Programme potential for the prevention of and response to sexual violence among female refugees: a literature review

Figures & data

Table 1. Search strategy

Topic	Search terms
Sexual Violence	Rape, forced marriage, early marriage, survival sex, gender-based violence OR sexual violence
Interventions	Evaluation, evidence, program, health services, integration, best practice, models of care, evidence, response OR prevention
Displacement	Crisis, humanitarian setting
Refugees	Refugee* OR migrant* OR asylum seeker*

Note: * Used in database searches so that words beginning with refugee, migrant or asylum seeker, but ending differently, e.g. in the plural, were included.

Table 2. Eligibility criteria

Criteria	Included	Excluded
Topic	Sexual violence (SV)	Other types of violence
Types of studies/literature	Evaluated interventions, NGO or UN reports, systematic reviews, RCT, cohort, case-control, cross-sectional studies with comparison	Case studies, ecologic studies, cross-sectional studies without comparison group
Type of participants	Survivors of SV and GBV/IVP if it also includes SV. Refugee women and girls or vulnerable women, healthcare providers and displaced communities	Do not target or include SV/GBV. Do not include/mention or target refugees or displaced people or vulnerable women and girls
Type of interventions	Evaluated interventions integrating SRH or maternal health care with GBV/SV services OR evaluated interventions addressing SV/GBV prevention or response	Interventions with descriptive results only apart from qualitative studies. Intervention reports without outcome description
Settings	Conflict, crisis, humanitarian, displacement, refugee camps, refugee transit locations	Other settings
Type of publications	Quantitative and qualitative research	Comments, letters to editor, narratives
Language of publication	English and German	Other than English and German
Publication date	1 January 2000–31 August 2016	Before 1 January 2000

Table 3. UNHCR guidelines with framework of analysis

Prevention	Response
Participation/engagement All measures need to engage refugees as part of protection measures Conserve social community from country of origin as much as possible Engage refugee community and women’s organisations in protection measures Focus on and involve vulnerable female refugees in camp management and leadership roles in all aspects related to food security, increasing livelihood options, decision making in regard to protection measures etc., peace and reintegration processes Provide activities, e.g. for income generation, to prevent frustration and boredom of male refugees Recruit female refugees as staff, e.g. protection officers Establish women’s committees and groups in refugee camps Engage men and boys in gender equality efforts	Treatment and counselling Provide appropriate medical treatment, e.g. emergency contraception, HIV prophylaxis, test for pregnancy and provide guidance if positive, arrange follow-up visits Ensure confidential coordinated response Provide counselling and support to victim Engage women’s organisations in response measures
Safety Place camps in safe geographical location and design camps with basic protective measures, e.g. sufficient lights, lockable accommodation and sanitary facilities separated by gender Ensure regular safety patrols day and night Find alternatives to closed camps Identify vulnerable refugees and identify protection strategies for them Create safe spaces for refugee women Prioritise family reunification Address factors contributing to risk exposure to SV on all protection levels Increase safety through clear and adequate monitoring, evaluation, audit and reporting mechanism	Protection from Repeat Abuse Provide protection from further victimisation, act in the best interest of and according to the wishes of the victim, ensure confidentiality and ensure same-gender SV response staff, e.g. doctor Follow-up on domestic nature of SV with special care in response measures Create safe reporting channels for SV, e.g. women’s organisations
Legal protection Ensure legal protection and prosecution of SV perpetrators with the help of women’s organisations, for example, legal protection Provide personal documentation to all refugee women Ensure protection and enjoyment of one’s rights as refugee (rights-based approach)	Legal protection Report abuse to police Interview victim to obtain information for legal prosecution Ensure legal action (if victim agrees to it) and punishment of perpetrator(s) Provide essential information about rights and available options to victim
Education and training Run information campaigns and training courses about SV and related issues for staff and refugees Activities that promote gender equality as this is a cause of SV (help women to obtain capacity and skills to control over their own livelihood)	Education and training Training courses about SV and related issues for staff and refugees
In addition the following general principles apply to all programmes: Protection measures need to be gender-sensitive and responsive Measures need to include immediate, intermediate and long-term solutions for effective sustainable protection Include LGBT women as a vulnerable target group Include women with disabilities as a vulnerable target group Empowerment and engagement are key components to majority of protective measures Prevention and response measures need to be multi-sectoral (health care, psychosocial and legal support, etc.) Improve data collection methods and interagency information sharing to design evidence-informed and effective programmes

