Linking, Aligning, and Convening Gender-Based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts The Republic of Uganda O ce of the Prime Minister Linking, Aligning, and Convening Gender-Based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts The Republic of Uganda O ce of the Prime Minister © 2020 International Bank for Reconstruction and Development/The World Bank 1818 H Street NW, Washington, DC 20433 202-473-1000 | www.worldbank.org Some rights reserved. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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The State and Peacebuilding Fund (SPF) is a global fund to finance critical development operations and analysis in situations of fragility, conflict, and violence. The SPF is supported by Australia, Denmark, France, Germany, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and International Bank for Reconstruction and Development. Contents ACKNOWLEDGMENTS ................................................................................................................................................... V ACRONYMS ...................................................................................................................................................................... VI EXECUTIVE SUMMARY ................................................................................................................................................ VII 1 INTRODUCTION .........................................................................................................................................................1 Forced Displacement in Uganda ........................................................................................................................................... 2 Refugee Policy framework in Uganda .................................................................................................................................. 2 Development Response to Displacement Impact Project (DRDIP) ................................................................................3 GBV and VAC in the Context of Displacement ...................................................................................................................4 2 METHODS ...................................................................................................................................................................6 Objective and Scope of the Assessment ............................................................................................................................ 8 Design .......................................................................................................................................................................................... 8 Study Sites and Participants ................................................................................................................................................... 8 Research Team and Training .................................................................................................................................................. 9 Data Collection Methods ......................................................................................................................................................... 9 Data Management and Analysis ...........................................................................................................................................10 Ethical Aspects ..........................................................................................................................................................................10 Limitation ..................................................................................................................................................................................... 11 Data Validation ........................................................................................................................................................................... 11 3 ASSESSMENT RESULTS ........................................................................................................................................ 12 Scope of the Problem .............................................................................................................................................................. 14 Key Risk Factors OF GBV and VAC in refugee-hosting communities .......................................................................20 GBV and VAC Response Services in Hosting and Refugee Communities ..............................................................30 Referral Pathways .................................................................................................................................................................... 49 Information Systems ................................................................................................................................................................51 Monitoring and Evaluation ....................................................................................................................................................52 Assessment of GBV and VAC Prevention Programs ......................................................................................................52 4 CONCLUSIONS ....................................................................................................................................................... 58 5 RECOMMENDATIONS ...................................................................................................................................................64 REFERENCES .................................................................................................................................................................. 68 APPENDIXES ................................................................................................................................................................... 70 A List of Documents Reviewed .....................................................................................................................................................................72 B Services Provided in Refugee and Hosting Communities .................................................................................................................74 C Organizations Providing GBV Prevention Services .............................................................................................................................77 iii BOX 3.1 Bottlenecks in the Referral Pathway ........................................................................................................................................................ 50 FIGURES 1.1 Refugee Versus Host Population by District .............................................................................................................................................2 3.1 Legal and Justice Actors and their Roles ................................................................................................................................................37 MAP 2.1 Refugee-Hosting Districts in Uganda ........................................................................................................................................................8 TABLES 3.1 Risk Factors of GBV and VAC in Refugee-Hosting Communities .................................................................................................... 25 3.2 Health Facilities in Refugee Settlements and Host Communities in Study Districts.................................................................... 31 B.1 Number of Institutions Mapped .................................................................................................................................................................74 B.2 Availability of Health Services for Gender-based Violence and Violence Against Children.....................................................74 B.3 Availability of Essential Medicines ............................................................................................................................................................75 B.4 Availability of Medical Equipment .............................................................................................................................................................75 B.5 Accessibility to GBV and VAC Services at Health Facility Level .......................................................................................................76 B.6 GBV- and VAC- Related Services Provided by Police ..........................................................................................................................76 iv Acknowledgments This report is an output of the Uganda Development thank Jeanne Ward, International GBV Consultant, Pelucy Response to Displacement Impacts Project (DRDIP), Ntambirweki, Independent Child Protection Consultant, the supported by the World Bank. The team leading the United Nations High Commissioner for Refugees (UNHCR), research includes Margarita Puerto Gomez, Senior Social and United Nations International Children’s Emergency Development Specialist, and Varalakshmi Vemuru, Lead Fund (UNICEF) Uganda for reviewing and providing con- Social Development Specialist. structive feedback on drafts of this report. The report was prepared by the Applied Research Bureau In addition, we gratefully acknowledge guidance, input, (ARB) research team, under the leadership of Paul Bukuluki, and comments from Elaine Chee, Social Development PhD. Special thanks are due to Tina Musuya, Ronald Specialist; Michael Christian Mahrt, Senior Social Kalyango, Aloysious Nnyombi, Alex Bagabo, Kato Francis, Development Specialist; Pamela Chebiwott Tuiyott, Senior and Robert Bakanoma for their contributions to the prepa- Social Development Specialist; and Diana Jimena Arango, ratory processes, fieldwork, and writing of this report. Senior Gender Specialist. We are grateful to Benjamin Reese, Senior Operations O cer, and Zewditu Haile, The project implementation support team for the Uganda consultant from the forced displacement program in DRDIP provided invaluable support and feedback. The Uganda for their invaluable inputs. We also thank Damalie team was led by Dr. Robert Limlim, Project Director in Evalyne Nyanja, Program Assistant, and Kate Kanye, the O ce of the Prime Minister; Charles Bafaki, former Consultant, for their logistical support; and Laura Johnson Project Manager; Michael Nsamba, Safeguards O cer; for editing and design. Caro Breda Lorika, Environmental and Social Specialist; and Jane Ekapu, Acting Secretary Equal Opportunities And finally, our heartfelt thanks go to all our study partic- Communication. ipants for giving us their time and for generously sharing their views, opinions, and experiences as they relate to the Special thanks are extended to Ismael Ddumba-Nyanzi key issues presented here. for technical assistance to the study. We would also like to v Acronyms CBSD community-based service department NWOW New Way of Working CID criminal investigation department PF3 Police Form 3: Medical Examination of an Injured Person CFPU child and family protection unit PF3A Police Form 3A: Medical Examination CSO civil society organization of a Victim of Sexual Assault DPP Directorate of Public Prosecution ReHoPE Refugee and Host Population Empowerment DRDIP Development Response to Displacement RSA resident state attorney Impacts Project RWC refugee welfare committee GBV gender-based violence SGBV sexual and gender-based violence HC health center UN United Nations IPV intimate partner violence UNHCR United Nations High Commissioner for km kilometer Refugees LLC local council court UNICEF United Nations Children’s Fund M&E monitoring and evaluation VAC violence against children NGO nongovernmental organization vi Executive Summary vii U ganda currently hosts the third-largest refugee data show an increase in GBV and VAC, exacerbated by population in the world, and the largest in Africa. confinement measures, particularly adolescents girls and In May 2020, the country was hosting about 1.4 mil- women at risk of intimate partner violence. lion refugees and asylum seekers, mostly in the West Nile, Northern, and Western parts of the country.1 The majority of This assessment complements the UNHCR-led interagency these refugees are from South Sudan and the Democratic assessment that focused on GBV and VAC in 11 refugee Republic of Congo. Women and children comprise 82 per- settlements (UNHCR and OPM 2019). The DRDIP analysis cent of Uganda’s overall refugee population, about 56 per- includes a comprehensive mapping of services for GBV cent of refugees are below the age of 15, and 25 percent and VAC prevention and response across the key sectors are younger than five years of age (World Bank 2019). of health, police, justice, and social services in refugee settlements and host communities. In addition, qualitative Gender-based violence (GBV) and violence against children data were collected through focus group discussions with (VAC) are key protection concerns for refugees and host refugees and local populations; interviews with key infor- communities alike, with women and girls disproportion- mants, including duty bearers such as health workers and ately a ected. The United Nations High Commissioner police o cers; and consultations with local stakeholders. for Refugees (UNHCR) recorded 4,297 cases of GBV in 12 refugee settlements between January and November 2019.2 In addition, the 2016 Uganda Demographic and SUMMARY OF FINDINGS Health Survey reveals a high prevalence of GBV in districts GBV and VAC are prevalent in both refugee and host com- that host refugees. munities. The assessment reveals that GBV and VAC are pervasive in refugee-hosting communities, and it identifies The Development Response to Displacement Impacts perceived drivers and risk factors associated with victimiza- Project (DRDIP) is a World Bank-funded project that seeks tion. Notably, sex, age, disability, substance abuse, financial to address the impacts of forced displacement in com- stress, physical environment (e.g., location, porous border, munitieshosting refugees in 11 districts in Uganda. DRDIP and environmental degradation), and discriminatory social provides access to basic social services, expands economic and gender norms are identified as key risk factors for vio- opportunities, and enhances environmental management lence against women and children in the host communities. targeted at both refugees and host communities. DRDIP Economic hardship and substance abuse are the most com- conducted a rapid assessment in 11 of the 12 refugee- monly mentioned factors in the study’s qualitative findings. hosting districts to: (1) identify key risk factors for GBV and Additionally, domestic violence, violence in schools, and a VAC and to examine the intersections between them, with lack of child-friendly and accessible services to report and an emphasis on host communities; (2) map existing GBV respond to violence against children increase boys’ and and VAC prevention and response services in both refugee girls’ risk of victimization. and host communities, including the e ectiveness of exist- ing referral pathways; and (3) provide recommendations to In general, risks of GBV and VAC in communities hosting align and link the GBV and VAC prevention and response refugees are similar to those documented in refugee services provided in refugee settlements and host commu- settlements (see UNHCR and OPM 2019a; GWI, LWF, nities. The contributions of this assessment will strengthen and Makerere University 2019; Sengupta and Calo 2016). GBV and VAC risk management associated with the However, women and children in situations of forced implementation of DRDIP. Data for this assessment were displacement face specific vulnerabilities associated with collected before the COVID-19 outbreak, but subsequent poverty, food insecurity, aid dependency, and trauma that 1. According to UNHCR, Government of Uganda, O ce of the Prime Minister (2020): can exacerbate their risks to violence and constrain their https://data2.unhcr.org/en/country/uga [accessed May 21, 2020]. ability to look for help and access services. According to 2. Available at https://reliefweb.int/sites/reliefweb.int/files/resources/73839.pdf. viii Executive Summary UNHCR, socioeconomic status and ethnicity influences survivor may seek health care but may not follow up on case reporting, and survivors who have access to resources referrals to law enforcement or psychosocial services, or means of livelihood are more likely to report GBV3 than which is attributed to gaps and bottlenecks in the existing the deprived refugees. Reporting is also limited among referral systems, including a lack of standardized referral the more conservative communities, such as Somalis and protocols, poor case tracking, and limited follow-up with Eritreans. The assessment also reveals that poverty and a survivors to ensure they are promptly receiving needed lack of safeguards drives children into the hands of abusers services. Poor initial experiences and perceptions among and perpetrates harmful practices, such as early marriage survivors regarding the quality and safety of services are (UNHCR and OPM 2019a: 18). also identified as barriers to follow-up care and/or utilization of other referrals across study sites. Understanding the intersections between GBV and VAC is crucial to comprehensively addressing risk factors. GBV Services for women and children survivors of violence in and VAC share similar risk factors that tend