Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review (1981–2014)

Public Health

Volumn 142, Issue , 2017, Pages 121-135

  Ba, I ^a   Bhopal, R S ^b  

^a Independent Researcher   (Burkina Faso)

^b UNIVERSITY OF EDINBURGH   (United Kingdom)

Author keywords

Civilian; Conflict; Rape; Sexual Violence; Systematic review; War

Indexed keywords

LITERATURE REVIEW; MENTAL HEALTH; SOCIAL CONFLICT; VIOLENCE; WAR;

ABDUCTION; AFRICA; ANXIETY; CIVILIAN; COMMUNITY; CONFLICT; DEMOCRATIC REPUBLIC CONGO; DEPRESSION; FAMILY RELATION; GANG RAPE; GENITAL INJURY; HEALTH; HUMAN; INTERPERSONAL COMMUNICATION; MENTAL HEALTH; NAMED GROUPS OF PERSONS; OUTCOME ASSESSMENT; POSTTRAUMATIC STRESS DISORDER; PREGNANCY; RAPE; RECTUM INJURY; REVIEW; SEXUAL DYSFUNCTION; SEXUAL SLAVERY; SEXUAL VIOLENCE; SEXUALLY TRANSMITTED DISEASE; SOCIAL ASPECT; SPOUSE; SYSTEMATIC REVIEW; VAGINA DISEASE; WAR; CHILD; CRIME VICTIM; FEMALE; MALE; MENTAL STRESS; PSYCHOLOGY; PSYCHOTRAUMA; SEXUAL BEHAVIOR; SEXUAL CRIME; SOCIAL STIGMA; STATISTICS AND NUMERICAL DATA; SURVIVOR; WARFARE;

DEMOCRATIC REPUBLIC CONGO;

ANXIETY; CHILD; CRIME VICTIMS; DEPRESSIVE DISORDER; FEMALE; HUMANS; MALE; PREGNANCY; PSYCHOLOGICAL TRAUMA; RAPE; SEX OFFENSES; SEXUAL BEHAVIOR; SOCIAL STIGMA; STRESS DISORDERS, POST-TRAUMATIC; STRESS, PSYCHOLOGICAL; SURVIVORS; WARFARE;

EID: 84992699692     PISSN: 00333506     EISSN: 14765616     Source Type: Journal    
DOI: 10.1016/j.puhe.2016.07.019     Document Type: Review

References (81)

