Medicine, Conflict and Survival

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Hidden victims: a call to action on sexual violence against men in conflict Harry Apperley To cite this article: Harry Apperley (2015) Hidden victims: a call to action on sexual violence against men in conflict, Medicine, Conflict and Survival, 31:2, 92-99, DOI: 10.1080/13623699.2015.1060575 To link to this article: http://dx.doi.org/10.1080/13623699.2015.1060575

Published online: 20 Jul 2015.

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Date: 09 November 2015, At: 12:12

Medicine, Conflict and Survival, 2015 Vol. 31, No. 2, 92–99, http://dx.doi.org/10.1080/13623699.2015.1060575

COMMENTARY Hidden victims: a call to action on sexual violence against men in conflict Harry Apperley*

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University of Bristol Medical School, Bristol Medical School, Bristol, UK (Accepted 7 June 2015)

Introduction In the last decade, sexual violence against men has been documented in conflicts in over 25 countries (Russell et al. 2011). Yet, a review of 4076 nongovernmental organizations (NGOs), that attend to sexual violence in conflict, found male victims mentioned in only 3% of their literature, usually only in passing (Del Zotto and Jones 2002). Conflict creates an environment uniquely susceptible to sexual violence. Poverty is combined with impunity. The destruction of infrastructure, distorted moral code and sociopolitical unrest that war generates mean that sexual abuse has become ever-present in the landscape of conflict, ‘a regrettable side effect’ of war (Seifert 1996). This commentary will describe the forms of sexual violence that target men; the dynamics of conflict that permit them, and the reasons these cases remain a buried phenomenon. Examining the barriers to action brings to light the responsibility that the international community must take on in order to tackle sexual violence against men. A strategic demand for change, this call to action clarifies the need for inclusive policy and international awareness, prioritization of prevention and the provision of effective support, regardless of gender. Gender-based violence and the international community There are many forms of sexual violence and it is a tool with a multitude of uses. Whether it is repression of enemies, ethnic cleansing or punishment of prisoners, male victims are abundant and largely ignored. Whilst the preponderance of adult sexual violence implicates a female target and a male perpetrator, male victims are an often-unnoticed group that we neglect in terms of recognition, assistance and resources. The term ‘gender based violence’ *Email: [email protected] © 2015 Taylor & Francis

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(GBV) is widely used in the global literature; however, its meaning has become synonymous with sexual victimization and abuse of women (Lewis 2009). The assumption that men are not vulnerable propagates stigmatization and undermines our understanding of the conflicts in which these crimes take place. Addressing sexual violence against men and women is a necessity; we cannot choose to attend to only one or the other. Despite the influence of gender as a social construct, the subjects of male and female abuse are far from mutually exclusive (Buvinic et al. 2013). Recent developments in the UN remit on sexual violence suggest little progress towards a more gender-neutral approach. ‘The UN Action Against Sexual Violence in Conflict’ was established in 2007 to synchronize the efforts of 13 UN organizations working in different spheres regarding sexual violence. Their publication concludes with the slogan, ‘UN Action: making a real difference in the lives of women and girls during and in the wake of conflict’. The neglect of men and boys from their mission statement is blatant. In February 2010, the UN representative for Sexual Violence in Conflict, Margot Wallstrom, made her first address. She mentioned women 35 times without a single reference to men. Similarly, Security Council Resolution 1888, the most recent resolution on sexual violence, stated ‘deep concern’ over the progress on sexual violence ‘against women and children, notably against girls’(United Nations Security Council 2009), the focal point still exclusive of men. Forms of sexual violence against men For the majority of health workers and for the general public, sexual violence refers to the rape of women. Thus, it is often assumed that sexual violence against men takes the same form (Tienhoven 1993). However, sexual abuse has many manifestations in a variety of contexts and cultural settings, with power being the pervasive feature. Sexual cruelty is used to inflict pain during fighting itself, and also to have lasting effects on a man’s physical and mental well-being after the cessation of conflict. There are short-term consequences such as pain and sexual dysfunction and long-term manifestations through the transmission of HIV/AIDS, persistent emotional trauma and social exclusion. Rape is the most perceptible and yet most concealed form of sexual violence. Destructive conceptions of gender motivate the perpetrators and condemn the victims to silence. Men are forced into sexual acts that violate all social norms. Enforced abuse of other family members ensures that the physical mistreatment is coupled with psychological torment for both parties (Lewis 2009). For example, more than a fifth of Sri Lankan Tamil men detained in the conflict report being sexually abused; forced to rape each other in front of soldiers for their ‘entertainment’ (Peel et al. 2000). Thirteen NGOs based in the developing world cited sexual violence as motivated by male sexual desire (Hoglund 2003). However, when soldiers rape, the manner in which it is conducted suggests it is a weapon of war rather than a sexually motivated side