to be mutually refugee settlements are provided by UNHCR, other United reinforcing. For example, children in households where Nations (UN) agencies, and implementing partners (e.g., women experience intimate partner violence (IPV) are at nongovernmental organizations, or NGOs) in coordination higher risk of VAC. This has long-term implications because with the O ce of the Prime Minister. The humanitarian children exposed to violence are more likely to become response to the protection of GBV survivors tends to gener- survivors or perpetrators in adulthood. In addition, social ate parallel structures for the provision of services, which norms that deem such violence normal, acceptable, or even are not always aligned or integrated with national systems, justified perpetuate GBV and VAC. The assessment docu- hampering the standardization of procedures, protocols, ments a high rate of acceptance for physical violence as a and interventions among service providers, and undermin- form of “disciplining” women and children. ing local capacity to address GBV and VAC in a sustainable and integrated manner. GBV and VAC prevention and response in refugee and host communities remain inadequate. First, e ective GBV and E ective prevention of GBV and VAC also requires several VAC case management continues to be undermined by the interventions at the individual, interpersonal, community, lack of accessible, integrated services and reporting mech- and societal level. The few prevention programs that are anisms; weak institutional capacity across sectors (justice, being implemented in refugee and host communities are health, education, and social welfare); and the absence low-scale, fragmented, and dispersed. Evidence-based of e ective coordination of services in all refugee-hosting approaches to reduce the key risks of violence identified districts. For example, the medical services and the justice in this assessment, such as economic and social empow- system, including the police and courts, are profoundly erment of women and adolescent girls, have not been ill-equipped to support and assist survivors. Moreover, the systematically undertaken over time. long distances from areas a ected by displacement to where services are o ered often prohibits optimal access Despite the recognition of overlapping risks and interven- to services. tions, GBV and child protection programming in refugee and host communities still follows distinct trajectories, each GBV and VAC survivors in host communities are often with its own funding streams and actors. While there are unable to access an essential package of multisectoral important and strategic reasons to separate advocacy and services, including health, psychosocial support, and programming for women and children, it is important to justice/legal services. In some cases, utilization is limited identify opportunities for leveraging programming where to seeking one of the available services. For example, a there are linkages, particularly around intersecting risk factors. 3. UNCHR (2016) uses the term sexual and gender-based violence, or SGBV. Executive Summary ix RECOMMENDATIONS 3. Scale up evidence-based community violence pre- 1. Integrate GBV risk mitigation and prevention in the vention approaches using a systemic approach. The development response to forced displacement. The assessment shows several risks factors for VAC and humanitarian-development nexus provides a broader GBV at di erent levels of the socioecological framework, framework for the protection of women and children in including discriminatory social and gender norms that protracted situations of forced displacement. Nonetheless, generate and perpetuate violence against women and development projects, depending on their scope, can also girls. These risk factors need to be addressed through exacerbate existing risks of GBV, or can create new ones, multipronged prevention interventions reflective of recent unless appropriate safeguard measures are put in place. evidence of what works (DFID 2015). Prevention e orts For instance, projects can cause shifts in gender dynam- could focus on changing social norms that underpin VAC ics between community members and within households and GBV, engaging men and boys, supporting economic (World Bank 2018). Therefore, development projects such and social empowerment for women and adolescent girls, as Uganda DRDIP should consider any potential nega- and promoting positive parenting practices. For example, tive impacts and embed measures across the program evidence-based community mobilization and social norm to mitigate risks related to GBV, sexual exploitation and change approaches, such as the SASA! methodology,4 abuse, and VAC that could result from project activities or should be adapted or contextualized and implemented by that already exist in the community. Such measures might district/local government structures for scale and sustain- include the establishment of grievance redress mecha- ability. E ective implementation and institutionalization nisms that can e ectively refer GBV/VAC cases; community may require building the capacity of government structures mobilization e orts; and the training of project stakeholders and duty bearers, such as probation social welfare o cers on GBV and VAC risk identification and mitigation across and community development o cers, through training and sector interventions, including health, education, water and mentorship. Similarly, school-based violence prevention sanitation, access to energy, and livelihood programs. programs, such as Raising Voices’ “Good School” toolkit could be replicated in both refugee and host communities. 2. Strengthen and enhance multisectoral services at all This program could also contribute to the rolling out of the levels. E ective GBV and VAC case management continues “Reporting, Tracking, Referral and Response Guidelines on to be undermined by weak institutional capacity across sec- Violence Against Children in Schools,” developed by the tors, including justice, health, and social protection, and by Ministry of Education and Sports in 2014.5 Finally, promoting limited referral services for survivors. Measures should be women’s and girls’ empowerment through livelihood sup- implemented to strengthen the local response capacity to port and economic opportunities is critical to reducing risk ensure that survivors can access quality essential services, factors of violence at the household level in both hosting such as medical/health services, psychosocial support, and refugee communities. justice and policing services, legal aid, and shelter. Specific activities could focus on strengthening the case manage- 4. Consider and address intersections between GBV and ment capacity of GBV and child protection actors as well as VAC. The nexus between GBV and VAC highlights the need the coordination among duty bearers through training and for greater collaboration and integrated programming to mentorship; ensuring that the di erent institutions have the addresses both forms of violence. There is a need to break facilities and logistical resources they need to e ectively execute their mandates; and strengthening coordination 4. The SASA! methodology utilizes a structured community engagement and phased approach to address underlying beliefs, social norms, and attitudes that perpetuate and referral mechanisms. Where possible, capacity of local violence against women and girls. A cluster randomized controlled trial of the SASA! leaders and refugee welfare committees (RWCs) should be methodology in Uganda revealed a 52 percent reduction in intimate partner violence against women in SASA! communities. built so they can appropriately refer cases of GBV and VAC 5. The ministry’s guidelines complement the child-friendly-schools model and are designed to improve reporting by children and school o cials of incidents of vio- to formal services as required by the referral pathways. lence against children/girls and to be integrated with the broader district referral and response systems. x Executive Summary conceptual “silent spaces” across GBV and child protec- important entry points and opportunities for humanitarian tion programming, while also recognizing that in some and development actors to work together toward devel- instances the two fields need dedicated approaches, by oping a more integrated and sustainable approach to GBV focusing on areas overlap where possible (e.g., addressing and VAC prevention and response. For example, humanitar- shared risk factors such as social norms that underpin both ian and development partners could develop district-level forms of violence and training service providers to address capacity to ensure integrated information and reporting both GBV and VAC). In addition, an assessment is needed systems, referral pathways, and case management. In of the added value of coordinating e orts at preventing addition, the humanitarian-development nexus and commit- and responding to these forms of violence in an integrated ment to the New Way of Working (NWOW)6 also provides an manner. opportunity to work collaboratively and align funding and financing modalities to strengthen district-level and national 5. Bridge the humanitarian-development divide in GBV systems to address the protection needs of refugee and and child protection programming. The gap between the host communities—with a greater focus on sustainability. humanitarian and development responses to addressing GBV- and VAC-related risks must be reduced using deliber- ate e orts to align violence prevention and response inter- 6. The New Way of Working, or NWOW, is an approach promoted by the UN Joint Steering Committee to advance humanitarian and development collaboration. The ventions with national systems and local structures. The approach calls on humanitarian and development actors to work together collabo- Comprehensive Refugee Response Framework provides ratively, based on their comparative advantages, toward “collective outcomes” that reduce need, risk, and vulnerability over multiple years (UN OCHA 2017). Executive Summary xi 1 Introduction xii 1 FORCED DISPLACEMENT IN UGANDA U FIGURE 1.1 ganda is the largest refugee-hosting country in Refugee Versus Host Population by District Africa and the third largest worldwide. The o - Host population cial statistics from the O ce of the Prime Minister Refugee population and the United Nations High Commissioner for 120 100 Refugees (UNHCR) estimate that by May 2020, Uganda 80 percent 60 was hosting over 1.4 million refugees and asylum seekers. 40 Women and children comprise 82 percent of the overall 20 0 refugee population in Uganda. Refugees are concentrated la a be e o ge go ko i gi o wa an Aru mb gi r mw a on bo uu en on mp jum eg in 12 districts in a total of 134 Ugandan districts, including Isi n Ob Yu La Ko Ki k mw nd eg Ka Ad ya Ky the capital city of Kampala. Six of these districts—Adjumani, Ka Ki r Arua, Koboko, Obongi, Yumbe, and Lamwo—are located in the West Nile and northern subregions. The five southwest- Source: https://data2.unhcr.org/en/country/uga. ern districts hosting refugee settlements are Kiryandongo, Kikuube, Kyegegwa, Kamwenge, and Isingiro.1 refugees are vulnerable to a vast array of protection risks particular to the refugee contexts, including the threat of Uganda’s long-standing open-door refugee policy and sexual and gender-based violence (Holloway, Stavropoulou, geographic proximity to countries experiencing conflict and Daigle 2019). Against this backdrop, refugee-hosting and political instability, such as South Sudan and the districts are now recognized under the vulnerability criteria Democratic Republic of Congo, means that the country will of Uganda’s National Development Plan 2015/16–2019/20, probably continue to receive refugees. The prolonged and which prioritizes them for development interventions. steady arrival of refugees has far-reaching implications. Further, the potential of refugees to contribute to the social Refugee-hosting areas are among the poorest and least- and economic development of the country is gaining developed areas of Uganda, struggling with their own increasing recognition, particularly if their skills are har- development challenges, including poverty and unemploy- nessed and utilized to improve livelihoods, incomes, and ment, deficits in human capital development, weak social productivity. service delivery, and limited access to basic infrastructure. The influx of refugees into such areas has increased pres- sure on already strained public services, natural resources, REFUGEE POLICY FRAMEWORK and local infrastructure; exacerbated existing vulnerabilities; IN UGANDA and rendered the population in refugee-hosting areas less The 2006 National Refugee Act and the 2010 Refugee resilient to economic and environmental shocks (Miller Regulations are the two major regulatory frameworks 2018). The impact of these challenges has increased due to that govern the refugee situation in Uganda. These enti- the protracted situation of many refugees who do not fore- tle refugees to documentation (e.g., identity cards, birth see a time when they will be able to return to their country certificates, and death certificates) and to the same rights of origin and therefore remain dependent on the refugee as Ugandan nationals in terms of access social services response. Studies also show that the presence of refugees (e.g., health, water and sanitation, and education); the right a ects the coping abilities of host communities, especially to land for agricultural use and shelter; the right to work where such communities have limited social capital, less (e.g., start a business or seek employment); freedom of diverse livelihoods, and low levels of assets (Zhu et al. movement; the right to receive fair justice; and the principle 2016; Miller 2018). Available evidence also indicates that of family unity. Further, the 2010 regulations require the Commissioner for Refugees to ensure the integration of 1. Obongi and Kikuube are newly created districts cut from Moyo and Hoima, respec- tively, which had not yet been created at the time of data collection. 2 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts refugees into local communities; sensitize host commu- Minister launched the Comprehensive Refugee Response nities to coexistence; and liaise with national, local, and Framework on March 24, 2017, adapting most of the regional planning authorities to ensure that refugee con- principles and objectives set out in annex 1 of the New York cerns and related matters are considered, particularly those Declaration on Refugees and Migrants to the Ugandan relating to sustainable development and environmental context. The framework is a multistakeholder coordination plans. The Refugee Act prioritizes assistance to women, model for refugee matters focused on humanitarian and children, and persons living with disabilities, including their development needs of both refugees and host communi- integration into host communities. ties.2 The framework in Uganda encompasses five mutually reinforcing pillars: (1) admission and rights; (2) emergency In addition, the country’s policy approach to refugees response and ongoing needs; (3) resilience and self- is embedded and articulated in various policy docu- reliance of refugees; (4) expansion of solutions through ments and strategies. For example, the second National resettlement and complementary pathways; and Development Plan (2015/16–2019/20) provides for refugee (5) voluntary repatriation. It also includes cross-cutting management and protection as a priority through the issues on gender equality, women’s empowerment, nondis- Settlement Transformation Agenda, which provides for the crimination, and accountability to a ected populations. expansion of services such as health, education, water, and sanitation for refugees and refugee-hosting areas Notwithstanding Uganda’s progressive refugee policy, a (UN, GoU, and World Bank 2017). The agenda recognizes 2016 World Bank study determined that refugees and their that refugee-hosting areas require special attention due host communities remain vulnerable due to underlying to the added demands of hosting displaced populations poverty and vulnerabilities exacerbated by weak social and emphasizes the need to integrate refugee service services delivery, poor infrastructure, and limited market structures with the government. It also provides a clear opportunities (World Bank 2016). entry point for a range of actors to support both the objectives of refugee self-reliance through development interventions and as a basis to support host communities. DEVELOPMENT RESPONSE TO Building on this, the government of Uganda, in collabora- DISPLACEMENT IMPACT PROJECT tion with United Nations (UN) agencies and the World Bank, DRDIP launched the Refugee and Host Population Empowerment The World Bank-funded DRDIP, implemented by the O ce (ReHoPE) strategic framework in 2017 to foster a multiyear, of the Prime Minister in 11 districts in Uganda, addresses multisectoral program that would bridge humanitarian and the impacts of forced displacement on refugee-hosting development approaches and actors (UN, GoU, and World communities. Targeting both refugees and host communi- Bank 2017). ReHoPE aims to ensure that humanitarian ties, DRDIP’s development objective is to improve access action is embedded in a long-term development approach. to basic social services, expand economic opportunities, It emphasizes building institutional capacity to deliver and enhance environmental management. Specific sub- appropriate, accessible, cost-e ective, and a ordable projects under DRDIP are focused on improving social and services to all people in refugee-hosting districts in ways economic infrastructure and services, environmental and that build resilience and self-reliance among both refugee natural resource management, and livelihoods. and host communities. The government’s ReHoPE strategy is integrated into the UN Development Assistance Framework for Uganda 2. Like the ReHoPE strategic framework, the CRRF seeks to strengthen the resilience (UNDAF 2016–20). In addition, the O ce of the Prime and self-reliance of host communities and refugees through multisector and coordi- nated interventions. 