Strengthening the Response to Conflict-Related Sexual Violence

Why is the UN Security Council talking about sexual violence, and will it be discussing health care for survivors?

On 6 July, the UN Secretary-General issued his annual report on sexual violence in conflict, which identifies global and country-specific trends such as the use of sexual violence as a tactic of war and the lack of compliance with UN Security Council resolutions on sexual violence by parties to conflict (as part of efforts to “name and shame” parties responsible for this crime). The report makes recommendations as to what the Security Council and member states can do to strengthen the response to this issue. These reports have appeared every year since 2010, when the UN Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict was launched.

The Council generally meets shortly after the annual report’s release to discuss its contents and exchange views on a topic related to conflict-related sexual violence, or CRSV, which the UN defines as “rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, enforced sterilization, forced marriage and any other form of sexual violence of comparable gravity perpetrated against women, men, girls or boys that is directly or indirectly linked to a conflict”. In 2023, the Council will convene on 14 July, hosted by the UK (the Council member holding the presidency for the month), which has chosen the topic of implementation of Security Council resolutions on CRSV.

Conflict actors engage in CRSV for myriad reasons. In some cases, they use it systematically and strategically. In Haiti, for instance, criminal gangs wield sexual violence as a way to expand their control of territory, humiliate rivals and community members, and press the families of kidnapping victims to pay ransom. In Cameroon’s Anglophone conflict, as noted in Crisis Group’s coverage, both sides have used rape as a way to punish victims and reward fighters.

Conflict-related displacement and deprivation, combined with a collapse of the rule of law, also create openings for perpetrators (not necessarily conflict actors themselves) to commit more opportunistic forms of abuse. In Haiti, girls and women have reportedly been raped at makeshift displacement camps, some by aid workers or government officials. In Colombia, Crisis Group found that Venezuelan women and girl migrants have become targets for criminal networks, which offer them jobs in restaurants or hotels before forcing them into sexual exploitation.

An essential component of UN and other support to CRSV survivors is sexual and reproductive health care. This may include treatment for internal physical injuries, sexually transmitted diseases, safe abortion and pre- and post-natal care. Variations in national health care capacity, political attitudes, legal restrictions (particularly with respect to abortion) and the ways that these interact with insecurity hamper the ability to respond, however, making health care an under-implemented area of the response to CRSV. Questions about how the UN can help survivors get access to health care should therefore be at the top of the list of topics for Council members when they discuss ways to strengthen implementation of the CRSV resolutions on 14 July.

What kinds of challenges do survivors face in trying to get sexual and reproductive health care in conflict situations?  

In many conflict-affected countries, widespread violence and resource challenges meant that access to sexual and reproductive health services was limited even before full-blown conflict erupted. The outbreak of larger-scale violence tends to make it even harder for survivors to get the care they need. At an event in Kyiv, Crisis Group heard the testimony of a woman from Bucha, Ukraine, who was raped by Russian forces shortly before they retreated from the town in the spring of 2022. Amid the chaos of the Russian departure, it took her ten days to locate a gynaecologist who could treat her. Ukrainian experts also told Crisis Group that, given a lack of both resources and coordination, survivors of CRSV in the country often have to retell their stories repeatedly, amplifying their trauma, before finding someone who is able to help them.

A major problem is that health care infrastructure and workers frequently become targets of attacks in conflict-affected areas, forcing hospitals and local health centres to run at reduced capacity or to cease operations altogether. Crisis Group has reported such attacks in the Anglophone conflict in Cameroon. Worldwide, 2022 proved particularly dire in this regard, with a 45 per cent increase in incidents of violence against or obstruction of health care in conflicts compared to 2021. So far, 2023 appears to be on an equally dismal trajectory. In Sudan, 67 per cent of health facilities in areas affected by the fighting that erupted in April have closed. Reports of sexual violence continue to emerge from both the capital and Darfur, and access to the warehouses where the UN Population Fund had stored supplies to respond to 47,000 emergency reproductive health cases, including contraceptives and post-rape treatment, has been blocked. In Haiti, the Doctors Without Borders clinic in Cité Soleil, a shantytown in the capital city Port-au-Prince that is under gang control, had to shut down between March and the end of May due to insecurity. Meanwhile, it is hard to imagine that the need for the facility’s services did anything but increase: from January to May, the organisation’s other clinics in Port-au-Prince assisted almost twice the number of survivors of sexual violence that they had during the same period in 2022.