1. 1 Themnér, L., Wallensteen, P., Armed conflicts, 1946–2013. J Peace Res 51:4 (2014), 541–554, 10.1177/0022343314542076.
2. 2 Cohen, D.K., Explaining rape during civil war: Cross-National Evidence (1980–2009). Am Polit Sci Rev 107:3 (2013), 461–477, 10.1017/s0003055413000221.
3. 3 Human Rights Watch, The war within the war: sexual violence against women and girls in Eastern Congo. 2002.
4. 4 Hynes, H.P., On the battlefield of women's bodies: an overview of the harm of war to women. Womens Stud Int Forum 27:5–6 (2004), 431–445, 10.1016/j.wsif.2004.09.001.
5. 5 United Nations, Rome Statute of the International Criminal Court, Article 7(2), ICC Element of Crimes (n 85). 1998 http://untreaty.un.org/cod/icc/statute/romefra.htm.
6. 6 United Nations Security Council, Resolution 1820. 2008 http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N08/391/44/PDF/N0839144.pdf?OpenElement.
7. 7 Trenholm, J.E., Olsson, P., Ahlberg, B.M., Battles on women's bodies: war, rape and traumatisation in eastern Democratic Republic of Congo. Glob Public Heal 6:2 (2011), 139–152, 10.1080/17441690903212065.
8. 8 Longombe AO, Claude KM, Ruminjo J. Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: case studies. Reprod Health Matters. 16(31):132–141. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18513615.
9. 9 Carpenter, R.C., Recognizing gender-based violence against civilian men and boys in conflict situations. Secur Dialogue 37:1 (2006), 83–103, 10.1177/0967010606064139.
10. 10 Tol, W.A., Stavrou, V., Greene, M.C., Mergenthaler, C., van Ommeren, M., Garcia Moreno, C., Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions. Confl Heal, 7(1), 2013, 16, 10.1186/1752-1505-7-16.
11. 11 Ward, J., Marsh, M., Sexual violence against women and girls in war and its aftermath: realities, responses, and required resources. 2006.
12. 12 Amowitz, L.L., Reis, C., Lyons, K.H., Vann, B., Mansaray, B., Akinsulure-Smith, A.M., et al. Prevalence of war-related sexual violence and other human rights abuses among internally displaced persons in Sierra Leone. JAMA 287:4 (2002), 513–521 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11798376.
13. 13 Watts, C.H., Foss, A.M., Hossain, M., Zimmerman, C., von Simson, R., Klot, J., Sexual violence and conflict in Africa: prevalence and potential impact on HIV incidence. Sex Transm Infect 86:Suppl. 3 (2010), iii93–iii99, 10.1136/sti.2010.044610.
14. 14 Johnson, K., Scott, J., Rughita, B., Kisielewski, M., Asher, J., Ong, R., et al. Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. JAMA 304:5 (2010), 553–562.
15. 15 Vinck, P., Pham, P., Baldo, S., Shigekane, R., Living with fear: a population-based survey on attitudes about peace, justice, and social reconstruction in Eastern Democratic Republic of the Congo. 2008 http://www.escholarship.org/uc/item/9738b4pm.
16. 16 Bartels, S.A., Scott, J.A., Leaning, J., Kelly, J.T., Joyce, N.R., Mukwege, D., et al. Demographics and care-seeking behaviors of sexual violence survivors in South Kivu province, Democratic Republic of Congo. Disaster Med Public Health Prep 6:4 (2012), 393–401.
17. 17 Reseau des Femmes pour un Developpement Associatif, Reseau des Femmes pour la Defense des Droit et la Paix, International Alert, Women's bodies as a battleground: sexual violence against women and girls during the war in the Democratic Republic of Congo. South Kivu 2005 (1996-2003), 1–76 http://www.international-alert.org/pdf/sexual_violence_congo_english.pdf.
18. 18 Kelly, J.T., Betancourt, T.S., Mukwege, D., Lipton, R., Vanrooyen, M.J., Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study. Confl Health, 5, 2011, 25, 10.1186/1752-1505-5-25.
19. 19 Gingerich, T., Leaning, J., The use of rape as a weapon of war in the conflict in Darfur, Sudan. 2004, Office of Transition Initiatives, US Agency for International Department, Washington (District of Columbia), 6–33 http://www.physiciansforhumanrights.org/library/documents/reports/the-use-of-rape-as-a-weapon.pdf.
20. 20 Dossa, N.I., Zunzunegui, M.V., Hatem, M., Fraser, W., Fistula and other adverse reproductive health outcomes among women victims of conflict-related sexual violence: a population-based cross-sectional study. Birth-Issues Perinat Care 41:1 (2014), 5–13, 10.1111/birt.12085.