1. Introduction 3 GBV AND VAC IN THE CONTEXT In addition, several studies in Uganda have documented OF DISPLACEMENT a high prevalence of GBV among refugees (GWI, LWF, Gender-based violence (GBV) and violence against chil- and Makerere University 2019; Care International 2018; dren (VAC) are widespread in Uganda. The 2016 Uganda Kwiringira et al. 2018; Refugee Law Project 2017). A mixed- Demographic Health Survey found that, among women method study conducted by the Global Women’s Institute ages 15–49, 51 percent had experienced physical violence at George Washington University shows that almost and 22 percent had experienced sexual violence in their 65 percent of South Sudanese refugee women had ever lifetimes (UBOS and ICF 2018). Further, nearly 10 percent experienced IPV; and 43 percent of those women had of girls ages 15–19 and almost 20 percent of women ages experienced it in the year preceding the survey (GWI, LWF, 20–24 report having ever experienced sexual assault, with and Makerere University 2019). Further, UNHCR recorded more than half reporting having had such an experience 4,297 cases of GBV in 12 refugee communities between in the year preceding the survey (UBOS and ICF 2018). In January and November 2019.4 Eighty-seven percent of the addition, harmful practices such as child/early marriage and survivors were female, 13 percent male. Child survivors female genital mutilation are still prevalent in some parts accounted for 14 percent of reported cases. However, the of Uganda. More than 15 percent of ever-married women actual number could be higher because many survivors are (ages 20–49) were married by age 15; 49 percent by age 18 hesitant to report incidents of violence due to social stigma, (UBOS and ICF 2018). shame, and fear of reprisal. VAC is also pervasive in many settings, including homes, While data for this assessment were collected before the schools, and communities. According to the National COVID-19 outbreak, subsequent data show an increase Violence Against Children Survey, one in four girls of GBV and VAC in refugee and host communities, exac- (25 percent) and one in 10 boys (11 percent) reported having erbated by confinement measures and mobility restric- experienced sexual violence in the 12 months preceding tions. Nationally, 3,280 cases of GBV, including IPV, were the survey. Four in 10 girls (44 percent) and six in 10 boys reported to the police between March 30 and April 28, (59 percent) ages 13–17 had experienced physical violence. 2020, while in 2019, an average of 1,137 domestic violence And more than one in five children ages 13–17 report hav- cases were reported per month. UNHCR mentioned that ing experienced emotional abuse (MGLSD 2017a). the number of sexual and gender-based violence (SGBV) cases, particularly IPV, has increased 55 percent during the Research suggests that GBV and VAC can be exacerbated COVID-19 crisis. Furthermore, inadequate livelihoods due in contexts of displacement. Notably, the 2016 Uganda to the current COVID-19 preventive measures, alcoholism, Demographic Health Survey reveals a comparably high and the loss of social protection provided by schools have prevalence of GBV across subregions where refugee- contributed to the increased vulnerability to SGBV. hosting districts are located.3 For example, in the West Nile subregion, 63.8 percent of women ages 15–49 have ever The high prevalence of GBV and VAC in the context of experienced physical, sexual, or emotional violence by forced displacement has been generally linked to the their current or most recent spouse/partner compared with breakdown of protective mechanisms and support net- the national average of 51 percent. More than 43 percent works, post-traumatic stress following experiences of had experienced intimate partner violence (IPV) in the violent events, changing gender roles, inadequate access 12 months preceding the survey (UBOS and ICF 2018). to basic services, limited access to economic and liveli- hood opportunities, and predisplacement norms (Wirtz 3. The five subregions where the refugee-hosting districts are located are: West Nile et al. 2014; Horn et al. 2014; Vu et al. 2014). For example, (Arua, Adjumani, Koboko, Obongi, and Yumbe districts); Northern (Lamwo district); Bunyoro (Kiryandongo and Kikuube districts); Tooro (Kamwenge and Kyegegwa districts); and Ankole (Isingiro district). 4. Available at https://reliefweb.int/sites/reliefweb.int/files/resources/73839.pdf. 4 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts refugees arriving in Uganda perpetuate their social norms, refugee and host communities. Notably, a recent inter- which often include harmful practices, such as female agency rapid gender analysis and GBV assessment in five genital mutilation and child marriage. refugee settlements (Holly 2018: 3) underscores the need to assess the GBV referral pathways and investigate the In Uganda, there is limited information regarding the drivers extent to which service providers are aware of and enforce of GBV and VAC and the points of intersection between the standard operating procedures for GBV case manage- them in refugee host communities.5 In addition, there are ment and referral pathways. Furthermore, there is limited limited data on the nature and quality of existing services to alignment and integration of GBV and VAC prevention and address GBV and VAC, including referral pathways, in both response services in refugee settlements with district- and national-level protection and case management systems. 5. There are few studies have documented the drivers of GBV and VAC in refugee settlements (see UNHCR and OPM, 2019; The Global Women’s Institute et al, 2019; Sengupta & Calo, 2016). 1. Introduction 5 2 Methods 6 7 OBJECTIVE AND SCOPE OF THE DESIGN ASSESSMENT This assessment uses a predominantly qualitative T he World Bank, in coordination with the Ugandan approach. Primary data were collected using in-depth O ce of the Prime Minister and Ministry of Gender, interviews with key informants, focus group discussions, Labour and Social Development, as well as the and consultations with local stakeholders and develop- United Nations High Commissioner for Refugees (UNHCR), ment partners on preliminary results. The assessment also conducted an assessment of the key drivers, risk factors, includes a mapping of services for GBV and VAC preven- and intersections between gender-based violence (GBV) tion and response across the key sectors of health, police and violence against children (VAC), as well as a and justice, and social services for both refugee settle- mapping of prevention and response services in refugee- ments and host communities. hosting communities and settlements for 11 districts in Uganda. As part of that e ort, this study seeks to: STUDY SITES AND PARTICIPANTS Identify the contextual and specific risks of GBV and The assessment was conducted in 11 out of the 12 refugee- VAC in the 11 refugee-hosting communities and exam- hosting districts in Uganda:6 Arua, Adjumani, Kiryandongo, ine existing intersections; Isingiro, Kamwenge, Kyegegwa, Lamwo, Moyo, Yumbe, Koboko, and Hoima7 (map 2.1). The study sites are pur- Map the availability and accessibility of GBV and VAC posively selected to reflect the sociocultural diversity of prevention and response services in both refugee and host communities, including scope, geographic cover- age, types of providers, and reporting mechanisms and MAP 2.1 support systems for survivors; Refugee-Hosting Districts in Uganda Assess the adequacy and quality of GBV and VAC prevention and response services, including referral mechanisms, against best practices, as articulated in international and Ugandan protocols, standard oper- ating procedures, and guidelines (e.g., multisectoral capacity and coordination with other agencies, includ- ing humanitarian actors); and Identify opportunities to align GBV and VAC services in refugee and host communities to national systems, and to reduce the gap between humanitarian and develop- ment responses. This assessment complements a UNHCR-led interagency assessment focused on GBV and VAC in refugee settle- ments (UNHCR and OPM 2019). The UNHCR-led assess- ment focuses on measures, services, and safeguards for the protection of women and children against GBV among 6. The 12th refugee-hosting district, Kampala, is left out because it largely hosts urban refugees. The interest of this assessment is more inclined toward communities refugees in Uganda. hosting refugee settlements. 7. Obongi and Kikuube are newly created districts cut from Moyo and Hoima, respec- tively, which had not yet been created at the time of data collection. 8 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts refugee-hosting communities. In all cases, subcounties and analytical frame of reference (see appendix A for a full list of communities residing within a 15-kilometer radius of the reviewed documents). refugee settlements are considered hosts. Study participants include: (1) representatives from govern- Institutional mapping ment structures across key sectors—social services, health, The assessment includes a mapping of institutions justice, and policing; (2) community protection structure engaged in providing GBV and VAC prevention and members from village health teams and child protection response services across the key sectors of health, committees and from para-social workers; (3) adult commu- police and justice, and social services, using a specifically nity members (female and male); (4) children in and out of designed institutional mapping tool. The purpose was to school, ages 13–17; and (5) nongovernmental organizations assess the services provided as well as institutional capac- (NGOs) involved in GBV and VAC prevention and response. ities. The mapping was conducted using a preprogrammed tool on Survey CTO on Android tablets. Internal checks were included to ensure the completeness and logic of RESEARCH TEAM AND TRAINING entries and the consistency of responses. A team of 21 researchers with backgrounds and training in social sciences, public health, gender, and social work collected data between August and December 2018. Team In-depth interviews with key informants members received three days of training on the purpose In-depth interviews were conducted with selected key and objectives of the assessment, conducting GBV and informants, including representatives from various GBV VAC research, research ethics, interviewing techniques, service providers at the district and community level across and qualitative and quantitative data management pro- key sectors, such as social services, health, justice, safety, cedures. The data collection team was divided into three and security. Interviewees included representatives from subgroups based on fluency in the local languages of the government departments and agencies at the district various refugee-hosting communities. Each subgroup, com- level (n=60) as well as NGOs (n=25). The discussions were prising a supervisor and five data collectors, was assigned primarily around risk factors for GBV and VAC and the at least three refugee-hosting districts. Female researchers availability, access, and quality of GBV and VAC prevention were assigned to interview female study participants. and response services. Community leaders at all local council levels, as well as camp commandants, assisted in the mobilization of study participants. Focus group discussions Forty-four focus group discussions were conducted with various categories of participants across 11 refugee-hosting DATA COLLECTION METHODS districts, including members of community structures involved in GBV and VAC prevention and response at the Desk review community level, such as child protection committees, Field data collection was preceded by a review of relevant village health teams, and para-social workers; adult commu- literature, including protocols and standards on GBV and nity members; and children in and out of school. The focus VAC. The desk review helped provide contextual informa- group discussions were conducted in the local language, tion on GBV and VAC, existing legal and policy frameworks, with detailed notes written in English. Each focus group dis- practice standards, and guidelines, which informed the cussion, comprising 8 to 10 people, elicited collective views development of the data collection tools and provided an about GBV and VAC in terms of vulnerability, risk factors, experiences, case management, and perceived benefits of reporting. To mitigate the potential for participants to feel inhibited, focus group discussions of women were 2. Methods 9 moderated by women, and those for men were moderated are included in this report to demonstrate the accuracy of by men. Research assistants were trained in data collection interpretation, to deepen understanding, to provide a nar- techniques. rative for the findings, and to enhance the voice of women and children. DATA MANAGEMENT AND ANALYSIS Quantitative data Qualitative data Quantitative data were synchronized on a daily basis with All audio recordings were transcribed and simultaneously an online server managed by Applied Research Bureau. translated into English. Transcripts were entered and coded Data were downloaded daily for storage and review by using Dedoose (version 4.5), a web-based qualitative the data validation team. Daily monitoring checked the data analysis tool. The research team developed a code quality of the data and confirmed the receipt of completed structure using systematic and inductive procedures to questionnaires on the cloud server. Data were checked for generate insights grounded in the views expressed by the accuracy and outliers. Inconsistencies were communicated study participants. The team coded the interview transcripts to the field teams and resolved by calling back respon- using the constant comparison method, which ensures dents. The data from the server were imported into Stata themes are consistently classified and that also allows for (version 13) for analysis. The analysis of the data is primarily the expansion or refinement of existing codes based on the descriptive. objectives of the assessment. Select verbatim quotations 10 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts ETHICAL ASPECTS information on the purpose of the study and ethical princi- The study was conducted in accordance with guidelines ples of privacy, confidentiality, and voluntary participation for safe and ethical research on violence against women in an age-appropriate manner, including ensuring that the (Watts et al. 1999) and against children (Powell et al. 2013). children understood how their personal information would The research process and methods were also consistent be used before their consent was solicited. with the World Health Organization guidance and other best practices on researching sexual violence in emer- gency settings. Prior clearance was sought from the O ce LIMITATION of the Prime Minister, UNHCR, and district-level authorities The assessment relies heavily on qualitative data. As such, for the field data collection. All researchers were trained in the findings are not generalizable but are rather illustrative. research ethics and passed the Collaborative Institutional Training Initiative Human Research curriculum. They were also trained on how to safely refer women and children DATA VALIDATION requesting assistance to available local services and The study’s findings were validated at three national-level sources of support. meetings with the O ce of the Prime Minister, UNHCR, the United Nations Children’s Fund (UNICEF), and UN Women; as well as at regional-level, one-day workshops Adults held in each of the four regions where the study districts Participation was voluntary, and informed consent was are located. These validation meetings were attended obtained from all study participants. Participants were by policy makers, service providers, and administrators, discouraged from sharing intimate personal details about including representatives from the national o ces relevant their experiences with violence; anyone who wanted to to GBV and VAC prevention and response. The validation discuss such experiences was provided with a list of local workshops also included the research team and represen- GBV services and were o ered the opportunity to speak tatives from the World Bank and the O ce of the Prime with someone immediately. Minister. Feedback from the validation meetings informed revisions to the report. Recommendations generated by participants in validation workshops with stakeholders were Children synthesized with those that emerged from the assessment Informed consent was also obtained from children (ages findings to produce a final set of recommendations that can 13–17), as well as their parents, guardians, or teachers, inform programming. prior to their participation in this study. They were provided 2. Methods 11 3 Assessment Results 12 13 SCOPE OF THE PROBLEM IPV also manifests in the form of “emotional violence.” Examples include