women (n=34) and boys and men (n= 43) in a conflict-affected region of north-eastern Uganda. They found that SGBV was ubiquitous, with poverty and being widowed constituting intersecting vulnerabilities. Women who were victims of sexual violence frequently then suffered further domestic physical violence. The authors recommended community, organisational, and policy-level interventions, which include attention to intersecting vulnerabilities in addition to psychological interventions for affected women and girls ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6Vb64lir","properties":{"formattedCitation":"(Mootz et al., 2017)","plainCitation":"(Mootz et al., 2017)","noteIndex":0},"citationItems":[{"id":3188,"uris":[""],"uri":[""],"itemData":{"id":3188,"type":"article-journal","title":"Gender-Based Violence and Armed Conflict: A Community-Informed Socioecological Conceptual Model From Northeastern Uganda","container-title":"Psychology of Women Quarterly","page":"368-388","volume":"41","issue":"3","archive":"Scopus","abstract":"The high prevalence of gender-based violence (GBV) in armed conflict has been documented in various national contexts, but less is known about the complex pathways that constitute the relation between the two. Employing a community-based collaborative approach, we constructed a community-informed socioecological conceptual model from a feminist perspective, detailing how armed conflict relates to GBV in a conflict-affected rural community in Northeastern Uganda. The research questions were as follows: (1) How does the community conceptualize GBV? and (2) How does armed conflict relate to GBV? Nine focus group discussions divided by gender, age, and profession and six key informant interviews were conducted. Participants’ ages ranged from 9 to 80 years (n = 34 girls/women, n = 43 boys/men). Grounded theory was used in analysis. Participants conceptualized eight forms of and 22 interactive variables that contributed to GBV. Armed conflict affected physical violence/quarreling, sexual violence, early marriage, and land grabbing via a direct pathway and four indirect pathways initiated through looting of resources, militarization of the community, death of a parent(s) or husband, and sexual violence. The findings suggest that community, organizational, and policy-level interventions, which include attention to intersecting vulnerabilities for exposure to GBV in conflict-affected settings, should be prioritized. While tertiary psychological interventions with women and girls affected by GBV in these areas should not be eliminated, we suggest that policy makers and members of community and organizational efforts make systemic and structural changes. Online slides for instructors who want to use this article for teaching are available on PWQ's website at . ? 2017, ? The Author(s) 2017.","DOI":"10.1177/0361684317705086","author":[{"family":"Mootz","given":"J.J."},{"family":"Stabb","given":"S.D."},{"family":"Mollen","given":"D."}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} (Mootz et al., 2017). A quantitative study conducted in Kosovo collected survey data from 1358 women, finding that 6.1% had been raped or witnessed rape. High rates of PTSD were not however, statistically associated with rape alone. The authors recommended community mobilisation, economic opportunities and inclusion of women in distribution of aid as preventive measures, along with psychosocial and medical interventions for victim survivors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5uCtRbRd","properties":{"formattedCitation":"(Hynes & Cardozo, 2000)","plainCitation":"(Hynes & Cardozo, 2000)","noteIndex":0},"citationItems":[{"id":3101,"uris":[""],"uri":[""],"itemData":{"id":3101,"type":"article-journal","title":"Observations from the CDC: Sexual violence against refugee women.","container-title":"Journal of Women's Health & Gender-Based Medicine","collection-title":"Journal of Women's Health","page":"819-823","volume":"9","issue":"8","abstract":"Focuses on the issue of sexual violence, its prevalence in refugee settings, health consequences of sexual violence, and what measures health professionals working with refugee populations can take. Topics discussed include who the perpetrators are, prevalence of sexual violence against women in times of conflict and displacement, constraints in assessing sexual violence in refugee women, health consequences, confounding factors, Center for Disease Control and Prevention's (CDC's) sexual violence research among refugee women, prevention and response to sexual violence, research solutions, and future studies in gender-based violence in refugee settings at the CDC. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1089/152460900750020847","ISSN":"1524-6094","author":[{"family":"Hynes","given":"Michelle"},{"family":"Cardozo","given":"Barbara Lopes"}],"editor":[{"family":"Bracken","given":"Brownmiller","suffix":"Frijak, Heise, Heise, Heise, Kirk, Koss, Kozaric-Kovacic, Lopes Cardoza, Lunde, Swiss, Swiss, Tjaden"}],"issued":{"date-parts":[["2000"]]}}}],"schema":""} (Hynes & Cardozo, 2000). Displacement settings Three quantitative survey studies focused on the correlates and consequences of intimate partner violence (IPV) in refugee camps and urban refugee settings. Two of these studies were conducted by the same researcher in Jordan with Palestinian refugees ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"P42ZwRBp","properties":{"formattedCitation":"(Al-Modallal, 2012, 2016)","plainCitation":"(Al-Modallal, 2012, 2016)","noteIndex":0},"citationItems":[{"id":840,"uris":[""],"uri":[""],"itemData":{"id":840,"type":"article-journal","title":"Patterns of coping with partner violence: experiences of refugee women in Jordan.","container-title":"Public health nursing (Boston, Mass.)","page":"403-11","volume":"29","issue":"5","abstract":"OBJECTIVE: The relationship between intimate partner violence (IPV) and women's use of negative and positive coping strategies was investigated., DESIGN AND SAMPLE: For this cross-sectional study, a convenience sample of 300 refugee women was recruited from health care centers in three cities in Jordan. Logistic regression adjusted to women's demographic characteristics was used., RESULTS: The study's results revealed that, compared to non victims, victimized women showed a lower tendency to receive psychological support from the family (adjusted OR = 0.53, 95% CI = 0.29-0.96), to smoke (adjusted OR = 0.28, 95% CI = 0.09-0.82), to use tranquilizers (adjusted OR = 0.014, 95% CI = 0.00-0.86), to think of suicide (adjusted OR = 0.04, 95% CI = 0.009-0.15), and to attempt suicidal actions (adjusted OR = 0.02, 95% CI = 0.002-0.19)., CONCLUSIONS: The study indicated that women's lack of use of negative coping strategies (smoking, use of tranquilizers, suicidal thoughts, and suicidal actions) was promising. However, lack of use of positive coping stragies, such disclosure of abuse, support from friends, and help from familthe lack of use of positive coping strategies (disclosure of abuse, psychologicy/friends) was somewhat concerning. The role of health care professionals may be helpful in this context. Counseling and support to IPV victims via effective listening, nonjudgmental discussions, and provision of information can be offered by health professionals as part of the treatment in health care centers.Copyright ? 2012 Wiley Periodicals, Inc.","DOI":"10.1111/j.1525-1446.2012.01018.x","ISSN":"1525-1446","note":"Al-Modallal, Hanan. Department of Community and Mental Health Nursing, Hashemite University, Zarqa, Jordan. hmodallal@hu.edu.jo","journalAbbreviation":"Public Health Nurs","author":[{"family":"Al-Modallal","given":"Hanan"}],"issued":{"date-parts":[["2012"]]}}},{"id":2875,"uris":[""],"uri":[""],"itemData":{"id":2875,"type":"article-journal","title":"Effect of intimate partner violence on health of women of Palestinian origin.","container-title":"International nursing review","page":"259-266","volume":"63","issue":"2","abstract":"BACKGROUND: Intimate partner violence is a problem in women who are refugees but the relationship of this violence to physical health has not been studied well. AIM: To identify significant associations between physical health problems and partner violence by type in refugee women. METHODS: For this cross-sectional study, data were collected from a convenience sample of 238 women attending healthcare centres of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) in three Jordanian cities (Amman, Irbid and Zarqa). RESULTS: Victims of violence reported different health problems. However, rates of health problems were higher among victims of psychological partner violence and more health problems had significant associations with psychological violence when compared to physical and sexual partner violence. Furthermore, women's self-rated health status was only significantly associated with psychological partner violence but not with the other types of partner violence. CONCLUSION: Vulnerability to partner violence is related to life stressors women may encounter. Physical health is a fundamental target for psychological partner violence; evidenced by the resultant wide range of health problems in victims. This association occurs although psychological violence is not associated with health trauma/injury that physical and sexual partner violence usually generate. This conclusion highlights one aspect of the associated harm of psychological partner violence in victims' lives. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Empowerment of women socially, economically and psychologically, in collaboration with related community parties, should be an adopted international health policy by the governments. Screening policy for partner violence should be integrated with health and nursing services. Nurses are in a position to facilitate the implementation of health policy. Their role include helping women identify resources of help, develop required skills necessary for dealing with violence and identify their social support network. LIMITATIONS: Social desirability and use of convenience sampling are major limitations of the study.","DOI":"10.1111/inr.12239","ISSN":"1466-7657 0020-8132","note":"PMID: 26791470","journalAbbreviation":"Int Nurs Rev","language":"eng","author":[{"family":"Al-Modallal","given":"Hanan"}],"issued":{"date-parts":[["2016",6]]}}}],"schema":""} (Al-Modallal, 2012, 2016) finding low use of either positive or negative coping strategies and higher rates of physical health problems for victims of psychological violence than for victims of physical or sexual violence. A study surveying Eritrean women in a refugee camp in Ethiopia found high rates of violence linked to knowing other victims, being a farmer, having a ‘drunkard’ partner and being Muslim ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fMrLJ7qm","properties":{"formattedCitation":"(Feseha, G/mariam, & Gerbaba, 2012)","plainCitation":"(Feseha, G/mariam, & Gerbaba, 2012)","noteIndex":0},"citationItems":[{"id":2829,"uris":[""],"uri":[""],"itemData":{"id":2829,"type":"article-journal","title":"Intimate partner physical violence among women in Shimelba refugee camp, northern Ethiopia.","container-title":"BMC public health","page":"125","volume":"12","abstract":"BACKGROUND: Domestic violence has unwanted effects on the physical and psychological well-being of women, which have been recognized globally as an important public health problem. Violence perpetrated by intimate partner is one form of domestic violence, a serious human rights abuse and a public health issue, among refugees owing to its substantial consequences for women's physical, mental and reproductive health problems. Because the incidents are under-reported, the true scale of the problem is unknown and unexamined among refugee women in Ethiopia. Thus, this study aim to assess the magnitude of intimate partner physical violence and associated factors among women in Shimelba refugee camp, Northern Ethiopia. METHODS: A community-based cross-sectional study was conducted among a sample of 422 refugee women from March to April 2011. A simple random sampling method was used to select the study subjects from seven zones of the refugee camp. Census was done to identify all households with women having an intimate partner. A pre-tested interviewer guided structured questionnaire was used for data collection. Data were entered, cleaned and analyzed using SPSS software version 16.0. Descriptive, bivariate and multivariate logistic regression analyses were done where applicable. A p-value less than 0.05 with 95% CI were set and used as a cut-off point to examine the statistical association between the explanatory and outcome variables. RESULTS: The prevalence of physical violence in the last 12 months and lifetime were 107(25.5%) and 131(31.0%) respectively. The commonest forms of physical violence reported included slapping 101(61.6%) and throwing objects 32(19.5%). Significant risk factors associated with experiencing physical violence were being a farmer (AOR = 3.0[95%CI: 1.7, 5.5]), knowing women in neighborhood whose husband to beat them (AOR = 1.87[95%CI: 1.0, 3.5]), being a Muslim (AOR = 2.4 [95%C.I: 1.107, 5.5]), and having a drunkard partner (AOR = 2.1[95%C.I:1.0, 4.5]). CONCLUSIONS: Intimate partner physical violence was found to be high and a serious problem among women in Shimelba refugee camp. Multifaceted interventions such as male counseling, increasing awareness on the consequences of intimate partner violence and the effect of substance use like alcohol will help to reduce intimate partner violence.","DOI":"10.1186/1471-2458-12-125","ISSN":"1471-2458 1471-2458","note":"PMID: 22340756 \nPMCID: PMC3293014","journalAbbreviation":"BMC Public Health","language":"eng","author":[{"family":"Feseha","given":"Girmatsion"},{"family":"G/mariam","given":"Abebe"},{"family":"Gerbaba","given":"Mulusew"}],"issued":{"date-parts":[["2012",2,13]]}}}],"schema":""} (Feseha, G/mariam, & Gerbaba, 2012). Each of these studies is likely to have been affected by sampling and response biases. They prompted general recommendations (not necessarily arising specifically from the studies’ findings) for IPV screening, awareness raising, counselling and support to victims, male counselling, and for psychological, social and economic empowerment of women. A qualitative study involving focus groups with 157 refugees from various nationalities in Kakuma refugee camp in Kenya explored refugees’ narratives about how IPV was dealt with and how community responses interacted with formal response systems. Community responses did not necessarily result in women receiving protection from violence and only cases regarded as the most serious reached the UNHCR and its implementing partners. Development of a more coordinated response was recommended ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tHVLit7S","properties":{"formattedCitation":"(Horn, 2010)","plainCitation":"(Horn, 2010)","noteIndex":0},"citationItems":[{"id":2703,"uris":[""],"uri":[""],"itemData":{"id":2703,"type":"article-journal","title":"Responses to intimate partner violence in Kakuma refugee camp: Refugee interactions with agency systems.","container-title":"Social Science & Medicine","page":"160-168","volume":"70","issue":"1","abstract":"Intimate partner violence (IPV) has been recognised as a significant problem amongst forcibly displaced communities, and great progress has been made by the United Nations High Commission for Refugees (UNHCR) in responding to IPV and other forms of sexual and gender based violence. However, they have not always effectively engaged refugee communities in these activities, with potentially negative consequences for the health and protection of women. This study was conducted in Kakuma refugee camp, north-west Kenya. Eighteen focus group discussions were conducted with 157 refugees from various nationalities, including Sudanese, Somali, Ethiopian, and Congolese. They focused on the nature and consequences of IPV in Kakuma. The aim of this paper is to explore how refugees in Kakuma talk about the ways that IPV is dealt with, focusing particularly on the ways that community responses are said to interact with formal response systems established by UNHCR and its implementing partners. Refugees talked about using a 'hierarchy of responses' to IPV, with only particularly serious or intransigent cases reaching UNHCR or its implementing agencies. Some male refugees described being mistrustful of agency responses, because agencies were believed to favor women and to prioritise protecting the woman at all costs, even if that means separating her from the family. Whilst community responses to IPV might often be appropriate and helpful, the findings of the current study suggest that in Kakuma they do not necessarily result in the protection of women. Yet women in Kakuma are reported to be reluctant to report their cases to UNHCR and its implementing agencies. A more effective protection response from UNHCR might involve closer co-operation with individuals and structures within the refugee communities to develop a co-ordinated response to IPV. