* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Omission of four words represents a major ethical and human rights setback, and ultimately threatens the wellbeing, rights and dignity of women and girls around the world
Mazeda Hossain is co-Director of the UKRI GCRF Gender, Justice and Security Hub and Assistant Professor in Social Epidemiology at the London School of Hygiene and Tropical Medicine.
Natasha Howard is Director of the Security, Conflict, and Health Research programme and Assistant Professor in Global Health and Conflict at the London School of Hygiene and Tropical Medicine.
Neha Singh is Deputy Director of the Health in Humanitarian Crises Centre and Assistant Professor in Health Systems and Reproductive, Maternal, Child and Adolescent Health at the London School of Hygiene and Tropical Medicine.
Last week, the UN Security Council reaffirmed its commitment to ending sexual violence in conflict. However, after heated debate, the adopted resolution omitted words that many of us working with survivors of sexual violence during humanitarian emergencies understand as crucial – ‘reproductive and sexual health’ rights and services. These words proved too controversial for the USA administration, which threatened to veto the resolution if included.
The UN estimates that 25.4 million people were forcibly displaced by the end of 2017 as a consequence of conflict and persecution - the largest increase ever seen in a single year. An estimated 1 in 5 displaced or refugee women and girls have experienced sexual violence, with the actual figure likely to be far higher as sexual violence is under-reported due to fear of stigmatisation, spousal abandonment, or persecution from authorities or communities.
For survivors of sexual violence in conflict, reproductive and sexual healthcare is essential. Complications from sexual violence are known to include traumatic genital injuries and tears, debilitating rectal and vaginal fistula, sexually transmitted infections, HIV, unwanted pregnancy and long-term psychological trauma (such as post-traumatic stress, anxiety, and depression). Minimum services for survivors currently includes access to services for the clinical management of rape, emergency obstetric and newborn care, sexually transmitted infections and HIV, contraception, and safe abortion care. Offered through a survivor-centred response, they have been shown to help survivors of sexual violence rebuild their lives after trauma. They are part of an evidence-based minimum package of essential sexual and reproductive health services that humanitarian experts and agencies have agreed should be provided in all humanitarian emergencies. We cannot risk the reduction or loss of crucial services, which are already frequently under-funded, due to political expedience.
By omitting these four words and thus refusing to explicitly express support for access to sexual and reproductive healthcare services in conflict, the international community is failing to ensure the right to healthcare and dignity for millions of innocent victims. While some may continue to provide appropriate care to survivors, without any wording on reproductive and sexual health, other donors and governments will not feel the pressure of collective agreement that the resolution could have provided, to ensure this necessary healthcare is embedded in programmes and funding. For those affected by sexual violence, a lack of treatment or care will lead to worsened physical and mental health, and even the risk of death from the many complications of acts inflicted upon them.
Considering earlier commitments to sexual and reproductive health by the UN Security Council, it is unacceptable that Resolution 2467 was approved without reference to sexual and reproductive health. Its adoption suggests that all member states who approved it are not committed to the provision of essential sexual and reproductive healthcare for survivors of sexual violence in conflict-affected settings. As members of the Health in Humanitarian Crises Centre at the London School of Hygiene and Tropical Medicine and alongside dozes of our colleagues, we strongly condemn this decision.
Omission of these four words represents a major ethical and human rights setback, and ultimately threatens the wellbeing, rights and dignity of women and girls around the world.