a husband scolding his wife, using coarse Gender-based violence in or humiliating language, shouting or screaming, threatening refugee-hosting communities to take away her children, marrying another woman, or T his section highlights the context and forms of sending her back to her family or place of origin. In addi- gender-based violence (GBV) in host communities, tion, participants note that many men and women use a highlighting the prevalent forms—intimate partner “cold war” approach, where they ignore their spouse for violence (IPV), socioeconomic violence, sexual violence, prolonged periods of time. and harmful customary practices. Information was collected during interviews with key informants and focus group “Some men use abusive language toward their women. discussions with refugees and local populations. A man can return home and find his wife resting in bed; he takes o ence in this and begins to abuse her.” Intimate partner violence – Focus group discussion (female), Yumbe IPV is the most common form of GBV identified by the study, with young women perceived as the most vulnerable Sexual violence perpetrated by an intimate partner is among the group interviewed. Physical violence—mainly in also widespread but remains largely shrouded in silence the form of beating, punching, kicking, throwing objects, or because in most communities, it is not necessarily concep- pushing—is very common but rarely reported. tualized as a form of GBV or as a violation. One key infor- mant describes how most women do not speak about such “The common form of violence is men beating up their incidents. wives and chasing them to go and sleep in the bush … this is so common in this village.” “It is only when they can’t bear it any more … – Focus group discussion (male), Kyegegwa they open up.” “We have witnessed cases of women who have been The reluctance to discuss intimate partner sexual violence beaten by their husbands and some of them wounded, seems to stem from the cultural expectations of wifely traumatized.” loyalty and obedience to a husband. – Key informant interview (female), Hoima “Some women have shared about how their husbands While most male participants claimed that they do not come home while drunk and force them into sex.” condone physical violence against women, a few justified – Focus group discussion participant (female), Hoima its use in response to wifely “disobedience,” or perceived it as a necessary disciplinary measure to maintain control “They say that before having sex with your husband you “over domestic a airs.” are supposed to agree as a couple, but the other doesn’t care. You be in deep sleep you hear him enter. And you “She just gets me so jealous. I keep telling her, over and can’t talk about this anywhere, now how do you start tell- over again, but do you think she listens? I keep telling her, ing the chairman that the man raped you? Yet he is your look, don’t speak to these other men. Do you think she husband, you just keep quiet, you can’t even tell a friend listens? No. I think she’s doing this deliberately to get at about it.” me. She knows I get angry when she talks to other men. – Focus group discussion (female), Kyegegwa But she still does it.” – Focus group discussion (male), Adjumani In many cases, IPV is attributed to alcohol use, infidelity or perceived infidelity, power imbalances, and gender norms. 14 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts Testimonies indicate that in most cases rape/forced sex Participants reported that, regardless of a woman’s contri- occurs when a husband has consumed alcohol; others report bution to her household’s income, the husband tends to that physical violence is the price a woman pays for refusing monopolize the money, and he is likely to use the money her husband’s sexual advances. In some communities, the for personal interests, including alcohol consumption. use of family planning by a woman without the permission of her husband is reportedly a source of family dispute. “I normally see most families that have harvested their However, IPV is not restricted to married partners. Physical produce like maize, there are misunderstandings because violence and sexual coercion within premarital relationships the man wants to sell on his own but also the woman are reportedly widespread. It is common for a boyfriend to wants to know why the man is selling. If the man is a sexually harass his girlfriend, including verbal harassment, drunkard, he will become rude and even beat the woman. unwanted touching, forced kissing, and forced sex. They can even reach a point of divorce.” – Focus group discussion (male), Kiryandongo Unfortunately, many members in the community perceive IPV as a private matter; and women are sometimes blamed Sexual violence for the violence inflicted upon them, contributing to a cul- Qualitative findings reveal that women and girls are at risk ture of impunity and adding to the stigma that deters many of being harassed or experiencing multiple forms of vio- women and girls from seeking medical services or legal lence by community members other than intimate partners redress. In most focus group discussions, male and female and family. Common forms of violence include verbal and participants agreed that a man does not have the authority sexual harassment, such as “unwanted touches.” Study to perpetrate violence against his wife, but at the same participants also mentioned defilement as being common. time, during almost all of them, women and men qualified Most associate such perpetration with men and boys from this assertion by suggesting that it is acceptable for a man their own or a surrounding village; some specifically cited to perpetrate violence against his wife if he is provoked, if male refugees, powerful men with authority, and men who the violence is “mild,” or if it is only occasional rather than have consumed alcohol as the predominant perpetrators. regular. “Refugee men are not to be trusted. What I know is that Socioeconomic violence they move in groups in the nights and it is worse when Socioeconomic violence is prevalent in refugee-hosting they have taken alcohol; they harass and sometimes rape communities and reportedly reinforces physical, sexual, and women and girls.” emotional violence. The denial of women’s and girls’ land – Focus group discussion (female), Yumbe and inheritance rights, including the illegal deprivation of widows’ and orphans’ assets, remains rampant. Property- Focus group participants noted that sexual violence and grabbing is reportedly common, including the eviction of the fear of it permeates the lives of women and girls who widows from their lands and homes and the stripping away fear being assaulted when going into the bush to collect of their possessions. firewood or fetching water unaccompanied, especially in the early morning, in the early evening, and at night. “There is a woman who lost her husband. She had worked hand in hand with her man to achieve all that Harmful customary practices they achieved. A few days after the burial of her husband, Early/child marriage—a formal or informal union before the the relatives claimed the property and she was left with age of 18—is widespread in the host communities, fueled nothing. She remained working hard and looking after her in part by parental pressure for daughters to marry early three children.” to bring in bridewealth. Unfortunately, individuals at the – Key informant interview (female), Adjumani community level rarely denounce early/child marriage. In 3. Assessment Results 15 some cases, marriages are conducted across the border in “Another form of violence is widow inheritance. When a South Sudan, where law enforcement and community sanc- woman’s husband passes on, she is inherited by a relative tions are weak. Monitoring and interventions are extremely who may be married at that time. What happens then is di cult because survivors are beyond the jurisdiction of the that these two women begin to fight among each other Ugandan authorities. for the man’s attention.” – Focus group discussion (male), Arua “They go back to Sudan and they go and get married there and come back. Even when we were called to Gulu “The relatives do not only inherit the wife but also take for a workshop where the same issue was raised as here.” away the property that the husband has left behind for his – Key informant interview (male), Adjumani family. This leaves the woman and her children su ering and in pain.” “There was a girl from that side of Madi. This is a man – Key informant interview (male), Moyo planned to give a daughter to a man without the knowl- edge of the girl. Now when these people organized to “Culturally, when a woman loses her husband, his brother give the girl, she realized it and refused to go. Then after, or another relative is to inherit her so that they can raise they decided to give the youngest sister of the girl to the the orphaned children together.” man. So, it happens like that.” – Focus group discussion (female), Yumbe – Key informant interview (female), Adjumani Some communities in Isingiro District expect a new bride Violence against children in to have sexual intercourse with her father-in-law; and an refugee-hosting communities impotent man can transfer his marital rights to his brother. According to the collected narratives, violence against children (VAC) is widespread in host communities. Children “In some families, the father-in-law sleeps with the encounter violence in many settings—at home, at school, daughters-in-law. In instances where one’s husband is and in the wider community/public spaces. Such experi- impotent, the brothers take up his wife and have children, ences are interconnected; and the same child can expe- at times against the will of women.” rience multiple forms of violence in multiple settings. The – Key informant interview (male), Isingiro most prevalent forms of VAC and their contexts across study sites are highlighted below. In the West Nile districts of Yumbe, Moyo, Koboko, and Arua, incidences of widow inheritance are reported among Physical violence refugee and host communities. Participants reported that, Notably, most physical violence against children occurs although the practice has declined over the years, a few in the context of their being disciplined, especially by a cases still occur in the communities, especially among the parent, sibling, or teacher. Within the home setting, some of Dinkas, the Kuku, and the Bari from South Sudan. the reasons given for physically punishing a child include disobedience, perceived disrespect, stealing, lying, and “When a woman loses her husband, she is inherited. I answering back. In schools, behavior that commonly have personally seen three cases where a widow was evokes corporal punishment includes making noise in class, inherited. One of them even gave birth for the man who failing to complete homework or assignments, arriving to inherited her.” class late, answering questions incorrectly, receiving poor – Focus group discussion (male), Moyo grades, or going outside without permission. 16 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “There is a belief that the African child understands best Reported incidents of rape and sexual assault by a stranger after being beaten, which is not true. We are trying to talk or person unknown to the survivor in refugee settlements to parents to reduce the beating of the children.” and host communities include acts of rape involving two or – Key informant interview (male), Arua more perpetrators. “There is a lot of caning in schools, private schools “We have registered several cases where girls have been mainly … when a child fails an exam that is a cane. Any raped, for example, last week a girl was sent for medi- slight mistake, caning. So physical violence is too much in cines by the mother but on her way, she was grabbed homes and schools.” by a group of men and was raped; the rescuer was only – Key informant interview (male), Kiryandongo able to get the last perpetrator yet she was still in primary school. This was a really sad incident.” Participants reported that peer-to-peer violence is wide- – Key informant interview (female), Hoima spread among children in host communities, including bullying and physical assault with and without weapons. “Sometimes the girl can be raped/defiled in the camp. Bullying involves repeated physical or psychological harm, Sometimes the fellow refugees rape her because they often taking place at school or in other settings where chil- know she has no parents to protect her. Such cases are dren gather. More research is needed to better understand so common among refugees.” the nature and dynamics of bullying in refugee settlements – Focus group discussion (female), Arua and communities. Participants also cited cases of physical violence against children by strangers. Some incidents However, such cases are rarely reported to health care pro- occur in the context of or as an extension of conflicts viders or law enforcement. There are a variety of reasons over resources—particularly water and firewood—in the why children underreport their experiences with sexual vio- wider community, especially between refugee and host lence, including feelings of guilt, shame, fear of not being populations. believed, and even fear of being reprimanded. Sexual violence Psychological violence Qualitative findings indicate that children are exposed to Psychological violence is common in host communities, diverse forms of sexual violence, including unwanted sex- including shouting, cursing, name-calling, belittling, threat- ual advances, harassment, and assault. For example, cases ening with abandonment, locking someone out of the of rape, attempted rape, fondling, and unwanted sexual house, and whippings. Emotional violence often coexists touching are reportedly common in both refugee and host with other forms of violence. For example, participants communities. A perpetrator is usually a person on whom reported that a child who experiences physical or sexual the child relies for care and protection, such as a parent, a violence is probably also exposed to some level of emo- relative, or a teacher. tional abuse. “There are some men who drink alcohol and when they “There are children who are orphans and live with their get drunk, they chase their wives out of the house, and if relatives, while others live with their stepparents. These the girl child remains in the house, the man defiles her, it children are shouted at and humiliated when they make a is not common, but we receive such cases at times.” mistake. The words told to them are so unfair. Demeaning – Key informant interview (police o cer), Kyegegwa words, such as ‘you are useless,’ ‘can’t you work to make your own money?’” – Focus group discussion (child), Hoima 3. Assessment Results 17 “Some guardians, for example, aunts and stepmothers, “It is very common, especially for the girls. What happens if they are not provided for by your father, they start is that when she asks for help from her father; he has insulting you of how your father is not providing for them. nothing, the mother has nothing. She, therefore, finds a Even if you start reading, they will insult you that you are man outside who can o er her the money and ends up not bright. This makes you very worried.” o ering him sex.” – Focus group discussion (child), Adjumani – Focus group discussion (female), Adjumani Neglect Child labor and exploitation Study findings reveal that neglect—the ongoing failure Child labor is common in host communities. Participants to meet a child’s basic needs—is rampant in the study reported that children work across many sectors and types settings, especially in Adjumani, Arua, and Moyo dis- of jobs, including commercial agriculture, fishing, mining tricts. Study participants indicated that the basic needs of (tin mining and stone quarrying), and cattle rearing. Children orphaned children, unaccompanied children, children not work on tobacco farms; labor in sand mines in Arua District; living with their biological parents, and children with disabil- fish in Hoima, Kiryandongo, Arua, and Moyo districts; and ities are, for the most part, neither met nor prioritized. participate in tin mining and stone quarrying in Isingiro District. “When I ask aunt for the money she just quarrels, and I don’t know why she doesn’t want to give me school “The common concerns are forced labor by mainly fees. Sometimes they don’t give me food at home and tobacco growers and also rice farmers. During the time sometimes I have to sleep hungry until I come to school for school, they are told to tend to these farms. There and get some food from my friends who come with some are cases of rape that are never reported. Defilement is of it at school. If I don’t look for my water, I will not bathe also here. And when you go to the landing sites there are that day.” many children engaged in fishing.” – Focus group discussion (child), Kiryandongo – Focus group discussion (community structure member), Hoima “There are high cases of child neglect in our community. Parents refuse to provide for their children the necessities “Another one is fishing. Because we are next to the river and they refuse to take the children to school and even most of the children spend a lot of time there fishing in the hospital, so if nothing is done in the community, the the river Nile.” children are not okay.” – Focus group discussion (male), Kiryandongo – Focus group discussion (village health team member), Kamwenge Some mentioned that children are being tra cked from the study communities to urban areas to provide cheap Neglect a ects all domains of child development— labor in the informal sector and for commercial sexual physical, psychological, emotional, behavioral, and social. exploitation. The children are introduced to the informal job It also exposes children to further victimization, including market in housekeeping positions or as bar and restaurant dropping out of school, early marriage, and exploitative attendants: labor. Participants for this study o ered examples of the link between girls engaged in transactional sex and their being neglected by their parents. 