GBV case management: data analysis, response and ethics

Total: 186 new cases (+42% compared with 131 in the previous quarter). Sexual violence (rape and sexual assault): 73, i.e. 39.2%. Minors: 41 / 186 = 22.0%. Rapes reported within 72 hours: 14 / 52 = 26.9%; within 120 hours: 19 / 52 = 36.5%. Almost three out of four rape survivors therefore arrive too late for HIV PEP.

Referrals accepted: health 51 / 73 = 69.9%, psychosocial 138 / 160 = 86.3%, legal 9 / 40 = 22.5%. The low uptake of legal assistance probably reflects fear of reprisals, cost and distrust of the justice system; it must not be "corrected" by putting pressure on survivors. The share of intimate partners (46%) shows that violence is not limited to the conflict.

Limitations: these data relate to cases reported to services; the 42% increase may reflect greater trust or better access, not necessarily an increase in violence. Neither prevalence nor comparisons between areas can be inferred from them.

1. Safety and reception: confidential space, female case worker trained in caring for children; check whether there is immediate danger. With her agreement, the aunt may stay if the girl wishes.

2. Information and consent: at 15, obtain her informed assent and, in line with her best interests, the consent of a trusted adult; explain the limits of confidentiality, including the legal reporting obligation, before she gives details.

3. Emergency health care: at 96 hours, HIV PEP is no longer indicated (72-hour limit), but emergency contraception is still possible (up to 120 hours); presumptive treatment of sexually transmitted infections, vaccinations according to protocol, wound care, medical certificate if she wishes. Accompanied referral to the centre 18 km away, transport covered, the same day.

4. Psychosocial support and safety plan, as the perpetrator is armed.

5. Mandatory reporting: the dilemma sets the law against the risk to her (reprisals, rejection). It is handled with supervision and the protection focal point: analyse her best interests, inform her of what will be passed on and to whom, pass on only the minimum, seek to do so through the safest channel (for example via social services), and document the decision. Absolute confidentiality is never promised.

6. Parents: respect her refusal unless her best interests require otherwise; work with the aunt as a trusted person.

Current caseload: 132 / 4 = 33 cases per case worker, above the maximum of 25. Requirement: 132 / 25 = 5.28, i.e. 6 case workers; 2 are missing, not counting the increase in cases. Meanwhile: prioritisation of cases by risk, reinforced supervision, burnout prevention.

Other gaps: (1) no paediatric PEP kits although 22% of cases are minors, and only 6 adult kits; (2) late access to care (73% of rapes reported after 72 hours); (3) insufficient legal assistance (once a month).

Priorities: 1. Paediatric PEP kits and adult restocking, immediate request to the GBV sub-cluster and health actors. 2. Community awareness on the importance of seeking care within 72 hours, and closer entry points (mobile teams, trained health workers). 3. Recruitment of 2 case workers, at least one trained in caring for children. 4. More frequent legal clinic, without pressure to file a complaint.

Example: "Dear Sir, we share your concern for the safety of women and girls. However, we cannot pass on any named information or anything that could identify a person, nor any list by village: this information is confidential and disclosing it would expose survivors to reprisals and stigma, and would deter others from seeking help. Under the information-sharing protocol of the GBV sub-cluster, we can share aggregated and anonymised trends, and flag areas and times of risk, without any link to individual cases. We propose a meeting with the GBV sub-cluster to define together the information useful for patrols. Respectfully."

These are allegations of sexual exploitation by an aid worker: all staff are obliged to report them, whoever employs the alleged perpetrator. (1) Immediate and confidential report to my organisation's PSEA focal point, who passes it on to the PSEA network and the organisation concerned in line with the agreed procedures. (2) Survivors are referred to GBV case management if they wish; their identity is shared only with their informed consent and only the minimum necessary. (3) I carry out no investigation and do not confront the worker. (4) I support the case worker and remind her that she is protected against retaliation. (5) Through the network, I follow up on the introduction of protective measures at distributions.