In each city, between 4 and 6 facilities were selected based on the availability of services for migrants and refugees, as well as the type of facility and their Registro Especial de Prestadores REPS the kind registry as healthcare providers according to the Ministry of Health MOH. Assessments took around one hour and a half and were commonly performed with the help of the manager or the person in charge.
Research participants were selected based on previous experience and by mapping the organizations that have presence in the four cities that had been selected. The semi-structured interviews qualitative centered around three main topics: a knowledge and training of MISP; b public health actions during migration; and c availability and critical issues in the access to SRH.
The focus groups were conducted by an interviewer and an observer in each city. Participants were selected through the snowball sampling method in areas at which migrants typically arrive. All focus groups were conducted in Spanish and all participants agreed to being audio-recorded. Observational field notes were taken directly after each discussion.
The analysis followed the guide of indicators listed in the MSIP toolkit. Focus groups sessions were coded using N-Vivo. Some categories were set following the list provided by the toolkit, and others emerged during analysis based on grounded theory. After researchers selected the main categories, one person coded the focus group's information and identified emerging categories. Data triangulation was performed to complement the findings from different sources according to MISP objectives and the toolkit's list of indicators.
Ethical approval was granted by the Advisory Committee of Research Ethics at Profamilia on the 1st of November of The participation in the study was fully confidential and anonymous.
In order to avoid potential identification of individuals, no names were used in the analysis. Also, a written informed consent was obtained from each participant. This study provided equal gender opportunity and no individual was excluded due to gender. When and wherever possible, researchers included as many male as female respondents. We paid special attention to any potential power consideration of gender, age or any other that may have affected the way interviewees and participants made decisions.
Results provided insight into three main topics. Firstly, the level of implementation of SGBV preparedness and response; secondly, the availability of services for migrants and refugees who have been affected by sexual violence; and thirdly, the perception of migrants on sexual and gender-based violence. The problems that impact the level of implementation of the second goal presented in the MISP are related to inter-sectoral coordination and the appropriateness of common objectives to address SGBV.
Six of the seven key informants on SGBV reported having heard about sexual violence events that had occurred during the current emergency. In Valledupar, one organization offering SGBV programs was found, but none of the programs it offered addressed the needs of migrants and refugees. Assessments showed how high and severe were the number of unmet sexual and reproductive health needs of migrants as they arrive in Colombia.
The main unmet SRH needs are: access to contraception services, emergency contraception, safe abortion services and post abortion care, management and treatment of Sexually Transmitted Infections STIs , prevention of teenage pregnancy, youth friendly services and comprehensive sexual education. In particular, as a result of all the forms of SGBV they are exposed to once they decide to migrate, women and girls often face inequity in access to health care, contraception methods, quality information, or mental health, protection and justice services 7.
Nevertheless, leadership by the Ministry of Health MOH in addressing the humanitarian emergency at the border is lacking, and interagency coordination in response to SGBV was not evident. For instance: there was no record of interagency coordination in response to SRH, HIV and GBV; there has been a lack of leadership in the SGBV interagency response and coordination throughout the Venezuelan migration as well as a lack of leadership by the government in addressing SGBV prevention and care; and there is a need to strengthen coordination of SRH and HIV response among local technical teams who tend to the migration emergency.
Access to healthcare services by survivors of sexual assault and violence were evident in two dimensions: the current availability of services and the knowledge about the existence of these services by those who need them.
The people in charge of sexual violence prevention and care programs were not fully equipped for comprehensive care for GBV; only 3 out of the 23 key informants stated having sufficient supplies, funds, data, and information to monitor SGBV disaggregated by migration.
In this sense, some main gaps were identified: the first one regarding the shortage of services for the clinical management of sexual violence. All the aforementioned actions are required for the care and management of SGBV to be considered all-encompassing. Most of the facilities do not seem to have enough installed capacity for sexual violence prevention and management. In addition, migrant populations do not recognize the need for this type of services in case of an incident.
Although training spaces for the clinical management of sexual violence are being created and all organizations have established SGBV referral mechanisms, several informants mentioned after interviews that the health, justice and protection sectors did not fully facilitate these mechanisms in coordination with each other.
