Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala

[摘要] ENGLISH SUMMARY: Background. Armed conflicts place ordinary people at risk of injury, displacement, sexual violence, and hunger among other challenges. The United Nations High Commissioner for Refugees (UNHCR) states that conflicts result in people fleeing their countries, and consequently, a significant increase in the number of people affected, such as the over half a million found in Uganda. The DRC has one of the largest population of refugees in the Great Lakes Region, with Uganda hosting about 195 746 refugees from the country. A salient feature of the conflict in DRC is the widespread sexual violence inflicted on males and females of all ages. Male victims of rape often fall through the cracks especially regarding the delivery of services as most focus on female survivors. Few studies on conflict-related sexual violence (CRSV) in general have been conducted among male refugee survivors in urban post-conflict settings. Specifically, very few studies have been conducted to investigate barriers and facilitators among male survivors who are seeking help from physical and mental health services. This study explored barriers and facilitators encountered by male refugee survivors of CRSV seeking physical and mental health assistance, and elicited suggestions for overcoming the identified barriers.Methods. Sixteen participants were recruited in total, and of these, ten were male refugee survivors of CRSV from DRC, aged between 18 and 47 years, living in Kampala, Uganda. The rest of the participants were six service providers including: medical practitioners, psychologists and counsellors. 4 were male and 2 female, aged between 25 and 58 years, working in Kampala, Uganda. The study adopted a qualitative research design using semi-structured in-depth interviews. The study was mainly conducted at the premises of the head office of the Refugee Law Project (RLP), an organisation providing support to refugees. Qualitative research computer software, NVivo 11 for Windows, was used to analyse the data, with the aid of the framework approach, which ensured a systematic analysis of the data.Results. Regarding barriers to accessing treatment, themes that emerged from the analysis included socio-cultural and political barriers, poor health and infrastructural systems, poverty and lack of livelihood, physical effects of CRSV, fear of marital disharmony and breakup, and self-sufficiency. Facilitators to accessing treatment described by the respondents included social support, symptom severity, professionalism among service providers, availability of free tailored services; and information, education and communication. To overcome the barriers, participants suggested strategies such as increasing information and communication, providing education and training, providing required infrastructure, developing and implementing gender inclusive policies and models, increasing research and addressing basic food and employment needs. In order to attain a broad understanding of the issues raised, the Ecological Systems Theory by Bronfenbrenner was used in the discussion.Conclusion. Overall, findings of the study show that male survivors of CRSV are faced with several barriers in seeking physical and mental health assistance. A multidisciplinary and multisectoral approach is important to address the issues raised. In addition, participants recommended that government should effect change in several legal and health policies to recognise that sexual violence against men is an issue of genuine concern.

[发布机构] Stellenbosch University