18 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “Girls are being used as housemaids; they are taken to some such marriages are conducted across the border other districts to work as housemaids.” in South Sudan, where law enforcement and community – Focus group discussion sanctions are weak. (community structure member), Hoima “Early marriages are still so high in the district. Initially, it “Most parents refuse to pay for the girl’s school fees was mainly among the Bakiga, but now it has spread over. and o er their children to brokers who take girls to Girls as early as P.6 are married o . It is thought they are Kampala to work as maids.” old enough to get into marriage.” – Focus group discussion (child), Kamwenge – Key informant interview (male), Isingiro Most of these children are being compelled to engage in “The girls are 13–15 years, some are in school but at times work not suitable for their age. Working conditions and the parents of the boy go to the parents of the girl when arrangements are intolerable, and children endure long she is at school and they tell them that they would like working hours as well as hazardous and abusive working to marry their daughter, the parents get excited that their environments. daughter has gotten a husband when it is still early, when she comes back from school, the parents tell her to go “Some parents give their children big jerry cans to go and and get married and stop her from studying.” fetch water; if you bring it back when it’s broken because – Focus group discussion you dropped it, they beat you. They tell you to bring a full (village health team member), Kamwenge jerry can, yet you are feeling pain in the chest.” – Focus group discussion (child), Hoima Some participants, especially those living in the West Nile region, blame the high incidence of child marriage on the “There are parents who give children so much work to lack of support given to teenage mothers to stay in or do. When the parent has burnt charcoal, they give it to return to school. Due to the stigma attached to teenage the child to carry on their head and take to the market for pregnancy, some young girls opt for marriage over return- selling. Other parents put heavy foodstu s such as cas- ing to school. sava and sweet potatoes on the child’s head for the child to take for sale. This food is so heavy for the child to carry “The moment a girl accidentally gets pregnant, that is the and it ends up breaking them.” end of her school. There are very few parents who will – Focus group discussion (female), Adjumani say that after delivery the girl should go back to school and parents don’t bother about the girls even when they Harmful traditional practices get married early because they look at it as a source of EARLY/CHILD MARRIAGE wealth. The other thing is that these girls are not asser- Child marriage, although illegal in Uganda, remains preva- tive, they have low self-esteem, they will think that after lent in host communities. For example, sometimes families that has happened to them, people will undermine them opt to marry their daughters to ease the pressure on scarce not knowing that accidents can happen and you can learn resources in the household or for other pecuniary bene- from them.” fits. Unfortunately, there are limited sanctions or censure – Key informant interview against parents who marry their daughters o or for the (local government o cer), Moyo adult men who marry children. This is especially true in Arua, where some parents reportedly see nothing wrong with the marrying o of young girls. Rather than seek liti- gation when early/forced marriage occurs, families tend to agree on compensation or a dowry. In the West Nile region, 3. Assessment Results 19 INFANT ORAL MUTILATION to GBV, including IPV, than those without a disability. Infant oral mutilation—a traditional practice involving the Unfortunately, economic and physical dependence on per- “gouging out” of an infant’s unerupted teeth—is reported in petrators hampers their ability to end violent relationships. some study settings. Crude methods to remove these are employed using tools that are not sterile. “We say that women with disabilities are more at risk of violence because in some homes they have been aban- “I usually interact with parents that choose to cut the doned and discriminated by their relatives. Some of them gums of their children and remove the tooth buds. They are considered a burden to the household.” do think that these cause illness in children.” – Key informant interview (female), Kiryandongo – Key informant interview (female), Kamwenge HOUSEHOLD CONFLICT The reason most frequently cited by married women KEY RISK FACTORS OF GBV AND VAC and men for domestic violence is action by the wife IN REFUGEE HOSTING COMMUNITIES that displeases the husband, such as “disobedience” or This analysis of risk factors for GBV and VAC is guided by “unfaithfulness.” For example, some participants identified the socioecological model, according to which they are an provocation or disobedience of the wife as a key under- outcome of the interaction of multiple factors at four levels: lying reason for marital violence, suggesting that women individual, interpersonal, community, and societal (Heise invite violence by not behaving appropriately. 1998, 2012). “I will agree with what this man has said, women have been over empowered, a woman can be in a meeting or Risk factors for GBV training with the husband, and a man says something, The two most important risk factors that emerged in this the woman stands up immediately and attacks the man, study are economic hardship and alcohol abuse. In many she abuses him and they end up fighting in public, such instances, these two issues are inexorably linked. Other scenarios are very common here.” major factors include marital conflict resulting from infidel- – Focus group discussion ity or contraceptive use, social norms that justify violence (village health team member), Kamwenge against women and girls, a lack of economic opportunities, weak social support systems, and poor enforcement of “The other is the issue of family planning, which is causing laws. Such factors are also associated with psychosocial domestic violence, because if the woman goes to the problems, including trauma, particularly in settings where hospital and gets it without her husband’s knowledge, social support systems are weak. Some of these factors are and when he finds out he is very bitter.” discussed below. – Focus group discussion (male), Kiryandongo Individual and interpersonal factors “In families where the couples earn a salary when the SEX, AGE, AND DISABILITY woman has a job and the man does not and the end of Participants reported several individual-level risk factors for the month the woman gets the money, her husband wants GBV, including sex, age, health, and disability status. Across to control the money, yet the woman does not want it. It is all host communities, GBV tended to be perceived as a same as when the woman earns more than the man still problem solely encountered by women. In addition, ado- the man wants to have a say on her money and this too lescent girls and young women are also perceived to be brings up quarrels.” at highest risk of exposure to GBV. Participants’ narratives – Focus group discussion (male), Kiryandongo reveal that women with disabilities are also more exposed 20 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts POVERTY AND FINANCIAL INSECURITY due to unequal power relations, men usually have control Poverty and financial insecurity were identified as risk over money earned through the sale of household agri- factors for GBV. During in-depth interviews and focus group cultural produce as well as other financial compensation discussions, poverty was linked to both the perpetration of gained from paid labor. violence and the risk of experiencing it. For example, some participants observed that the lack of resources to support “Men can go and sell agricultural produce in the market the household, limited opportunities for employment, and and to avoid being questioned by the wife—he goes the “idleness” of men contribute to GBV in many of the home drunk and beats up the wife.” refugee-hosting communities. The absence of livelihood – Focus group discussion (female), Yumbe opportunities and resultant frustrations are identified as particular triggers of household violence. “If there are conflicts, it is because all the burdens of the home are on the woman. And the men keep every- “The frustration of not being able to provide for the family thing, do not share, and take other wives—that’s how the often results in anger that could be directed toward the violence begins. When there are too many chores, the spouse, especially when she comments or requests him woman cannot manage her field, she is forced to work on to meet her needs.” another’s field. And the man either deserts the home, or – Key informant interview (female), Kyegegwa he hits you.” – Focus group discussion (female), Hoima “When people are poor, they are usually short-tempered and can easily take actions they don’t mean like beat- ALCOHOL AND SUBSTANCE ABUSE ing up their wives. Just asking for food could result in Participants discussed the link between alcohol abuse and violence.” GBV. Alcohol use is specifically linked to both the perpe- – Key informant interview (male), Koboko tration of violence and the risk of experiencing it. Alcohol consumption by men, for example, is linked to the perpetra- Financial dependence on families, which increases in a dis- tion of both physical and sexual violence. placement context, tends to limit a woman’s ability to leave an abusive partner. For example, a woman is more likely “Marital rape cannot fail to be common where men drink to remain in an abusive relationship if she thinks the costs so much. When a man returns home and has taken alco- of enduring the relationship are less than the costs she hol, you must give him whatever he wants; be it food, be would incur in ending it. In some circumstances, women it sex; anything or else you earn a beating. It is also not become vulnerable to sexual exploitation due to poverty. good when women deny their men sex because many For example, some women may engage in transactional men here go out and get other women to satisfy them.” sex with men to support individual and family survival. In – Key informant (female), Adjumani turn, transactional sex leaves already vulnerable women susceptible to further exploitation and violence by multiple Participants observed that drinking alcohol may place partners. women in settings where the chances are higher that they will encounter a potential o ender. Similarly, substance UNEQUAL POWER RELATIONS abuse was mentioned as a contributing factor for GBV in Participants discussed the link between unequal power refugee and host communities. Participants noted that sub- relations and IPV. In the context of intimate relationships, stances such as opium and marijuana are commonly used these gendered power relationships impact a woman’s abil- among men in the study settings. Participants say such use ity to access and control resources, as well as her involve- makes individuals aggressive, violent, or abusive; and, in ment in decision-making processes. Participants report that, 3. Assessment Results 21 combination with the high level of unemployment, consider passive and subservient in relationships can lead to the it linked to men’s use of violence against women and girls. acceptance of IPV. MULTIPLE CONCURRENT PARTNERS “We think that it’s normal when he hits me, he loves Having multiple concurrent partners is identified as a risk me. We are not aware that the person is supposed to factor for GBV. Notably, participants report that some men respect you.” with multiple and concurrent sexual partners become – Focus group discussion (female), Kiryandongo violent when their female partners question their fidelity, and/or sometimes force regular partners to have sex when “In Bunyoro, we know that a woman is not supposed to these partners resist their advances. say anything when the man is talking. When a man says go, you must go. You are not supposed to refuse.” Community factors – Key informant interview (male), Hoima ATTITUDES TOWARD SEXUALITY AND RELATIONSHIPS Qualitative findings indicate that, in most communities, “Even some women themselves, by the way, think if they many men and women do not consider nonconsensual sex are not beaten by the husband, then their husbands do within a dating relationship or marriage to be rape. Such not love them. In the evening when they are fetching a view is linked to the assumption that men are entitled to water, you hear them saying that I don’t know what has have sex with their partners when and how they wish. happened to my husband. He has not slapped me for the last two weeks.” Men and boys, as well as women and girls, reportedly – Key informant interview (male), Lamwo believe that a man is entitled to have sexual relations with his female intimate partner without her consent or, as one “There is a Rutooro saying that ‘ibega tirikira mutwe’ participant describes, “putting them in that mood to have meaning that ‘a shoulder can’t be taller than the head.’ A sex.” The perception that men have sexual rights over woman is the shoulder and the man is the head. … A man women is said to be linked to the traditional practice of is the president of his home. He can do anything that he paying bridewealth for a wife, which is equated with men wants.” having ownership of their female partner and therefore – Focus group discussion being entitled to sex with her. (village health team member), Kyegegwa “Women are supposed to be submissive and they are Qualitative findings also reveal social norms that prioritize supposed to do everything at home … and when you’re a family’s privacy or a family’s or perpetrator’s reputation tired but your husband wants sex, you have to give in. above the well-being of the survivor. For example, in some And if you don’t, violence ensues because you have not communities, social norms dictate that families must settle fulfilled what the other person wants.” their conflicts privately, or at least at the village level, and – Key informant interview (male), Kiryandongo that women must support the opinions of the head of the family. Consequently, “amicable” settlements are often SOCIAL NORMS preferred because survivors and their families consider the Participants discussed how di erent social norms increase social consequences of formal reporting to be problematic. the risk of GBV in refugee-hosting communities, including ones that link masculinity to male dominance, support or tolerate aggression and violence, accept male violence to resolve family conflicts, stigmatize or blame survivors, and accept or expect that violence and abuse in a domestic context be treated as a private concern. The expectation that men be dominant and powerful and that women be 22 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “We have a culture here in Arua and it is believed that if a “We struggle with what they can get as a percentage, woman reports her husband to police she has brought a it is supposed to be 16 liters of water per day for each bad omen to the whole family and she has to cleanse the individual if it is stable it is supposed to 20 but currently in family by bringing two goats, 100 kilograms of flour, a jerry Kyangwali, because of the number that has increased for can of waragi (local brew). This has discouraged women an emergency, it is about 10 when you find women and from reporting since they don’t have all these items nec- children lining up for the water on the tanks either you essary for cleansing the homes.” find the woman has delayed there and the husband asks – Key informant interview (female), Arua why did you cook late so fighting’s begin … these women also go to the forest illegally to fetch firewood they some- “When a woman reports the husband to the police she times find men there who try to rape them.” brings a disgrace to the whole family, the children get sick – Key informant interview (male), Hoima or die plus other family members so in cases of violence they fear to report their husbands to bring such misfor- WEAK SOCIAL SUPPORT SYSTEMS AND tune to their homes.” ENFORCEMENT OF LAWS – Key informant interview (male), Koboko Participants observed that weak law enforcement and a lack of adequate social support systems for survivors of SOCIAL AND PHYSICAL ENVIRONMENT violence contributes to a culture of impunity, increasing the Participants blamed the high levels of GBV, especially in risk of GBV. Participants reported that GBV survivors face refugee communities, on the breakdown of protective numerous barriers and challenges to disclosing and report- mechanisms and social norms that regulate behavior in ing abuse, accessing support and services, and navigating stable communities. They discussed the link between the intersecting legal processes and social support systems, physical and social environment and GBV in various host including the social stigma