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1016/j.socscimed.2009.09.036","ISSN":"0277-9536","author":[{"family":"Horn","given":"Rebecca"}],"editor":[{"family":"Bhuyan","given":"Callamard","suffix":"Carlson, Crisp, Dobash, Duvvury, Feyissa, Hyder, Kim, Kimmel, Lee, Miller, Mulu, Payne, Rothkegel, Schmidt, Shiu-Thornton, Sullivan, Szczepanikova, Turner, Turton, Wessells, Wilson-Williams"}],"issued":{"date-parts":[["2010"]]}}}],"schema":""} (Horn, 2010). Izugbara and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3CkrIicJ","properties":{"formattedCitation":"(2018)","plainCitation":"(2018)","noteIndex":0},"citationItems":[{"id":3102,"uris":[""],"uri":[""],"itemData":{"id":3102,"type":"article-journal","title":"‘They Say Our Work Is Not Halal’: Experiences and Challenges of Refugee Community Workers Involved in Gender-based Violence Prevention and Care in Dadaab, Kenya","container-title":"Journal of Refugee Studies","page":"fey055-fey055","abstract":"Notwithstanding the growing centrality of refugee community workers (RCWs) in the current response to gender-based violence (GBV) in the Dadaab refugee camps, they remain poorly studied. Using interview data, we explored the work-related experiences and challenges as well as GBV-related beliefs of RCWs. Whilst they demonstrated elevated knowledge of the forms and drivers of GBV in their community, some of the RCWs did not deem early marriage, female genital mutilation and wife-beating to be GBV acts. In their work, RCWs were motivated by compassion for survivors as well as a sense of community service, but they faced challenges such as insecurity; poor pay; opposition and violence by community members; tense relationships with and suspicion by professional providers; and limited skills and preparation in GBV management. RCWs’ GBV-related beliefs and work experiences underscore the challenges of programming in a complex humanitarian space and offer insights for strengthening their contribution in GBV care and service delivery.","ISSN":"0951-6328","journalAbbreviation":"Journal of refugee studies","author":[{"family":"Izugbara","given":"Chimaraoke"},{"family":"Muthuri","given":"Stella"},{"family":"Muuo","given":"Sheru"},{"family":"Egesa","given":"Carolyne"},{"family":"Franchi","given":"Giorgia"},{"family":"Mcalpine","given":"Alys"},{"family":"Bacchus","given":"Loraine"},{"family":"Hossain","given":"Mazeda"}],"issued":{"date-parts":[["2018"]]}},"suppress-author":true}],"schema":""} (2018) interviewed 20 refugee community workers (RCWs) employed in Dadaab refugee camp in Kenya. Their roles included promoting and facilitating access to assistance for survivors of SGBV, facilitating SGBV education campaigns and promoting positive behaviour change regarding SGBV in the community. RCWs demonstrated elevated knowledge of the forms and drivers of SGBV in their community but some did not deem early marriage, FGM and wife-beating to be acts of SGBV. Challenges to their work included insecurity, opposition and violence by community members. The authors concluded that RCWs fulfilled an important function with respect to responses to SGBV and called for interventions to address challenges identified by these workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rjZ9p4fJ","properties":{"formattedCitation":"(Izugbara et al., 2018)","plainCitation":"(Izugbara et al., 2018)","noteIndex":0},"citationItems":[{"id":3102,"uris":[""],"uri":[""],"itemData":{"id":3102,"type":"article-journal","title":"‘They Say Our Work Is Not Halal’: Experiences and Challenges of Refugee Community Workers Involved in Gender-based Violence Prevention and Care in Dadaab, Kenya","container-title":"Journal of Refugee Studies","page":"fey055-fey055","abstract":"Notwithstanding the growing centrality of refugee community workers (RCWs) in the current response to gender-based violence (GBV) in the Dadaab refugee camps, they remain poorly studied. Using interview data, we explored the work-related experiences and challenges as well as GBV-related beliefs of RCWs. Whilst they demonstrated elevated knowledge of the forms and drivers of GBV in their community, some of the RCWs did not deem early marriage, female genital mutilation and wife-beating to be GBV acts. In their work, RCWs were motivated by compassion for survivors as well as a sense of community service, but they faced challenges such as insecurity; poor pay; opposition and violence by community members; tense relationships with and suspicion by professional providers; and limited skills and preparation in GBV management. RCWs’ GBV-related beliefs and work experiences underscore the challenges of programming in a complex humanitarian space and offer insights for strengthening their contribution in GBV care and service delivery.","ISSN":"0951-6328","journalAbbreviation":"Journal of refugee studies","author":[{"family":"Izugbara","given":"Chimaraoke"},{"family":"Muthuri","given":"Stella"},{"family":"Muuo","given":"Sheru"},{"family":"Egesa","given":"Carolyne"},{"family":"Franchi","given":"Giorgia"},{"family":"Mcalpine","given":"Alys"},{"family":"Bacchus","given":"Loraine"},{"family":"Hossain","given":"Mazeda"}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (Izugbara et al., 2018)Two studies focused specifically on reproductive health services. One multi-method project investigated the availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand–Burma border. The authors recommended provider training, education campaigns and organisational information sharing to address low rates of use of ECPs associated with a lack of evidenced-based protocols and misinformation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5CioXWCj","properties":{"formattedCitation":"(Hobstetter, Sietstra, Walsh, Leigh, & Foster, 2015)","plainCitation":"(Hobstetter, Sietstra, Walsh, Leigh, & Foster, 2015)","noteIndex":0},"citationItems":[{"id":2823,"uris":[""],"uri":[""],"itemData":{"id":2823,"type":"article-journal","title":"\"In rape cases we can use this pill\": a multimethods assessment of emergency contraception knowledge, access, and needs on the Thailand-Burma border.","container-title":"International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics","page":"E37-41","volume":"130 Suppl 3","abstract":"OBJECTIVES: To evaluate availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand-Burma border. METHODS: From June 2010 to May 2011 we undertook a multimethods qualitative assessment among cross-border populations, migrants, and refugees. We conducted 46 key informant interviews with representatives from 25 organizations, 18 focus group discussions with migrant adults, migrant adolescents, and healthcare workers, and a service mapping exercise with 22 stakeholders. RESULTS: We found low use of ECPs among the target populations. Structural barriers and lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available in this region. Misinformation about ECPs was widespread among health workers and organizational policies were often non-evidence based. CONCLUSION: Potential policy and program interventions to improve access to ECPs along the Thailand-Burma border include integrating evidence-based practices into community efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border.","DOI":"10.1016/j.ijgo.2015.05.008","ISSN":"1879-3479 0020-7292","note":"PMID: 26140949","journalAbbreviation":"Int J Gynaecol Obstet","language":"eng","author":[{"family":"Hobstetter","given":"Margaret"},{"family":"Sietstra","given":"Cari"},{"family":"Walsh","given":"Meredith"},{"family":"Leigh","given":"Jennifer"},{"family":"Foster","given":"Angel M."}],"issued":{"date-parts":[["2015",8]]}}}],"schema":""} (Hobstetter, Sietstra, Walsh, Leigh, & Foster, 2015). Chynoweth conducted a study in which stories were collected from refugee Iraqi men, women and young people in Jordan to explore their priority reproductive health needs and service gaps. Participants reported high levels of sexual violence, high reproductive health need, and significant service gaps especially coordination of care and prevention of sexual violence. Recommendations included additional funding for services, a focal point to coordinate services, provision of care to survivors of sexual violence, emergency obstetric care, provision of condoms and opportunities for economic participation to reduce poverty ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Clb8nzrT","properties":{"formattedCitation":"(Chynoweth, 2008)","plainCitation":"(Chynoweth, 2008)","noteIndex":0},"citationItems":[{"id":2849,"uris":[""],"uri":[""],"itemData":{"id":2849,"type":"article-journal","title":"The need for priority reproductive health services for displaced Iraqi women and girls.","container-title":"Reproductive health matters","page":"93-102","volume":"16","issue":"31","abstract":"Disregarding reproductive health in situations of conflict or natural disaster has serious consequences, particularly for women and girls affected by the emergency. In an effort to protect the health and save the lives of women and girls in crises, international standards for five priority reproductive health activities that must be implemented at the onset of an emergency have been established for humanitarian actors: humanitarian coordination, prevention of and response to sexual violence, minimisation of HIV transmission, reduction of maternal and neonatal death and disability, and planning for comprehensive reproductive health services. The extent of implementation of these essential activities is explored in this paper in the context of refugees in Jordan fleeing the war in Iraq. Significant gaps in each area exist, particularly coordination and prevention of sexual violence and care for survivors. Recommendations for those responding to this crisis include designating a focal point to coordinate implementation of priority reproductive health services, preventing sexual exploitation and providing clinical care for survivors of sexual violence, providing emergency obstetric care for all refugees, including a 24-hour referral system, ensuring adherence to standards to prevent HIV transmission, making condoms free and available, and planning for comprehensive reproductive health services.","DOI":"10.1016/S0968-8080(08)31348-2","ISSN":"1460-9576 0968-8080","note":"PMID: 18513611","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Chynoweth","given":"Sarah K."}],"issued":{"date-parts":[["2008",5]]}}}],"schema":""} (Chynoweth, 2008).Keygnaert and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jJwuVUtk","properties":{"formattedCitation":"(2014)","plainCitation":"(2014)","noteIndex":0},"citationItems":[{"id":2802,"uris":[""],"uri":[""],"itemData":{"id":2802,"type":"article-journal","title":"Sexual violence and sub-Saharan migrants in Morocco: a community-based participatory assessment using respondent driven sampling.","container-title":"Globalization and health","page":"32","volume":"10","abstract":"BACKGROUND: The European Union contracted Morocco to regulate migration from so-called \"transit migrants\" from Morocco to Europe via the European Neighbourhood Policy. Yet, international organisations signal that human, asylum and refugee rights are not upheld in Morocco and that many sub-Saharan migrants suffer from ill-health and violence. Hence, our study aimed at 1) investigating the nature of violence that sub-Saharan migrants experience around and in Morocco, 2) assessing which determinants they perceive as decisive and 3) formulating prevention recommendations. METHODS: Applying Community-Based Participatory Research, we trained twelve sub-Saharan migrants as Community Researchers to conduct in-depth interviews with peers, using Respondent Driven Sampling. We used Nvivo 8 to analyse the data. We interpreted results with Community Researchers and the Community Advisory Board and commonly formulated prevention recommendations. RESULTS: Among the 154 (60 F-94 M) sub-Saharan migrants interviewed, 90% reported cases of multiple victimizations, 45% of which was sexual, predominantly gang rape. Seventy-nine respondents were personally victimized, 41 were forced to witness how relatives or co-migrants were victimized and 18 others knew of peer victimisation. Severe long lasting ill-health consequences were reported while sub-Saharan victims are not granted access to the official health care system. Perpetrators were mostly Moroccan or Algerian officials and sub-Saharan gang leaders who function as unofficial yet rigorous migration professionals at migration 'hubs'. They seem to proceed in impunity. Respondents link risk factors mainly to their undocumented and unprotected status and suggest that migrant communities set-up awareness raising campaigns on risks while legal and policy changes enforcing human rights, legal protection and human treatment of migrants along with severe punishment of perpetrators are politically lobbied for. CONCLUSION: Sub-Saharan migrants are at high risk of sexual victimization and subsequent ill-health in and around Morocco. Comprehensive cross-border and multi-level prevention actions are urgently called for. Given the European Neighbourhood Policy, we deem it paramount that the European Union politically cares for these migrants' lives and health, takes up its responsibility, drastically changes migration regulation into one that upholds human rights beyond survival and enforces all authorities involved to restore migrants' lives worthy to be lived again.","DOI":"10.1186/1744-8603-10-32","ISSN":"1744-8603 1744-8603","note":"PMID: 24885537 \nPMCID: PMC4122073","journalAbbreviation":"Global Health","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Dialmy","given":"Abdessamad"},{"family":"Manco","given":"Altay"},{"family":"Keygnaert","given":"Jeroen"},{"family":"Vettenburg","given":"Nicole"},{"family":"Roelens","given":"Kristien"},{"family":"Temmerman","given":"Marleen"}],"issued":{"date-parts":[["2014",5,8]]}},"suppress-author":true}],"schema":""} (2014) undertook a study in Morocco where they trained twelve sub-Saharan ‘transit’ migrants as community researchers who subsequently interviewed 154 (60 F; 94 M) peers. The study found extremely high rates of SGBV including high rates of gang rape. Perpetrators were mostly Moroccan or Algerian officials and sub-Saharan gang leaders. The undocumented and unprotected status of victims was seen as the key underlying risk factor. Participants recommended awareness raising as a protective measure with the authors also emphasising the need for legal and policy changes to protect human rights and migrants’ lives ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"C5DvJcCl","properties":{"formattedCitation":"(Keygnaert et al., 2014)","plainCitation":"(Keygnaert et al., 2014)","noteIndex":0},"citationItems":[{"id":2802,"uris":[""],"uri":[""],"itemData":{"id":2802,"type":"article-journal","title":"Sexual violence and sub-Saharan migrants in Morocco: a community-based participatory assessment using respondent driven sampling.","container-title":"Globalization and health","page":"32","volume":"10","abstract":"BACKGROUND: The European Union contracted Morocco to regulate migration from so-called \"transit migrants\" from Morocco to Europe via the European Neighbourhood Policy. Yet, international organisations signal that human, asylum and refugee rights are not upheld in Morocco and that many sub-Saharan migrants suffer from ill-health and violence. Hence, our study aimed at 1) investigating the nature of violence that sub-Saharan migrants experience around and in Morocco, 2) assessing which determinants they perceive as decisive and 3) formulating prevention recommendations. METHODS: Applying Community-Based Participatory Research, we trained twelve sub-Saharan migrants as Community Researchers to conduct in-depth interviews with peers, using Respondent Driven Sampling. We used Nvivo 8 to analyse the data. We interpreted results with Community Researchers and the Community Advisory Board and commonly formulated prevention recommendations. RESULTS: Among the 154 (60 F-94 M) sub-Saharan migrants interviewed, 90% reported cases of multiple victimizations, 45% of which was sexual, predominantly gang rape. Seventy-nine respondents were personally victimized, 41 were forced to witness how relatives or co-migrants were victimized and 18 others knew of peer victimisation. Severe long lasting ill-health consequences were reported while sub-Saharan victims are not granted access to the official health care system. Perpetrators were mostly Moroccan or Algerian officials and sub-Saharan gang leaders who function as unofficial yet rigorous migration professionals at migration 'hubs'. They seem to proceed in impunity. Respondents link risk factors mainly to their undocumented and unprotected status and suggest that migrant communities set-up awareness raising campaigns on risks while legal and policy changes enforcing human rights, legal protection and human treatment of migrants along with severe punishment of perpetrators are politically lobbied for. CONCLUSION: Sub-Saharan migrants are at high risk of sexual victimization and subsequent ill-health in and around Morocco. Comprehensive cross-border and multi-level prevention actions are urgently called for. Given the European Neighbourhood Policy, we deem it paramount that the European Union politically cares for these migrants' lives and health, takes up its responsibility, drastically changes migration regulation into one that upholds human rights beyond survival and enforces all authorities involved to restore migrants' lives worthy to be lived again.","DOI":"10.1186/1744-8603-10-32","ISSN":"1744-8603 1744-8603","note":"PMID: 24885537 \nPMCID: PMC4122073","journalAbbreviation":"Global Health","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Dialmy","given":"Abdessamad"},{"family":"Manco","given":"Altay"},{"family":"Keygnaert","given":"Jeroen"},{"family":"Vettenburg","given":"Nicole"},{"family":"Roelens","given":"Kristien"},{"family":"Temmerman","given":"Marleen"}],"issued":{"date-parts":[["2014",5,8]]}}}],"schema":""} (Keygnaert et al., 2014). In the only study located for this review, which focused specifically on refugees with a disability, Marshall and Barrett ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"y65Jky4Y","properties":{"formattedCitation":"(2018)","plainCitation":"(2018)","noteIndex":0},"citationItems":[{"id":293,"uris":[""],"uri":[""],"itemData":{"id":293,"type":"article-journal","title":"Human rights of refugee-survivors of sexual and gender-based violence with communication disability.","container-title":"International journal of speech-language pathology","page":"44-49","volume":"20","issue":"1","abstract":"Article 19 of the Universal Declaration of Human Rights (United Nations, 1948 ) states that all people have the right to seek, receive and impart information using any means. Ensuring that people with communication disability achieve this right is inherently challenging. For people with communication disability, who are refugee-survivors of sexual and gender-based violence (SGBV), additional human rights are challenged, including the right to education, protection from discrimination, a safe place to live, security of person and legal protection. Their experiences and needs, however, are poorly understood. This paper reports on a literature review of the intersectionality between SGBV, being a refugee and having a communication disability, and a preliminary investigation of the situation of refugee-survivors of SGBV with communication disability, in Rwanda. The project involved 54 participants, including 50 humanitarian and partner organisation staff and four carers of refugees with communication disabilities, from two locations (camp-based and urban refugees). Findings from both revealed that, for people with communication disability, barriers are likely to occur at each step of preventing and responding to SGBV. Moreover, stigmatisation of people with communication disability challenges SGBV prevention/support and people with communication disability may be targeted by SGBV perpetrators. SGBV service providers acknowledge their lack of knowledge and skills about communication disability, but wish to learn. Findings highlight the need for increased knowledge and skill development, in order to improve the situation for refugee-survivors of SGBV with communication disability.","DOI":"10.1080/17549507.2017.1392608","ISSN":"1754-9515","note":"Marshall, Julie. a Health Professions Department , Manchester Metropolitan University , Manchester , UK and.