Sequelae of conflict-related sexual violence on survivors: the perspective of two systematic reviews

BACKGROUND: Conflict-related sexual violence (CRSV) is a form of gender-based violence and a violation of human rights. We conducted two systematic reviews (1) to analyze the qualitative evidence reported in peer reviewed scientific literature published in the last ten years and focusing on the negative consequences of conflict-related sexual violence on survivors’ physical, psychological, and social dimensions of health and (2) to summarize the knowledge on the forensic medical examination (FME) of victims of CRSV in the same study period. METHODS: A literature search was conducted on January 13, 2023, and on April 3rd, 2023, on three different databases. The search strings combined blocks of terms related to sexual violence and conflict, and in the second review FME. Information regarding the main characteristics and design of the study, survivors and their experience, CRSV, and FME was collected. In the first review, the negative consequences on the physical, psychological, and social dimension of victims were extracted following the Biopsychosocial model of health, while in the second information pertained the different phases of FME. RESULTS: Considering CRSV, 23 articles met inclusion criteria, with 18 of them reporting negative repercussions on physical health, all of them highlighting adverse psychological outcomes, and 21 disclosing unfavorable social consequences. The outcomes described in more studies were sexual and reproductive health issues, manifestations of symptoms attributable to post-traumatic stress disorder, and stigma. Barriers to access to care were emerging findings. Our analysis highlighted that CRSV takes place in an enabling environment. The level and the modalities of violence, employed by a variety of stakeholders, created a chain of brutality in conflict-affected settings, on the move, and in the host countries. Concerning the second review, 17 articles met inclusion criteria. The majority underlined physical (e.g., nonsexual) sequelae and were conducted in the host country of survivors who fled from conflict. Physician’s opinion on the consistency of the findings and protection outcomes were rarely reported. CONCLUSION: The first review highlighted the importance of qualitative evidence in understanding the negative outcomes of conflict-related sexual violence on survivors. Conflict-related sexual violence is a sexual and reproductive health issue and a violation of human rights. Sexuality education is needed, challenging gender norms and roles and encompassing gender-based violence. Gender-inclusive protocols and services need to be implemented to address the specific needs of all victims. Governments should translate health policies into concrete action targeting survivors. The second review emphasized the limited attention given in literature to FME of CRSV and to CRSV-specific lesions, as well as the need for specialized training and expertise for professionals in this field.