In addition to the failure by many organizations to provide sufficient information to migrant communities about the availability of services, it was evidenced that neither male or female migrants recognize different types SGBV consistently, did not identify SGBV as a medical emergency, and participants were not fully aware of Colombian laws regarding sexual violence:.
She went to file a legal complain, but she was told that she was paid [as a sex worker] […], and that is why they did not provide me any care. Participant in a focus group of women between the ages of 19 and 24 years old — Riohacha. As many other participants expressed, the first thing they usually do as migrants after suffering sexual violence was to seek justice, and that is why during focus group participants often mentioned that survivors of sexual violence should go to the police.
This was an idea mentioned by men and women of different ages in all the cities that were assessed, and it represents an important barrier for women and men who need comprehensive healthcare services as survivors of sexual violence, because migrants, especially those with irregular legal status, usually try to avoid interaction with authorities. It should be noted that the lack of timely health care carry important consequences on the lives of migrants such as unwanted pregnancies, sexually transmitted infections, mental health problems, among others.
Additionally, migrants were found to experience SGBV both prior and during migration. Based on the focus group discussion, we found that events are especially common in those cases in which migrants cross the border through unauthorised paths. When they arrive to towns, migrants experience xenophobia and all forms of sexual, psychologic and physical violence.
Their vulnerability to SGBV tends to be exacerbated due to the dire circumstances in which they are in and when they are not able to meet their basic needs.
Migrants, especially women and girls, are particularly exposed to this kind of violence in their host communities, and often suffer from symbolic violence by which they are seen as prostitutes or sex workers. Furthermore, during focus groups women generally talked about sexual and gender-based violence they were subjected to by their partners and families even before leaving Venezuela:.
I was threatened, I left the father of my child because he was hitting me, but I didn't file a claim against him because I was afraid I was going to be left to fend for myself. Women also recognized that migration has left them especially vulnerable to sexual and gender-based violence.
In this sense, they were not only living under continuous violence in which their families and partners were aggressors, but also being abused by people in the streets they transited, at their jobs, and their living quarters. Women from different age groups mentioned that sexual violence and abuse was one of their main worries, and also mentioned that they had heard about many cases of Venezuelan migrant women having suffered this kind of violence in Colombia.
It was clear that sexual abuse and violence has been a phenomenon that affected both men and women. Nonetheless, women were perceived as more vulnerable than men, and when men talked about this subject, they always referred to women's vulnerability:. Participants in a focus group of men between the ages of 14—17 years old - Valledupar.
The notion that women are specially exposed to sexual violence was expressed by men from different ages. In turn, men did not easily identify themselves as possible victims of sexual violence. During field work, it was evident they were concerned about the fact that Venezuelan women that have migrated to Colombia are particularly vulnerable to sexual violence and abuse. In general, migrants and refugee from both sexes were aware of the problems and risks to which women were exposed as migrants in these humanitarian emergency settings.
However as will be shown, awareness regarding the problem was not necessarily translated into strategies and knowledge regarding how to act and respond to cases of sexual abuse and violence. Even though during focus groups specific questions about the occurrence of this type of violence were not asked, discussion showed this is a problem that migrants are familiar with and revealed the magnitude of the issue.
Yes, I have seen it because next to my house it is [happening] day and night; day and night, one sees their own family members staying silent, but I am not going to shut up about it. Participants in a focus group of women between 25 and 49 years old — Cucuta. In this scenario, actions focused on preventing and responding to these types of violence should be aligned with the most urgent sexual and reproductive health needs.
These needs are connected with other basic, unmet, and sexual and reproductive health needs specific to migrants, such as access to information and communication about offer and locations for SRH services; access to contraceptive services including emergency methods, safe abortions and post-abortion care; and access to services related to prevention of STIs, including PEP. Given that migrant women are experiencing a continuum of violence in which gender could be understood as a part of system of oppression, the relationship patterns of Venezuelan migrant women could be traced to events that have taken place even before their migratory journeys began.
Migration requires confronting the different forms of violence that women have experienced at home as well as the various types of SGBV that many women face throughout their journey. Their encounters with violence are somehow connected with previous experiences in a continuum. Iraburu — lee online. Las Vidas de los Santos P. La Ciudad de Dios S.
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