\nBarrett, Helen. b Communicability Global , Kigali , Rwanda.","journalAbbreviation":"Int J Speech Lang Pathol","author":[{"family":"Marshall","given":"Julie"},{"family":"Barrett","given":"Helen"}],"issued":{"date-parts":[["2018"]]}},"suppress-author":true}],"schema":""} (2018) conducted interviews and focus groups with humanitarian organisational staff and carers of refugees with communication disabilities in Rwanda. This study highlighted the specific vulnerabilities of refugee-survivors of SGBV who have a communication disability. Increased risk of SGBV for refugees with a communication disability was linked to reduced access to sexual and reproductive health education, discreditation, stigma, being considered an easy target, lack of understanding by service providers and reduced ability to report. Recommended responses included identification of people with communication disabilities; an inclusive approach to sexual and reproductive health education, general education and employment; provider training; involving refugees with communication disabilities in SGBV response planning, implementation and evaluation; providing a range of communication methods; multi-agency collaboration; and high-quality funded research on SGBV, communication disability and refugees ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aQA7JoBZ","properties":{"formattedCitation":"(Marshall & Barrett, 2018)","plainCitation":"(Marshall & Barrett, 2018)","noteIndex":0},"citationItems":[{"id":293,"uris":[""],"uri":[""],"itemData":{"id":293,"type":"article-journal","title":"Human rights of refugee-survivors of sexual and gender-based violence with communication disability.","container-title":"International journal of speech-language pathology","page":"44-49","volume":"20","issue":"1","abstract":"Article 19 of the Universal Declaration of Human Rights (United Nations, 1948 ) states that all people have the right to seek, receive and impart information using any means. Ensuring that people with communication disability achieve this right is inherently challenging. For people with communication disability, who are refugee-survivors of sexual and gender-based violence (SGBV), additional human rights are challenged, including the right to education, protection from discrimination, a safe place to live, security of person and legal protection. Their experiences and needs, however, are poorly understood. This paper reports on a literature review of the intersectionality between SGBV, being a refugee and having a communication disability, and a preliminary investigation of the situation of refugee-survivors of SGBV with communication disability, in Rwanda. The project involved 54 participants, including 50 humanitarian and partner organisation staff and four carers of refugees with communication disabilities, from two locations (camp-based and urban refugees). Findings from both revealed that, for people with communication disability, barriers are likely to occur at each step of preventing and responding to SGBV. Moreover, stigmatisation of people with communication disability challenges SGBV prevention/support and people with communication disability may be targeted by SGBV perpetrators. SGBV service providers acknowledge their lack of knowledge and skills about communication disability, but wish to learn. Findings highlight the need for increased knowledge and skill development, in order to improve the situation for refugee-survivors of SGBV with communication disability.","DOI":"10.1080/17549507.2017.1392608","ISSN":"1754-9515","note":"Marshall, Julie. a Health Professions Department , Manchester Metropolitan University , Manchester , UK and.\nBarrett, Helen. b Communicability Global , Kigali , Rwanda.","journalAbbreviation":"Int J Speech Lang Pathol","author":[{"family":"Marshall","given":"Julie"},{"family":"Barrett","given":"Helen"}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (Marshall & Barrett, 2018).Resettlement The majority of studies conducted in resettlement contexts came to similar conclusions with respect to recommended responses. These focused on the need for outreach to, and partnerships with, communities; English language, life skills and rights education for women; and culturally appropriate services including employment of bicultural and bilingual staff with one study also pointing to the need for specialist housing for women from refugee backgrounds leaving abusive relationships ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"frqT7ZPQ","properties":{"formattedCitation":"(Gill & Banga, 2008)","plainCitation":"(Gill & Banga, 2008)","noteIndex":0},"citationItems":[{"id":3725,"uris":[""],"uri":[""],"itemData":{"id":3725,"type":"article-journal","title":"'A specialist refuge space of my own': Black, minority ethnic and refugee women, housing and domestic violence.","container-title":"Ethnicity and Inequalities in Health and Social Care","collection-title":"International Journal of Human Rights in Healthcare","page":"24-34","volume":"1","issue":"2","abstract":"This paper argues that there is a need for an independent specialist women's refuge sector to address the housing needs of BMER (Black, minority ethnic and refugee) women. It will consider barriers to equal access that BMER women have and how these could be resolved by providing specialist services tailored to their specific needs. Specifically, the paper shows how such services, attuned to concerns of race, class, and gender, could positively help resolve additional barriers confronting BMER women due to housing inequality. The primary research, based on an analysis of questionnaire responses and a focus group with service users, offers a snapshot of the impact that the lack of access to housing provision has for BMER women including increasing their social exclusion and vulnerability if need remains unmet. A case is made for a strengthened independent specialist sector to deal with the housing needs of women fleeing domestic violence. Key recommendations are identified on how housing policies, practices and service provision can be strengthened through the implementation of a specialist sector. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","DOI":"10.1108/17570980200800018","ISSN":"1757-0980","author":[{"family":"Gill","given":"Aisha"},{"family":"Banga","given":"Baljit"}],"editor":[{"family":"Chahal","given":"Cohen","suffix":"Collins, Gilroy, Hague, Jones, Kelly, Morley, Patel, Radford, Soteri, Thiara, Walby, Williams-Crenshaw"}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Gill & Banga, 2008).Three studies investigated experiences of IPV and help seeking for IPV amongst African immigrants to the United States. In one study, focus groups and interviews with 32 West African, primarily refugee, immigrants (19 female; 13 male) found that support structures within the West African community existed but all maintained a gender hierarchy that left women dissatisfied. The authors recommended that service providers use outreach to provide culturally informed education and partner with progressive religious leaders and engage women leaders in the community ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Y7F8eX3S","properties":{"formattedCitation":"(Akinsulure-Smith, Chu, Keatley, & Rasmussen, 2013)","plainCitation":"(Akinsulure-Smith, Chu, Keatley, & Rasmussen, 2013)","noteIndex":0},"citationItems":[{"id":3604,"uris":[""],"uri":[""],"itemData":{"id":3604,"type":"article-journal","title":"Intimate Partner Violence among West African Immigrants","container-title":"Journal of Aggression, Maltreatment & Trauma","page":"109-126","volume":"22","issue":"2","source":"Taylor and Francis+NEJM","abstract":"Although the number of African immigrants arriving to the United States has increased significantly, there has been little investigation regarding their experiences of intimate partner violence or coping strategies. This study used focus groups and individual interviews to explore intimate partner violence among 32 heterosexual West African immigrants. Results suggest that although cultural expectations influence their coping strategies, West African–born men and women face different realities, with women reporting multiple instances of abuse and a sense of frustration with the existing options for assistance. Although participants discussed multilevel support structures within the immediate West African community to address intimate partner violence, all of these options maintained a gender hierarchy, leaving women dissatisfied. Challenges and barriers to partner violence resolution and coping strategies are identified. Results are examined in terms of their implications for addressing the needs of this underserved population. Implications for future research and services are discussed and highlighted.","DOI":"10.1080/10926771.2013.719592","ISSN":"1092-6771","note":"PMID: 23730146","author":[{"family":"Akinsulure-Smith","given":"Adeyinka M."},{"family":"Chu","given":"Tracy"},{"family":"Keatley","given":"Eva"},{"family":"Rasmussen","given":"Andrew"}],"issued":{"date-parts":[["2013",2,1]]}}}],"schema":""} (Akinsulure-Smith, Chu, Keatley, & Rasmussen, 2013). Sullivan and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3VuWEhPj","properties":{"formattedCitation":"(2005)","plainCitation":"(2005)","noteIndex":0},"citationItems":[{"id":3068,"uris":[""],"uri":[""],"itemData":{"id":3068,"type":"article-journal","title":"\"For us it is like living in the dark\": Ethiopian women's experiences with domestic violence.","container-title":"Journal of interpersonal violence","page":"922-940","volume":"20","issue":"8","abstract":"This article discusses the experiences of domestic violence among Ethiopian refugees and immigrants in the United States. A subset (n=18) of the larger study sample (N=254) participated in three focus groups with Amharic-speaking survivors of domestic violence who were currently in or had left abusive relationships. The research was conducted through a public health department, University, and community agency partnership. Findings show domestic violence as taking place within a context of immigration, acculturation, and rapid changes in family and social structure. Participants expressed a need for language and culture-specific domestic violence support and advocacy as well as education programs regarding U.S. laws and resources.","DOI":"10.1177/0886260505277678","ISSN":"0886-2605 0886-2605","note":"PMID: 15983131","journalAbbreviation":"J Interpers Violence","language":"eng","author":[{"family":"Sullivan","given":"Marianne"},{"family":"Senturia","given":"Kirsten"},{"family":"Negash","given":"Tigist"},{"family":"Shiu-Thornton","given":"Sharyne"},{"family":"Giday","given":"Beruke"}],"issued":{"date-parts":[["2005",8]]}},"suppress-author":true}],"schema":""} (2005) conducted focus groups with 18 Amharic speaking refugees women survivors of domestic violence. Based on their participants’ responses, recommendations included life skills and English language classes, childcare, rights and legal education, legal support, and use of bilingual and bicultural service providers. Similar recommendations arose from Keller and Brennan’s study in which they interviewed eight victim advocates, justice personnel and other service providers who worked with the Sudanese community in Nebraska ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9hO7x8OS","properties":{"formattedCitation":"(Keller & Brennan, 2007)","plainCitation":"(Keller & Brennan, 2007)","noteIndex":0},"citationItems":[{"id":167,"uris":[""],"uri":[""],"itemData":{"id":167,"type":"article-journal","title":"Cultural considerations and challenges to service delivery for Sudanese victims of domestic violence: Insights from service providers and actors in the criminal justice system.","container-title":"International Review of Victimology","page":"115-141","volume":"14","issue":"1","abstract":"Omaha, Nebraska has recently seen an influx of immigrant refugees from the African nation of Sudan. Domestic violence service providers worry that many Sudanese women are suffering abuse in silence. With that in mind, we identified a number of common obstacles that immigrant women are likely to face when accessing services for domestic violence. We interviewed victim advocates, criminal justice personnel, and other community-based service providers. Our respondents identified the areas of difficulty they encountered most frequently when working with Sudanese clients. Everyone interviewed agreed that Sudanese cultural norms created barriers to service delivery. Our respondents also discussed the strategies they employed when they provided services to Sudanese women, along with their impressions about how well or how poorly those approaches worked. We present their experiences, their challenges, and their recommendations for the future. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1177/026975800701400107","ISSN":"0269-7580","author":[{"family":"Keller","given":"Elizabeth M"},{"family":"Brennan","given":"Pauline K"}],"editor":[{"family":"Abraham","given":"Belknap","suffix":"Bhuyan, Browne, Bui, Bui, Davis, Davis, Erez, Faizi, Gonzalez, Jasinki, Kulwicki, Kurz, Lainof, Lee, Mehrotra, Morracco, Murdaugh, Perilla, Santiago, Sentaria, Vandello, Watts, Wengraf"}],"issued":{"date-parts":[["2007"]]}}}],"schema":""} (Keller & Brennan, 2007). A quantitative survey with North Korean refugee women living in South Korea (n=180) looked at correlates of different forms of abuse and recommended in response empowerment, provision of job skills and culturally tailored services ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xlccBcB8","properties":{"formattedCitation":"(Um, Kim, & Palinkas, 2016)","plainCitation":"(Um, Kim, & Palinkas, 2016)","noteIndex":0},"citationItems":[{"id":687,"uris":[""],"uri":[""],"itemData":{"id":687,"type":"article-journal","title":"Correlates of Domestic Violence Victimization Among North Korean Refugee Women in South Korea.","container-title":"Journal of interpersonal violence","issue":"8700910","abstract":"Although many North Korean (NK) refugee women are victims of domestic violence (DV) in North Korea, face sexual exploitation during migration, and remain at risk of DV while adapting to life in South Korea, there is no empirical evidence about risk factors for DV in this population. To fill this gap, this study examined whether gender role beliefs, child abuse history, and sociocultural adaptation were associated with past-year physical, emotional, sexual, and economic abuse, and whether they were associated with multiple forms of abuse. We also explored whether these associations were similar or different across different types of DV among NK refugee women. A sample of 180 ever-married NK refugee women in South Korea from the 2010 National Survey on Family Violence was used for analysis. Physical abuse was associated with more traditional gender role beliefs; emotional abuse and multiple forms of abuse were associated with lower levels of sociocultural adaptation; and sexual and economic abuse were associated with an increased likelihood of childhood abuse and poor sociocultural adaptation. Our study findings underscore the importance of assisting NK refugee women to be better adapted to the new culture in a practical way, because better sociocultural adaptation might protect them from experiencing various types of abuse. At the same time, findings of this study highlight the need for empowering NK refugee women who report physical abuse by educating their rights and altering their traditional beliefs of gender roles, and screening of childhood abuse and providing culturally sensitive psychotherapy to those who report sexual or economic abuse. Moreover, we suggest future studies to examine correlates of different forms of abuse separately because they can inform culturally tailored interventions for abused NK refugee women. To prevent further victimization, educational programs should be provided to NK refugee women at an early stage of resettlement in South Korea.Copyright ? The Author(s) 2016.","ISSN":"1552-6518","note":"Um, Mee Young. University of Southern California, Los Angeles, CA, USA mum@usc.edu.