Photo: The women of Sepur Zarco.
As part of the Women, Peace and Security #UN1325 ten year anniversary I was asked to speak at the UNSG Special Representative on Sexual Violence and the International Organisation for Migration’s organised event on reparations for sexual violence in New York (31st October). This is my talk reflecting on our project on the implementation of reparations at Queen’s University Belfast we have been working in seven countries emerging from conflict and spoken to around 400 individuals, including victims, perpetrators, reparation programme designers, as well as healthcare practitioners. As a registrar doctor in obstetrics and gynaecology in Northern Ireland, I have been approaching reparations from a medico-legal perspective, in particular with victims of sexual violence. I have been asked to speak on the immediate and important needs of victims and a helpful way to approach these issues is through a series of questions: who; what; when; and how?
Who to repair?
In relation to the who; this speaks to who are the eligible victims and beneficiaries of reparations. There are three key tensions here.
First we need to appreciate the differentiated impact of harm and resultant needs on an individual and community; this will affect how they understand, express and engage on reparations. Vulnerable, rural and marginalised groups such as LGBTQI+, those based on gender identity, children, elderly, and those with disabilities may not have the time or resources to engage on reparations, fill in forms or be aware that they could be eligible. Moreover such individuals can suffer prolonged and multiple forms of sexual violence, due to their vulnerability and marginalisation. It may be best to prioritise such individuals when it comes to receiving certain forms of reparation in order to mitigate their harm from worsening.
A related issue is how do we support such vulnerable or marginalised individuals from engaging and benefiting from reparations, as they often do not have sufficient evidence or paperwork to support their claims. In Peru’s domestic reparation programme, a lower evidentiary threshold is used for sexual violence based on ‘good faith’, in which their statement is taken and then corroborated by relevant news or other sources. Whereas in Nepal victims of sexual violence were excluded from the reparation programmes, and when we spoke to the government they said that this was because they did not come forward. So we also need to create a conducive space for victims to speak about reparations.
Second the notion of ‘conflict-related sexual violence’ or rape as a weapon of war, while useful in bringing attention to the issue, is problematic in framing the totality of sexual violence that occurs during wartime. Reparations solely based on rape as a war tactic risks neglecting sexual violence in detention centres, homes and private spaces, where the perpetrators are often known to the victim and who are taking advantage of the disorder caused by conflict to carry out sexual violence. By way of example, in Northern Ireland, victims of sexual violence were ineligible for compensation when the perpetrator was under ‘the same roof.’ These victims have needs that should fall into a reparation programme. While these two forms of sexual violence might appear to be different, they have the same source, i.e. patriarchy. Therefore, it makes sense to generate reparation programmes that include both categories, if reparations are serious about contributing to tackling the root causes. In addition, in prolonged conflicts, perpetrators can also be victims of sexual violence and need to be included in reparation programmes. In practice they are often excluded, due to their role in victimising others, such as in Colombia and Peru, leaving a situation where some sexual violence is implicitly justified and not redressed.
Third some victims of sexual violence may not define themselves on their direct violations they have suffered themselves, but rather on the other harm that has been caused to them and the resulting needs. For instance, we spoke to some victims of sexual violence in Nepal, who were demanding justice for family members who were tortured or disappeared. This is not to suggest that needs for sexual violence are secondary or binary with other violations, but that victims and survivors may see these other issues as more pressing. So we have to be careful that in highlighting sexual violence and making it visible that we are not invisibling or simplifying victims’ experience and needs. This leads us on to what to repair?
What to repair?
Sexual violence encompasses a range of violations which a reparation programme should be attuned to. As such, reparation is for the harm as a result of the violation, which may give rise to certain needs. If we approach this in terms of the potential spectrum of needs, as we heard this morning victims and survivors can have physical, psychological, social, economic and moral needs. However not all of these can or should be met by a reparation programme, and be better provided by other actors or programmes. That said if we think about Maslow’s hierarchy of needs, victims may require their basic needs of survival and security be met before, such as feeding and supporting themselves and their family, or waiting until the end of hostilities, before they can take the time to engage on reparation, truth and justice issues. However for other victims, needs are not necessarily progressively ordered in this way and very much depends on the context.
From our fieldwork three common needs stood out that could be met by a reparation programme:
- First, mental health support which can be delivered through a range of actors and services, from psycho-social interventions, psychotherapy and medication.
- Second sensitization to the issue of transitional justice and pathways for redress, in order to help victims to articulate their needs on a rights and reparation basis.
