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ACQUIRE Report

Traumatic Gynecologic Fistula:

A Consequence of Sexual

Violence in Conflict Settings

May 2006

A Report of a Meeting Held in Addis Ababa, Ethiopia,

September 6 to 8, 2005

Addis Ababa Fistula Hospital

EngenderHealth/The ACQUIRE Project

Ethiopian Society of Obstetricians and Gynecologists

Synergie des Femmes pour les Victimes des Violences Sexuelles

© 2006 EngenderHealth/The ACQUIRE Project. All rights reserved.

The ACQUIRE Project

c/o EngenderHealth

440 Ninth Avenue

New York, NY 10001 U.S.A.

Telephone: 212-561-8000

Fax: 212-561-8067

e-mail: [email protected]

www.acquireproject.org

The meeting described in this report was funded by the American people through the

Regional Economic Development Services Office for East and Southern Africa

(REDSO), U.S. Agency for International Development (USAID), through The

ACQUIRE Project under the terms of cooperative agreement GPO-A-00-03-

00006-00. This publication also was made possible through USAID cooperative

agreement GPO-A-00-03-00006-00, but the opinions expressed herein are those of

the publisher and do not necessarily reflect the views of USAID or the United States

Government.

The ACQUIRE Project (Access, Quality, and Use in Reproductive Health) is a

collaborative project funded by USAID and managed by EngenderHealth, in

partnership with the Adventist Development and Relief Agency International

(ADRA), CARE, IntraHealth International, Inc., Meridian Group International, Inc.,

and the Society for Women and AIDS in Africa (SWAA). The ACQUIRE Project’s

mandate is to advance and support reproductive health and family planning services,

with a focus on facility-based and clinical care.

Printed in the United States of America. Printed on recycled paper.

Suggested citation: Addis Ababa Fistula Hospital, EngenderHealth/The ACQUIRE

Project, Ethiopian Society of Obstetricians and Gynecologists, and Synergie des

Femmes pour les Victimes des Violences Sexuelles. 2006. Traumatic gynecologic

fistula: A consequence of sexual violence in conflict settings. New York:

EngenderHealth/The ACQUIRE Project.

Contents

Acknowledgments ......................................................................................................................... v

Acronyms ..................................................................................................................................... vii

Executive Summary ...................................................................................................................... ix

Introduction .................................................................................................................................... 1

A Landmark Event to Address Traumatic Gynecologic Fistula .............................................. 1

Meeting Objectives .................................................................................................................. 2

Magnitude and Programmatic Interventions .................................................................................. 3

Definition of Traumatic Gynecologic Fistula .......................................................................... 3

Overview of Sexual and Gender-based Violence in Conflict Settings .................................... 3

Harsh Realities in Two Countries ............................................................................................ 4

Programming Experiences in Six Countries ............................................................................ 5

Critical Related Issues ................................................................................................................... 11

Female Genital Cutting/Female Genital Mutilation .............................................................. 11

Child Rape ............................................................................................................................. 11

Domestic Violence ................................................................................................................ 12

Strategies for Successful Programming ....................................................................................... 13

Quality of Care: Key Components of Programming ............................................................. 13

Providers’ Roles, Attitudes, and Skills in the Treatment of Traumatic Fistula ..................... 13

Training Issues ...................................................................................................................... 14

Garnering Political and Policy-Level Support ...................................................................... 15

Data Collection ...................................................................................................................... 17

Establishing Linkages to Family Planning, HIV/AIDS, and Other Services ........................ 17

Managing Traumatic Fistula ........................................................................................................ 19

Clinical Management ............................................................................................................ 19

Psychological and Counseling Issues .................................................................................... 19

Social/Community Interventions ........................................................................................... 20

Political Advocacy ................................................................................................................. 20

Referral Systems .................................................................................................................... 21

Country Action Plans ................................................................................................................... 23

Conclusions .................................................................................................................................. 25

Appendixes

Appendix 1: Meeting Participants ............................................................................................... 27

Appendix 2: Meeting Agenda ...................................................................................................... 35

Appendix 3: Draft Country Action Plans ..................................................................................... 39

The ACQUIRE Project Traumatic Gynecologic Fistula: A Consequence of Sexual Violence in Confict Settings iii

Acknowledgments

The partners who collaborated on this meeting—the Addis Ababa Fistula Hospital,

EngenderHealth/The ACQUIRE Project, the Ethiopian Society of Obstetricians and Gynecologists

(ESOG), and Synergie des Femmes pour les Victimes des Violences Sexuelles (SFVS)—

acknowledge the U.S. Agency for International Development (USAID) and its Regional Economic

Development Services Office for East and Southern Africa (REDSO) for funding this meeting, with

special thanks to Vathani Amirthanayagam, Patricia MacDonald, Dr. Ann McCauley, and Mary

Ellen Stanton. We are also indebted to the Ethiopian Ministry of Health for their support.

The partners are grateful to EngenderHealth/The ACQUIRE Project’s Ethiopia office staff, who

provided invaluable assistance on behalf of meeting partners in coordinating partner collaboration,

organizing on-site logistics for the meeting, and managing a wide spectrum of related issues.

Many individuals from institutions across Africa generously shared their insights on traumatic

gynecologic fistula for the purposes of this meeting and for creating a shared road map for the

journey ahead. Although their names are too numerous to mention, we are indebted to them all.

Specific writers and reviewers of this report included Karen Beattie, Lauren Pesso, Dr. Joseph

Ruminjo, Erika Sinclair, Dr. Shipra Srihari, Katie Tell, and Mary Nell Wegner from

EngenderHealth/The ACQUIRE Project, Ruth Kennedy from the Addis Ababa Fistula Hospital, Dr.

Solomon Kumbi from ESOG, and Justine Masika from SFVS. Donna Grosso edited the report,

Elkin Konuk formatted the report, and Michael Klitsch provided editorial supervision.

Most importantly, we recognize the many women and girls who courageously endured the hardship

and atrocity that resulted in traumatic fistula.

The ACQUIRE Project Traumatic Gynecologic Fistula: A Consequence of Sexual Violence in Confict Settings v