21. 21 Loncar, M., Henigsberg, N., Hrabac, P., Mental health consequences in men exposed to sexual abuse during the war in Croatia and Bosnia. J Interpers Violence 25:2 (2010), 191–203 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19641182.
22. 22 Tayler-Smith, K., Zachariah, R., Hinderaker, S.G., Manzi, M., De Plecker, E., Van Wolvelaer, P., et al. Sexual violence in post-conflict Liberia: survivors and their care. Trop Med Int Health 17:11 (2012), 1356–1360, 10.1111/j.1365-3156.2012.03066.x.
23. 23 Carlson, E.S., The hidden prevalence of male sexual assault during war – observations on blunt trauma to the male genitals. Br J Criminol 46:1 (2006), 16–25, 10.1093/bjc/azi041.
24. 24 Oosterhoff P, Zwanikken P, Ketting E. Sexual torture of men in Croatia and other conflict situations: an open secret. Reprod Health Matters. 12(23):68–77. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15242212.
25. 25 Vu, A., Adam, A., Wirtz, A., Pham, K., Rubenstein, L., Glass, N., et al. The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLoS Curr, 6, 2014, 10.1371/currents.dis.835f10778fd80ae031aac12d3b533ca7.
26. 26 Stark, L., Ager, A., A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma Violence Abuse 12:3 (2011), 127–134, 10.1177/1524838011404252.
27. 27 Spangaro J, Adogu C, Ranmuthugala G, Powell Davies G, Steinacker L, Zwi A. What evidence exists for initiatives to reduce risk and incidence of sexual violence in armed conflict and other humanitarian crises? A systematic review. PLoS One [Electronic Resour]. 8(5):e62600. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=23690945.
28. 28 Spangaro, J., Adogu, C., Zwi, A.B., Ranmuthugala, G., Davies, G.P., Mechanisms underpinning interventions to reduce sexual violence in armed conflict: a realist-informed systematic review. Confl Health, 9, 2015, 19, 10.1186/s13031-015-0047-4.
29. 29 Warren, E., Post, N., Hossain, M., Blanchet, K., Roberts, B., Systematic review of the evidence on the effectiveness of sexual and reproductive health interventions in humanitarian crises. BMJ Open, 5(12), 2015, 10.1136/bmjopen-2015-008226.
30. 30 Tol, W.A., Stavrou, V., Greene, M.C., Mergenthaler, C., Garcia-Moreno, C., van Ommeren, M., Mental health and psychosocial support interventions for survivors of sexual and gender-based violence during armed conflict: a systematic review. World Psychiatry 12:2 (2013), 179–180, 10.1002/wps.20054.
31. 31 Asgary, R., Emery, E., Wong, M., Systematic review of prevention and management strategies for the consequences of gender-based violence in refugee settings. Int Health 5:2 (2013), 85–91, 10.1093/inthealth/iht009.
32. 32 Acquire Project, Traumatic gynecologic fistula as a result of sexual violence. New York, USA, 2006.
33. 33 Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., The, P.G., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7), 2009, e1000097, 10.1371/journal.pmed.1000097.
34. 34 Lunde, I., Ortmann JCN-UO in WR (Not borrowable) 2001. 9. 316. Sexual torture and the treatment of its consequences. Basoglu, M., (eds.) Torture and its consequences : current treatment approaches, xxiii, 1998, Cambridge University Press, Cambridge, 527.
35. 35 Sharp, P.M., Hahn, B.H., Origins of HIV and the AIDS pandemic. Cold Spring Harb Perspect Med 1:1 (2011), 1–22, 10.1101/cshperspect.a006841.
36. 36 UCDP, Overview of UCDP data. 2014.
37. 37 EpiGear. Meta XL. Barendregt JJ, Doi SA (eds) 2014;Version 2.
38. 38 Pluye, P., Robert, E., Cargo, M., Bartlett, G., O'Cathain, A., Griffiths, F., et al. Proposal: a mixed methods appraisal tool for systematic mixed studies reviews. 2011 http://mixedmethodsappraisaltoolpublic.pbworks.com.
39. 39 Bartels, S., Scott, J., Mukwege, D., Lipton, R., VanRooyen, M., Leaning, J., Patterns of sexual violence in eastern Democratic Republic of Congo: reports from survivors presenting to Panzi hospital in 2006. Confl Health, 4(1), 2010, 9 http://www.conflictandhealth.com/content/4/1/9.
40. 40 Mukwege, D.M., Nangini, C., Rape with extreme violence: the new pathology in South Kivu, Democratic Republic of Congo. PLoS Med/Public Libr Sci, 6(12), 2009, e1000204 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=20027215.