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effect. When perpetrators lack the physiological ability to get an erection in times of danger, they resort to using sticks, bayonets or rifles (Dolan 2010). Although inflicted on an individual, castration, and sexual violence generally, can be used to emasculate an entire ethnic group whom the victim is representative of. In the former Yugoslavia, castration systematically feminized one ethnic group (Oosterhoff, Zwanikken, and Ketting 2004). Similarly, during the Rwandan genocide, castration or beating of the sexual organs was a brutal form of sterilization inflicted by Hutus on young Tutsi men (de Brouwer et al. 2005). Cultural views on masculinity mean that this stripping of manhood leaves men without their traditional ‘function’, leaving them seen as useless and burdensome. Finally, sexual violence is also used to torture men in detention. For example, 76% of political prisoners in El Salvador in the 1980s reported experiences of sexual torture and almost 5000 men held in camps outside Sarajevo were raped during their incarceration (Oosterhoff, Zwanikken, and Ketting 2004). It is important to remember that abuses like this are not confined to conflicts in developing countries. The US military use nudity to humiliate prisoners during interrogation, a technique employed in operations in Afghanistan, Iraq and at Guantanamo Naval Base (Wood 2006). These techniques utilize the varying cultural conceptions of nudity to exacerbate the punishment. There appears to be an escalation of such practices towards even more serious ill treatment (Jones and Fay 2005). The abuse scandal of Abu Ghraib prison in Iraq revealed the role of American soldiers in enforcing group masturbation and photographing homosexual intimacy (Human Rights Watch 2004). Stigma and survivors All the forms of sexual violence described above, regardless of the victim’s sex, humiliate and disempower (Lewis 2009). The dynamics manipulated by the perpetrator rely on the gendered identities and relative social, political and economic hierarchies that feed destructive social norms exacerbated by conflict. Masculinity and victimization are an awkward and unnatural juxtaposition in many cultures. Some of the stigma attached to male rape victims stems from negative perceptions of homosexuality, making the victim a de facto female in the act of sex emasculates and feminizes them. Experiencing arousal during rape can cause the victim to doubt their sexual orientation and suffer prolonged social withdrawal (Sivakumaran 2007). It seems an ironic double standard that the perpetrator escapes the homosexual attributes imputed to the male victim. Men are not just targeted directly and physically. The rape of women can be used to inflict damaging psychological effects on men as secondary victims. In the Democratic Republic of Congo (DRC), women reported that men were traumatized having been forced to illuminate the scene while their wives were being raped (Kinyandonyi FDG 2010). Female rape is used as a tool for communication between men; a man’s inability to defend the women he protects is

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indicative of ‘masculine impotence’ (Brownmiller 1976). This is not to downplay the traumatic effects on females. However, the lasting effects on men can be more pronounced, as any support that is in place for victims of GBV reflects social awareness and is usually structured for women and children (Dolan 2010). The psychosocial effects of sexual violence are profound and ongoing, at both an individual and community level (Russell et al. 2011). High numbers of men report symptoms of posttraumatic stress disorder, depression and anxiety (Johnson 2008). Alcohol and drug abuse are the most common coping mechanisms. In Liberia, for example, 14% of male victims attempted suicide as a result of sexual abuse (Krug 2002). When asked about the rape of men, women in Kinyandonyi (DRC) said, ‘It’s an incomprehensible act in the community, because it is impossible with a man; it reduces the man to a useless being, he loses authority and his personality in the community’ (Kinyandonyi FDG 2010). Victims, both male and female, can face abandonment and isolation from their families due to the stigmatization that follows these abuses (Amnesty International 2010). Some wives divorce from men suffering impotence as a result of the sexual violence (Dolan 2010). In turn, women are driven out of their community and often forced to turn to prostitution, deserting their children. The impact of GBV on children is also profound. Children born as a result of rape are stigmatized long after the cessation of conflict. In Rwanda, they are referred to as ‘children of bad memories’. The effects are therefore not isolated to an individual; the loss of a working-age male or a mother has destructive effects on a family and the function of a community. Barriers to prioritizing male victims Complex interactions of stigma and politics will have a detrimental impact on the subsequent prospects of survivors of sexual violence. Understanding why the issue isn’t prioritized is key to ensuring future development. Until the cessation of the Bosnian conflict in the early 1990s, the international community paid little attention to advocacy for female victims of sexual violence (Askin 1997). Similarly, at present, there is a systemic deficiency in support and legal protection for male victims, despite the global progress in humanitarianism and human rights law in the latter half of the twentieth century. To date, sexual violence towards men is poorly explored. Following events in the DRC, Cambodia and the former Yugoslavia, Amnesty International and Human Rights Watch both published reports on sexual violence against women (Amnesty International 2010; Human Rights Watch 2009). However, neither fully attended to the suffering of male victims (Spitzberg 1999). Mention of abuses against men is normally qualified by stating that because women form the majority of victims that is where the discussion will focus (Sivakumaran 2007). While this is valid, the ancillary position given to male victims