associated with disclosure of and refugee communities. For example, women and girls domestic violence, lack of accessible shelters, and cultural are exposed to violence on their journey to water collection beliefs that support keeping the family together and not points or when collecting firewood. Participants reported disclosing “private” matters. that the refugee influx in some districts has resulted in a sudden and massive demand for scarce natural resources “Someone breaks the law and is not apprehended. This and has put even more pressure on woodland resources. person will continue being violent toward the spouse. The depletion of forest resources, for example, means that The spouse shall also not report the case since she well women and girls have to walk long distances in unsafe knows that nothing will be done.” areas to collect firewood for household energy consump- – Key informant interview (female), Koboko tion, exposing them to violence. “The police will arrest the perpetrator especially if the “There is no doubt that there is massive environmental case is serious physical injuries. But they will tell you to go degradation. This means that the communities will not back and sort your things. That family thing should not be be able to get firewood with ease. They will have to walk brought to police. They can even abuse you and say that long distances where they will find men with all wrong you are stubborn; you don’t respect your husband and intentions, some are raped, and others survive.” other things. How can a real woman report her husband?” – Focus group discussion – Focus group discussion (female), Isingiro (community protection structure member), Arua 3. Assessment Results 23 TENSION BETWEEN REFUGEE AND HOST COMMUNITIES Individual-level factors The varied interactions between host and refugee popula- AGE AND GENDER tions present GBV-related risks, including those between Participant narratives reveal that young children are more employer and employee, trader and consumer, patron and likely to experience violence at the hand of a primary client, marriage, and friendship. The power embedded in caregiver or other family member, while older children are such relationships renders some vulnerable to GBV, particu- more likely to be victimized by a person outside the home larly women. or family setting. Study participants also shared their views about the gendered nature of violence. Girls are reportedly Further, the emergence of relationships between members at higher risk than boys of experiencing sexual violence. of the host population and refugees, particularly marriage, may a ect the quality of earlier relationships. This is “If a girl is defiled, she would be defiled because she is especially the case, for example, when a man from a host female. At the same time, girls could be discriminated community abandons his family to start a new one with a against and neglected by the family because of their woman from a refugee camp/settlement. Marriages in experience.” communal Ugandan societies, including those in refugee- – Key informant interview (female), Adjumani hosting communities, are unions between families rather than individuals, which means that such new relationships ILLNESS OR DISABILITY OF THE CHILD can escalate tensions between host communities and refu- Participants further o ered thoughts on how children with gees, and can lead to physical and emotional violence. disabilities may experience heightened vulnerability. “They are up to 18 settlements with big number; some set- “The most at-risk child is the one with disabilities. I have tlements with a population bigger than in town so many worked on several cases where the wife gives birth to a men have shifted to these settlements under a disguise child who later turns to be a disabled person. Such peo- that they are looking for employment. Now what happens, ple are discriminated and stigmatized here.” there are single women, some women go for men then – Key informant interview (male), Isingiro the men also go for the women and then they marry them and they abandon their family.” “Disabilities have led to family breakdown. Fathers have – Key informant interview (male), Adjumani abandoned the mothers with their children. This has made some mothers engage in casual labor, they end up It is also common for participants in the host community to locking up the children inside the houses to go and work. blame refugees for nonpartner sexual violence occurring in At the end of the day, these children are neglected. These their areas. children are also blamed for causing the bad experiences the parents may be going through.” – Key informant interview (female), Kiryandongo Risk factors for VAC in refugee-hosting communities Children with specific health conditions are, by comparison, Study participants discussed several factors that increase considered more vulnerable to specific forms of violence. the risk of violence against children at the individual, inter- For example, in Lamwo District, children with nodding personal, community, and societal levels, summarized in syndrome are frequently sexually assaulted by older men table 3.1 and discussed in more detail below. and bullied by boy children. Further, these children often experience neglect, remaining at home by themselves for long periods of time. Their parents and communities fre- quently discriminate against children with these conditions, preferring to prioritize the needs of other children. 24 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “Another issue that is responsible for GBV or VAC is that family stress, resulting in higher rates of alcoholism and we have a lot of mental health cases because nodding domestic violence. The stress on families may also under- conditions are very prevalent. So, they su er greatly with mine the mental health of parents, exacerbate depression, sexual violence because of their mental status.” and result in their abusing their children. Poverty is also – Key informant interview (female), Lamwo linked to family tensions, dysfunction, and separations—all of which heighten children’s vulnerability to violence. Family- and interpersonal-level factors Participants noted how poverty can sometimes increase POVERTY AND FINANCIAL STRESS pressure on children to work under exploitive conditions Participants also report that VAC risks are greater when to meet their basic needs or to support their parents in families are under stress from poverty. Notably, poverty, meeting the needs of the household. particularly the inability to meet basic needs, increases TABLE 3.1 Risk Factors of GBV and VAC in Refugee-Hosting Communities Level Risk factors for GBV Risk Factors for VAC Individual • Sex, age, and disability • Sex, age, and disability • Heath status, including trauma • Heath status, including trauma • Harmful use of alcohol and drugs • Lack of awareness of individual and collective rights • Harmful use of alcohol and drugs Interpersonal • Alcohol and substance use • Parental beliefs and practices • Marital tension and conflict • Alcohol/substance abuse • Family structure • Financial stress • Financial stress • Quality of the relationship between parent and child • Unequal power relations • Domestic violence Community • Physical environment (location, environmental • Physical environment degradation, and porous borders) • Poor social cohesion and transient populations • Low social cohesion and transient populations • Easy access to alcohol • Easy access to alcohol • Lack of culturally appropriate and accessible services to • Financial and material poverty report and respond to violence against children • Violence in schools Societal • Gender inequality • Social and gender norms • Social and gender norms • Absent or inadequate social protection • Weak legal and social support systems • Weak governance and poor law enforcement • Weak law enforcement • Weak institutional capacity to respond to violence 3. Assessment Results 25 “Children work because the rate of poverty is very high “There are families where you find a man having like 8 here. Parents are not able to provide for their children children, but with only one room, which is shared by the all the basic needs. Most fathers love to drink alcohol man and his wife plus the children. When the man comes and end up forgetting about their children. That is a big back he will want to have sex with his wife amidst chil- problem here.” dren, this makes the children learn bad manners and they – Key informant interview (male), Adjumani start practicing what they see their parents do.” – Focus group discussion (male), Kyegegwa Further, in both refugee and host communities, poverty is linked to the commercial sexual exploitation of girls. BELIEFS AND NORMS REGARDING PHYSICAL PUNISHMENT Participants reported that poverty pushes girls into rela- Social norms regarding physical discipline remain among tionships with older men for the promise of money or gifts. the most prevalent risk factors for physical violence in These findings are similar to those in the 2019 interagency refugee-hosting communities. Norms around the physi- GBV assessment conducted among refugees. It reveals that cal punishment of children center around the belief that poverty and a lack of safeguards drives children into the parents and teachers should use violence as a means of hands of abusers and perpetuates harmful practices, such control and discipline. Participants report, for example, that as early sex and marriage (UNHCR and OPM 2019: 18). most parents and teachers approve of and continue to use spanking and other forms of physical punishment as “Defilement happens where girls who are 14 years to disciplinary measures. Reasons for approval are rooted in 16 years get defiled. It is the problem of money that leads beliefs linking the use of physical punishment with positive them to get defiled. Because of poverty, men can sleep or neutral outcomes, such as “I was spanked and I am with girls and provide for basic needs. Some of these men okay,” “spanking improves child behavior,” and “spanking is get married to these girls before they are 18 years of age, more e ective than other forms of discipline.” and automatically it becomes defilement.” – Key informant interview (male), Adjumani “Corporal punishment is still acceptable in schools, not only in schools even in homes. There we need to do a lot Qualitative findings also indicate that some poor families of work against physical violence. While some teachers are forced to live in overcrowded conditions, which often and parents believe that children can listen when talked results in children sharing sleeping spaces with sexually to, many still believe that physical punishment is the most active adults. This may put children at risk of experiencing e ective form of discipline.” and/or witnessing sexual violence. – Key informant interview (male), Isingiro “Poor housing facility of one room is exposing the children “Inadequate knowledge about child rights! Because if you to high risks of engaging in sex early since most families know the rights of this child you will not abuse his/her sleep in one room with the children and their beds are rights but you will have a reflection that this should not separated by just a curtain so in most cases when the par- happen. So the inability to handle child’s rights is because ents are engaging in sexual intercourse the children are many parents still believe in the African purpose of the hearing or even seeing and they are tempted to practice child because I think when you are beaten you cannot what they see with their fellow children.” hear or see from the buttocks.” – Key informant interview (female), Moyo – Key informant interview (female), Adjumani 26 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts INTIMATE PARTNER VIOLENCE Alcohol consumption makes adolescent girls and young Several participants discussed the link between IPV and women more vulnerable to sexual abuse. The contexts of children’s exposure to violence. For example, exposure to alcohol consumption, such as bars, can also facilitate sexual IPV is linked to the use of violent methods (including shout- negotiations. For example, participants reported that older ing, striking, and slapping) to correct a child’s behavior. men in the community buy girls alcohol to lure them into sexual activity. “When a woman and a man are fighting, the children are also a ected. When a father is beating his wife, the chil- “The older men buy them alcohol and when they get dren may also be beaten.” drunk, they sleep around with them. It is very risky – Focus group discussion (female), Koboko because you do not know what someone’s intentions for you are.” “Violence between adults a ects children so much. When – Focus group discussion (male), Adjumani the man has not given the woman anything at home, the children are also a ected especially about how they will Attitudes and norms about adolescents and young women survive or what they will eat. What happens is children who drink and accept drinks from men compounds the step in to help their mothers you find a child working problem. Many believe it is legitimate for a man to force sex beyond their capacities like carrying the jerry can to help on such a woman; they do not consider that to be rape. The the mother.” belief that if a girl accepts a drink from a man, he has paid – Focus group discussion (female), Kamwenge to have sex with her remains widespread. ALCOHOL AND OTHER SUBSTANCE ABUSE “If you buy a drink for a woman and you don’t go and Participants discussed the link between alcohol/substance sleep with her, it means she has drained you.” abuse and VAC. At the family level, participants reported – Focus group discussion (male), Hoima that children with parents or caregivers who abuse alcohol or drugs are significantly more at risk of abuse, including Community-level factors sexual abuse. Participants also reported that family interac- PHYSICAL ENVIRONMENT tions are degraded by alcohol abuse, which a ects com- Qualitative findings indicate that the physical environment munications between parent and child, as well as general in which children live or spend their time can increase parenting practices. their risk of experiencing violence. The commercial sexual exploitation of children is more common in refugee-hosting “When I ask for money, my father tells me that he is going districts near border areas or in urban areas/towns. to use it for alcohol. When my father drinks, he chases Participants reported incidents of children in West Nile us away from home and uses bad language toward my getting married across the border in South Sudan, and mother. My mother has a very young child whom she because of the porous borders, the Ugandan authorities goes away with.” have no control over the situation. – Focus group discussion (child), Koboko “When it comes to Sunday, it is a market day here, men and boys are involved in substance use and take so much alcohol. Because of that, they end up defiling and abusing young girls.” – Focus group discussion (child), Yumbe 3. Assessment Results 27 “In South Sudan, if a girl is above 14 years, she is ready for participants discussed the link between bridewealth and marriage which is not right in Uganda … parents negotiate coping in times of economic hardship and food insecurity. for dowry without her will and those dowries are paid without her knowledge. At the end of the day, after paying “Sometimes parents fail to get money to educate their dowry, they will plan to kidnap this girl to be taken back to children. The children stay at home and when they get a South Sudan … This girl will come back married and when boy they go away. The parents get money and the child she has delivered. So that is the nature and because of gets married. Some parents when the girl gets a boy to the porous borders, this is very frequent. So, when such marry her, they force her to get married to get money or things happen, as [O ce of the Prime Minister] it is very even reduce the burden because of the poverty at home.” hard for us to get that information because they conceal – Focus group discussion (male), Kyegegwa the information.” – Key informant interview (female), Adjumani Intersections between GBV and VAC Study participants from several communities identified Assessment results point to intersections between GBV particular “hotspots”—areas where children are at very and VAC, which is consistent with previous studies. First, high risk of abuse, such as water collection points, fire- this study reveals several shared risk factors between wood collection areas, and recreational spaces (e.g., shack GBV and VAC, including alcohol and substance use, family cinema/video halls, and night clubs). They reported that conflict, poverty, social norms regarding gender roles, and children are at high risk of assault when they go to the bush norms that deem violence acceptable. In addition, the expe- to collect firewood or if they fetch water unaccompanied, rience of household violence reflects inequitable gender especially in the early morning hours and at night. and age-related power dynamics. For example, women and children are more likely than men to experience household “One thing I would like to talk about is the films and conflict or violence. discos that children go to. They leave home and go to the trading centers and are exposed to drinking. After drink- GBV and VAC are repeatedly found in connection to the ing, many things happen to them.” division of and expectations associated with household – Focus group discussion (child protection responsibilities. With regard to GBV, violence stems from committee