\nKim, Hee Jin. Myongji University, Yongin-si, South Korea.\nPalinkas, Lawrence A. University of Southern California, Los Angeles, CA, USA.","journalAbbreviation":"J Interpers Violence","author":[{"family":"Um","given":"Mee Young"},{"family":"Kim","given":"Hee Jin"},{"family":"Palinkas","given":"Lawrence A"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (Um, Kim, & Palinkas, 2016). Two studies looked specifically at cultural practices and spiritual beliefs as resources for refugee women who have been the victims of sexual violence. Atlani and Rousseau ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Cj6dm06a","properties":{"formattedCitation":"(2000)","plainCitation":"(2000)","noteIndex":0},"citationItems":[{"id":3207,"uris":[""],"uri":[""],"itemData":{"id":3207,"type":"article-journal","title":"The politics of culture in humanitarian aid to women refugees who have experienced sexual violence.","container-title":"Transcultural Psychiatry","collection-title":"Transcultural Psychiatric Research Review","page":"435-449","volume":"37","issue":"3","abstract":"Discusses concepts of culture underlying the responses of international aid agencies to refugee victims of sexual abuse and rape in refugee camps. As there is a growing sense of urgency within international humanitarian aid agencies to intervene quickly when faced with organized violence stemming from war or armed conflict, the rape of refugees calls for prompt psychological intervention. Beyond this sense of urgency, the premises underlying the different models of humanitarian intervention being utilized require further documentation. Issues discussed include: (1) the concepts and practices that characterize the mental health interventions for refugee women who have suffered sexual violence, (2) how transcultural psychiatry is conceived and practiced in refugee camps, (3) how refugee culture is defined, and (4) what do these definitions imply when translated into therapeutic care to rape victims? The author also raises some concerns about the appropriateness and the scope of United Nations and nongovernmental approaches. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1177/136346150003700309","ISSN":"1363-4615","author":[{"family":"Atlani","given":"Laetitia"},{"family":"Rousseau","given":"Cecile"}],"editor":[{"family":"Atlani","given":"Barnett","suffix":"Bhabha, Condominas, Escobar, Fassin, Ferguson, Hitchcox, Hobart, Joralemon, Khuong, Kleinman, Lin, Long, March, Mohanty, Potier, Rechtman, Richters, Rousseau, Scheper-Hugues, Scheper-Hugues, Strathern, Taussig, Vigarello, Young"}],"issued":{"date-parts":[["2000"]]}},"suppress-author":true}],"schema":""} (2000) conducted ethnographic research with Vietnamese refugees in France and Canada. They argue that flexibility of response is essential for women who had survived rape during the Vietnamese exodus to enable them to ‘participate in a collective discourse that protects her links to her family and community, as well as her own sense of a meaningful world’ ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3WeIvkOk","properties":{"formattedCitation":"(Atlani & Rousseau, 2000, p. 446)","plainCitation":"(Atlani & Rousseau, 2000, p. 446)","noteIndex":0},"citationItems":[{"id":3207,"uris":[""],"uri":[""],"itemData":{"id":3207,"type":"article-journal","title":"The politics of culture in humanitarian aid to women refugees who have experienced sexual violence.","container-title":"Transcultural Psychiatry","collection-title":"Transcultural Psychiatric Research Review","page":"435-449","volume":"37","issue":"3","abstract":"Discusses concepts of culture underlying the responses of international aid agencies to refugee victims of sexual abuse and rape in refugee camps. As there is a growing sense of urgency within international humanitarian aid agencies to intervene quickly when faced with organized violence stemming from war or armed conflict, the rape of refugees calls for prompt psychological intervention. Beyond this sense of urgency, the premises underlying the different models of humanitarian intervention being utilized require further documentation. Issues discussed include: (1) the concepts and practices that characterize the mental health interventions for refugee women who have suffered sexual violence, (2) how transcultural psychiatry is conceived and practiced in refugee camps, (3) how refugee culture is defined, and (4) what do these definitions imply when translated into therapeutic care to rape victims? The author also raises some concerns about the appropriateness and the scope of United Nations and nongovernmental approaches. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1177/136346150003700309","ISSN":"1363-4615","author":[{"family":"Atlani","given":"Laetitia"},{"family":"Rousseau","given":"Cecile"}],"editor":[{"family":"Atlani","given":"Barnett","suffix":"Bhabha, Condominas, Escobar, Fassin, Ferguson, Hitchcox, Hobart, Joralemon, Khuong, Kleinman, Lin, Long, March, Mohanty, Potier, Rechtman, Richters, Rousseau, Scheper-Hugues, Scheper-Hugues, Strathern, Taussig, Vigarello, Young"}],"issued":{"date-parts":[["2000"]]}},"locator":"446"}],"schema":""} (Atlani & Rousseau, 2000, p. 446). This argument is based on a case study of Vietnamese refugees transforming their idea of victimhood using the Buddhist Law (understood as the inescapable process of cause and effect or huatqua bao) to rationalise and remove the burden of the collective experiences of sexual violence in a context where it was ‘necessary’ to protect the lives of the group that was fleeing. Smigelsky and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"OYSFFiCD","properties":{"formattedCitation":"(2017)","plainCitation":"(2017)","noteIndex":0},"citationItems":[{"id":3260,"uris":[""],"uri":[""],"itemData":{"id":3260,"type":"article-journal","title":"\"My heart is in his hands\": The lived spiritual experiences of Congolese refugee women survivors of sexual violence.","container-title":"Journal of prevention & intervention in the community","page":"261-273","volume":"45","issue":"4","abstract":"The Democratic Republic of Congo (DRC) has experienced widespread violence, including sexual violence. Sexual violence toward women includes rape, genital mutilation, and sexual slavery. Many Congolese have sought to escape such conditions as refugees in the USA. In the present study, we examined lived spiritual experiences of nine Congolese refugee women survivors of sexual violence. Overall, this study provides new insights into participants' experiences of spirituality in the aftermath of sexual trauma and in living as a refugees. Consensual qualitative research (CQR) methods were used to analyze participants' responses to a semistructured interview protocol. Participants endorsed faith that God was in control, reliance on prayer, gratitude toward God, and difficulty practicing their faith in the USA relative to Africa. Results indicated that religion/spirituality is an integral part of the women's lives and that it appears to facilitate coping. Clinical and community mental health implications are discussed.","DOI":"10.1080/10852352.2016.1197754","ISSN":"1540-7330 1085-2352","note":"PMID: 28880807","journalAbbreviation":"J Prev Interv Community","language":"eng","author":[{"family":"Smigelsky","given":"Melissa A."},{"family":"Gill","given":"Alison R."},{"family":"Foshager","given":"Deb"},{"family":"Aten","given":"Jamie D."},{"family":"Im","given":"Hannah"}],"issued":{"date-parts":[["2017",12]]}},"suppress-author":true}],"schema":""} (2017) came to a similar conclusion regarding the need for incorporation of religious practices and spirituality into interventions by mental health practitioners and community advocates. This recommendation was based on their study into the spiritual experiences of Congolese survivors of sexual violence living in Tennessee ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZceAG4dO","properties":{"formattedCitation":"(Smigelsky et al., 2017)","plainCitation":"(Smigelsky et al., 2017)","noteIndex":0},"citationItems":[{"id":3260,"uris":[""],"uri":[""],"itemData":{"id":3260,"type":"article-journal","title":"\"My heart is in his hands\": The lived spiritual experiences of Congolese refugee women survivors of sexual violence.","container-title":"Journal of prevention & intervention in the community","page":"261-273","volume":"45","issue":"4","abstract":"The Democratic Republic of Congo (DRC) has experienced widespread violence, including sexual violence. Sexual violence toward women includes rape, genital mutilation, and sexual slavery. Many Congolese have sought to escape such conditions as refugees in the USA. In the present study, we examined lived spiritual experiences of nine Congolese refugee women survivors of sexual violence. Overall, this study provides new insights into participants' experiences of spirituality in the aftermath of sexual trauma and in living as a refugees. Consensual qualitative research (CQR) methods were used to analyze participants' responses to a semistructured interview protocol. Participants endorsed faith that God was in control, reliance on prayer, gratitude toward God, and difficulty practicing their faith in the USA relative to Africa. Results indicated that religion/spirituality is an integral part of the women's lives and that it appears to facilitate coping. Clinical and community mental health implications are discussed.","DOI":"10.1080/10852352.2016.1197754","ISSN":"1540-7330 1085-2352","note":"PMID: 28880807","journalAbbreviation":"J Prev Interv Community","language":"eng","author":[{"family":"Smigelsky","given":"Melissa A."},{"family":"Gill","given":"Alison R."},{"family":"Foshager","given":"Deb"},{"family":"Aten","given":"Jamie D."},{"family":"Im","given":"Hannah"}],"issued":{"date-parts":[["2017",12]]}}}],"schema":""} (Smigelsky et al., 2017).A Swedish study in which midwives were interviewed about their experiences of providing antenatal care to Somali refugee women found that trust was key to enabling midwives to be an important ‘bridge’ to other healthcare and social work professionals in a context of previous or ongoing violence. Trust was built through focusing on individual women’s resources and needs, addressing language barriers and adapting to different conceptions of violence across cultures ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"k3WDR2fX","properties":{"formattedCitation":"(Byrskog, Olsson, Essen, & Allvin, 2015)","plainCitation":"(Byrskog, Olsson, Essen, & Allvin, 2015)","noteIndex":0},"citationItems":[{"id":2853,"uris":[""],"uri":[""],"itemData":{"id":2853,"type":"article-journal","title":"Being a bridge: Swedish antenatal care midwives' encounters with Somali-born women and questions of violence; a qualitative study.","container-title":"BMC pregnancy and childbirth","page":"1","volume":"15","abstract":"BACKGROUND: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. METHODS: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. RESULTS: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. CONCLUSION: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.","DOI":"10.1186/s12884-015-0429-z","ISSN":"1471-2393 1471-2393","note":"PMID: 25591791 \nPMCID: PMC4299129","journalAbbreviation":"BMC Pregnancy Childbirth","language":"eng","author":[{"family":"Byrskog","given":"Ulrika"},{"family":"Olsson","given":"Pia"},{"family":"Essen","given":"Birgitta"},{"family":"Allvin","given":"Marie-Klingberg"}],"issued":{"date-parts":[["2015",1,16]]}}}],"schema":""} (Byrskog, Olsson, Essen, & Allvin, 2015).Keygnaert and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Ef2oexB7","properties":{"formattedCitation":"(2012)","plainCitation":"(2012)","noteIndex":0},"citationItems":[{"id":2801,"uris":[""],"uri":[""],"itemData":{"id":2801,"type":"article-journal","title":"Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands.","container-title":"Culture, health & sexuality","page":"505-520","volume":"14","issue":"5","abstract":"Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.","DOI":"10.1080/13691058.2012.671961","ISSN":"1464-5351 1369-1058","note":"PMID: 22468763 \nPMCID: PMC3379780","journalAbbreviation":"Cult Health Sex","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Vettenburg","given":"Nicole"},{"family":"Temmerman","given":"Marleen"}],"issued":{"date-parts":[["2012"]]}},"suppress-author":true}],"schema":""} (2012) employed community researchers to investigate violence experiences of 223 refugees, asylum seekers and undocumented migrants living in Belgium and the Netherlands. Their study highlighted the argument made by the same authors elsewhere ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cRHrXWJf","properties":{"formattedCitation":"(Keygnaert & Guieu, 2015)","plainCitation":"(Keygnaert & Guieu, 2015)","noteIndex":0},"citationItems":[{"id":2803,"uris":[""],"uri":[""],"itemData":{"id":2803,"type":"article-journal","title":"What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants.","container-title":"Reproductive health matters","page":"45-55","volume":"23","issue":"46","abstract":"In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply 'tunnel vision'. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants' legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an 'outsider' and 'female only' issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.","DOI":"10.1016/j.rhm.2015.11.002","ISSN":"1460-9576 0968-8080","note":"PMID: 26718996","journalAbbreviation":"Reprod Health Matters","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Guieu","given":"Aurore"}],"issued":{"date-parts":[["2015",11]]}}}],"schema":""} (Keygnaert & Guieu, 2015) that SGBV is not only a problem that refugees encounter prior to settlement in Europe. Only one quarter of their respondents did not report violence, with 87 of 223 reporting personal experience of SGBV and 79 reporting SGBV experienced by a close peer since arriving in Europe. More than half of the reported violence was sexual, and most violence had been perpetrated by (ex) partners or asylum professionals. They argue that their results show refugees in Belgium and Netherlands are extremely vulnerable to SGBV and responses and preventive measures should be rights-based and include participatory interventions on multiple socio-ecological levels concurrently. Specific recommendations include education regarding SGBV and rights; support for development of social networks; awareness raising; improved services that are safe and accessible; improved rights such as the right to work and shortening the asylum procedure ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"R7i7L9b3","properties":{"formattedCitation":"(Keygnaert et al., 2012)","plainCitation":"(Keygnaert et al., 2012)","noteIndex":0},"citationItems":[{"id":2801,"uris":[""],"uri":[""],"itemData":{"id":2801,"type":"article-journal","title":"Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands.","container-title":"Culture, health & sexuality","page":"505-520","volume":"14","issue":"5","abstract":"Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.","DOI":"10.1080/13691058.2012.671961","ISSN":"1464-5351 1369-1058","note":"PMID: 22468763 \nPMCID: PMC3379780","journalAbbreviation":"Cult Health Sex","language":"eng","author":[{"family":"Keygnaert","given":"Ines"},{"family":"Vettenburg","given":"Nicole"},{"family":"Temmerman","given":"Marleen"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} (Keygnaert et al., 2012).SummaryRecommendations for responses arising from the research reported in this section are often quite general and not necessarily based directly on the specific findings of the study, rather drawing on the wider literature and guidelines we have reported in previous sections. Adding to the previously reported recommendations for multi-sectoral, multi-level interventions however, several authors noted that while culturally-attuned understandings of and responses to SGBV are essential, gender hierarchies sometimes meant that community responses failed to protect women from violence. Awareness-raising, outreach and education as well as participatory and rights-based approaches are recommended. Studies that evaluated responses to SGBV These 15 papers included reports of intervention and evaluation studies as well as evaluations of existing responses and services in the field. Four studies were conducted in conflict