Multi-country synthesis report: Afghanistan, Colombia and Central African Republic (CAR)
Executive Summary
Healthcare systems in conflict-affected settings serve as critical entry points and healing pathways for male victims/survivors of sexual violence. Yet barriers such as internalised and social stigma, inadequate capacities and approaches, discriminatory attitudes, and policy gaps can prevent them from accessing healthcare.
Between 2020 and 2024, All Survivors Project (ASP), in collaboration with partners in Afghanistan, Colombia and Central African Republic (CAR), conducted research into these barriers and the opportunities available to address them. This multi-country study outlines how survivor-centred care for male victims/survivors is achievable when operationalised in line with the core principles of safety, confidentiality, respect and non-discrimination.
Methodology
This study prioritised victim/survivor perspectives and experiences as the foundation for understanding both the challenges and opportunities in healthcare provision and access. It centres the voices of those who have lived experience, including male victims/survivors who suffered sexual violence as children along with those with diverse sexual orientations, gender identities, gender expressions and sex characteristics (SOGIESC).
The study employed qualitative methodologies across all three country contexts to examine how survivor-centred approaches are defined and implemented in healthcare settings, and what the perceived gaps are in existing healthcare responses. Research methods included in-person interviews with 62 male victims/survivors and 135 key stakeholders. The stakeholders included healthcare providers, community health workers, gender-based violence (GBV) prevention and response practitioners, professionals working in LGBTI+ rights, advocacy and protection, child protection sectors, and those working in justice processes, including government officials and civil society representatives. Desk reviews of the literature on sexual violence against men and boys and of relevant laws and policies in each country were conducted, as was a mapping of the existing healthcare systems and relevant stakeholders in each setting.
The study adopted survivor-centred approaches that prioritised the safety and choice of participants throughout. It placed victim/survivor safety, well-being, and agency at the centre of all research activities. Ethics approval was secured from relevant Institutional Review Boards (IRBs) and national ethics committees in each country, with protocols designed for survivor-centred research. Rigorous ethical protocols ensured participant safety through trauma-informed approaches, secure data handling, in-country partnerships and established referral pathways to support services. Working through trusted national healthcare partner organisations, the study ensured safe access to victim/survivor participants while maintaining rigorous confidentiality and informed consent. An international advisory group comprised of survivor networks, sexual violence and research ethics experts, academics, representatives from Médecins Sans Frontières (MSF), UN agencies, the Mukwege Foundation, The Havens, and country experts also provided strategic guidance and country-specific oversight throughout the project.
Key findings
Using a socio-ecological framework, this study identifies multiple interconnected obstacles that male victims/survivors of sexual violence face when trying to access healthcare, with these obstacles operating at structural, organisational, community, interpersonal and individual levels. Many relate to the general weaknesses in the provision of healthcare and are therefore not specific to men and boys, however, some of the barriers identified were more gender-specific.
At the structural level, barriers included policy frameworks that were designed without consideration for male victimisation, limited healthcare infrastructure in rural areas, economic constraints, and legal complexities that may criminalise victims/survivors seeking help. Within healthcare services, provider knowledge gaps about male sexual victimisation and trauma-informed care, discriminatory attitudes, absence of clear protocols, resource constraints, and confidentiality failures undermining trust and access were identified as key obstacles. Community and interpersonal-level barriers included deep-rooted stigma, victim-blaming, family rejection, safety threats from perpetrators, poverty, and geographic isolation from facilities. At the individual level, internalised shame, a lack of awareness about available services, trauma symptoms affecting help-seeking ability, and compounded and specific challenges for boys and victims/survivors with diverse SOGIESC, further obstruct access to care.
Despite these persistent barriers, the study also reveals how survivor-centred care can be achieved when implemented thoughtfully. For example, facilities that are secure, private, in easily accessible locations and with rapid service provision can reduce barriers for male victims/survivors while maintaining confidentiality. The assurance of confidentiality, with clear explanations of principles and procedures, emerges as critical for victims’/survivors’ willingness to engage with services across all contexts. Approaches that minimise re-traumatisation by requiring victims/survivors to share experiences only once rather than repeatedly to multiple providers respect dignity and psychological well-being. Eliminating financial barriers through free service provision and supporting transportation costs where needed proves essential given the economic constraints that prevent access for many victims/survivors.
