Sexual and gender-based violence (SGBV) is a particular and terrible trauma that happens against a person’s will in a situation they are unable to control. SGBV exists in armed conflict areas and humanitarian crises much as it does in other areas of the world—except that SGBV is weaponised to an exponential degree in areas and periods of armed conflict. It is a tactic of war and terror, a political tool of oppression, a means to a population-controlling end. Conflict and sociopolitical national or regional instability increase the presence of SGBV in vulnerable populations and embolden violent actors who seldom adhere to established law. 

INTERNATIONAL LAW

Article 25 of the Universal Declaration of Human Rights guarantees that “[e]veryone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care”. Similarly, article 12 of the International Convention on Economic, Social and Cultural Rights binds state ratifiers to recognise “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. 

Survivors of SGBV in conflict require adequate healthcare not only on a basic, human level but also in direct response to the violent sexual trauma they have experienced. These specific healthcare needs are recognised by the international community. For example, the Convention on the Elimination of Discrimination Against Women asserts the right to healthcare regardless of gender, including family planning and reproductive healthcare, in articles 10, 11, 12, and 14. The Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict (OSRSG-SVC) recognises the grave harms of SGBV in conflict areas, as well as the fact that SGBV is “[not] an inevitable byproduct of war, but rather a crime that is preventable and punishable under International Human Rights Law and International Criminal Law”.

THE CONSEQUENCES OF A LACK OF ACCESS TO HEALTHCARE

Survivors of conflict-related SGBV face exceptional obstacles to the medical attention and sexual and reproductive health services they need, including treatment for exposure to HIV and other sexually transmitted infections and diseases, trauma counseling, and abortion services. Political and infrastructural instability leads to underfunded and inaccessible healthcare services. Displaced populations in refugee camps are not only more vulnerable to sexual violence but are less able to access sexual and reproductive healthcare safely and reliably. Trained medical staff and personnel are essential for the administration of adequate healthcare, and such persons are few and far between in areas of conflict. 

On 31 January 2022, the UN Secretary-General outlined the risks and harms to impregnated survivors of SGBV in conflict, including the significant obstacles that exist with regard to accessing safe abortion services and other necessary sexual and reproductive healthcare, in a report titled “Women and girls who become pregnant as a result of sexual violence in conflict and children born of sexual violence in conflict”. In this report, the UN Secretary-General recognises the “specific needs of women and girls who become pregnant as a result of conflict-related sexual violence”. Further, the report notes the harm caused to and needs of the children born of these pregnancies. The UN Secretary-General concludes by calling on states to ensure and protect the sexual and reproductive health rights of women and girls.

Abortion services are among the most critical and most restricted services for survivors of SGBV in areas of conflict. Even where political instability leaves criminal law enforcement unclear, in states where abortion is criminalised, it is even more difficult to access abortion services. Further, with unreliable access to sexual and reproductive healthcare, survivors seeking abortions must hope that when they do find a healthcare provider, the provider is willing to perform abortion services. However, abortion is a human right. It is therefore of critical importance that all survivors of SGBV, including those living through armed conflict and humanitarian crises, retain access to abortion services.

Unwanted pregnancies result where abortion services are not safely available and accessible to survivors of conflict-related sexual violence. The children of these pregnancies experience intergenerational trauma, rejection from their biological parents’ communities, and often denial of rights, including documentation, education, and shelter. These children are particularly vulnerable; according to the UN Secretary-General, “[t]he plight and rights of children born of war need to be further examined, including the question of whether these children are particularly susceptible to recruitment, radicalization and trafficking, and what can be done to support their social integration”. Children born of wartime rape can often face abandonment by their biological mothers, increasing their vulnerability to trafficking, armed militia conscription, and sexual violence themselves. Indeed, in some communities, the biological mother is forced to either abandon a child born out of sexual slavery or be shunned by her community. The international community and some post-conflict states have recognised the need to provide mental and physical healthcare services to children of wartime rape, as well as implement policies protecting the political rights that these children are so often deprived of. Still, the social and economic challenges children of wartime rape encounter are often insurmountable. 

UKRAINE

Since Russia’s invasion of Ukraine on 24 February 2022, testimonies of rampant sexual violence committed by Russian troops have been widely reported. Survivors of SGBV in remote areas report receiving medical assistance in large cities like Kharkiv after fleeing there by foot. Women have been giving birth in subway stations and underground shelters, far from safe and sterile hospital conditions. The World Health Organization is tracking how Russian attacks on Ukraine are affecting healthcare: as of 5 April 2022, 95 attacks had impacted healthcare facilities; 62 attacks had impacted healthcare personnel; 29 attacks had impacted healthcare transport; and 18 attacks had impacted healthcare supplies. Notably, these attacks included one on a maternity and children’s hospital in Mariupol, Ukraine. 