or immediate post-conflict settings; seven were in displacement settings i.e. refugee camps and urban refugee sites; and four studies were carried out in resettlement contexts. Evaluation of SGBV responses in conflict settingsFour of the papers evaluated interventions in conflict or immediate post-conflict settings. Three focused on sexual violence with two of these evaluating provision of individual medical or psychological care for victims ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"j8Nt5BT0","properties":{"formattedCitation":"(Hustache et al., 2009; Tanabe et al., 2013)","plainCitation":"(Hustache et al., 2009; Tanabe et al., 2013)","noteIndex":0},"citationItems":[{"id":3562,"uris":[""],"uri":[""],"itemData":{"id":3562,"type":"article-journal","title":"Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo","container-title":"International Journal of Mental Health Systems","page":"7","volume":"3","issue":"1","ISSN":"1752-4458","journalAbbreviation":"International Journal of Mental Health Systems","author":[{"family":"Hustache","given":"Sarah"},{"family":"Moro","given":"Marie-Rose"},{"family":"Roptin","given":"Jacky"},{"family":"Souza","given":"Renato"},{"family":"Gansou","given":"Grégoire Magloire"},{"family":"Mbemba","given":"Alain"},{"family":"Roederer","given":"Thomas"},{"family":"Grais","given":"Rebecca F"},{"family":"Gaboulaud","given":"Valérie"},{"family":"Baubet","given":"Thierry"}],"issued":{"date-parts":[["2009"]]}}},{"id":3563,"uris":[""],"uri":[""],"itemData":{"id":3563,"type":"article-journal","title":"Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma.","container-title":"Conflict and Health","page":"12","volume":"7","issue":"1","abstract":"BACKGROUND: Given the challenges to ensuring facility-based care in conflict settings, the Women's Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization's Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings., METHODS: A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age., RESULTS: Qualitative feedback contributed to an understanding of the model's feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment., CONCLUSIONS: Data speak to the promising \"feasibility\" of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not accessible for women and girls that need it most.","DOI":"10.1186/1752-1505-7-12","ISSN":"1752-1505","note":"Tanabe, Mihoko. Women's Refugee Commission, 122 East 42nd Street 11F, New York, NY 10168-1289, USA. Mihokot@.","journalAbbreviation":"Confl Health","author":[{"family":"Tanabe","given":"Mihoko"},{"family":"Robinson","given":"Keely"},{"family":"Lee","given":"Catherine I"},{"family":"Leigh","given":"Jen A"},{"family":"Htoo","given":"Eh May"},{"family":"Integer","given":"Naw"},{"family":"Krause","given":"Sandra K"}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} (Hustache et al., 2009; Tanabe et al., 2013) in Congo and Burma respectively, and one paper comparing the effectiveness of a counselling intervention and a support group and skills training intervention for women in Liberia ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xX5IVRKC","properties":{"formattedCitation":"(Lekskes, van Hooren, & de Beus, 2007)","plainCitation":"(Lekskes, van Hooren, & de Beus, 2007)","noteIndex":0},"citationItems":[{"id":3625,"uris":[""],"uri":[""],"itemData":{"id":3625,"type":"article-journal","title":"Appraisal of psychosocial interventions in Liberia:","container-title":"Intervention","page":"18-26","volume":"5","issue":"1","source":"Crossref","DOI":"10.1097/WTF.0b013e3280be5b47","ISSN":"1571-8883","title-short":"Appraisal of psychosocial interventions in Liberia","language":"en","author":[{"family":"Lekskes","given":"Jeannette"},{"family":"Hooren","given":"Susan","non-dropping-particle":"van"},{"family":"Beus","given":"Jos","non-dropping-particle":"de"}],"issued":{"date-parts":[["2007",3]]}}}],"schema":""} (Lekskes, van Hooren, & de Beus, 2007). The fourth paper appraised responses to all types of SGBV in a conflict-affected region of Uganda ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jgsR73jC","properties":{"formattedCitation":"(Henttonen M, Watts C, Roberts B, Kaducu F, & Borchert M, 2008)","plainCitation":"(Henttonen M, Watts C, Roberts B, Kaducu F, & Borchert M, 2008)","noteIndex":0},"citationItems":[{"id":216,"uris":[""],"uri":[""],"itemData":{"id":216,"type":"article-journal","title":"Health services for survivors of gender-based violence in northern Uganda: a qualitative study.","container-title":"Reproductive Health Matters","page":"122-131","volume":"16","issue":"31","source":"EBSCOhost","archive":"ccm","abstract":"The 20-year war in northern Uganda has resulted in up to 1.7 million people being internally displaced, and impoverishment and vulnerability to violence amongst the civilian population. This qualitative study examined the status of health services available for the survivors of gender-based violence in the Gulu district, northern Uganda. Semi-structured interviews were carried out in 2006 with 26 experts on gender-based violence and general health providers, and availability of medical supplies was reviewed. The Inter-Agency Standing Committee (IASC) guidelines on gender-based violence interventions in humanitarian settings were used to prepare the interview guides and analyse the findings. Some legislation and programmes do exist on gender-based violence. However, health facilities lacked sufficiently qualified staff and medical supplies to adequately detect and manage survivors, and confidential treatment and counselling could not be ensured. There was inter-sectoral collaboration, but greater resources are required to increase coverage and effectiveness of services. Intimate partner violence, sexual abuse of girls aged under 18, sexual harassment and early and forced marriage may be more common than rape by strangers. As the IASC guidelines focus on sexual violence by strangers and do not address other forms of gender-based violence, we suggest the need to explore this issue further to determine whether a broader concept of gender-based violence should be incorporated into the guidelines.","ISSN":"0968-8080","journalAbbreviation":"Reproductive Health Matters","author":[{"literal":"Henttonen M"},{"literal":"Watts C"},{"literal":"Roberts B"},{"literal":"Kaducu F"},{"literal":"Borchert M"}],"issued":{"date-parts":[["2008",5]]}}}],"schema":""} (Henttonen M, Watts C, Roberts B, Kaducu F, & Borchert M, 2008). Evaluation of the effects of post-rape psychological support in Brazzaville, Congo found the intervention produced significant and lasting mental health benefits, as measured by the Global Assessment of Functioning scale, immediately after psychological care and one to two years later for the 56 participants retained in the study. The attrition of 108 of 178 of the women initially enrolled however, limited the conclusions that could be drawn and highlighted the difficulty of delivering and evaluating such interventions in an unstable setting ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7JFkNqen","properties":{"formattedCitation":"(Hustache et al., 2009)","plainCitation":"(Hustache et al., 2009)","noteIndex":0},"citationItems":[{"id":3562,"uris":[""],"uri":[""],"itemData":{"id":3562,"type":"article-journal","title":"Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo","container-title":"International Journal of Mental Health Systems","page":"7","volume":"3","issue":"1","ISSN":"1752-4458","journalAbbreviation":"International Journal of Mental Health Systems","author":[{"family":"Hustache","given":"Sarah"},{"family":"Moro","given":"Marie-Rose"},{"family":"Roptin","given":"Jacky"},{"family":"Souza","given":"Renato"},{"family":"Gansou","given":"Grégoire Magloire"},{"family":"Mbemba","given":"Alain"},{"family":"Roederer","given":"Thomas"},{"family":"Grais","given":"Rebecca F"},{"family":"Gaboulaud","given":"Valérie"},{"family":"Baubet","given":"Thierry"}],"issued":{"date-parts":[["2009"]]}}}],"schema":""} (Hustache et al., 2009). Tanabe and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"X2Vl69S8","properties":{"formattedCitation":"(2013)","plainCitation":"(2013)","noteIndex":0},"citationItems":[{"id":3563,"uris":[""],"uri":[""],"itemData":{"id":3563,"type":"article-journal","title":"Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma.","container-title":"Conflict and Health","page":"12","volume":"7","issue":"1","abstract":"BACKGROUND: Given the challenges to ensuring facility-based care in conflict settings, the Women's Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization's Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings., METHODS: A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age., RESULTS: Qualitative feedback contributed to an understanding of the model's feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment., CONCLUSIONS: Data speak to the promising \"feasibility\" of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not accessible for women and girls that need it most.","DOI":"10.1186/1752-1505-7-12","ISSN":"1752-1505","note":"Tanabe, Mihoko. Women's Refugee Commission, 122 East 42nd Street 11F, New York, NY 10168-1289, USA. Mihokot@.","journalAbbreviation":"Confl Health","author":[{"family":"Tanabe","given":"Mihoko"},{"family":"Robinson","given":"Keely"},{"family":"Lee","given":"Catherine I"},{"family":"Leigh","given":"Jen A"},{"family":"Htoo","given":"Eh May"},{"family":"Integer","given":"Naw"},{"family":"Krause","given":"Sandra K"}],"issued":{"date-parts":[["2013"]]}},"suppress-author":true}],"schema":""} (2013) assessed the safety and feasibility of providing community-based (as opposed to facility-based) care by trained community health workers and traditional birth attendants to survivors of sexual assault in Karen State, Eastern Burma. Focus groups with community health workers and traditional birth attendants suggested promising feasibility of the model, though focus groups with male and female community members showed little awareness of the pilot and reservations about reporting sexual violence, suggesting a need for greater awareness-raising and trust-building activities for this to be an effective response. Lekskes and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4shzEuff","properties":{"formattedCitation":"(2007)","plainCitation":"(2007)","noteIndex":0},"citationItems":[{"id":3625,"uris":[""],"uri":[""],"itemData":{"id":3625,"type":"article-journal","title":"Appraisal of psychosocial interventions in Liberia:","container-title":"Intervention","page":"18-26","volume":"5","issue":"1","source":"Crossref","DOI":"10.1097/WTF.0b013e3280be5b47","ISSN":"1571-8883","title-short":"Appraisal of psychosocial interventions in Liberia","language":"en","author":[{"family":"Lekskes","given":"Jeannette"},{"family":"Hooren","given":"Susan","non-dropping-particle":"van"},{"family":"Beus","given":"Jos","non-dropping-particle":"de"}],"issued":{"date-parts":[["2007",3]]}},"suppress-author":true}],"schema":""} (2007) conducted a mixed methods evaluation comparing outcomes from two interventions run by different NGOs for victims of war-related sexual violence in Liberia. The first offered a series of counselling sessions, while the second comprised a support group and skills training intervention. The analyses also included a control group comprising women on the waiting lists for assistance. Qualitative research indicated that both interventions were appraised positively by the women who took part. Quantitative analyses found that counselling was effective in reducing trauma symptoms compared with both the support and skill training intervention and the control group. When just those with high post-traumatic stress disorder scores were included in the analysis however, both interventions were effective at reducing trauma symptoms compared with the control group ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"usrwzREU","properties":{"formattedCitation":"(Lekskes et al., 2007)","plainCitation":"(Lekskes et al., 2007)","noteIndex":0},"citationItems":[{"id":3625,"uris":[""],"uri":[""],"itemData":{"id":3625,"type":"article-journal","title":"Appraisal of psychosocial interventions in Liberia:","container-title":"Intervention","page":"18-26","volume":"5","issue":"1","source":"Crossref","DOI":"10.1097/WTF.0b013e3280be5b47","ISSN":"1571-8883","title-short":"Appraisal of psychosocial interventions in Liberia","language":"en","author":[{"family":"Lekskes","given":"Jeannette"},{"family":"Hooren","given":"Susan","non-dropping-particle":"van"},{"family":"Beus","given":"Jos","non-dropping-particle":"de"}],"issued":{"date-parts":[["2007",3]]}}}],"schema":""} (Lekskes et al., 2007). Henttonen and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FBQUZEpF","properties":{"formattedCitation":"(2008)","plainCitation":"(2008)","noteIndex":0},"citationItems":[{"id":216,"uris":[""],"uri":[""],"itemData":{"id":216,"type":"article-journal","title":"Health services for survivors of gender-based violence in northern Uganda: a qualitative study.","container-title":"Reproductive Health Matters","page":"122-131","volume":"16","issue":"31","source":"EBSCOhost","archive":"ccm","abstract":"The 20-year war in northern Uganda has resulted in up to 1.7 million people being internally displaced, and impoverishment and vulnerability to violence amongst the civilian population. This qualitative study examined the status of health services available for the survivors of gender-based violence in the Gulu district, northern Uganda. Semi-structured interviews were carried out in 2006 with 26 experts on gender-based violence and general health providers, and availability of medical supplies was reviewed. The Inter-Agency Standing Committee (IASC) guidelines on gender-based violence interventions in humanitarian settings were used to prepare the interview guides and analyse the findings. Some legislation and programmes do exist on gender-based violence. However, health facilities lacked sufficiently qualified staff and medical supplies to adequately detect and manage survivors, and confidential treatment and counselling could not be ensured. There was inter-sectoral collaboration, but greater resources are required to increase coverage and effectiveness of services. Intimate partner violence, sexual abuse of girls aged under 18, sexual harassment and early and forced marriage may be more common than rape by strangers. As the IASC guidelines focus on sexual violence by strangers and do not address other forms of gender-based violence, we suggest the need to explore this issue further to determine whether a broader concept of gender-based violence should be incorporated into the guidelines.","ISSN":"0968-8080","journalAbbreviation":"Reproductive Health Matters","author":[{"literal":"Henttonen M"},{"literal":"Watts C"},{"literal":"Roberts B"},{"literal":"Kaducu F"},{"literal":"Borchert M"}],"issued":{"date-parts":[["2008",5]]}},"suppress-author":true}],"schema":""} (2008) conducted semi-structured interviews with SGBV experts (n=15) and general health service providers (n=11) to assess the health services provided to SGBV survivors in conflict-affected Northern Uganda. They found that legislation, programming and intersectoral collaboration all existed but health facilities generally lacked sufficiently qualified staff and medical supplies to adequately detect and manage survivors. Greater resources and training for staff were needed to increase coverage and effectiveness of services.Evaluation of SGBV responses in countries of first asylumSeven papers evaluated responses to SGBV for displaced populations in first countries of asylum, either in refugee camps or urban settings. Four of the papers reported evaluation findings based on multi-method data collection with service providers and refugee women, while three of the papers focused on providing detailed description of interventions delivered in refugee camps along with the authors’ own observations and assessments of their impacts. Lilleston and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Vknd4tAZ","properties":{"formattedCitation":"(2018)","plainCitation":"(2018)","noteIndex":0},"citationItems":[{"id":2788,"uris":[""],"uri":[""],"itemData":{"id":2788,"type":"article-journal","title":"Evaluation of a mobile approach to gender-based violence service delivery among Syrian refugees in Lebanon.","container-title":"Health policy and planning","page":"767-776","volume":"33","issue":"7","abstract":"As the landscape of humanitarian response shifts from camp-based to urban- and informal-tented settlement-based responses, service providers and policymakers must consider creative modes for delivering health services. Psychosocial support and case management can be life-saving services for refugee women and girls who are at increased risk for physical, sexual and psychological gender-based violence (GBV). However, these services are often unavailable in non-camp refugee settings. We evaluated an innovative mobile service delivery model for GBV response and mitigation implemented by the International Rescue Committee (IRC) in Lebanon. In October 2015, we conducted in-depth interviews with IRC staff (n = 11), Syrian refugee women (n = 40) and adolescent girls (n = 26) to explore whether the mobile services meet the support needs of refugees and uphold international standards for GBV service delivery. Recruitment was conducted via purposive sampling. Data were analysed using deductive and inductive approaches in NVivo. Findings suggest that by providing free, flexible service delivery in women's own communities, the