Special treatment needs of sexual violence

Many colleagues in the field of refugee mental health have sought to break the 'conspiracy of silence related to sexual violence'. (15> While this issue has been well documented in refugee communities, it was not until the Bosnian conflict that rape was finally accepted by the international community not as a criminal act but as a crime against humanity. This recognition of sexual violence as the most common type of torture of women, as well as a major terrorist instrument of war, has contributed to the protection and psychiatric care of sexually abused refugee survivors. While the political will now exists to condemn rape, and to protect refugees from it, the cultural stigma and corresponding social punishments of women considered 'tainted' by sexual violence, sometimes including their murder by relatives, continues to make the psychiatric care of these survivors extremely difficult. In most cultures, rape remains a secret issue caused by the refugee's extreme resistence to reveal any details to the physician. Psychiatric practitioners must approach this issue with extreme caution in a strictly confidential manner. They must also be aware of the severe consequences to the patient if the rape experience becomes public knowledge, even to the patient's family members.

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