Interestingly, the number of male victims who are reporting sexual assault seems to depend a lot on whether the clinic or hospital has the reputation to treat those issues, which also feeds a kind of vicious circle—male victims being more likely to avoid places that have a reputation of treating women only, thus reinforcing existing patterns. Conversely, when men are encouraged to seek help, for instance, through the publication of brochures mentioning the phenomenon of sexual violence against men, or quoting testimonies from men who have been victimized and who have received support, the level of reporting significantly increases, as explained by Rumbold in the case of one Kenyan hospitaclass="underline"
The Gender Violence Recovery Centre in Nairobi Women’s Hospital treats sexual abuse survivors of all ages and genders. The presentation of male survivors (albeit 85% 15 and under) has increased steadily over the last four years, which is attributed to increased awareness among the population (personal communication, 2006 with GVRC counsellor). The hospital conducts awareness campaigns, during which they advertise the availability of services to male survivors. Services, both medical and psychological, are broadly the same as those offered to women, with the exception of pregnancy prevention. (2008, 15)
In the same perspective, a UN report on conflict-related sexual violence against men proposes to generalize screening in order to improve the level of reporting and, therefore, raise the awareness of service providers: “Normalising the screening for everybody can prompt a change in patterns of reporting. The resultant increase in numbers requiring services will help create the pressure required for service providers to seek new resources for this area of work, and for donors to allocate new resources to it” (2013, 16). In the absence of such proactive strategies, the access of male survivors to adequate care is likely to remain very low, and restricted to the most tragic cases.
One of the most immediate consequences of the low level of reporting and general lack of awareness about conflict-related sexual violence against men is an un-preparedness of medical facilities and staff for dealing with such cases. Medical staff and health care professionals lack training with regards to detecting, identifying and tackling the injuries related to this type of violence, and many doctors in conflict areas even seem to ignore that such cases exist (Féron 2015, 37). Because most of the time services for survivors of sexual and gender-based violence are located in gynecology departments, many male survivors are referred to them, but medical staff in these departments are not trained and prepared to take care of the psychological and physical suffering induced by sexual violence on males. The amount of knowledge and training about how to deal with survivors of violence and torture is very low, and often limited to extremely general guidelines like the 2004 Istanbul Protocol (UNHCR 2004). Even in services where male survivors are treated, the medical staff frequently works under the assumption that their needs (apart from fistulas and unwanted pregnancies following rape) are entirely similar to those of female survivors, which is untrue. For instance, they display different kinds of physical injuries, have different psychological needs and do not necessarily relate to what happened to them in exactly the same way—for example, in terms of questioning their gender identity. A UN report highlights these shortcomings:
In most contexts, medical, social and humanitarian workers have no training in working with male survivors, and are thus ill-equipped to identify or respond to the specificities of such cases. Clinics, particularly within emergency settings, have neither the protocols, medication, supplies, nor the trained staff needed for adequate clinical management (…). The spaces within which they work are often not safe or conducive for male survivors; in some situations male survivors are referred to gynecological units, to their own discomfort and that of the women for whom these units are intended. Information, Education and Communication (IEC) materials such as posters and pamphlets giving information to male survivors are almost non-existent. (UN 2013, 15)
Some male survivors also find it difficult to speak to female service providers (UNHCR 2017a, 43), who often are in majority in departments offering support to sexual violence survivors, which is sometimes interpreted as an indication of the need to set up separate units to accommodate them. However, as explained by Le Pape (2012, 4), there is no agreement among health-care professionals about whether separate support units for male survivors are a good option or not. Some argue that separate units for male and for female victims are indispensable for avoiding re-traumatizing female survivors, and for creating “safe spaces” for them; from the perspective of male survivors, having separate services is less likely to reinforce the confusion they frequently feel about their gender identity. It also helps to avoid “feminizing” them a second time—by treating them in units that are mostly treating women, after the feminizing nature of sexual violence itself. On the other hand, others argue that offering joint services would effectively fight stereotypes associated with sexual violence, for instance, by demonstrating that vulnerability is not a quality attached to the female body, and also by countering the idea that all men are violent and aggressive. For the time being, the solution that is most frequently adopted by hospitals and clinics operating in conflict zones is that of joint services, but more because of a lack of resources than because of a deliberate choice:
We try to do as much as we can with what we have, and we don’t have much. (Panzi Hospital 2012, interview)
In any case, it looks indispensable to develop ways to provide support to male survivors without further damaging their self-image and further “feminizing” them—just as it is crucial to unpack the link that is constantly made, consciously as well as unconsciously, between female bodies, femininity, victimhood and vulnerability. This link is detrimental to both male and female survivors, as it traps them, and the staff supporting them, in pre-determined roles that also assign to them a specific social positioning. This conceptual nexus might be quite complicated to entangle, though. This is what Vaittinen explains:
To write about the vulnerable body is to write about a deeply feminized field of discourse where two effeminate realms of life come together: the body and vulnerability. In the Cartesian mind/body dualism(s) that dominates modern political thinking, the mind tends to be associated with masculine forms of autonomous, rational and public (political) life; whereas the body is linked with femininity, irrationality and the private (apolitical) life (…). This means that when a person—regardless of sex—is perceived as vulnerable, s/he is simultaneously coded as effeminate. (2015, 103)
Such representations dominate most humanitarian narratives and interventions, and also underpin practices of care well beyond the specialized field of support to survivors of sexual violence. However, in this case in particular, it seems particularly important to carefully review and adapt discourses, facilities and protocols to the specific needs of male survivors, in order to avoid deepening, instead of mending, the psychological scars left by sexual violence.