Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands

Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently

'Breaking the silence' : sexual victimisation in an old age psychiatry patient population in Flanders

Background: Sexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging. Methods: Between July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape. Outcomes: In 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before. Interpretation: Sexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures

Communication barriers in maternity care of allophone migrants : experiences of women, healthcare professionals and intercultural interpreters

This is the peer reviewed version which has been published in final form at [https://doi.org/10.1111/jan.14093]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Aim: To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals and intercultural interpreters. Background: Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication. Design: Qualitative explorative study. Methods: A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March‐June 2016) who participated in 3 focus group discussions and seven semi‐structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed. Results: The analysis revealed three main themes: the challenge of understanding each other's world, communication breakdowns and imposed health services. Without interpretation communication was reduced to a bare minimum and thus insufficient to adequately inform women about treatment and address their expectations and needs. Conclusion: A primary step in dismantling barriers is guaranteed intercultural interpreting services. Additionally, healthcare professionals need to continuously develop and reflect on their transcultural communication. Institutions must enable professionals to respond flexibly to allophone women's needs and to offer care options that are safe and in accordance to their cultural values. Impact: Our results provide the foundation of tenable care of allophonic women and emphasize the importance of linguistic understanding in care quality

Applying Community Based Participatory Research on sexual health & sexual violence with refugees, asylum seekers and undocumented migrants in Europe and the European Neighbourhood

Abstract Background Refugees, asylum seekers and undocumented migrants are at risk of sexual violence (SV). SV can induce ill-health in the victims, their offspring and community. However, prevention and response actions are leaping behind and rarely tap on the agency of the migrants themselves. Community Based Participatory Research (CBPR) is a collaborative research approach in public health that focuses on inequalities and aims to improve the health and well-being of community members by integrating knowledge in action, including personal, social and policy change. Methods Building on the concept of Desirable Prevention from a human-rights and gender-sensitive perspective, in three consecutive projects we applied CBPR to study SV and sexual health (SH) and collegiately developed SV prevention and response tools for personal, social and policy change. Results Each of the three CBPR projects was steered by local Community Advisory Boards composing of key stakeholders. With 1001 Community Researchers being refugees, asylum seekers, undocumented migrants and asylum reception professionals themselves we collegiately conducted the mixed-method research and co-created the tools that were validated at largely attended public seminars and implemented widely. While the projects clearly resulted in social and policy change, several professional researchers personally struggled with the principle of co-learning and co-creation while migrants struggled with the regained respect and identity that fell away beyond project scopes and in between project resulting in poor mental health in some. Conclusions Applying CBPR with refugees, asylum seekers and undocumented migrants on sensitive topics as SV and SH is a valuable research approach. Yet, the CBPR principles of cyclical participatory processes and the commitment to sustainability might clash with the current funding and timing of EU research projects challenging participants’ mental health and researchers’ ethics. </jats:sec

Improving medical students’ communication competencies to deal with intimate partner violence using clinical simulations in Mozambique

Abstract Background During their medical training, medical students aim to master communication skills and professionalism competencies to foster the best possible patient-physician relationship. This is especially evident when dealing with sensitive topics. This study describes and analyses the outcomes of a simulation-based training module on clinical communication competency through interacting with simulated intimate partner violence (IPV) survivors. The training was set up as part of a broader IPV module within a Gynaecology and Obstetrics Bachelor of Medicine and Bachelor of Surgery of Medicine (MBBS). Methods In total, 34 (59%) of all fourth-year medical students from one medical school in Mozambique were involved. A mixed-method approach was adopted. First, a quasi-experimental pre-test/post-test design was adopted to study the impact of the intervention to tackle critical IPV knowledge, skills, and attitudes, underlying a patient communication script. Second, a qualitative analysis of student perceptions was carried out. Results The results of the paired sample t-tests point at a significant and positive change in post-test values when looking at the general IPV self-efficacy (IPV SE) score and the subscales mainly in attitudes. Participants expressed a desire for additional IPV communication competency and suggested enhancements to the module. Conclusion We conclude that due to IPV being a sensitive issue, simulation activities are a good method to be used in a safe environment to develop clinical skills. The results of this study are a good complement of the analysis of the competencies learned by the medical students in Mozambique with the current curriculum. </jats:sec