The prevalence of sexual violence against boys and men in war and migration is disturbingly high. A UN report estimates that 30 to 40 percent of all men who were imprisoned in Syria were exposed to different forms of sexual violence. The same report states that boys down to the age of 10 and men up to the age of 80 experienced sexual violence. This situation is not unique for Syria, it often occurs when the situation is unstable, the social norms are unpredictable, and the legal framework is absent.
It is difficult to estimate the prevalence of conflict-related sexual violence. An important reason is underreporting, which results from the intimidation and stigmatization of survivors. People travelling to seek refuge are also likely to be exposed to sexual violence at the border crossing and after their arrival in the country of refuge. Females are more likely to be victims of sexual and gender-based violence, as well as LGBTQ+ and people with disability, but also a high number of men and boys are violated during war and conflict. A significant number of boys and men living refugee camps or asylums centers have also experienced this before or during migration and even at the camps or centers. Children living in asylum receptions are especially vulnerable.
Sexual violence against men and boys in conflict, war and during migration, can involve many different things. Some have experienced sexual abuse by other men, older boys or women in situations where they were alone or without any means of protection, such as on the run, in detention or in asylum centres. Some have been forced to perform sexual acts against their will because of power imbalances, threats of violence, or in exchange for money, food, safety, protection, or help to escape and asylum. Others may have been sexually assaulted as part of torture, punishment and humiliation.
In some countries, LGBTQ people might be convicted for their sexual orientation. Some might even have to flee from their country to seek safety. Abuse and violence by security agents, local community members and other refugees is common. To protect themselves, LGBTQ individuals may hide their sexual orientation.
For individuals with diverse sexual orientations and gender identities, accessing supportive and safe services is difficult. LGBTQ survivors may not seek medical or mental health services because of fear, lack of protection or the perception that help is unavailable. At worst, seeking help can lead to harm and exclusion.
Research shows that there have been efforts to improve healthcare providers’ knowledge and attitudes about survivors. Community sensitization, awareness and training may be a strategy to overcome the stigma and discrimination. Also, Human rights bodies do a considerable effort to strengthen the protection of LGBTQ people. We must continue to highlight their challenges to create positive change.
There is a need for a low threshold resource of information for helpers working with boys and men exposed to sexual violence. This form of assault is associated with taboos and shame, maybe even more for men and boys because of the misconception that rape does not happens to men and boys since they are supposed to be strong and able to defend themselves. In addition, the lack of knowledge about your rights and where to seek help make it more difficult for male survivors. We need to know where, when and how it happens to be able to do something about the problem, to know where to use our resources. We need to know about the problem to be able to do something about it.
We are in the process of developing a handbook as a tool for helpers to strengthen the psychosocial help provided to male survivors (boys and men) in the context of migration, war and conflict. Our goal is that helpers who meet survivors in a work- or volunteer context shall 1) feel safer in their expertise, 2) have knowledge about what they can do to help, and 3) know how they can make sure that the survivor is given further help and assistance.
Human rights as a tool when working with survivors.
The handbook is written and inspired by a human rights framework. This means that in our daily psychosocial work and the measures we take, we keep in mind that we act In line with human rights. This includes respecting the person’s dignity and integrity and understand their experiences with sexual violence in light of human rights. We can contribute to making the survivor understand that the violence they were exposed to violate international rights and principles, and that states and governments have a responsibility to provide assistance, treatment and protection. Our thought is that knowledge and understanding about human rights and what these mean in practice, can give us inspiration and tools for helping survivors.
Physiologically, humans react to danger and shock in much the same way everywhere, independent of culture. Someone who has been robbed in France, captured in Congo or devastated by a tsunami in Thailand, will have similar physiological reactions based on human physiology and reflexes.
Under cultural influence the way in which people express and interpret their behavior can vary. The bodily reactions they show are common to most people exposed to traumatic events. At the same time, survivors can understand and express these reactions in many different ways in light of their cultural background. We who are helpers should understand and deal with these cultural interpretations – and do so while taking into account our own culture, because of course we also have cultural values and assumptions.