Routine access to contraception, post-exposure prophylaxis, and abortion services are equally or more important now, in the wake of reports of sexual violence by Russian actors, as they ever have been. Generally, abortion services and other sexual and reproductive healthcare needs are among the last healthcare services offered during a humanitarian crisis. This is counter-intuitive, as living during an armed conflict exacerbates obstacles to terminating an unwanted pregnancy or treating a sexually transmitted disease or infection.

It is troubling to consider what options are available to Ukrainian refugees fleeing violent conflict. Poland has accepted 2.3 million Ukrainian refugees. However, Poland currently has an oppressively strict abortion ban in place. Abortion is permitted only in situations of rape, incest, or if there is a danger to the mother’s health, and, in reality, it is nearly impossible for those who are eligible for a legal abortion to access one. Sanctions are possible against abortion providers and people who assist the abortion. Minors require parental consent. Polish people seeking safe access to abortion have been known to travel to neighboring countries, including Ukraine, to obtain an abortion. This dilemma poses a troubling question: how will Ukrainian refugees who survived sexual violence receive necessary and safe abortion care?

The International Criminal Court announced on 28 February 2022 that it opened an investigation into war crimes committed in Ukraine by Russian invading troops; these war crimes include rape. As the conflict unfolds, Ukrainian survivors of SGBV must have safe access to sexual and reproductive healthcare.

AFGHANISTAN 

On 15 August 2021, the Afghan government fell to the Taliban for the second time. The Taliban, a fundamentalist Islamist group, previously held control of Afghanistan between 1996 and 2001. During that period, the Taliban severely restricted the rights of women and girls, banning girls from education and women from the workforce. Women and girls had to don a niqab. The Taliban's return ushers in a new era of human rights violations, including SGBV. In fact, even before the Taliban’s return to power, sexual and reproductive healthcare in Afghanistan was limited and abortion was illegal. The only exceptions to the abortion ban were if a mother's life was at risk or if the child was going be born with severe deformities. 

With the Taliban again in control, oppression, authoritarian patriarchy, and SGBV committed by violent Taliban actors are part of everyday life in Afghanistan. In the 1990s, kidnapping and gang rape were terrorism tactics employed by the Taliban, although this was underreported by the media at the time. This practice has returned, as detailed by a report as recently as January 2022, where eight women were kidnapped and gang-raped by Taliban members in Mazar-e-Sharif. Women who survive these attacks can become the victims of femicide, as the dominant societal honor code among Taliban members, Pashtunwali, prohibits women from engaging in “immoral behaviour” such as extramarital sex, regardless of consent. Similar codes of conduct and societal norms in Afghanistan hold women responsible for being subjected to sexual violence, which further discourages women from reporting instances of sexual violence or from seeking medical treatment. LGBTIQIA+ people, especially transgender individuals, gender non-conforming individuals, and gay cisgender men whose sexual identities are known to the Taliban, have also been reported to experience heightened sexual violence and gang rape as a form of torture. Further, the Taliban is purposefully making sexual and reproductive healthcare difficult to access. As an example, the Taliban threatened a female doctor with a death sentence for giving a child bride contraception. The Taliban has eliminated shelters and services for SGBV survivors across Afghanistan, including sexual and reproductive healthcare services, and released previously detained SGBV perpetrators. 

Lack of financial support for medical services has been an overarching problem in Taliban-held Afghanistan. COVID-19, polio, and measles infections remain worrying in a nation facing medicine and qualified medical personnel shortages. The Taliban dictates that women may only be treated by female medical staff. At the beginning of the Taliban’s second regime, it imposed limitations on women in the workforce that therefore systematically denied women access to healthcare. The Taliban later shifted its position and called women back to work in healthcare settings, but it has not guaranteed the safety of female healthcare workers against violence, retribution, or vigilantism. Further, female healthcare workers and female patients are bound by the laws mandating that all women must have a male relative escorting them in public. Taliban members have beaten male doctors for attending to female patients without a female nurse or doctor present. There are 5.5 million displaced Afghan people, the majority of whom are women and children. Remote and mobile health clinics are permitted by Taliban leaders in certain districts, where women work as doctors and nurses and where men will treat women in the absence of female medical staff, despite laws against it. Access to sexual and reproductive healthcare in Afghanistan is plagued by significant obstacles already, and as Western aid diminishes, the future of healthcare in Afghanistan remains uncertain.

Survivors of SGBV in conflict areas face systematic denial of access to sexual and reproductive healthcare, which they so desperately need. As armed conflicts and humanitarian crises continue, vulnerable populations face SGBV. It remains of the utmost importance to protect and ensure that survivors of SGBV in conflict areas have unfettered access to safe, quality sexual and reproductive healthcare.

Heidi is a JD Candidate and aspiring human rights defender from New York. She is the Editor-in-Chief for Vol. 29 of the Cardozo Journal for Equal Rights and Social Justice. Heidi will continue exploring gender and reproductive justice in her career.

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