This requires, among other imperatives, taking stock of the knowledge accumulated on masculinities, and mainstreaming it in support programs. Helping male survivors cannot be efficiently done without acknowledging the specific challenges that this type of violence entails in contexts where conceptions of masculinity render the sexual brutalization of men unthinkable. In a very interesting paper adopting precisely that perspective, Russell et al. (2011, 5) list a series of messages that public information campaigns on conflict-related sexual violence against men should focus on, such as “You are not alone”, “It was not your fault” or “Men who have experienced sexual violence need the support of their families and communities”, which could admittedly be applied to female survivors too. However, they also add a series of messages that specifically address masculinity models and try to dissociate masculinity from concepts such as violence or invulnerability. The objective is to help male survivors cope with what happened to them, and to help them make sense of their experience, such as: “You do not need to question your sexuality”, especially for dismissing the confusion that survivors feel at having been involuntarily aroused during an assault; or, crucially, “The experience of sexual violence does not make you ‘less of a man’”, which underscores the fact that a man can be vulnerable, and that not all masculinity models are linked to aggression and violence.
One of the other main difficulties with the provision of adequate care lies in the need to offer holistic support not just targeting male survivors’ physical pain, but also providing often much-needed psychological support, as well as proposing community-based options for promoting reintegration and for fighting stigma and segregation. Supporting survivors’ families might also be needed, especially in order to compensate for the survivors’ loss of financial resources, and to help them deal with potential tensions within the family itself. In some cases, involving community leaders, and raising awareness at the local level on cases of sexual violence against men, in order especially to dissociate them from homosexuality, might also be necessary, though, as noted above, public disclosure of acts of sexual violence entails a risk of further discrimination against survivors. Support has, in other words, to be multifaceted and multilevel. The UNHCR Guidelines on “Working with men and boys survivors of sexual and gender-based violence in forced displacement” (2012, 10) have adopted such a holistic perspective and list, for instance, beyond medical treatment, mental and social health issues, livelihood support and legal protection as major survivors’ needs. Similarly, Dr. Chris Dolan, the director of the Refugee Law Project that has spearheaded several support initiatives in this field, underscores the importance of a series of key challenges like “medical and psychosocial service provision, legal redress (both immediate, and in terms of transitional justice measures after a conflict is over), survivor organization (particularly to recover lost voice, lost livelihoods and lost respect in their communities), and dealing with community shaming so that the community can once again become a source of support to survivors rather than the driver of stigmatization” (Refugee Law Project 2013b, 10–11).
Addressing these challenges undoubtedly represents a considerable and daunting task, in a context where most health systems in conflict-affected countries are underfunded and understaffed. When they are still operating, hospitals and clinics located in conflict areas struggle to cope with the number of patients, and often prioritize those who present the most serious diseases and injuries, and also those whom they think they can really help. Because of the lack of awareness and training in how to deal with sexual violence against men, and because humanitarian assistance also tends to prioritize female survivors, male survivors are often left in limbo. And even in the few instances when their physical injuries are taken care of, the widespread understanding of health as absence of disease, overlooking the psychosocial aspects of relief, prevents the other dimensions of their suffering from being addressed and alleviated. If, as we have seen, survivors-led organizations existing in some countries like Uganda provide psychological support, the deep social impact that sexual violence can have on male survivors seems much more complicated to handle, especially in terms of lost livelihoods and work incapacity. So far, these difficulties have not been addressed in support programs, even by the largest humanitarian organizations: “Although it is recognized in work with women survivors that livelihoods are an important component of recovery and protection from further violence, livelihood programs for male survivors which recognize that they may have particular physical limitations during their recovery process, have yet to be established” (UN 2013, 16). Alleviating that type of suffering lies well beyond the competences and expertise of medical services, but it does not seem to be tackled by any other public or private institution or initiative either. The great majority of male survivors of wartime sexual violence have thus access to scattered and limited support, if at all, notably because many of them live far away from urban centers where medical, psychological and social help is more readily available.
Last but certainly not least, the development and setting up of adequate support programs for male survivors of wartime sexual violence will not be fully achieved if they are still viewed as competing with existing services for female survivors. For numerous humanitarian actors, speaking about the need to support male survivors of sexual violence amounts to somehow undermining policies and programs designed to fight rape and other types of sexual and gender-based violence against women during wartime, by demonstrating that women are not the only victims—and might even also be perpetrators—of sexual violence. For instance, a UNHCR worker interviewed by Charli Carpenter argued: “I recognize our discourse is a bit outdated. But it’s very difficult because as soon as you stop talking about women, women are forgotten. Men want to see what they will gain out of this gender business, so you have to be strategic” (Carpenter 2006, 99). It is true that the recognition of the scope and severity of sexual violence against women during conflict times is relatively recent, and arguably still fragile, but such discourses feed competition between categories of victims, which is useless, not to mention indecent, even in a context where funds are limited. These discourses also overlook the deep and complex connections that exist between patterns of sexual violence against men and against women, and they have tragic consequences on practices (Oosterhoff et al. 2004, 68).
The clear dichotomy that is established between male perpetrators and female victims lies at the very core of many humanitarian narratives, which feeds on gendered representations to garner support, and funding. Because there is an expectation that women will be victimized and in need of support, it is much easier to undertake fund-raising activities for helping them than supporting male survivors, who fall outside of normal interpretative schemes (Solangon and Patel 2012, 424). In a context where funding is scarce and difficult to come by, the weight of these representations has to be reckoned with. Many funding agencies demand that their contributions are used for helping women and girls, and them only, as recognized during a workshop organized by the UN: “Donors create funds to address sexual and gender-based violence, but specify that the intervention must work with women and girls, or, at best, women and children” (UN 2013, 9). The trend towards a “commercialization of rape” of women (Eriksson Baaz and Stern 2013, 96–106) in DRC and in other conflict areas, whereby rape has become a lucrative issue for various local, national and international actors, also explains the reluctance to acknowledge the existence of other types of victims.