Figure 1. PRISMA diagram

Table A1. Key characteristics of included literature

Study	Setting and participants	Type of violence	Study design	Intervention	Quality
Bass et al^Citation55	DRC (conflict setting), survivors of SV	SV	Randomised controlled trial	SV survivors from 16 villages randomly assigned to either CPT or individual support treatment for approx. 4 months	Weak
Hossain et al^Citation39	Rural Cote d’Ivoire (conflict setting), Refugee men	IPV/SV	Two-armed, non-blinded cluster randomised trial	16-week men’s discussion group for IPV prevention	Weak
Vu et al^Citation48	Ethiopia and Columbia, (conflict setting), refugees and internally displaced people	GBV/SV	Quantitative evaluation	Evaluation of implementation phase of a GBV screening tool	Weak
Willman et al^Citation45	Africa, Indonesia, Sri Lanka, Haiti (conflict, displacement, post-conflict and post-disaster setting), refugees and displaced communities	SV	Strategic review	Review of demobilisation and reintegration programmes, livelihood interventions for SV prevention, awareness-raising campaigns and psychosocial support programmes	Moderate
Casey et al^Citation56	Sub-Saharan Africa, Asia and Haiti (humanitarian setting), women and men	SV	Systematic review	Review of reproductive health programmes in humanitarian settings	Moderate
O’Brien et al^Citation62	Worldwide, Africa (conflict settings), female SV survivors	GBV/SV	Systematic review	Integration of culturally practices into GBV treatment models to improve accessibility of SV response for more women from diverse backgrounds	Weak
Spangaro et al^Citation41	Africa, former Yugoslavia, Liberia, Rwanda, Kenya (conflict, post-conflict and humanitarian settings), refugees, displaced populations and SV survivors	SV	Systematic review	Review of survivor care, livelihood, community mobilisation, systems and security and legal interventions for SV reductions among displaced communities	Moderate
Spangaro et al^Citation42	Africa, Haiti, Afghanistan, Bosnia and Herzegovina (conflict and crisis settings), displaced populations	SV	Systematic review	Realist review of the literature on interventions for the identification of mechanisms that are effective across the range of types of intervention	Moderate
Tappis et al^Citation43	Worldwide (Humanitarian settings), refugee populations	GBV/SV	Integrative review	Review of scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations	Moderate
Tol et al^Citation57	West and Central Africa, USA and Albania (conflict settings), vulnerable women	GBV/SV	Systematic review	Review of mental health and psychosocial support interventions for SV survivors in conflict-affected countries	Moderate
Smith et al^Citation66	Kenya, Congo, Ethiopia, Jordan (conflict settings in four countries), healthcare providers in contact with SV survivors	SV	Mixed methods	Survey of purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge and confidence in regard to sexual assault and treatment response	Moderate
Wirtz et al^Citation49	Ethiopia and Colombia (humanitarian settings), vulnerable women	GBV/SV	Mixed methods	Development and pilot testing of ASIST-GBV screening tool for humanitarian settings in four phases: (1) systematic literature review, (2) qualitative research including interviews and focus groups with GBV survivors and service providers, (3) pilot testing of the developed screening tool and (4) 3-month implementation testing of the screening tool	Strong
Hustache et al^Citation58	Republic of Congo (conflict setting), female SV survivors	SV	Retrospective cohort study	Evaluation of the psychological consequences of SV and the effect of post-rape psychological support	Weak
Doucet and Denov^Citation59	Sierra Leone (post-conflict setting), experiences of social workers and women SV survivors	SV	Qualitative Study	Exploration of the experiences and common success factors for psycho social interventions	Weak
Stark^Citation60	Sierra Leone (post-conflict setting), girl soldiers who were raped during conflict	SV	Qualitative evaluation	Exploration of the effect of traditional cleansing ceremonies on girl soldiers who survived rape on their psychosocial healing and reintegration process	Moderate
Lekskes et al^Citation61	Liberia (conflict setting), female SV survivors	SV	Quantitative case-control 2 intervention arm study	Comparison of the effectiveness of two psychosocial interventions, support group with skills training vs. counselling, for the treatment of SV trauma	Moderate
Gurman^Citation40	Liberia, South Sudan Thailand, Uganda, Rwanda (post-conflict settings), project staff, service providers and local communities	GBV/SV	Qualitative evaluation	A community-based multi-year participatory video project to raise awareness and initiate a public discourse about GBV	Weak
Bolten^Citation50	Eastern DRC (conflict setting), female survivors of SV	GBV/SV	Cohort study quantitative study	Analysis of the effect of the IRC programme against trauma caused by GBV on functioning and symptomology	Moderate
Abdelnour^Citation51	Darfur, Sudan and Dabaab, Kenya (conflict and displacement settings), refugee communities	SV	Discourse analysis	Analysis of the tendency to oversimplify complex problems such as SV, leading to the provision of stoves as the cure for rape in a displacement context	Moderate
WCRWC^Citation52	Darfur, Sudan (displacement setting), displaced communities and women	SV	Evaluation report	Discussion of effective approaches to reduce displaced women’s vulnerability to GBV during firewood collection	Weak
Henttonen et al^Citation64	Uganda (displacement setting), displaced communities	GBV/SV	Qualitative evaluation	Evaluation of GBV programmes and services in the internally displaced camp in Northern Uganda. The study interviews 26 staff in GBV programming and 11 healthcare service providers	Weak
Lattu^Citation54	Kenya, Thailand, Namibia (displacement setting), refugee communities	SV	Qualitative evaluation	Exploration of the perceptions on the prevention and response measures in place in cases of sexual exploitation by humanitarian staff. 295 humanitarian aid beneficiaries have been consulted	Strong
Gruber^Citation63	Eritrea (post-conflict setting), SV survivors	SV	Analytical evaluation	Evaluation of a failed GBV programmes, which aimed to reach SV survivors for services and treatment. It attempts to analyse potential reasons and dynamics which caused the limited uptake of provided services	Moderate
Horn^Citation65	Kenya (displacement setting), abused women	IPV/SV	Qualitative evaluation	Conduct of 18 focus group discussions with camp residents to explore community responses to IPV	Strong
UNFPA^Citation46	Sierra Leone and Colombia, (post-conflict and conflict setting), women and girls vulnerable to exploitation and violence	GBV/SV	Evaluation report	Presentation and evaluation of interventions in different countries, which addressed violence against women	Weak
Ray et al^Citation47	Globally, (displacement setting), displaced women and girls	GBV/SV	Evaluation report	Evaluates the impact of economic empowerment programmes on GBV reduction and prevention	Weak
Doedens et al^Citation70	Chad, (displacement setting), refugee community	SV	Qualitative evaluation	Qualitative assessment of the Minimum Initial Service Package (MISP) of reproductive health, implemented for Sudanese refugees in Chad	Moderate
Thompson et al^Citation44	Darfur, Sudan, (displacement setting), refugee women and girls	GBV/SV	Programme report	Description and lessons learned of a programme, which involved refugee women in efforts to increase camp security and decrease GBV	Weak
CASA Consulting^Citation53	Dabaab, Kenya (displacement setting), refugee women	SV	Evaluation report	Evaluation of a firewood provision project as a solution against rape	Moderate