But attacks on staff and facilities are not the only reason why access to services may be curtailed in conflict-affected regions. For example, in Myanmar, where both the military and armed resistance groups have committed sexual violence, doctors and other medical personnel have been at the forefront of the civil disobedience movement following the 2021 coup, with many of them refusing to work under the military junta – meaning that survivors often cannot get the services they need.

As for those who flee conflict-affected countries after experiencing sexual violence, they may find themselves facing tighter legal restrictions on sexual and reproductive health care, especially abortion, than back at home. In Poland, where hundreds of thousands of Ukrainian women arrived in 2022, rape is one of the few circumstances in which abortion is legal. The process is prohibitively complex and traumatic, however, especially for refugees, as it requires survivors of rape to report the incident to the police and obtain a prosecutorial certificate before they can qualify for legal abortion. Moreover, survivors have to take all these steps in the first twelve weeks of pregnancy, making legal abortion nearly impossible to obtain in practice.

What are the consequences of lack of access?

Lack of access to sexual and reproductive health care services has far-reaching implications for both survivors of CRSV and their communities. Without these services, women survivors may face long-term health consequences that compound gender inequalities they are often already facing – eg, lack of equal access to political and economic participation. Without treatment for both the immediate effects of rape – such as sexually transmitted diseases, vaginal injuries and pregnancy – and the later consequences of complications during pregnancy and childbirth, they may struggle to stay in school, continue their livelihoods or otherwise participate in public life. Resorting to more readily available alternatives, such as unsafe abortions, can exacerbate these risks. In addition to the physical consequences of sexual violence, pregnancies resulting from rape can cause stigmatisation of survivors and their children, as Crisis Group found in north-eastern Nigeria. Social opprobrium further constrains survivors’ ability to engage in political and economic activity.

A lack of access to relevant services in safe havens may also push survivors back into the conflict zone. Some Ukrainian women who sought refuge in Poland, for instance, felt that their best chances of getting sexual and reproductive care lay in going back to Ukraine, despite even temporary return being a costly and risky endeavour.

What is the state of work on sexual and reproductive health care at the Security Council?

The starting point for UN Security Council action on this issue was Resolution 2106 (2013), which urges UN entities and donors to provide “non-discriminatory and comprehensive health services”, including in the area of “sexual and reproductive health”. That turned out to be an unusual moment of consensus for the Council, however. In fact, the issue has been extremely contentious in recent years as global debates on women’s rights have become increasingly pitched. The fault lines run along several axes.

Much of the discord can be chalked up to disagreements about abortion. The U.S. position on abortion tends to change with the party in power. Democratic administrations generally favour abortion rights, whereas Republican administrations are opposed. In 2019, for instance, the administration of President Donald Trump (a Republican) fought hard to exclude any reference to health care services for survivors in negotiations over Resolution 2467 (2019), which outlined wide-ranging measures constituting what the resolution defines as a “survivor-centred approach” to the prevention of and response to CRSV. Leading an unusual alliance that included Russia and China, the U.S. threatened to veto the resolution if it referred to health care. The resolution therefore makes no mention of sexual and reproductive health at all.

While the U.S. position oscillates, depending on who is in the White House, other permanent members of the Security Council tend to have fixed – and diametrically opposing – views. France and the UK are longstanding supporters of sexual and reproductive health care as a component of the response to CRSV; their positions do not waver. As for Russia and China, they take the view that sexual and reproductive health care does not qualify as a peace and security priority. They take issue with it being addressed by the Council instead of by other, non-security focused, UN member state forums.