- Third for those suffering serious injuries or health complications as a result of sexual violence, specialised medical care is often needed. This needs to be appropriate as far as possible. From my own practice and speaking to other medical practitioners in Uganda, fistula surgeons may be required to repair traumatic genital fistula as a result of rape; however, the majority of genital fistulas are the result of obstetric factors, such as prolonged or obstructed labour without access to appropriate medical care. Accordingly, such needs may not always fit within the parameters of a reparation programme.
The ‘what’ issue is also connected to the appropriate timing and sequencing of providing measures, as it may be beneficial to implement some forms before others, such as medical rehabilitation.
When to repair?
Time can be a mitigating factor for speaking about loss and trauma, but it can also exacerbate the physical and psychological harm caused when not redressed, allowing it to fester. In dealing with the health consequences from sexual violence some needs are time-critical, such as providing prophylaxis for HIV (72 hours), Hepatitis A and B vaccines, emergency contraception within 120 hours… Where programmes do exist they may also take years to be fully attuned to the needs of victims, currently Colombia is updating its Protocol on Medical Assistance to Victims of Sexual Assault, to include specific guidelines for armed conflict victims to ensure a comprehensive response to those who may have long-term medical needs.
It also takes time for victims to become mobilised. In Peru, victims of forced sterilisation by the state were excluded from engagement on the truth commission and reparation programme, which were set up for victims of the conflict and Fujimori regime. It took time for them to comprehend how their rights were violated, become organised and to recover, due to surgery complications some of those experienced.
At the same time it may be too soon after the violations for victims to be engaged on reparations when the impact of the harm has not fully manifested itself. For instance in Northern Ireland, many victims who were left seriously injured and disabled including those violently raped, were often judged to have a life expectancy of 15 years in the 1970s for the amount of their compensation, yet 45 years on they are still alive and left in poverty, as some have said to us they now feel like ‘beggars’.
On the other hand reparations can equally be too late, such as in the Bemba case at the ICC, that while the defendant was later acquitted, the reparation process started some fifteen years after the mass rapes. This meant that many victims had died from sexual transmitted diseases or left in terrible hardship and rejected from their communities by the time reparations were about to be determined. This underlines the significance of how we can coordinate timely approaches to repairing victims’ harm, and how far?
In meeting victims’ needs we also need to think about how far we need to go in redressing the harm of the past, present and future. We saw that victims of sexual violence need physical and psychological rehabilitation, but how will this work in practice when there is no infrastructure or specialised medical staff in their region. Do they travel, risking being exposed, will their costs be covered, and what does this say about the sustainability and local development of healthcare provision if these violations occur again? Reparation and redressing sexual violence not only require measures such as rehabilitation and compensation, but also institutional and legislative reform. Some of these reforms may not occur during the lifetime of the direct victim, so how do we address these issues today?
If we are concerned about meeting victims’ needs we also have to engage with difficult issues of changing laws around sexual and reproductive rights such as abortion, that women’s lives are not put at further risk if they choose to have a termination of pregnancy after being raped. In Northern Ireland we have only this month decriminalised our abortion law, where previously women who were raped had to travel to another country to obtain such a service.
Ultimately we have to be modest on what reparations can and cannot do. Not only to make them feasible, given the resources that they can muster, but also in being honest to victims in informing their expectations and that certain needs require action sooner rather than later. As such, it can be helpful to map out the harm victims have suffered and their needs, to demonstrate why better co-ordination should exist between assistance and reparation.
We need to recognise that in claiming for reparations, it takes time, to decipher the: who, what, when and how. Therefore, when reparation programmes are implemented for victims of sexual violence, there needs to be sensitivity to potential obstacles. If claims for reparations are time-barred, some victims may miss the opportunity or they may feel that are not ready to engage in these processes within a designated time period. Further still, some victims of sexual violence may not want to claim reparations or come forward, and so respecting their choices is important. That said, the process of demanding reparations can be a significant pathway for victims to vindicate their good name and seek measures to alleviate the consequences of sexual violence.
Finally, having the correct legal, political and social tools to apply pressure to the state to implement reparations are key. Human rights is a useful framework here in that it gives us tools to hold the state to account to ensure victims’ right to remedy and reparation, but also respects victims’ agency and dignity. This can be seen by the courageous struggle of the women of Sepur Zarco in Guatemala where after years of campaigning with civil society allies they manage to secure the conviction of those responsible for the sexual enslavement as well as an order on reparations. So in demanding reparations for victims of sexual violence, we are not seeing them as dependants with needs, but as dignified human beings with agency and rights. The role for us is to find a way to support victims in their campaign, by echoing their voices and putting pressure on states to ensure their rights to reparations.