member), Kiryandongo men perceiving women as not performing their expected gendered responsibilities, such as meal preparation. “When people go to markets at night they become vul- Similarly, a perceived lack of contribution to household nerable and even young girls who go to fetch water in the responsibilities also result in VAC. In these instances, a late hours of the evening, are vulnerable to rapists and range of adult caregivers, including mothers, fathers, and various cases have been reported in Yumbe.” extended family members, perpetrate violence against – Key informant interview (female), Yumbe children. Societal-level factors In addition, IPV is found to be closely linked with both phys- SOCIAL NORMS ical and psychological violence against children (see the Harmful practices, such as child marriage, are normalized previous section). Focus groups and interviews reveal that in some communities. Economic vulnerability exacerbates IPV and VAC commonly overlap within the same household. some of these norms. For example, in some cases, children Notably, children in households where women are abused are married o because families cannot a ord to meet their are perceived to be more likely than other children to basic needs or in the hopes of obtaining bridewealth. Some experience harsh physical discipline. This is consistent with 28 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts findings from other studies in Uganda, which show that IPV their registration. However, limited capacity among border and VAC co-occur and can become profoundly intertwined, authorities and reception sta , as well as coordination creating cycles of abuse in the family (Devries et al. 2017; shortfalls among key partners, creates delays and backlogs Namy et al. 2017). in the registration process and issuance of documentation. Mechanisms and pathways that allow refugees to report Given these intersections, building a close collaboration complaints and receive feedback about reception, verifica- between GBV interventions and child protection systems is tion, registration, and refugee status determination are lim- essential. The evidence implies that policies and programs ited; they need to be strengthened and better coordinated. need to be more integrated, and coordinated strategies are needed for addressing violence against women and Findings also indicate that, at present, there is very little children. For example, service providers who assist abused information available to women and girls at the reception women should also assess the safety and well-being of chil- centers about GBV and how they can access services. At dren, and take steps to provide them with appropriate care. times, information is shared through megaphones, but GBV- Conversely, those who provide services to children who are related messages get lost amid a flurry of other informa- survivors of abuse should consider the possibility that IPV tion that new arrivals receive. In some reception centers, may be co-occurring in the home, and develop appropriate informational GBV handouts are distributed, which describe responses. GBV, its root causes, and its consequences to survivors, their families, and society. This approach is fundamentally GBV and VAC risk factors for refugees flawed and will do little to promote reporting and access- The recent interagency assessment led by the United ing services by survivors. The handout is written in highly Nations High Commissioner for Refugees (UNHCR) reveals technical English, and some of its pictorial messages are several risks of GBV and VAC specific to the refugee confusing or inappropriate. context (UNHCR and OPM 2019). The main risks include poverty and limited access to livelihood opportunities; Further, despite the widely publicized reports of sexual and predisplacement norms that emphasize female submissive- other forms of GBV in South Sudan and other countries, ness and normalize masculine aggression, dominance, and there has been surprisingly little e ort to identify survivors control; exposure to trauma, alcohol, and substance abuse; upon their arrival in Uganda or to meet their immediate normalization of violence; and changing gender roles or health needs at the reception centers. The vast majority of shifting gendered division of labor occasioned by displace- the existing GBV prevention and response programs are ment. Regarding the last, men’s inability to live up to their dedicated to incidents that may occur in the Ugandan refu- most fundamental gendered role as providers and the cor- gee settlements themselves. During the interviews, UNHCR responding increase in women’s participation in economic sta said they are aware of this gap and are brainstorming activities is particularly mentioned as heightening the risk solutions to identify survivors and give them care. of IPV. Notably, men’s perceived failure to provide for their families and a “feeling of disempowerment” prompts some Further, UNHCR, the O ce of the Prime Minister, and other to use violence as a way of rea rming their manhood, partners involved in the screening of refugees at the recep- especially if they feel challenged by a woman. tion centers need to review their procedures for identifying people with specific needs. At present, representatives Reception, registration, and refugee status determination from several agencies sit at one table and ask refugees services are key to ensuring the e ective protection of questions to determine their vulnerability. At the reception refugee women and girls. Registration legitimizes the status center, screeners are often of mixed gender, reducing the and rights of refugees and entitles them to protection possibility that a woman or separated child would report a from violence. Responsible entities are accountable for case of GBV or VAC. 3. Assessment Results 29 GBV AND VAC RESPONSE SERVICES IN medical attention and, as a result, report weeks HOSTING AND REFUGEE COMMUNITIES or months after the event. The multifaceted nature of GBV and VAC necessitates myriad strategies to respond to the diverse manifestations The capacity to diagnose and treat trauma- of violence and the various settings in which it occurs. GBV related GBV remains low in most health facilities and VAC response services fall under four interrelated located in refugee and host communities. categories, delivered under a multisectoral framework. Most police sta in refugee-hosting districts have 1. Health/medical services. GBV survivors, including not received GBV-related training. women and girls, need access to quality, life-saving health care services, with an emphasis on the clinical Referrals and linkages between health care management of rape. facilities and community-based services remain particularly weak. 2. Mental health and psychosocial support. GBV survi- vors need access to quality mental health and psycho- Only a small fraction of GBV cases are prose- social support focused on healing, empowerment, and cuted through the legal system, and even fewer recovery. result in a conviction. Factors hindering the pros- ecution of GBV cases include costs associated 3. Protection: safety/security services. Safety and with accessing justice and distance to courts. security measures need to be in place to prevent and mitigate GBV and to protect survivors. Access to legal aid services is a challenge. While some nongovernmental organizations (NGOs) 4. Legal/justice response. A GBV response involves o er legal services, they are overstretched, with investigative services, prosecution, formal and informal limited geographic scope. justice, legal aid, assistance, and counseling. All justice, law, and order sector institutions have serious logistical and human resource deficien- GBV response services cies, negatively a ecting their capacity to dis- charge their functions e ectively and e ciently. KEY FINDINGS Because of problems associated with access to the formal criminal justice process, many survi- GBV cases are often unreported or reported late. vors and their families rely on informal justice The primary reasons identified for nonreporting mechanisms. include fear of reprisal; pressure from family members; safety concerns, especially when the abuser is a spouse or family member; lack of con- Health/medical services fidence in the legal system; and stigma. Access to high-quality, confidential, and integrated health care services is a critical and life-saving component of a Lower-level health facilities in refugee and host multisector response to GBV. Services include HIV coun- communities lack trained sta and necessary seling and testing, treatment of acute injuries; provision medical supplies to treat survivors of violence, of postexposure prophylaxis (PEP) for HIV; presumptive particularly sexual violence. Most survivors are testing and treatment of sexually transmitted infections; unaware of the benefits of seeking prompt provision of emergency contraception for eligible survivors; 30 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts TABLE 3.2 Health Facilities in Refugee Settlements and Host Communities in Study Districts Facility Level Hospital HC IV HC III HC II Total Refugee settlements 0 2 31 28 61 Host communities 2 9 57 67 135 Total 2 11 88 95 196 HC = health center. trauma counseling; safety planning; referrals to support ser- Impacts Project (DRDIP), UNHCR, and development part- vices, such as the police, emergency shelter, mental health, ners. For example, in Yumbe, 16 health facilities have been and economic empowerment programs; and medical established in the refugee settlement since 2017. These examinations for the collection of forensic evidence. Health facilities, established in line with Ministry of Health guide- providers are also mandated to collect medical and legal lines, report to the ministry through the district. evidence to corroborate the accounts of survivors and help identify perpetrators. These services should be delivered in An overall total of 196 health facilities were mapped in a confidential and nondiscriminatory manner that considers refugee and host communities across the study district the survivor’s gender, age, and any specific needs. (61 in refugee settlements and 135 in host communities, as shown in table 3.2). The study establishes that health Across all study sites, health services for refugees and care services are generally available for GBV survivors and host populations are provided based on an integrated are free in almost all health facilities visited in the refugee approach. The integration process is guided by the Uganda settlements and host communities. However, the scope of National Integrated Response Plan for Refugees and Host services varies across facility levels (see table B.2). Further, Communities and the UNHCR’s Global Strategy for Public the presence of NGOs and humanitarian organizations Health (2014–18). These plans operationalize integration by providing health services in refugee settlements makes linking humanitarian and development programming and health care more accessible to refugees. Although there is interventions. Notably, health services are provided by pub- a certain degree of integration of access to health services lic and private health facilities as well as by health NGOs,8 for both hosts and refugees, there is still a reluctance such as Medical Team International, with referrals directed among host communities to use health facilities primarily to the nearest district or regional hospital.9 Cognizant of set up for refugees in the settlements. the pressure that the increased refugee population would place on public health facilities, UNHCR and partners have HEALTH SEEKING AMONG GBV SURVIVORS supported infrastructure expansion in some facilities and GBV survivors, especially survivors of sexual assault equipped them with the requisite supplies and sta across (including rape) require immediate medical response to the study districts. In some districts, service delivery has heal injuries, administer medication to prevent or treat been expanded through the establishment of health facili- infections, and prevent unwanted pregnancies (where local ties by the Uganda Development Response to Displacement laws allow). However, findings indicate that most survivors do not seek medical assistance following a GBV incident. 8. United Nations High Commissioner for Refugees and/or individual donor organiza- tions provide funding to NGOs to implement a part or the entirety of a health service Even among those who do, misconceptions of the nature of delivery system focused on the refugee population. risk faced and the necessary preventative treatment results 9. Integration of services is considered an opportunity to improve access to health services and ultimately the standard of living for both refugee and host communities. in late reporting. While treatment within 72 hours is needed, 3. Assessment Results 31 particularly to administer PEP, survivors may present them- lower-level health facilities. For example, more than half selves much later. Decisions to not seek care and delays (39 out of 67) of the HC IIs in host communities do not have in care seeking often mean that evidence is lost and that emergency contraceptives in stock; and the majority (55) do cases requiring PEP go untreated. not have private consultation rooms or standard operating procedures, guidelines, or protocols on GBV. Participants discussed several challenges related to health seeking. First, most survivors are unaware of the benefits Survivors who seek services at these lower-level health of seeking prompt medical attention and, as a result, report facilities are often referred to higher-level facilities (HC IV weeks or months after an event. Educational campaigns and referral hospitals) to meet their needs, especially may, therefore, help inform the refugee and host commu- for medical examinations and the collection of forensic nity about the urgency of clinical care to e ectively treat evidence. This assessment finds that when referrals are sexual violence. Second, health centers are often located made to a survivor who is a refugee, that survivor is often far from the refugee and host communities, with limited escorted to or otherwise assisted in accessing services transportation options allowing them access to treatment. A at higher-level facilities, which is not always the case for lack of trust in service providers, limited community aware- survivors in host communities. ness of available services, and a fear of stigmatization by community members are other active deterrents to GBV “Because of contraceptive stockouts, as well as how survivors seeking help. clinics are structured, GBV survivors are often unable to receive all post-GBV services in one location. They may POOR CASE MANAGEMENT CAPACITY, ESPECIALLY IN receive an exam in one department, for example, and LOWER LEVEL HEALTH FACILITIES then be referred to another department for contraceptive The study’s findings indicate that the range and quality of needs. In the case of stockouts, survivors may have to medical services available to GBV survivors vary greatly visit a di erent clinic entirely. Visiting multiple locations across the study sites and facility levels. The GBV health can be di cult logistically and emotionally, especially in infrastructure is well-developed in higher-level facilities— the absence of a good case management system and can e.g., hospitals and health center (HC) IVs10—but poorly lead to delays in receiving essential care.” developed in lower-level health facilities—HC IIIs and IIs— – Key informant interview (female), Kiryandongo where the bulk of GBV cases are recorded. The lower-level facilities lack sta trained in the clinical management of rape Findings also show that despite interventions aimed at as well as the necessary medical supplies to treat survivors recruiting and retaining health workers, there are still of violence, particularly sexual violence, including a shortage challenges regarding their number, skills mix, retention, and of sexual assault forensic evidence kits, PEP, emergency motivation. In all surveyed health facilities, sta ng levels contraception, pregnancy test kits, and medications for the remain below standard, particularly in rural and hard-to- treatment of sexually transmitted infections. Due to this reach areas where most of the refugee settlements are situ- lack of capacity, case management is still very poor in the ated. In refugee-serving health facilities, partners have tried to supplement existing government sta by recruiting more 10. The government health service in Uganda is structured into national and regional referral public hospitals, general hospitals, and health centers. The health centers personnel and, in some cases, topping o the salaries of are divided into four levels (HC I to HC IV). HC I, the lowest level, comprises a village government sta to incentivize them and improve retention health team or individual health volunteer (who may or may not be formally trained) who links the community to the national health service. HC IIs, also known as dis- and performance. This support notwithstanding, the health pensaries, are parish-level facilities that serve roughly 5,000 people each, led by an centers remain overcrowded due to the large catchment enrolled nurse who works with a midwife and two nursing assistants. HC III facilities, which serve a subcounty of approximately 20,000 people, supervise community population that they serve, with hours-long waiting times health workers and the HC IIs within their jurisdiction. HC IVs are district hospitals before health care is provided. In addition, some donors, that serve counties