The Security Council’s elected members rotate, adding further complexity to the divergence of views among the permanent five. The current cohort takes positions running the gamut from abortion being legal only under certain circumstances, such as rape or danger to the life of the mother, to abortion being legal under any circumstances for a defined time after conception. Divisions over the topic of abortion are exacerbated by those over the war in Ukraine, which have drastically weakened Council members’ ability to form alliances. It would therefore be unrealistic to expect the Council to speak in unison (ie, in relevant language in a resolution or other text) on this component of support for survivors in the foreseeable future.

Fortunately, differences over resolution language do not reduce the UN’s ability to work on sexual and reproductive health care in implementing CRSV resolutions, because the call to support sexual and reproductive health care made in Resolution 2106 remains in effect. UN officials and experts told Crisis Group that as a technical matter the language in the current thematic and country-specific resolutions is sufficient for them to carry out this part of their mandate.

Yet the Council’s failure to consistently mention sexual and reproductive health care in its calls for action on CRSV conveys a lack of resolve that affects UN work on the issue, as it translates into meagre funding for UN support of sexual and reproductive health services among other components of the response to CRSV. UN officials complain that there are not a sufficient number of women’s protection advisers to support work on CRSV, among other tasks, by tens of thousands of personnel in the four peacekeeping missions that have a relevant mandate (in the Central African Republic, the Democratic Republic of Congo, Mali – where the mission is now winding down – and South Sudan). Civil society groups have reported similar challenges at the bilateral level, highlighting how sexual and reproductive health care is not often prioritised when donors plan resource allocation to respond to conflict-related needs. Health care proponents therefore need to use opportunities like the forthcoming debate on sexual violence to increase attention to and promote funding for the implementation of this part of the CRSV framework. 

What should Council members do?

In the forthcoming meeting on CRSV, individual Council members should highlight the need to implement sexual and reproductive health measures as an integral part of UN and national government compliance with the CRSV framework and make clear what exactly they mean by that. If there are certain aspects of sexual and reproductive health care they cannot support, for example abortion, they should highlight the specific components they are able to sponsor, for example HIV testing. Council members should also support the work of judicial entities that confirm whether a rape has taken place in systems where that is required for survivors to receive services. Support for better monitoring and reporting – which is essential to understand patterns of sexual violence, mobilise resources and design effective responses – should also be a priority.

Voicing support for survivors and their access to care should not be limited to this one meeting. Future country-specific Security Council meetings are opportunities for Council members to underscore the importance of sexual and reproductive health care as part of survivor care and measure progress in meeting concrete commitments. They should call on the UN to ensure that this type of support is readily and effectively available to the maximum extent legally possible. It is particularly important that they do so for the three countries in which peacekeeping missions have a mandate in this area (now just the Central African Republic, the Democratic Republic of the Congo and South Sudan, as the mission in Mali is due to end).

Both individual Council members and smaller groupings of Council members, such as a core group on CRSV with unified positions, could also consider press stakeouts and other statements outside formal meetings to urge action and generate momentum. The Informal Experts Group on Women, Peace and Security – which meets more or less monthly on country-specific situations and once per year on CRSV – is another space in which Council members could press high-level UN representatives to do more with regard to sexual and reproductive health care and to report back on tasks completed.

Although the Security Council itself does not make funding decisions, this political messaging can only help to encourage the relevant actors – from the UN leadership to national governments – to allocate needed money to sexual and reproductive health care. Consistent with this emphasis, proponents on the Council should also ensure that they are prioritising sexual and reproductive health care – and indeed sexual violence prevention and response more broadly – in their budget negotiations in relevant UN committees.

Individual Council members who are able should also back up their expressions of support with bilateral contributions to civil society organisations providing services and continue to encourage other bilateral donors to strengthen sexual and reproductive services. It is especially important that they do so in countries where public opinion may make survivors reluctant to engage with services that are visibly supported by the UN. For example, in the Democratic Republic of Congo, where the peace operation faces enormous pushback from the public, local civil society organisations may need to lead in service provision, backed up by flexible funding that allows for surge capacity when it is needed.

The provision of sexual and reproductive health care as an essential component of the response to CRSV is as complex as the conflicts in which such violence occurs. It is essential that Security Council members that are committed to the mitigation of CRSV ensure that this component of survivor support is honoured and funded, for the sake of both survivors and their communities.