Some male survivors’ organizations are also active in post-conflict settings, for instance, in Cambodia with the organization First Step Cambodia. There are also a lot of survivors’ organizations in Bosnia-Herzegovina and in other ex-Yugoslav countries, but most of them focus primarily on female survivors. In Bosnia-Herzegovina, for example, many of these organizations are gathered under an umbrella organization called the Association of Concentration Camp Torture Survivors (ACCTS), which was established in 1997. As in many other conflict and post-conflict countries though, there is no independent structure specifically providing support for male survivors of wartime sexual violence: structures are either dedicated to former detainees, and, therefore, focus on the experience of detention in general, and not specifically on sexual violence (though some of them have specific wings for former female detainees which primarily address the consequences of sexual torture), or to female survivors of sexual violence. The latter sometimes accept male members too, like, for instance, the Naš Glas association, established in 2012, or the Association of Women-Victims of War, an NGO founded in 2003 and which has accepted male members since 2006. Like their counterparts based in Uganda, these organizations focus on capacity-building activities, and on psychological as well as material support for survivors. However, some of these organizations additionally provide legal support, for instance, by issuing certificates attesting to the situation of victims of sexual violence, which survivors need in order to apply for the status as civilian victim of war in Bosnia-Herzegovina.
Whether located in refugee camps or in post-conflict settings, the impact of the work undertaken by these survivors-led organizations is, however, severely limited, mostly for financial reasons. The general lack of public awareness on wartime sexual violence against men impedes fund-raising, and the low socioeconomic status of their members prevents them from relying on members’ financial contributions. Their capacity for reaching out to other male survivors is also often very limited geographically, as many operate only within the limits of a single refugee camp, or of a municipality or region. This is particularly problematic since, as we have seen, in Africa in particular wartime sexual violence often occurs among rural and relatively isolated communities, which, therefore, have little chance to be offered any type of support. It is not uncommon to hear about (male and female) survivors of sexual violence who have died while they were being transported to the clinic or the hospital, because of geographical distance, or because of deteriorated roads (Panzi Hospital 2012, interview), not to mention those who, in the absence of any medical or psychological support, commit suicide.
In spite of these geographical limitations, the support offered to survivors-led groups by larger organizations like the Refugee Law Project or the African Centre for the Treatment and Rehabilitation of Torture Victims, also located in Uganda, is paramount. In addition to providing direct support to male survivors, these organizations cover the expenses related to many reconstructive surgery operations, and to related medical treatments, which survivor groups cannot afford. They also contribute to raising awareness on conflict-related sexual violence against men by organizing training programs targeting health services or policy makers, and they have participated in the launch of several research initiatives, such as the “South-South Institute on Sexual Violence against Men and Boys in Conflict and Displacement,” whose kick-off event was organized in April 2013 in Kampala. Of course they also have their own financial constraints, and neither of these organizations can afford to cover the other related costs for male survivors, like the compensation for job loss, provision of food or housing costs, which, therefore, constitute areas where major progress is needed. However, such support is unlikely to be offered until major international humanitarian organizations active in conflict areas implement comprehensive programs specifically addressing the needs of male survivors of sexual violence.
The challenges in offering support to male survivors are significant and varied, and pertain mostly to the medical, psychosocial, legal and social consequences that the experience of sexual violence entails for survivors. But since this is an issue that had until recently been almost totally ignored and silenced at the international and national levels, humanitarian organizations as well as national health-care service providers still lack insight and information on what works best (Chynoweth, Freccero and Touquet 2017). Of course the work of organizations offering support to male survivors of sexual violence does not entirely differ from what they propose to female survivors, and some inspiration can also be found in the support offered to male victims of rape in peaceful countries. However, working with male survivors of conflict-related sexual violence entails taking into account not only the context of war, but also the specific psychological and cultural situation of male survivors, which means that they will be highly unlikely to seek assistance unless they really have no other choice. In order to reach them, support organizations, therefore, don’t just need to be prepared to help them, they also have to develop a proactive approach, while paying attention to confidentiality issues. This is a difficult balance to keep, since being proactive entails a danger of disclosing the identity of male survivors in cultural environments where sexual violence against men is often strongly stigmatized. There is thus a high risk of involuntarily worsening the situation of the survivor, as explained by Duroch and Schulte-Hillen: “The difficulty lies in reaching a justifiable balance between the added value medical care can have for the victim, both in the short and long term, and the exposure to the social risk that rape-related stigma involves, including the risk of the victim being ostracized” (2014, 611).
The issue of access to support programs is a complicated one, and does not just pertain to the reluctance of male survivors themselves. A number of organizational practices are hampering their access to support, in particular the fact that most relevant organizations active in conflict areas seem to be targeting female survivors only. Their brochures, leaflets or posters often picture women only, and even their names sometimes include references to women and female issues, which ostracize male survivors. This in turn leads to a lack of data and of information available on prevalence rates, mostly due to underreporting, and feeds the impression that there are very few, if any, male survivors. Such targeted branding reinforces the feelings of shame of male survivors, who thus only come forward when their injuries are life threatening, and sometimes it is too late to save them (International Rescue Committee 2013, interview). Most other cases seem to be left unreported, and the level of reporting for wartime sexual violence against men is generally thought to be significantly lower than for women and girls (Sivakumaran 2007). This reluctance to speak about what happened is not only maintaining the level of reporting, and, therefore, of awareness, at very low levels, but it is also impeding the provision of proper support and care: “Some male survivors do not want the person they have confided in to share the information further, making referrals for additional service provisions problematic” (Refugee Law Project 2013b, 26). No wonder then that female survivors are always presented as making up the “vast majority” of victims (a highly credible assumption, but based on reported cases, and not on “actual” figures which are in any case almost impossible to gather), thus de facto dismissing the importance of the existence of male survivors. This dismissal in turn hampers the setting up of dedicated prevention and support programs: “The absent presence of masculinity and the silencing effects of the logic of ‘the vast majority’ in scholarly literature on war-time rape denies the materiality of the violated male body. For us, this is problematic, as without envisioning the violated male body we can neither hope to prevent its violation nor seek redress for violence committed against it” (Grey and Shepherd 2012, 122). This is what a UN report has described as a “chicken and egg situation” (UN 2013, 16), since programming is indeed often based on statistical reports.