41. 41 Johnson, K., Asher, J., Rosborough, S., Raja, A., Panjabi, R., Beadling, C., et al. Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. JAMA 300:6 (2008), 676–690 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18698066.
42. 42 Schalinski, I., Elbert, T., Schauer, M., Female dissociative responding to extreme sexual violence in a chronic crisis setting: the case of eastern Congo. J Trauma Stress 24:2 (2011), 235–238, 10.1002/jts.20631.
43. 43 Kinyanda, E., Nakiboneka, M.V., Ochieng, O.R., Were-Oguttu, J., Gayflor, V., Liebling-Kalifani, H., et al. Prevalence and correlates of psychological distress as seen in post-conflict Liberia. African J Trauma Stress 1:2 (2010), 96–102.
44. 44 Kinyanda, E., Musisi, S., Biryabarema, C., Ezati, I., Oboke, H., Ojiambo-Ochieng, R., et al. War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: a cross-sectional study. BMC Int Health Hum Rights, 2010, 10, 10.1186/1472-698x-10-28.
45. 45 Kinyanda, E., Weiss, H.A., Mungherera, M., Onyango-Mangen, P., Ngabirano, E., Kajungu, R., et al. Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda. AIDS Care 24:11 (2012), 1323–1332 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=22272693.
46. 46 Loncar, M., Medved, V., Jovanovic, N., Hotujac, L., Psychological consequences of rape on women in 1991–1995 war in Croatia and Bosnia and Herzegovina. Croat Med J 47:1 (2006), 67–75 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16489699.
47. 47 Médecins Sans Frontières, Ituri “civilians still the first victims” permanence of sexual violence and impact of military operations. 2007, Médecins Sans Frontières, Geneva.
48. 48 Steiner, B., Benner, M.T., Sondorp, E., Schimitz, K.P., Mesmer, U., Rosenberger, S., Sexual violence in the protracted conflict of DRC programming for rape survivors in South Kivu. Confl Health, 3(3), 2009.
49. 49 Mankuta, D., Aziz-Suleyman, A., Yochai, L., Allon, M., Field evaluation and treatment of short-term psycho-medical trauma after sexual assault in the Democratic Republic of Congo. Isr Med Assoc J 14:11 (2012), 653–657.
50. 50 Kohli, A., Makambo, M.T., Ramazani, P., Zahiga, I., Mbika, B., Safari, O., et al. A Congolese community-based health program for survivors of sexual violence. Confl Health, 6(1), 2012, 6, 10.1186/1752-1505-6-6.
51. 51 Hustache, S., Moro, M.-R., Roptin, J., Souza, R., Gansou, G.M., Mbemba, A., et al. Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo. Int J Ment Health Syst, 3(1), 2009, 7, 10.1186/1752-4458-3-7.
52. 52 Baelani, I., Dünser, M.W., Facing medical care problems of victims of sexual violence in Goma/Eastern Democratic Republic of the Congo. Confl Health, 5, 2011, 2, 10.1186/1752-1505-5-2.
53. 53 Human Rights Watch, War crimes in Bosnia-Hercegovina. 1993.
54. 54 Kozaric-Kovacic D, Folnegovic-Smalc V, Skrinjaric J, Szajnberg NM, Marusic A. Rape, torture, and traumatization of Bosnian and Croatian women: psychological sequelae. Am J Orthopsychiatry. 65(3):428–433. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7485428.
55. 55 Frljak A, Cengic S, Hauser M, Schei B. Gynecological complaints and war traumas. A study from Zenica, Bosnia-Herzegovina during the war. Acta Obstet Gynecol Scand. 76(4):350–354. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9174430.
56. 56 Lebigot, F., Repercussions psychiatriques et psychologiques immediates. Les traumatismes psychiques, 2001, 93–102.
57. 57 McKay, S., Wessells, M.G., Post-traumatic stress in former Ugandan child soldiers. Lancet, 363(9421), 2004, 1646, 10.1016/S0140-6736(04)16211-9.
58. 58 Sales, E., Baum, M., Shore, B., Victim readjustment following assault. J Soc Issues 40:1 (1984), 117–136, 10.1111/j.1540-4560.1984.tb01085.x.
59. 59 Frank, E., Turner, S., Stewart, B., Initial response to rape: the impact of factors within the rape situation. J Behav Assess 2:1 (1980), 39–53, 10.1007/BF01321431.
60. 60 Campbell, R., Sefl, T., Barnes, H.E., Ahrens, C.E., Wasco, S.M., Zaragoza-Diesfeld, Y., Community services for rape survivors: enhancing psychological well-being or increasing trauma?. J Consult Clin Psychol 67:6 (1999), 847–858.
61. 61 Bownes, I.T., O'Gorman, E.C., Sayers, A., Assault characteristics and posttraumatic stress disorder in rape victims. Acta Psychiatr Scand 83:1 (1991), 27–30.