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threatens both prevention and recovery. In stark contrast, victimization of women has been used as a political tool to justify modern conflicts. The war against the Taliban regime of Afghanistan that began in October 2001 was partially built on rhetoric surrounding a militia, who were committing atrocities against women. There was little mention of the genocidal massacre of hundreds of young males whose age identified them as a threat to the Taliban regime (Zogby 2007). It seems that the political discourse of aid denies publicity and assistance to male victims of sexual violence. The elite actors who fund most humanitarian agencies ‘rely on masculine stereotypes to uphold and advance their political agendas’ (Del Zotto and Jones 2002). The empirical evidence presenting women as the principal casualties of abuse (Brück and Schindler 2008), alongside an historical portrayal of women as vulnerable, means that advocacy of women’s rights sits high on Western political agendas. The outlook of governments and private bodies, who seek to be seen as protectors of women, is echoed in the direction of their funding, and with the oppression of women persistent in developing countries, it rightly remains an emotive target for aid. Consequently, even NGOs depend upon the politics of both state and private enterprise. For example, leading up to the screening of the Refugee Law Project’s (RLP) ‘Gender Against Men’ film (http://www.refugeelawproject.org), Dutch Oxfam threatened to cut the project’s funding unless women continued to form at least 70% of RLP’s patient base (Dolan 2009). Many organizations seem reticent to raise awareness of male victims of violence, perhaps in fear of compromising the existing systems in place to help women. Reporting and recording: stepping out of the shade On the global stage, a lack of evidence and research distances victims from both media coverage and political agenda. On an individual level, it prolongs the stigma and suffering of survivors. Differing forms of sexual violence, paired with the dynamics under which they occur, mean that there is not only a lack of reporting of cases, but also minimal infrastructure in place to follow them up. Even if there are systems of recording in peacetime, the likelihood of their persistence and effectiveness during conflict is diminished. There is attrition at each stage of the reporting process. Whether or not a victim seeks medical help or counselling in the first place affects the visible cases. In the DRC, at least 75% of incidents were not reported, even when seeking medical care for their injuries (Johnson et al. 2010). The doctor or counsellor decides whether or not to make a record of the maltreatment, and how they define it is crucial to its appearance in statistics and in granting the victim a sense of legitimacy. For example, categorizing castration exclusively as mutilation or torture in reports means that male victims do not appear in investigations of sexual violence. Lack of awareness by professionals leads to inadequate responses when men do seek help, and subsequently worsens discrimination.

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Men are silent victims, even compared to women (Bastick et al. 2007). In Sri Lanka, men said they felt too ashamed to discuss what had occurred (Peel et al. 2000). In many settings, men are socially discouraged from vocalizing their emotions, or lack the vocabulary to do so, for fear of breaching some masculine code (Stanko and Hobdell 1993). If they describe their victimization at all, it is often without depicting the totality of the offence (Sivakumaran 2007). In Uganda, for example, where homosexuality is illegal, shame is compounded by fear of punishment for sodomy, regardless of any coercion (Dolan 2009). Public information campaigns have a role in encouraging reporting by minimizing stigma within the community, as well as raising men’s awareness of the structures in place to assist them. Moving forward: policy and legislation Sexual violence is an indicator of unresolved social and political conflicts. The power of male–male rape stems from the same paradigm that means the international community is not tackling male sexual violence. We must recognize that men too can be weak and vulnerable (Storr 2011). The UN must show leadership and publically condemn sexual violence against men. Identifying men in policy and ensuring perpetrators are brought to justice are global-level measures. Future policy can promote equality and challenge discrimination by introducing gender-neutral definitions. In order to address all those affected by sexual violence, regardless of sex, the international community must call for accurate and inclusive classification of rape and torture, encompassing both physical and mental attacks that target sexual characteristics (Lewis 2009). Emphasis on prevention is crucial. Governments need to make financial commitments to invest in coordinating multiple sectors to prevent and respond to sexual violence against men. The international donor community should push governments to investigate incidents and prosecute, both during and in the aftermath of conflict. Educational community interventions can influence discriminatory cultural beliefs to overcome the stigmatizing fallout from sexual violence. NGOs that provide social support for female victims should be implored to facilitate inclusive aid. Health workers need to be better trained to recognize signs of sexual assault in men, whether physical or psychological, and integrate services for sexual and mental health. We must recognize the progress that has been made in dealing with violence against women and ensure a gender-neutral understanding of male victims accompanying this development. All actors should combat the artificial disconnect between how we treat rape in terms of gender. Policy and intervention should be universal. Sexual violence is no more a men’s issue than it is a women’s nor is it an issue of numerical priorities. It concerns human rights.

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It seems pertinent to conclude with a statement that should echo through the corridors of power: ‘compassion is not a finite resource, new concern for one type of victim, in this case, men and boys, need not signify the lessening of concern for women and girls’ (Stemple 2005). Disclosure statement No potential conflict of interest was reported by the author.

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Notes on contributor Harry Apperley is a medical student at the University of Bristol. Culminating in a firstclass BSc in Global Health, his special interests include the impact of conflict on health, trauma recovery and international development.

ORCID Harry Apperley

http://orcid.org/0000-0003-2813-9373

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