Visibility – Taboo and shame
After traumatic events, especially those that are man-made, we generally find many personality traits that become visible in the survivor, which deal with guilt and shame. You are ashamed that it has happened, and you think you are “to blame” for it. One can feel responsible for “not having done anything”. Many thoughts will come up: “if I had said …”, “if I had defended myself”, “if I had not been there at this time”, “why did I not run away?”, etc. When you become a victim of a rape, these questions become very big and take up a lot of space. All this represents an attempt to find an explanation for the inexplicable, for what has happened, and try to find answers. Could one have avoided the outcome?
As a helper, we all have a toolbox that we use when we work, which we have gained through experience and knowledge from our work. You as a helper are the most important tool. Through this handbook, we will acquire more tools and skills, and maintain them, so they are available in situations where we need them. The intention is to develop tools and approaches that can stabilize survivors after being exposed to potentially traumatic events, help them cope with situations that trigger traumatic memories, and teach them possible ways to regain control of their lives. Our hope is that the helper can give the survivor some tools that can help him, in the form of exercises that he can do to calm down, even when he is stressed and experiencing flashbacks.
Psychoeducation as a tool refers to the process where you “teach” the survivor about their own/usual trauma reactions and how they can affect one in everyday life. We believe that it is valuable to offer several ways to understand the problems. The information presented is about what trauma is, why it is experienced as painful, what are typical and known reactions to traumatic events, both mental and physical, and how trauma often develops.
This information can help the survivor gain the knowledge and abilities that make it easier for him to handle the reactions. Knowledge means that the survivor understands what traumatic events can do to a person, what he can expect, and be aware of what reactions he may have. We believe that the more knowledge and the greater understanding a person has about their own reactions and how they can affect the person’s life, and the lives of others, the more control he can have over his life. And the better equipped he is to tackle and handle various challenges. Psychoeducation strengthens the survivor and those close to him. We will also look at what tools the helpers feel they have, what they feel they lack and what they will find useful. What is taught in this handbook can be considered as useful tools in dialogue with the survivor as well as with society.
Stabilization is an approach to teach the survivor how to deal with trauma-related reactions. Teaching why it is important to stabilize a person who experiences trauma reminders or feels anxious and not present in the “here and now” can help the survivor return and be present in the now.
Grounding is a stabilization method for dealing with strong emotions such as fear or flashbacks, when memories “take over” and are experienced as if they happen here and now. Grounding exercises are an important therapeutic approach to deal with dissociation and flashbacks, and reduce symptoms of anxiety and panic, by activating the sensory experiences. This is something that needs to be practiced continuously to automate the skill so that they can be used by the survivor even in stressful situations. The purpose is to help the survivor out of the traumatic memory he relives and return to the present. By using the exercises, he can reorient his consciousness, and focus his attention on the present, instead of on the past.
Therapeutic metaphors are stories or images that convey something that can amaze, inspire or open up new thoughts. We use stories and metaphors consciously so that the survivor does not have to put into words his own experiences but can use the story to recognize trauma and reactions. Metaphors can be simple and effective tools for teaching and learning. They are more than a way of talking about an experience. They can describe our experiences; and they can be lenses through which we can understand the world and give it meaning. Metaphors and stories can help us switch between insight and experience. A metaphor has a charged meaning and can be a mental map that can show us how things are, how they are connected or how things can be understood. A metaphor can help us see what we have not yet seen.
In the handbook we will use simple metaphorical narratives to describe the experience and consequences of sexual abuse and trauma reactions. We explain the direction trauma takes in generic twists in stories; it remains a story, but at the same time it is clinically correct.
The project “Men and boys exposed to sexual violence in armed conflict and refugee situation” is developed in cooperation with Rådet for psykisk helse with support from Stiftelsen Dam and Norad. The contract with Norad you can find it here.