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Story Publication logo August 30, 2019

Picturing Health: Health Services in Refugee Camps Are Helping South Sudanese Women Tell Their Stories of Sexual Violence

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A patient receives her second hepatitis B injection at the Médecins Sans Frontières sexual violence and mental health clinic for refugees who have fled from South Sudan to Uganda.
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South Sudan's five-year war has impacted people in ways that have not previously been reported.

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Midwife Susan Oyera, with the help of medical interpreter Grace Ezati, writes a referral for a patient who has a positive HIV test to speak with a psychologist at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan.
Midwife Susan Oyera, with the help of medical interpreter Grace Ezati, writes a referral for a patient who has a positive HIV test to speak with a psychologist at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan. Image by Adriane Ohanesian. Uganda, 2019.

The Médecins Sans Frontières (MSF) sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension looks similar to the other refugee camp structures in northern Uganda, which are home to hundreds of thousands of South Sudanese refugees. Since the war in South Sudan erupted in 2013, a steady flow of people, including many women and children, have made the harrowing trek from their homes and across the border into Uganda.

I took these photographs in the Bidi Bidi and Omugo refugee settlements and the MSF clinic at the Omugo Rhino camp extension in June and July, 2019. The staff at the MSF sexual violence and mental health clinic provide the space for South Sudanese women to come forward with their stories of sexual violence and help them to receive health care. Susan Oyera, a midwife at the clinic, hears the women's accounts of their journeys. “I don't think that I have talked to any women who haven't been assaulted”, she said, looking down at a stack of patients' records. Working with a team that includes midwives, interpreters, psychologists, psychiatric nurses, psychiatric clinical officers, social workers, and community health educators, Susan said that she sees between three to eight patients each day. She has worked there since the clinic opened in October, 2018.

Some of the women who go to the clinic were raped when soldiers or rebels attacked their villages in South Sudan, some as they made their way to Uganda, and others had been assaulted in the camp. The women don't usually come to the clinic to tell these stories but to check on their health. “From the time of the assault, I started having pains. I felt that I should come to the facility and wanted to know my HIV status”, one woman said. Susan reassures each woman. “I don't blame anyone because anyone can be assaulted by anyone at any time”, she said. “Did any of this happen to you? Have you experienced anything like this?”, she continued. Susan tells each patient about the services at the clinic. She speaks slowly so that everything can be translated and understood. Susan talks about sexual and gender-based violence and explains that psychologists are available for counselling. She also gives details about immunisations, post-exposure prophylaxis, pregnancy tests, and tests and treatments for sexually transmitted infections and HIV. Susan always emphasises that to give the appropriate care, she needs to understand the patients' stories.

Midwife Susan Oyera, with the help of medical interpreter Grace Ezati, writes a referral for a patient who has a positive HIV test to speak with a psychologist at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan.
Midwife Susan Oyera, with the help of medical interpreter Grace Ezati, writes a referral for a patient who has a positive HIV test to speak with a psychologist at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan.
A woman walks out of her home in the Bidi Bidi settlement in northern Uganda. She arrived in Uganda in 2016 from South Sudan. Her village in South Sudan was attacked, her husband was shot outside of their door, and she was raped by at least seven soldiers in her home, she said. She discovered that she had HIV when she reached Uganda.
A woman walks out of her home in the Bidi Bidi settlement in northern Uganda. She arrived in Uganda in 2016 from South Sudan. Her village in South Sudan was attacked, her husband was shot outside of their door, and she was raped by at least seven soldiers in her home, she said. She discovered that she had HIV when she reached Uganda. Image by Adriane Ohanesian. Uganda, 2019.
Susan Oyera, a midwife at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension gives emergency contraception to a patient who was raped in the Omugo settlement for refugees after she had fled from South Sudan to Uganda.
Susan Oyera, a midwife at the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension gives emergency contraception to a patient who was raped in the Omugo settlement for refugees after she had fled from South Sudan to Uganda. Image by Adriane Ohanesian. Uganda, 2019.
A woman who arrived in Uganda a few months ago sits with her son and speaks to midwife Susan Oyera in the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan. Susan explained the reason for the tests: “We don't know the status and the health history of the person who assaulted you.'
A woman who arrived in Uganda a few months ago sits with her son and speaks to midwife Susan Oyera in the Médecins Sans Frontières sexual violence and mental health clinic in the Omugo settlement in the Rhino camp extension in Uganda for refugees from South Sudan. Susan explained the reason for the tests: “We don't know the status and the health history of the person who assaulted you". Image by Adriane Ohanesian. Uganda, 2019.
A patient receives her second hepatitis B injection at the Médecins Sans Frontières sexual violence and mental health clinic for refugees who have fled from South Sudan to Uganda.
A patient receives her second hepatitis B injection at the Médecins Sans Frontières sexual violence and mental health clinic for refugees who have fled from South Sudan to Uganda.
Women who come to the Médecins Sans Frontières clinic within the first 72 hours of sexual assault are asked a series of questions to determine what the best form of treatment should be. The women take a pregnancy test and an HIV test, and if both are negative, the women are given emergency contraception and 28 days of post-exposure prophylaxis for HIV. Additionally, women are given an antibiotic injection and pills to prevent syphilis, gonorrhoea, chlamydia, and trichomoniasis. Patients are asked if their immunisations for hepatitis B and tetanus are up to date. They are also invited to see a psychologist and to bring their children or husbands back for future counselling.
Women who come to the Médecins Sans Frontières clinic within the first 72 hours of sexual assault are asked a series of questions to determine what the best form of treatment should be. The women take a pregnancy test and an HIV test, and if both are negative, the women are given emergency contraception and 28 days of post-exposure prophylaxis for HIV. Additionally, women are given an antibiotic injection and pills to prevent syphilis, gonorrhoea, chlamydia, and trichomoniasis. Patients are asked if their immunisations for hepatitis B and tetanus are up to date. They are also invited to see a psychologist and to bring their children or husbands back for future counselling. Image by Adriane Ohanesian. Uganda, 2019.

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