mobile model overcame barriers that limited women's and girls' access to essential services, including transportation, checkpoints, cost and gendered expectations around mobility and domestic responsibilities. Participants described the services as strengthening social networks, reducing feelings of idleness and isolation, and increasing knowledge and self-confidence. Results indicate that the model requires skilled, creative staff who can assess community readiness for activities, quickly build trust and ensure confidentiality in contexts of displacement and disruption. Referring survivors to legal and medical services was challenging in a context with limited access to quality services. The IRC's mobile service delivery model is a promising approach for accessing hard-to-reach refugee populations with critical GBV services.","DOI":"10.1093/heapol/czy050","ISSN":"1460-2237 0268-1080","note":"PMID: 29905861","journalAbbreviation":"Health Policy Plan","language":"eng","author":[{"family":"Lilleston","given":"Pamela"},{"family":"Winograd","given":"Liliane"},{"family":"Ahmed","given":"Spogmay"},{"family":"Salame","given":"Dounia"},{"family":"Al Alam","given":"Dayana"},{"family":"Stoebenau","given":"Kirsten"},{"family":"Michelis","given":"Ilaria"},{"family":"Palekar Joergensen","given":"Sunita"}],"issued":{"date-parts":[["2018",9,1]]}},"suppress-author":true}],"schema":""} (2018) evaluated the outcomes of the International Rescue Committee’s (IRC’s) intervention to deliver mobile SGBV services comprising psychosocial support and case management to Syrian refugees in Lebanon. They conducted in-depth interviews with IRC staff (n=11), Syrian women (n=40) and adolescent girls (n=26) finding that by providing free, flexible services in women’s own communities, access barriers were effectively addressed. Participants described the services as strengthening social networks, reducing feelings of idleness and isolation, and increasing knowledge and self-confidence. Referring survivors to legal and medical services remained challenging however, and staff needed to be skilled and creative to build trust and ensure confidentiality. A study in Jordan by Krause and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zrhVfRb1","properties":{"formattedCitation":"(2015)","plainCitation":"(2015)","noteIndex":0},"citationItems":[{"id":3561,"uris":[""],"uri":[""],"itemData":{"id":3561,"type":"article-journal","title":"Reproductive health services for Syrian refugees in Zaatri Camp and Irbid City, Hashemite Kingdom of Jordan: an evaluation of the Minimum Initial Services Package.","container-title":"Conflict and Health","page":"S4","volume":"9","issue":"Suppl 1 Taking Stock of Reproductive Health in Humanitarian","abstract":"BACKGROUND: The Minimum Initial Services Package (MISP) for reproductive health, a standard of care in humanitarian emergencies, is a coordinated set of priority activities developed to prevent excess morbidity and mortality, particularly among women and girls, which should be implemented at the onset of an emergency. The purpose of the evaluation was to determine the status of MISP implementation for Syrian refugees in Jordan as part of a global evaluation of reproductive health in crises., METHODS: In March 2013, applying a formative evaluation approach 11 key informant interviews, 13 health facility assessments, and focus group discussions (14 groups; 159 participants) were conducted in two Syrian refugee sites in Jordan, Zaatri Camp, and Irbid City, respectively. Information was coded, themes were identified, and relationships between data explored., RESULTS: Lead health agencies addressed the MISP by securing funding and supplies and establishing reproductive health focal points, services and coordination mechanisms. However, Irbid City was less likely to be included in coordination activities and health facilities reported challenges in human resource capacity. Access to clinical management of rape survivors was limited, and both women and service provider's knowledge about availability of these services was low. Activities to reduce the transmission of HIV and to prevent excess maternal and newborn morbidity and mortality were available, although some interventions needed strengthening. Some planning for comprehensive reproductive health services, including health indicator collection, was delayed. Contraceptives were available to meet demand. Syndromic treatment of sexually transmitted infections and antiretrovirals for continuing users were not available. In general refugee women and adolescent girls perceived clinical services negatively and complained about the lack of basic necessities., CONCLUSIONS: MISP services and key elements to support implementation were largely in place. Pre-existing Jordanian health infrastructure, prior MISP trainings, dedicated leadership and available funding and supplies facilitated MISP implementation. The lack of a national protocol on clinical management of rape survivors hindered provision of these services, while communities' lack of information about the health benefits of the services as well as perceived cultural repercussions likely contributed to no recent service uptake from survivors. This information can inform MISP programming in this setting.","DOI":"10.1186/1752-1505-9-S1-S4","ISSN":"1752-1505","note":"Krause, Sandra. Women's Refugee Commission, 122 East 42nd Street, New York, New York 10168, USA.\nWilliams, Holly. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.\nOnyango, Monica A. Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.\nSami, Samira. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.\nDoedens, Wilma. United Nations Population Fund, 605 3rd Ave, New York, NY 10158, USA.\nGiga, Noreen. Women's Refugee Commission, 122 East 42nd Street, New York, New York 10168, USA.\nStone, Erin. Women's Refugee Commission, 122 East 42nd Street, New York, New York 10168, USA.\nTomczyk, Barbara. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.","journalAbbreviation":"Confl Health","author":[{"family":"Krause","given":"Sandra"},{"family":"Williams","given":"Holly"},{"family":"Onyango","given":"Monica A"},{"family":"Sami","given":"Samira"},{"family":"Doedens","given":"Wilma"},{"family":"Giga","given":"Noreen"},{"family":"Stone","given":"Erin"},{"family":"Tomczyk","given":"Barbara"}],"issued":{"date-parts":[["2015"]]}},"suppress-author":true}],"schema":""} (2015) was conducted to evaluate implementation of the Minimum Initial Services Package. The researchers interviewed 11 key informants, undertook 13 health facility assessments and conducted 14 focus groups with 159 female Syrian refugees. Health agencies had secured funding and established reproductive health focal points and coordinating mechanisms. Some reproductive services, including activities to reduce HIV, and prevent excess maternal and newborn morbidity and mortality were available, though refugee participants generally had negative perceptions of the available services. Communities’ lack of information about services and perceived cultural repercussions for reporting violence were deemed likely to have contributed to no recent service uptake of clinical management for rape survivors.The IRC delivered and evaluated an intervention comprising training for health care providers of services following sexual assault in refugee camps in Ethiopia and Kenya, a post-conflict setting in the Democratic Republic of Congo, and an urban refugee setting in Jordan ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rK0fR7AH","properties":{"formattedCitation":"(Smith et al., 2013)","plainCitation":"(Smith et al., 2013)","noteIndex":0},"citationItems":[{"id":3560,"uris":[""],"uri":[""],"itemData":{"id":3560,"type":"article-journal","title":"Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers' attitudes, knowledge, confidence, and practice in humanitarian settings.","container-title":"Conflict and Health","page":"14","volume":"7","issue":"101286573","abstract":"BACKGROUND: Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers' attitudes, knowledge, confidence, and practices in four countries., METHODS: Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers' practice. Quantitative and qualitative data underwent statistical and thematic analysis., RESULTS: While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p<.01) and 74% to 81% (p<.05) respectively. Healthcare providers' knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p<.001) and 58% to 73% (p<.001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p<.01), HIV post-exposure prophylaxis from 42% to 92% (p<.001), and STI prophylaxis and treatment from 45% to 96% (p<.01)., CONCLUSIONS: Although beliefs about sexual assault are hard to change, training can improve healthcare providers' respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.","DOI":"10.1186/1752-1505-7-14","ISSN":"1752-1505","note":"Smith, Janel R. International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.\nHo, Lara S. International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA ; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.\nLangston, Anne. International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.\nMankani, Neha. Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.\nShivshanker, Anjuli. International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.\nPerera, Dhammika. International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.","journalAbbreviation":"Confl Health","author":[{"family":"Smith","given":"Janel R"},{"family":"Ho","given":"Lara S"},{"family":"Langston","given":"Anne"},{"family":"Mankani","given":"Neha"},{"family":"Shivshanker","given":"Anjuli"},{"family":"Perera","given":"Dhammika"}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} (Smith et al., 2013). The multi-media training was designed to promote compassionate, confidential and competent clinical care. Data were collected through pre and post surveys with 106 healthcare providers, in-depth interviews with 40 providers, and medical record audits in 35 healthcare facilities. The research found no change in negative attitudes, with health workers still disbelieving and blaming women reporting sexual assault, but the research did find significant increases in respect for patient rights to non-discrimination and self-determination. Significant increases in knowledge and confidence in treating sexual assault survivors and improved practice e.g. supply of emergency contraception, HIV post-exposure prophylaxis and STI prophylaxis and treatment, followed the intervention.Vu and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"oTTQz4C7","properties":{"formattedCitation":"(2017)","plainCitation":"(2017)","noteIndex":0},"citationItems":[{"id":3052,"uris":[""],"uri":[""],"itemData":{"id":3052,"type":"article-journal","title":"Feasibility and acceptability of a universal screening and referral protocol for gender-based violence with women seeking care in health clinics in Dadaab refugee camps in Kenya.","container-title":"Global Mental Health","volume":"4","issue":"Health & Mental Health Services [3370]","abstract":"Background: Gender-based violence (GBV) is both a global public health problem and violation of human rights. Refugees and internally displaced persons experience an increased risk of GBV and health outcomes associated with GBV are often exacerbated in conflict settings. Methods: A mixed methods study to examine the feasibility and acceptability of universal screening for GBV in a refugee population in the Dadaab refugee camp of Kenya, using the ASIST-GBV from January to July 2015. Results: Of 9366 women offered screening at International Rescue Committee health clinics, about 89% (n = 8369) female refugees consented to participate. Only 15% of the potentially eligible population could participate in GBV screening because of the ongoing struggle to identify private space in the clinics. Over 85% of women reported being 'willing' or 'very willing' to participate in GBV screening; 96% felt they had a good or very good experience with the screening protocol. Qualitative findings stressed the importance of securing a room/space in the busy clinic is critical to universal screening with referral to safe and confidential services for survivors. Conclusions: The findings suggest that the evidence-based ASIST-GBV is both feasible to implement and acceptable to both providers and women seeking care. Universal GBV screening and referral is an effective way for health care and service providers in humanitarian settings to assist survivors of GBV. (PsycINFO Database Record (c) 2018 APA, all rights reserved)","DOI":"10.1017/gmh.2017.18","author":[{"family":"Vu","given":"A"},{"family":"Wirtz","given":"A. L"},{"family":"Bundgaard","given":"S"},{"family":"Nair","given":"A"},{"family":"Luttah","given":"G"},{"family":"Ngugi","given":"S"},{"family":"Glass","given":"N"}],"editor":[{"family":"Christian","given":"Hossain","suffix":"Tanabe, Vu, Vu, Wirtz, Wirtz, Wirtz"}],"issued":{"date-parts":[["2017"]]}},"suppress-author":true}],"schema":""} (2017) examined the feasibility and acceptability of universal screening for SGBV in a primarily Somali refugee population in the Dadaab refugee camp in Kenya. They conducted 101 exit interviews with screening participants, 19 in-depth interviews with women referred for additional services, and focus groups with 24 service providers. Implementation of this screening and referral program was judged to be a feasible and acceptable way to assist survivors of SGBV. Barriers included heavy workloads in health clinics and lack of private spaces, as well as possible reluctance amongst women to disclose SGBV experiences. Resulting low participation rates and low rates of SGBV reported through screening (2.5% compared with estimated previous-year prevalence of 20%) were serious limitations.Three papers described interventions delivered in refugee camps with appraisal consisting of the authors’ observations and reflections. Two of these were arts-based interventions ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"w1kMuKO1","properties":{"formattedCitation":"(Cohen, 2013; Sliep, Weingarten, & Gilbert, 2004)","plainCitation":"(Cohen, 2013; Sliep, Weingarten, & Gilbert, 2004)","noteIndex":0},"citationItems":[{"id":2753,"uris":[""],"uri":[""],"itemData":{"id":2753,"type":"article-journal","title":"Common Threads: A recovery programme for survivors of gender based violence.","container-title":"Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict","collection-title":"Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas","page":"157-168","volume":"11","issue":"2","abstract":"A multi-dimensional, intervention programme for survivors of gender based violence was piloted in Lago Agrio, Ecuador and a nearby Colombian refugee settlement. Local facilitators were trained to implement the programme with small groups of women. The model introduces art therapy techniques, psycho-education, peer support, symptom reduction techniques and psychosocial skill building, within the context of a women's hand sewing collective. Participants design and sew narrative textiles (known as 'arpilleras' in parts of Latin America) in order to share their experiences and process memories. This article documents the development of the model, and its implementation in that community. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1097/01.WTF.0000431118.16849.0c","ISSN":"1571-8883","author":[{"family":"Cohen","given":"Rachel A"}],"editor":[{"family":"Agosin","given":"Anderson","suffix":"Bacic, Boss, Cooke, Curran, Herman, Ogden, Rothschild, Rothschild"}],"issued":{"date-parts":[["2013"]]}}},{"id":732,"uris":[""],"uri":[""],"itemData":{"id":732,"type":"article-journal","title":"Narrative Theatre as an Interactive Community Approach to Mobilizing Collective Action in Northern Uganda.","container-title":"Families, Systems, & Health","collection-title":"Family Systems Medicine","page":"306-320","volume":"22","issue":"3","abstract":"The authors describe an interactive community approach that addressed the issue of domestic violence in a refugee camp in northern Uganda. Domestic violence had emerged at the time as one of the residents' most significant health problems. Based on principles of narrative therapy and Forum Theatre, this community-based approach, named Narrative Theatre by the community workers themselves, sought to address the causes and alter the trajectory of the potential outcomes of domestic violence at both the individual and community levels. The approach exemplifies working collaboratively with local psychosocial workers. The authors elucidate the participatory and contextually sensitive nature of Narrative Theatre, its ability to work individually as well as collectively, and its potential to keep the focus on local dynamics. The limits and potential of the strategy in terms of working recursively between individuals and society to address issues of social health are considered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1037/1091-7527.22.3.306","ISSN":"1091-7527","author":[{"family":"Sliep","given":"Yvonne"},{"family":"Weingarten","given":"Kaethe"},{"family":"Gilbert","given":"Andrew"}],"editor":[{"family":"Ankrah","given":""}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Cohen, 2013; Sliep, Weingarten, & Gilbert, 2004) and a third comprised delivery of a cognitive behavioural therapy intervention to Sudanese survivors of sexual violence in northern Uganda ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rWh4Xhik","properties":{"formattedCitation":"(Mogga, 2017)","plainCitation":"(Mogga, 2017)","noteIndex":0},"citationItems":[{"id":2676,"uris":[""],"uri":[""],"itemData":{"id":2676,"type":"article-journal","title":"Addressing gender based violence and psychosocial support among South Sudanese refugee settlements in northern Uganda.","container-title":"Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas","collection-title":"Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict","page":"9-16","volume":"15","issue":"1","abstract":"This personal reflection describes how the nongovernmental organisation, TPO Uganda, tried to expand an existing programme providing psychosocial support to survivors of sexual gender based violence in refugee camps in Adjumani District to Bidibidi in Yumbe District, Uganda with an enormous group of new refugees from South Sudan. It describes the kind of (sexual) gender based violence the refugee girls and women experience, how staff try to find these women and provide support through using cognitive behavioural treatment therapy for trauma intervention. The author gives voice to the women who went through this intervention and shows the challenges staff experience in supporting new resettlements of more than 200,000 people since opening in August 2016. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","DOI":"10.1097/WTF.0000000000000143","ISSN":"1571-8883","author":[{"family":"Mogga","given":"Rose"}],"editor":[{"literal":"Kigozi"}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} (Mogga, 2017). Common Threads is a multi-dimensional intervention for SGBV survivors that was piloted in Ecuador with Columbian refugees ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hMdjfORQ","properties":{"formattedCitation":"(Cohen, 2013)","plainCitation":"(Cohen, 2013)","noteIndex":0},"citationItems":[{"id":2753,"uris":[""],"uri":[""],"itemData":{"id":2753,"type":"article-journal","title":"Common Threads: A recovery programme for survivors of gender based violence.","container-title":"Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict","collection-title":"Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas","page":"157-168","volume":"11","issue":"2","abstract":"A multi-dimensional, intervention programme for survivors of gender based violence was piloted in Lago Agrio, Ecuador and a nearby Colombian refugee settlement. Local facilitators were trained to implement the programme with small groups of women. The model introduces art therapy techniques, psycho-education, peer support, symptom reduction techniques and psychosocial skill building, within the context of a women's hand sewing collective. Participants design and sew narrative textiles (known as 'arpilleras' in parts of Latin America) in order to share their experiences and process memories. This article documents the development of the model, and its implementation in that community. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1097/01.WTF.0000431118.16849.0c","ISSN":"1571-8883","author":[{"family":"Cohen","given":"Rachel A"}],"editor":[{"family":"Agosin","given":"Anderson","suffix":"Bacic, Boss, Cooke, Curran, Herman, Ogden, Rothschild, Rothschild"}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} (Cohen, 2013). Conceptualised as combining art therapy techniques, psycho-education, peer support, and psychosocial skill-building, participants hand sew ‘narrative textiles’ in facilitated small group sessions. The intervention builds on a tradition of textile-based responses to violence in South America, explicitly referencing the arpilleras, produced by Chilean women to document systemic violence and abuses during the Pinochet dictatorship. While the paper is focused primarily on documenting implementation of the model, it also reports observations of the group facilitators and author of several therapeutic benefits. These included building connections to others, working through traumatic experiences, stress reduction, and an increase in self-esteem among participants. More rigorous evaluation was recommended with a larger sample in order to make conclusive claims regarding effectiveness of this response. A Narrative Theatre intervention conceptualised as an interactive community approach to mobilising collective action in response to domestic violence in a refugee camp in Northern Uganda is also described ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vrDUWT08","properties":{"formattedCitation":"(Sliep et al., 2004)","plainCitation":"(Sliep et al., 2004)","noteIndex":0},"citationItems":[{"id":732,"uris":[""],"uri":[""],"itemData":{"id":732,"type":"article-journal","title":"Narrative Theatre as an Interactive Community Approach to Mobilizing Collective Action in Northern Uganda.","container-title":"Families, Systems, & Health","collection-title":"Family Systems Medicine","page":"306-320","volume":"22","issue":"3","abstract":"The authors describe an interactive community approach that addressed the issue of domestic violence in a refugee camp in northern Uganda. Domestic violence had emerged at the time as one of the residents' most significant health problems. Based on principles of narrative therapy and Forum Theatre, this community-based approach, named Narrative Theatre by the community workers themselves, sought to address the causes and alter the trajectory of the potential outcomes of domestic violence at both the individual and community levels. The approach exemplifies working collaboratively with local psychosocial workers. The authors elucidate the participatory and contextually sensitive nature of Narrative Theatre, its ability to work individually as well as collectively, and its potential to keep the focus on local dynamics. The limits and potential of the strategy in terms of working recursively between individuals and society to address issues of social health are considered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1037/1091-7527.22.3.306","ISSN":"1091-7527","author":[{"family":"Sliep","given":"Yvonne"},{"family":"Weingarten","given":"Kaethe"},{"family":"Gilbert","given":"Andrew"}],"editor":[{"family":"Ankrah","given":""}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Sliep et al., 2004). The authors outline the process in detail indicating that during workshops, there was a progression from a focus on an individual to a focus on the household, the greater community, and, ultimately, the society. They reflect that the dynamic interactive process of narrative theatre promoted an increase in awareness and was effective in bringing forward local knowledge ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NavBBPIC","properties":{"formattedCitation":"(Sliep et al., 2004)","plainCitation":"(Sliep et al., 2004)","noteIndex":0},"citationItems":[{"id":732,"uris":[""],"uri":[""],"itemData":{"id":732,"type":"article-journal","title":"Narrative Theatre as an Interactive Community Approach to Mobilizing Collective Action in Northern Uganda.","container-title":"Families, Systems, & Health","collection-title":"Family Systems Medicine","page":"306-320","volume":"22","issue":"3","abstract":"The authors describe an interactive community approach that addressed the issue of domestic violence in a refugee camp in northern Uganda. Domestic violence had emerged at the time as one of the residents' most significant health problems. Based on principles of narrative therapy and Forum Theatre, this community-based approach, named Narrative Theatre by the community workers themselves, sought to address the causes and alter the trajectory of the potential outcomes of domestic violence at both the individual and community levels. The approach exemplifies working collaboratively with local psychosocial workers. The authors elucidate the participatory and contextually sensitive nature of Narrative Theatre, its ability to work individually as well as collectively, and its potential to keep the focus on local dynamics. The limits and potential of the strategy in terms of working recursively between individuals and society to address issues of social health are considered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1037/1091-7527.22.3.306","ISSN":"1091-7527","author":[{"family":"Sliep","given":"Yvonne"},{"family":"Weingarten","given":"Kaethe"},{"family":"Gilbert","given":"Andrew"}],"editor":[{"family":"Ankrah","given":""}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Sliep et al., 2004).Mogga ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mSqzW5Ko","properties":{"formattedCitation":"(2017)","plainCitation":"(2017)","noteIndex":0},"citationItems":[{"id":2676,"uris":[""],"uri":[""],"itemData":{"id":2676,"type":"article-journal","title":"Addressing gender based violence and psychosocial support among South Sudanese refugee settlements in northern Uganda.","container-title":"Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas","collection-title":"Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict","page":"9-16","volume":"15","issue":"1","abstract":"This personal reflection describes how the nongovernmental organisation, TPO Uganda, tried to expand an existing programme providing psychosocial support to survivors of sexual gender based violence in refugee camps in Adjumani District to Bidibidi in Yumbe District, Uganda with an enormous group of new refugees from South Sudan. It describes the kind of (sexual) gender based violence the refugee girls and women experience, how staff try to find these women and provide support through using cognitive behavioural treatment therapy for trauma intervention. The author gives voice to the women who went through this intervention and shows the challenges staff experience in supporting new resettlements of more than 200,000 people since opening in August 2016. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","DOI":"10.1097/WTF.0000000000000143","ISSN":"1571-8883","author":[{"family":"Mogga","given":"Rose"}],"editor":[{"literal":"Kigozi"}],"issued":{"date-parts":[["2017"]]}},"suppress-author":true}],"schema":""} (2017) describes in detail delivery of a Cognitive Behavioural Therapy intervention in refugee camps in Northern Uganda, to Sudanese refugee women who had suffered primarily sexual GBV. Delivery of the intervention was limited by serious logistical challenges in that setting but she presents a case study of a previously suicidal woman who experienced remarkable benefit from the group-based therapy ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zMRUu24b","properties":{"formattedCitation":"(Mogga, 2017)","plainCitation":"(Mogga, 2017)","noteIndex":0},"citationItems":[{"id":2676,"uris":[""],"uri":[""],"itemData":{"id":2676,"type":"article-journal","title":"Addressing gender based violence and psychosocial support among South Sudanese refugee settlements in northern Uganda.","container-title":"Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas","collection-title":"Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict","page":"9-16","volume":"15","issue":"1","abstract":"This personal reflection describes how the nongovernmental organisation, TPO Uganda, tried to expand an existing programme providing psychosocial support to survivors of sexual gender based violence in refugee camps in Adjumani District to Bidibidi in Yumbe District, Uganda with an enormous group of new refugees from South Sudan. It describes the kind of (sexual) gender based violence the refugee girls and women experience, how staff try to find these women and provide support through using cognitive behavioural treatment therapy for trauma intervention. The author gives voice to the women who went through this intervention and shows the challenges staff experience in supporting new resettlements of more than 200,000 people since opening in August 2016. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","DOI":"10.1097/WTF.0000000000000143","ISSN":"1571-8883","author":[{"family":"Mogga","given":"Rose"}],"editor":[{"literal":"Kigozi"}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} (Mogga, 2017). Evaluation of SGBV interventions in a resettlement contextOur review located four studies that reported the outcomes from SGBV interventions for refugees in a resettlement setting. Two of these comprised single case studies of psychological treatments.In Israel, a program for training Ethiopian social workers (12 women and 5 men) to address domestic violence in the Ethiopian immigrant community was implemented and evaluated ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yZlbLraH","properties":{"formattedCitation":"(Ben-Porat, 2010)","plainCitation":"(Ben-Porat, 2010)","noteIndex":0},"citationItems":[{"id":3602,"uris":[""],"uri":[""],"itemData":{"id":3602,"type":"article-journal","title":"Connecting Two Worlds: Training Social Workers to Deal with Domestic Violence against Women in the Ethiopian Community","container-title":"The British Journal of Social Work","page":"2485-2501","volume":"40","issue":"8","source":"academic.","abstract":"Abstract. Domestic violence against women is a phenomenon that transcends religion, socio-economic status, nationality and culture. The literature indicates th","DOI":"10.1093/bjsw/bcq027","ISSN":"0045-3102","title-short":"Connecting Two Worlds","journalAbbreviation":"Br J Soc Work","language":"en","author":[{"family":"Ben-Porat","given":"Anat"}],"issued":{"date-parts":[["2010",12,1]]}}}],"schema":""} (Ben-Porat, 2010). Process data and focus group data were collected after one year. Process data showed that program participants had instituted community, family and individual level interventions. These included organising multi-sectoral committees; community days to raise awareness of the problem and of available services; study days for professionals who worked with the Ethiopian community; and individual and group therapy for male and female community members. Focus group data highlighted that program participation had broadened and enhanced participants’ knowledge and skills for intervention. Participants also reported changed attitudes about domestic violence – no longer blaming women for its occurrence - and about the Ethiopian community. They reported an increase in empathy toward members of their community. The findings underscore the need for integration of individual, group and community work and the use of culturally sensitive methods for interventions.In South Korea, Kim and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Sx0z7umv","properties":{"formattedCitation":"(2016)","plainCitation":"(2016)","noteIndex":0},"citationItems":[{"id":3104,"uris":[""],"uri":[""],"itemData":{"id":3104,"type":"article-journal","title":"\"Thank you, sorry, love\" (TSL) therapy with North Korean refugee women: A pilot study.","container-title":"Research on Social Work Practice","page":"816-824","volume":"26","issue":"7","abstract":"Objectives: This study was designed to evaluate the effectiveness of The \"Thank You, Sorry, Love\" (TSL) family therapy program in potentially improving the marital relationships and health of North Korean refugee women. Methods: The participants included 12 married North Korean female refugees in their 20s to 40s. Using a blinded assignment, six received the TSL family therapy program and six did not receive any treatment. Pretests (just before the program), posttests (just after termination of the program), and follow-up tests (1 month after termination of the program) were conducted. Results: The program participants experienced a statistically significant decrease in marital violence and an increase in their total antioxidant activity levels. Conclusions: TSL family therapy has the potential to contribute to improving the lives of traumatized North Korean refugee women. Larger scale replication studies involving random assignment would be a useful next step in evaluating the TSL program. (PsycINFO Database Record (c) 2017 APA, all rights reserved)","author":[{"family":"Kim","given":"Hee Jin"},{"family":"Kim","given":"Jae Yop"},{"family":"Kim","given":"Dong Goo"}],"editor":[{"family":"Altman","given":"Arnao"}],"issued":{"date-parts":[["2016"]]}},"suppress-author":true}],"schema":""} (2016) delivered and evaluated the Thank You, Sorry Love family therapy program with 12 married North Korean refugees. Half of the participants (n=6) received the intervention, designed to improve marital relationships by encouraging the expression of positive emotions between spouses by focusing on ‘what one was grateful and sorry for’ (Kim et al., 2016, p. 817). The authors note that families in Korean society are not accustomed to expressing positive emotions to one another. The study found the levels of intimate partner violence for program participants were significantly reduced in both the pre-test to post-test data and pre-test to follow-up test data. These participants also experienced better marital relations and mental health than the females in the control group after completing the program. We also found two publications that reported on single clinical case studies involving therapies for survivors of sexual violence in the United States. Shulz and colleagues report the success of Cognitive Behaviour Therapy for relieving the post-traumatic stress symptoms of a Bosnian rape victim ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HfFcFhlC","properties":{"formattedCitation":"(Schulz, Marovic-Johnson, & Huber, 2006)","plainCitation":"(Schulz, Marovic-Johnson, & Huber, 2006)","noteIndex":0},"citationItems":[{"id":733,"uris":[""],"uri":[""],"itemData":{"id":733,"type":"article-journal","title":"Cognitive-Behavioral