Table A2. Included literature according to framework

	Prevention				Response
Study	Participation, engagement	Safety	Legal protection	Education, training	Treatment, counselling	Protection from repeat abuse	Legal protection	Education, training
Bass et al^Citation55					✓
Hossain et al^Citation39	✓
Vu et al^Citation48		✓			✓
Willman et al^Citation45	✓	✓		✓	✓	✓		✓
Casey et al^Citation56					✓
O’Brien et al^Citation62					✓
Spangaro et al^Citation41	✓	✓	✓	✓	✓	✓	✓	✓
Spangaro et al^Citation42	✓	✓	✓	✓	✓	✓	✓	✓
Tappis et al^Citation43	✓	✓	✓			✓	✓
Tol et al^Citation57					✓
Smith et al^Citation66					✓			✓
Wirtz et al^Citation49		✓			✓
Hustache et al^Citation58					✓
Doucet and Denov^Citation59					✓
Stark^Citation60					✓
Lekskes et al^Citation61					✓
Gurman^Citation40	✓			✓		✓		✓
Bolten^Citation50		✓	✓			✓	✓	✓
Abdelnour^Citation51		✓
WCRWC^Citation52		✓
Henttonen et al^Citation64					✓			✓
Lattu^Citation54			✓			✓
Gruber^Citation63					✓
Horn^Citation65						✓
UNFPA^Citation46	✓			✓	✓		✓	✓
Ray et al^Citation47	✓			✓
Doedens et al^Citation70					✓
Thompson et al^Citation44	✓	✓		✓				✓
CASA Consulting^Citation53		✓

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