Treating Victims of Sexual Violence in Nairobi's Mathare Slum

Every month, Doctors Without Borders/Médecins Sans Frontières (MSF) treats some 200 new victims of sexual violence in the Mathare slums in Nairobi, the Kenyan capital. A unique program has been put in place to treat their injuries and help them overcome this trauma.

"The victims we treat range from a few months to over 80 years old,” explains Ginny Ponsford, an MSF doctor at the Mathare clinic. “Last April, we received two sisters aged seven and nine. The oldest had been raped by a neighbor. Their mother is a single parent and works to feed her daughters, so she couldn't accompany them to the clinic and we are now concerned about what may happen to the youngest girl. This is an example of the terrible situations experienced by many Mathare residents. It's also very difficult for us, the medical personnel, to receive patients that young with no parent.”

Mathare is home to some 200,000 inhabitants who live in extremely precarious social and sanitary conditions.The vast majority of patients MSF treats at the Lavender Clinic (so named for its light purple paint) are women and children, and their numbers continue to grow.

Emergency Assistance

"In order to provide emergency assistance, an ambulance is available 24/7 to collect the victims as close to the attack site as possible,” says Program Coordinator Corinne Torre. “A nurse and social worker take the victim into their care and record an initial statement about the attack. Upon arrival at the clinic, the patient meets with a social assistant who accurately documents what happened to them.

"Next, the victim is seen by a doctor who carries out a medical examination and provides initial treatment. A prophylaxis is administered to reduce the risk of HIV transmission and other transmittable diseases. Then the victim is given a file with a medical certificate listing the injuries and wounds recorded, enabling them to press charges if they want. This is just the start of a long fight for all of these victims.”

Rapid Expansion

It has taken time to get the program up and running in such a vast area. Eastern Nairobi is home to some two million people from an extremely diverse range of cultures. A lot of field work and discussions with communities, local authorities, and medical structures have been necessary in order to overcome reluctance and convince people to refer patients who have been victims of sexual violence to the MSF clinic.

In 2011, it was decided to keep the clinic open 24/7 in order to meet demand. Since then, the number of new patients received every month has continued to grow. In the first quarter of 2014, the medical teams treated more than 650 patients.

The most difficult times are at night and on weekends, as problems with violence are magnified by drug and alcohol use. Fortunately, the team’s community outreach has paid off, and MSF now has a good relationship with local authorities. Today, more than half of the patients received at the clinic are referred by police stations.

Beyond Medical Care

After their traumatic experiences, it is important that victims also receive social support, accommodation, clothes, and food in addition to medical treatment. MSF organizes short-stay accommodation and works with a local network to boost victim protection.

However, due to widespread poverty, after this short respite victims often have no other choice but to return to their original community, where the attack occurred. In response, MSF has introduced an awareness campaign to meet with communities, make them mindful of the seriousness of these crimes and the suffering of the victims, encourage new victims and their families and friends to speak out, improve access to treatment, and try to initiate violence prevention actions.

MSF is currently evaluating the possibility of adding a second ambulance with a second permanent team in order to keep pace with the rapidly expanding scope of the intervention. This will spare victims from having to wait several hours for help and running the risk of suffering another attack. MSF is also planning to develop a training and awareness program for the Kenyan Health Ministry's teams so they can also take care of victims.

In March 2014, the Lavender Clinic also treated 128 cases of trauma and injury. It is the sole medical structure providing free medical treatment 24/7 in the Mathare slums. Teams also treat tuberculosis in Mathare, and MSF treats victims of sexual violence in the Kibera slums as well.