Treatment of Rape- and War-Related Posttraumatic Stress Disorder With a Female, Bosnian Refugee.","container-title":"Clinical Case Studies","page":"191-208","volume":"5","issue":"Cognitive Therapy [3311]","abstract":"Prevalence of posttraumatic stress disorder (PTSD) among rape victims and war refugees is high. Cognitive-behavioral interventions have demonstrated effectiveness in alleviating PTSD in rape survivors. Effectiveness of such interventions when rape is perpetrated as part of war hostilities has not been examined. Rape and plunder of civilian populations characterized the 1991 to 1995 war in the former Yugoslavia. Rape camps terrorized civilians on all sides of that conflict. This case study illustrates a course of cognitive-behavioral treatment for PTSD with a female, Bosnian refugee and rape survivor. At post treatment, the client no longer met criteria for PTSD, and improvements were evident at 6- and 12-month follow-ups. Approaches to treating PTSD in war refugees are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1177/1534650103262408","ISSN":"1534-6501","author":[{"family":"Schulz","given":"Priscilla M"},{"family":"Marovic-Johnson","given":"Davorka"},{"family":"Huber","given":"L. Christian"}],"editor":[{"family":"Arcel","given":""}],"issued":{"date-parts":[["2006"]]}}}],"schema":""} (Schulz, Marovic-Johnson, & Huber, 2006). Akinsulure-Smith ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Jt4sIRTK","properties":{"formattedCitation":"(2012)","plainCitation":"(2012)","noteIndex":0},"citationItems":[{"id":764,"uris":[""],"uri":[""],"itemData":{"id":764,"type":"article-journal","title":"Responding to the trauma of sexual violence in asylum seekers: A clinical case study.","container-title":"Clinical Case Studies","page":"285-298","volume":"11","issue":"4","abstract":"Civil and social unrest, human rights abuses, and various acts of violence around the world continue to force many to flee their homelands in search of safety. Such chaos often results in the disintegration of social order, generating widespread gender-based violence. During such struggles, women and girls suffer disproportionately and often are targeted for brutal acts of sexual violence. For forced migrants, their traumatic experiences are further compounded by the complex and often lengthy process of seeking asylum in a host country. Drawing on a clinical case study, this article presents the case of a female asylum seeker in the United States who is a victim of sexual violence. Using Brief Recovery Program for Trauma Survivors to facilitate healing and prevent chronic posttraumatic reactions, this case highlights considerations for promoting emotional well-being within this population. In addition, this case emphasizes the importance of an interdisciplinary treatment team and comprehensive services to address the multifaceted needs of traumatized forced migrants. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","ISSN":"1534-6501","author":[{"family":"Akinsulure-Smith","given":"Adeyinka M"}],"editor":[{"family":"Akinsulure-Smith","given":""}],"issued":{"date-parts":[["2012"]]}},"suppress-author":true}],"schema":""} (2012) reported on the case of a female asylum seeker for whom the Brief Recovery Program for Trauma Survivors was used to facilitate healing. The author suggests that the case highlights the need for integrative methods of psychotherapy (such as cognitive-behavioural, psychodynamic, and interpersonal models) in an interdisciplinary setting to provides comprehensive care that systematically considers biological, psychological and social factors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"oEGCMt16","properties":{"formattedCitation":"(Akinsulure-Smith, 2012)","plainCitation":"(Akinsulure-Smith, 2012)","noteIndex":0},"citationItems":[{"id":764,"uris":[""],"uri":[""],"itemData":{"id":764,"type":"article-journal","title":"Responding to the trauma of sexual violence in asylum seekers: A clinical case study.","container-title":"Clinical Case Studies","page":"285-298","volume":"11","issue":"4","abstract":"Civil and social unrest, human rights abuses, and various acts of violence around the world continue to force many to flee their homelands in search of safety. Such chaos often results in the disintegration of social order, generating widespread gender-based violence. During such struggles, women and girls suffer disproportionately and often are targeted for brutal acts of sexual violence. For forced migrants, their traumatic experiences are further compounded by the complex and often lengthy process of seeking asylum in a host country. Drawing on a clinical case study, this article presents the case of a female asylum seeker in the United States who is a victim of sexual violence. Using Brief Recovery Program for Trauma Survivors to facilitate healing and prevent chronic posttraumatic reactions, this case highlights considerations for promoting emotional well-being within this population. In addition, this case emphasizes the importance of an interdisciplinary treatment team and comprehensive services to address the multifaceted needs of traumatized forced migrants. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","ISSN":"1534-6501","author":[{"family":"Akinsulure-Smith","given":"Adeyinka M"}],"editor":[{"family":"Akinsulure-Smith","given":""}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} (Akinsulure-Smith, 2012). SummaryThis section of the review confirms the paucity of evidence available for the effectiveness of responses to SGBV experienced by refugees. Only 15 of the 54 papers located for the review evaluated or appraised interventions. Of these, five comprised personal observations and reflections of the authors or single case studies rather than rigorous evaluation. Nine of the studies focused on individualised treatment providing some evidence for effectiveness of psychological and psychosocial interventions for reducing trauma symptoms. Three studies considered interventions combining individual and group level approaches, with reports that the latter were positively appraised by participants with further research recommended to investigate their potential to reduce isolation and increase knowledge and self-confidence. Only three of the studies reported in this section attempted to evaluate multi-level interventions. A study by Henttonen and colleagues ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"11rkepBk","properties":{"formattedCitation":"(2008)","plainCitation":"(2008)","noteIndex":0},"citationItems":[{"id":216,"uris":[""],"uri":[""],"itemData":{"id":216,"type":"article-journal","title":"Health services for survivors of gender-based violence in northern Uganda: a qualitative study.","container-title":"Reproductive Health Matters","page":"122-131","volume":"16","issue":"31","source":"EBSCOhost","archive":"ccm","abstract":"The 20-year war in northern Uganda has resulted in up to 1.7 million people being internally displaced, and impoverishment and vulnerability to violence amongst the civilian population. This qualitative study examined the status of health services available for the survivors of gender-based violence in the Gulu district, northern Uganda. Semi-structured interviews were carried out in 2006 with 26 experts on gender-based violence and general health providers, and availability of medical supplies was reviewed. The Inter-Agency Standing Committee (IASC) guidelines on gender-based violence interventions in humanitarian settings were used to prepare the interview guides and analyse the findings. Some legislation and programmes do exist on gender-based violence. However, health facilities lacked sufficiently qualified staff and medical supplies to adequately detect and manage survivors, and confidential treatment and counselling could not be ensured. There was inter-sectoral collaboration, but greater resources are required to increase coverage and effectiveness of services. Intimate partner violence, sexual abuse of girls aged under 18, sexual harassment and early and forced marriage may be more common than rape by strangers. As the IASC guidelines focus on sexual violence by strangers and do not address other forms of gender-based violence, we suggest the need to explore this issue further to determine whether a broader concept of gender-based violence should be incorporated into the guidelines.","ISSN":"0968-8080","journalAbbreviation":"Reproductive Health Matters","author":[{"literal":"Henttonen M"},{"literal":"Watts C"},{"literal":"Roberts B"},{"literal":"Kaducu F"},{"literal":"Borchert M"}],"issued":{"date-parts":[["2008",5]]}},"suppress-author":true}],"schema":""} (2008) conducted in conflict-affected Northern Uganda found that greater resources and training were needed to enhance implementation and effectiveness of intersectoral responses. Also in Norther Uganda, a Narrative Theatre intervention was implemented designed to progress from a focus on an individual to a focus on the household, the greater community, and, ultimately, the society. While not formally evaluated, the authors reflect that the process was effective in bringing forward local knowledge ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"W6KdiXfz","properties":{"formattedCitation":"(Sliep et al., 2004)","plainCitation":"(Sliep et al., 2004)","noteIndex":0},"citationItems":[{"id":732,"uris":[""],"uri":[""],"itemData":{"id":732,"type":"article-journal","title":"Narrative Theatre as an Interactive Community Approach to Mobilizing Collective Action in Northern Uganda.","container-title":"Families, Systems, & Health","collection-title":"Family Systems Medicine","page":"306-320","volume":"22","issue":"3","abstract":"The authors describe an interactive community approach that addressed the issue of domestic violence in a refugee camp in northern Uganda. Domestic violence had emerged at the time as one of the residents' most significant health problems. Based on principles of narrative therapy and Forum Theatre, this community-based approach, named Narrative Theatre by the community workers themselves, sought to address the causes and alter the trajectory of the potential outcomes of domestic violence at both the individual and community levels. The approach exemplifies working collaboratively with local psychosocial workers. The authors elucidate the participatory and contextually sensitive nature of Narrative Theatre, its ability to work individually as well as collectively, and its potential to keep the focus on local dynamics. The limits and potential of the strategy in terms of working recursively between individuals and society to address issues of social health are considered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1037/1091-7527.22.3.306","ISSN":"1091-7527","author":[{"family":"Sliep","given":"Yvonne"},{"family":"Weingarten","given":"Kaethe"},{"family":"Gilbert","given":"Andrew"}],"editor":[{"family":"Ankrah","given":""}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Sliep et al., 2004). Perhaps the best evidence for the effectiveness of a response targeting multiple sectors and ecological levels was provided by the Israeli intervention in which Ethiopian social workers were trained to address domestic violence in the Ethiopian immigrant community ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"e6szuKMU","properties":{"formattedCitation":"(Ben-Porat, 2010)","plainCitation":"(Ben-Porat, 2010)","noteIndex":0},"citationItems":[{"id":3602,"uris":[""],"uri":[""],"itemData":{"id":3602,"type":"article-journal","title":"Connecting Two Worlds: Training Social Workers to Deal with Domestic Violence against Women in the Ethiopian Community","container-title":"The British Journal of Social Work","page":"2485-2501","volume":"40","issue":"8","source":"academic.","abstract":"Abstract. Domestic violence against women is a phenomenon that transcends religion, socio-economic status, nationality and culture. The literature indicates th","DOI":"10.1093/bjsw/bcq027","ISSN":"0045-3102","title-short":"Connecting Two Worlds","journalAbbreviation":"Br J Soc Work","language":"en","author":[{"family":"Ben-Porat","given":"Anat"}],"issued":{"date-parts":[["2010",12,1]]}}}],"schema":""} (Ben-Porat, 2010). The evaluation indicated that the program led to multi-sectoral community, family and individual level interventions and was successful in changing attitudes about domestic violence.Discussion and ConclusionThis review demonstrates that recommended responses to SGBV tend to converge across the settings of conflict, displacement and resettlement. Available evidence suggests that intersectional and ecological principles need to underpin interventions. Thus, individual health and psychosocial responses should be supported by engagement with families, community leaders and communities, and by addressing underlying risk factors including harmful gender norms and social and economic marginalisation. Effective responses are understood to require change at organisational, societal, environmental, policy and legal levels. Several of the papers reviewed also highlight the importance of respecting and responding to cultural differences and incorporating indigenous knowledge in responses while maintaining the primacy of basic human rights and challenging gendered abuse and violence. Despite this convergence of expert opinion however - and while there is some limited evidence for the value of psychological interventions for reducing trauma symptoms - evidence for the effectiveness and impact of multi-faceted responses remains extremely scarce. As noted above, many of the guidelines and almost all the evidence reviews and recommendations arising from primary data collection with SGBV survivors and service providers emphasise the need for multilevel and multi-sectoral responses, yet the majority of published evaluations appraise individual level health and psychosocial interventions. Publications focused on the implementation and evaluation of responses to SGBV affecting men and boys, refugees with disability and LGBTI refugees are also lacking. Available evidence for effectiveness of responses to SGBV experienced by refugees only partially reflects the global distribution of displaced populations. Of the studies located: 14 focused on refugees in Africa; nine were based in North America; seven concerned Syrian or Palestinian refugees in Lebanon or Jordan (with one evidence review also including Turkey); six focused on refugees in Europe; two on displaced populations on the Thai/Burma border; and one each on refugees in Israel and South Korea. Eleven of the evidence reviews focused on unspecified refugee populations. The UNHCR’s most recently published statistics indicate that the top five refugee-producing countries (in order) are Syria, Afghanistan, South Sudan, Myanmar and Somalia which combine to produce 68% of the world’s refugees. Countries hosting the greatest number of refugees (in order) are Turkey, Pakistan, Uganda, Lebanon, Iran, Germany, Bangladesh and Sudan ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7QU9knTw","properties":{"formattedCitation":"(UNHCR, 2018b)","plainCitation":"(UNHCR, 2018b)","noteIndex":0},"citationItems":[{"id":3809,"uris":[""],"uri":[""],"itemData":{"id":3809,"type":"webpage","title":"UNHCR Global Trends - Forced Displacement in 2017","container-title":"UNHCR Global Trends - Forced displacement in 2017","abstract":"In 2017, the number of people forcibly displaced from their homes worldwide came at a rate of 44,400 every day. Raising the cumulative total to 68.5 million at the year’s end.","URL":"","language":"en-US","author":[{"literal":"UNHCR"}],"issued":{"date-parts":[["2018"]]},"accessed":{"date-parts":[["2019",1,23]]}}}],"schema":""} (UNHCR, 2018b). Research focused on SGBV experienced by Afghani refugees in countries such as Pakistan and Iran is notably lacking; no publications based on empirical research with Syrian refugees in Turkey were found; and refugees from Myanmar (particularly the large Rohingya) population in Bangladesh are also seriously under-represented in published research. The mismatch between the location of displaced populations and published research on SGBV undoubtedly reflects a range of factors including the location of researchers and research funding. The majority of the research represented in this review was carried out by researchers based in North America (18 studies plus 9 instigated by INGOs also predominantly North American based), followed by Europe (13 Studies). Four studies were conducted by African-based researchers, three by researchers in Australia and one each in Israel and South Korea. While sexual violence against refugees receives a lot of attention in the media, the research covered in this review was spread over a range of types of SGBV. Just under a third of included studies were concerned primarily with domestic violence or IPV, just over a third were concerned predominantly with sexual violence, and just over a third addressed all types of SGBV. To conclude, there are considerable gaps in evidence for what responses, approaches to treatment, and other supports are effective in assisting refugees who have experienced sexual and gender-based violence. While multi-level and multi-sectoral interventions are generally regarded as necessary, there is very little research documenting the implementation of such responses and even less evidence for their effectiveness. References ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Akinsulure-Smith, A. M. (2012). 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