Healthcare providers’ attitudes and competence function as critical determinants of a victim’s/survivor’s engagement with services, serving as either significant barriers or enablers. When providers demonstrate calm, kind, and empathetic reception combined with professionalism and specialised training, they build victims’/survivors’ confidence and willingness to engage with care. Holistic, integrated programmes addressing medical, psychosocial, and practical needs within coordinated models, (such as MSF’s Tongolo Project in CAR, Youth Health & Development Organization’s (YHDO) specialised services in Afghanistan, and Colombia’s national Programme of Psychosocial Support and Holistic Health Care for Victims (PAPSIVI)) if designed and implemented adequately, have the potential to reduce the navigation burden for victims/survivors and ensure comprehensive support. Community-based support through trained community health workers serving as trusted intermediaries, and peer support networks helping reduce isolation, demonstrates powerful potential for bridging gaps between victims/survivors and formal healthcare systems. Where implemented, legal frameworks recognising conflict victims’/survivors’ rights to priority healthcare access provide good foundations for advocacy and accountability.
Key recommendations
Addressing systematic barriers and implementing survivor-centred care for male victims/survivors of sexual violence will require coordinated interventions addressing all levels of the socio-ecological framework, from policy reform and provider training to community engagement and peer support networks.
Based on the study’s findings, ASP makes the following recommendations to government representatives, policy makers, healthcare providers and all those who work with victims/survivors of sexual violence:
Structural level
- Expand existing healthcare services to include capacity for male victims/survivors through staff training on male victims/survivor needs, adapted physical spaces, and male-specific service pathways.
- Ensure strengthened primary healthcare in underserved areas as well as transportation support for victims/survivors.
- Update national protocols and guidelines to address male-specific needs, physiological differences, and trauma presentation variations.
- Clarify healthcare provider reporting obligations while protecting survivor confidentiality through clear guidance.
Organisational level
- Ensure robust training for all healthcare personnel and organisations providing support to survivors on survivor-centred care, thereby challenging myths about sexual violence and building professional competence.
- Train community health workers on confidential referral practices to serve as trusted intermediaries.
- Maintain adequate medical supplies and implement strict confidentiality protocols as critical enablers for service engagement.
- Design healthcare and other relevant facilities with discreet access and secure, private environments that respect victim/survivor dignity.
- Implement child-friendly services with age-appropriate and gender-sensitive communication and specialised care pathways. Train providers on evolving capacities of children and trauma-informed care.
- Implement staff training and inclusive and specialised services for victims/survivors with diverse SOGIESC.
Community, interpersonal and individual level
- Raise awareness about available services and victim/survivor rights through multiple communication channels. Challenge myths about male sexual victimisation through contextually-appropriate messaging designed in consultation with victims/survivors.
- Engage religious and community leaders to reduce stigma and increase support for victims/survivors.
- Fund male victim/survivor networks and peer support groups to contribute to recovery processes by, for example, reducing isolation, enabling survivor mobilisation and facilitating formal service access.
- Provide family-level interventions supporting reintegration and education about sexual violence.
- Balance trusted adult involvement with the protection of children’s autonomy and privacy in accessing healthcare.
- Strengthen livelihood and economic support programmes to address displacement and poverty-related barriers to care.
Further research
- Deepen understanding of male victims/survivors’ specific needs through further research. This includes research that is designed in consultation with victims/survivors and relies on context-appropriate methodologies, in-depth consultations and validation of findings with victim/survivor groups, and thorough assessments of healthcare service responses.
- Identify critical gaps in support and care to enable targeted and effective interventions.
[1] A member of the research advisory group moved from the Mukwege Foundation to Global Survivors Fund during this period.