62. 62 DeCou, C.R., Lynch, S.M., Cole, T.T., Kaplan, S.P., Dissociation mediates the association between intimate partner violence and posttraumatic stress among treatment-seeking incarcerated women. J Trauma Dissociation, 17(4), February 2016, 10.1080/15299732.2016.1141148.
63. 63 Zerach, G., Greene, T., Ginzburg, K., Solomon, Z., The relations between posttraumatic stress disorder and persistent dissociation among ex-prisoners of war: a longitudinal study. Psychol Trauma Theory Res Pract Policy, 6(2), 2014, 99.
64. 64 Neuner, F., Shauer, M., Karunakara, U., Klaschik, C., Robert, C., Elbert, T., Psychological trauma and evidence for enhanced vulnerability for post-traumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry, 4, 2004, 34.
65. 65 Kolassa, I.T., Ertl, V., Eckart, C., Kolassa, S., Onyut, L.P., Elbert, T., Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychol Trauma Theory Res Pract Policy, 2(3), 2010, 169.
66. 66 Duroch, F., McRae, M., Grais, R.F., Description and consequences of sexual violence in Ituri province, Democratic Republic of Congo. BMC Int Health Hum Rights, 2011, 11, 10.1186/1472-698x-11-5.
67. 67 Onsrud, M., Sjoveian, S., Luhiriri, R., Mukwege, D., Sexual violence-related fistulas in the Democratic Republic of Congo. Int J Gynaecol Obstet 103:3 (2008), 265–269, 10.1016/j.ijgo.2008.07.018.
68. 68 Henigsberg N, Folnegovic-Smalc V, Moro L. Stressor characteristics and post-traumatic stress disorder symptom dimensions in war victims. Croat Med J. 42(5):543–550. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11596171.
69. 69 Bjelosević, E., Hadzikapetanović, H., Loga, S., Hodzić, M., Skelić, D., Savarimooto, B., [Relation between benzodiazepine abuse and trauma]. Med Arh 57:5–6 Suppl. 1 (2003), 33–36 http://www.ncbi.nlm.nih.gov/pubmed/15022567.
70. 70 Olujic MB. Embodiment of terror: gendered violence in peacetime and wartime in Croatia and Bosnia-Herzegovina. Med Anthropol Q. 12(1):31–50. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9527973.
71. 71 Nelson, B.D., Collins, L., VanRooyen, M.J., Joyce, N., Mukwege, D., Bartels, S., Impact of sexual violence on children in the eastern Democratic Republic of Congo. Med Confl Surviv 27:4 (2011), 211–225.
72. 72 Bosqui, T.J., Shannon, C., Tiernan, B., Beattie, N., Ferguson, J., Mulholland, C., Childhood trauma and the risk of violence in adulthood in a population with a psychotic illness. J Psychiatr Res 54 (2014), 121–125, 10.1016/j.jpsychires.2014.03.011.
73. 73 United Nations High Commission for Refugees, The state of the worlds's refugees. A Humanitarian Agenda. Women in war-torn societies. 1997 Box 4.3.
74. 74 Amnesty International, Sudan, Darfur: rape as a weapon of war – sexual violence and its consequences. 2004 http://www.amnesty.org/en/library/info/AFR54/076/2004.
75. 75 Bosmans, M., Challenges in aid to rape victims: the case of the Democratic Republic of the Congo. Essex Hum Rights Rev 4:1 (2007), 1–12.
76. 76 Ikuomola, A.D., Branche, R., Virgili, F., (eds.) The Nigerian Civil War of 1967 and the stigmatisation of children born of rape victims in Edo State, 2012 ://WOS:000319254300013.
77. 77 Liebling, H., Slegh, H., Ruratotoye, B., Women and girls bearing children through rape in goma, eastern Congo: stigma, health and justice responses. Itupale Online J Afr Stud, 4, 2012, 18.
78. 78 Mukwege, D.M., Mohamed-Ahmed, O., Fitchett, J.R., Rape as a strategy of war in the Democratic Republic of the Congo. Int Health 2:3 (2010), 163–164, 10.1016/j.inhe.2010.06.003.
79. 79 Suarez EB. Two decades later: The resilience and post-traumatic responses of Indigenous Quechua girls and adolescents in the aftermath of the Peruvian armed conflict. Child Abuse Negl. 37(2–3):200–210. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=23260118.
80. 80 Masterson, A.R., Usta, J., Gupta, J., Ettinger, A.S., Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. Bmc Womens Heal, 2014, 14, 10.1186/1472-6874-14-25.
81. 81 Spiric Z, Opacic G, Jovic V, Samardzic R, Knezevic G, Mandic-Gajic G, et al [Gender differences in victims of war torture: types of torture and psychological consequences]. Vojnosanit Pregl. 67(5):411–418. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20499736.