of about 100,000 people each; they o er the highest level of services in the district. such as the World Health Organization and the United 32 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts Nations Population Fund, have funded some trainings for LIMITED FOLLOW UP FOR SURVIVORS, AFFECTING health workers on the management of GBV cases, but the THE CONTINUITY OF CARE lack of su cient government financing is hampering the Most survivors never receive follow-up care by health ability of districts to expand the training to reach all health workers after their initial contact with health care facilities. providers. Health workers either do not have the time to conduct follow-up visits due to limited sta ng and heavy work- MEDICO LEGAL SERVICES loads or they do not see this as their mandate or duty. This Survivors who interface with the health care system should restricts the providers’ ability to track survivors and provide also receive medico-legal services, including the collection post-GBV care services, including family planning counsel- of forensic evidence from GBV survivors and completion of ing on short or long-term contraceptives. the medico-legal/GBV incident report forms (Police Form 3, or PF3)—both of which are necessary for prosecution. The “When survivors get out of here, everything is like we are police form provides medical evidence in cases of GBV. finished with them. Most of the survivors do not come The medical examination and documentation of forensic back and we are not able to follow-up. They always sit evidence is the responsibility of a medical o cer (doctor) back and solve their cases at home.” at a regional or district hospital and/or a clinical o cer or – Female health worker, Moyo midwife at an HC IV or HC III. However, findings indicate that 9 out 31 HC IIIs in the refugee settlements, particularly REFERRALS those that are privately run by NGOs, did not authorize their Beyond immediate medical attention, survivors of violence sta to independently complete PF3. In practice, the forms need services including mental health and psychosocial filled out by such clinicians would need to be stamped by a support and legal assistance. Among the GBV-related public health facility as part of the procedure. duties of health workers is the referral of survivors to ser- vices in other sectors to improve survivor outcomes. Allegations of corruption were also made against some medical personnel for receiving payments to complete Overall, the study findings show that bidirectional referrals Police Form 3. Some health providers are reportedly afraid occur between the health facilities and the police in both of retribution by perpetrators if they complete the requisite refugee settlements and host communities. Survivors who police form to report an incident of violence; and many present or register/report at the health facilities are referred others are reluctant to testify in court, or they consider the to the police for legal/justice support, including obtaining court process laborious and costly. PF3 and Police Form 3A (PF3A), depending on the form of violence they have been exposed to. Similarly, survi- “Cases in court take too long to end and health workers vors who report to the police are often referred to health have to be in court several times. Most of them even facilities for medical assistance and medico-legal support, move long distances and incur expenses. So many health including the completion of the form. Regardless of the first workers do not want to fill [Police Form 3] to avoid the point of reporting, survivors are required to return the form, processes of going to court. The government put in place which provides proof of abuse—a necessary element for a fund for health workers working on the case, however, prosecution. it’s not enough and process of getting it is also not clear to most of the health workers.” Nonetheless, respondents report challenges in implement- – Key informant interview (female), Arua ing the GBV referral guidelines e ectively. Health providers and police are aware that survivors should be referred to health clinics within 72 hours; however, survivors do not always have the time or financial resources to travel from 3. Assessment Results 33 the police station to a health clinic, especially when they are survivors of sexual violence are overlooked. For example, geographically distant from one another. Health referrals to government-operated and NGO-supported health facilities the legal system are also constrained, especially in refugee usually focus on the physical e ects of sexual violence, settlements where the presence of police and the judiciary such as pregnancy and HIV, and pay less attention to is limited or nonexistent. The study findings also indicate mental health and psychosocial e ects. At most facilities, that referrals and linkages between health care facilities and whatever counseling is o ered does not involve the deeper community-based services remain particularly weak. therapeutic engagement needed to facilitate mental health and psychosocial recovery. Notably, none of the visited “I only notice that the police and the health facilities health facilities is applying structured therapeutic interven- working together on these cases, probably because of tions, such as cognitive-behavioral treatment therapy for the forms that the health workers have to fill yet they can trauma. only be found at the police stations… I have not observed much happening beyond these two sectors, women need “At Health Center III, even counseling services are not things like counseling, but police rarely refer them [to the there because health workers don’t have the capacity. community development o cer].” They can talk about it just basing on the general knowl- – Key informant interview (male), Hoima edge they have but they don’t have that exact knowledge we expect of them to support these people.” Mental Health and Psychosocial Support – Key informant interview (male), Hoima Psychosocial support interventions are essential compo- nents of the comprehensive package of care that aims to Study findings indicate that most survivors do not receive protect or promote psychosocial well-being and to prevent clinical counseling beyond their first contact with health or treat trauma among survivors of violence. According to care providers, partly due to poor or nonexistent follow-up the National Guidelines for the Provision of Psychosocial e orts by health and mental health professionals, distance Support for Gender-based Violence Victims/Survivors, to health care facilities, and associated costs. It is therefore quality psychosocial services should be survivor-centric; not surprising that when questioned about GBV program- build individual and community resilience; support positive ming gaps, participants across the board said that the coping mechanisms; and draw on family, friends, and com- largest is psychosocial services to address trauma. munity members (MGLSD 2017b). The guidelines empha- size that such services be provided by specialized trained Findings indicate that there are a few NGOs dedicated to personnel, such as counselors, police o cers, nurses, providing professional psychiatric assistance and trauma social workers, psychologists, and psychiatrists—preferably counseling. However, they have had di culty securing of the same sex as the survivor—and that they should be funds, gaining implementing partner status with UNHCR, provided soon after the incident. and/or receiving authorization from the O ce of the Prime Minister to operate in the settlements. UNHCR and the CLINICAL MANAGEMENT OF GBV RELATED TRAUMA O ce of the Prime Minister should immediately prioritize In refugee and host communities, trauma-related services partnership applications related to the provision of counsel- for survivors are accessed mainly through the public health ing to refugees. care system. However, the capacity to diagnose and treat trauma-related GBV remains low in most public facilities. PSYCHOSOCIAL CARE AND COUNSELING Most facilities lack key personnel who can handle such The Ministry of Gender Labour and Social Development’s issues, such as medical social workers, psychiatrists, guidelines on psychosocial support require that interven- psychotherapists, and clinical psychologists. In such clinical tions adopt a family- and community-centered approach settings, the mental health and psychosocial needs of to strengthen the networks around survivors and minimize 34 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts their risk of further harm. Community structures, including including o ering counseling, advising survivors to seek religious groups, as well as community, clan, and political support, and linking survivors to NGOs for further help. leaders, are critical to supporting the psychosocial recovery However, some of these structures, especially in host com- of survivors. munities, lack adequate training and knowledge in handling the various psychosocial e ects associated with exposure Study findings indicate that survivors receive varying to violence. degrees of counseling services from the statutory duty bearers with whom they come into contact at the district, SAFE SPACES FOR WOMEN subcounty, and village level, including police—especially Organizations such as the International Rescue Committee, from o cers in the child and family protection unit, proba- the American Refugee Committee, and CARE International, tion o cers, district- and subcounty-level community devel- among others, in partnership with UNHCR, have set up opment o cers, and local council authorities. GBV-related women-friendly spaces (or female-friendly spaces) in counseling requires a deep knowledge of the underlying refugee settlements. These are safe areas where women causes of violence and of the various forms of violence, can access resources, support, basic services, social as well as the use of trauma counseling techniques to networks, and referrals to additional services. Women—and establish safety and to control trauma-related symptoms. sometimes girls—can socialize and rebuild their social However, most of the statutory duty bearers have received networks, acquire relevant skills, and receive information no training, nor have they received an adequate induction about a wide array of issues, including women’s rights, into how to provide GBV survivors with immediate and health, and services. The facilities and services available at longer-term psychosocial counseling as part of a mental these spaces vary greatly from one to another; each o ers health and psychosocial services package. a nonstandard package of services. A key priority is the establishment of additional such safe spaces in refugee Several NGOs support refugees and provide psychosocial settlements because the existing ones are insu cient to services to refugee survivors of GBV. Some, such as the respond to the demand. Lutheran World Federation, Transcultural Psychosocial Organization, Médecins Sans Frontières, International “These women centers are managed by the partners in Rescue Committee, CARE International, Danish Refugee di erent zones. In zone 1 and 2 we have IRC [International Council, TUTAPONA Trauma Rehabilitation, and the Rescue Committee], CARE is in zone 4, ARC [American American Refugee Committee, use a variety of approaches Refugee Committee] zone 5. Women at these centers do focused on providing psychosocial support to GBV survi- crafts, charcoal stove making, there is a lot that they do in vors, including individual and group counseling, especially that they forget about what happened.” in refugee settlements. Discussions, however, reveal that – Key informant interview (male), Arua psychosocial care services have limited scope of coverage and resources to meet the survivors’ needs in their entirety. Across each of the host communities, there are no shelters or safe spaces identified that would allow survivors to tem- Informal (community-based) counseling is available and porarily remain in secure conditions if it would not be safe easily accessible to survivors in each of the study districts. for them to return to their place of residence. For example, most survivors go to their family or friends for supportive counseling and emotional support regarding In situations when formal protection systems are weak or their experiences. In addition, community-based structures, nonexistent, informal community-based protection mecha- such as child protection committees, para-social workers, nisms can play an important role in ensuring women’s and community activists, and village health teams, play a key girls’ safety and security. However, options for the safety role in providing psychosocial support services to survivors, and protection of survivors and their families who are at 3. Assessment Results 35 risk of further violence and who wish to be protected at the an arrest. It is only then that the police presence is felt, but community level are severely limited. not through community policing activities or other police activities, such as patrols. Indeed, there is a general lack of Protection (security/safety) services police visibility in the refugee settlements, which portends a Survivors of GBV are often at high risk of further violence security risk. by their perpetrator(s) or others. Safety and security mea- sures are therefore an essential component of any com- Justice and legal aid services prehensive package of care for GBV survivors.11 Failure to Access to justice can be an empowering and essential part properly ensure the safety and protection of survivors and of a survivor’s healing process. Several statutory structures those at risk of violence negates any subsequent actions. and institutions are involved in ensuring justice for GBV survivors at the district level, including the police, health In Uganda, ensuring the safety and protection of GBV survi- care providers (who collect scientific evidence in cases of vors is primarily the responsibility of the police. Protection- assault or sexual violence), the community-based services related responsibilities begin with the early identification department, the directorate of public prosecution and of crime and continue throughout the justice continuum. courts of judicature, and local council courts (see figure 3.1). For example, any decision regarding arrest, detention, or The roles of these actors are articulated in several legal release of a perpetrator must consider the safety of the and statutory instruments and policies.12 These structures survivor and her family. In addition, as the receivers and serve both refugees and host communities. investigators of reports of GBV, police play an important role in providing information, safety, and protection to Within the settlements, the refugee welfare committees survivors and witnesses. Further, the police play a key role (RWCs), comprising elected refugee leaders, also play a key in directing or linking survivors to service providers who role in ensuring access to justice for refugees, including the can assist them in obtaining protection orders, restraining referral of survivors to the formal actors outlined above. For orders, and barring orders through criminal and civil court example, cases are first reported to the RWCs, which serve processes. Police are also generally responsible for enforc- as the foundation of the coordination of reporting; it is the ing any violations of such orders. RWC leader who decides if a case should be addressed at the RWC level or reported to the formal justice actors. Overall, findings indicate that the capacity and number of police o cers remain inadequate to e ectively respond to Specific gaps in the legal/justice response to GBV in refu- the physical security of GBV survivors in refugee and host gee and host communities are described below. communities (see detailed discussion in the next section). For example, in both refugee and host communities, there CASE REPORTING is a lack of facilities and infrastructure to e ectively investi- Overall, study participants said that GBV cases are often gate cases and protect survivors. Ine ective investigations unreported or reported late. As discussed earlier, the and a failure to prosecute GBV cases contribute to an primary reasons for nonreporting are fear of reprisal, environment of impunity that marginalizes survivors and especially pressure from family members, and safety discourages reporting and help-seeking behavior. concerns if the abuser is a husband or family member; low confidence level in the legal system; lack of accountability In addition, community policing activities are not reaching of perpetrators; and the stigma and social isolation associ- the refugee and host communities. This creates the per- ated with being a survivor. Women who report violence may ception that the only time the police show up is to execute 12 The legal environment of Uganda is robust, including laws relevant to the gov- erning of GBV-related cases, such as the Domestic Violence Act, Penal Code Act, 11. Safety refers to physical safety, security, and a sense of psychological and emo- Marriage and Divorce Act, Land Act, Evidence Act, Children Act, Refugee Act, and the tional safety among people experiencing a high level of distress. Constitution of Uganda. 36 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts be blamed for exposing the perpetrator and “getting him in “They never say, “My husband is beating me.” [Why is trouble.” In some cases, a woman is reluctant to report her that?] Scared, they are afraid. And if you have kids and spouse or partner because she cannot a ord to lose the your husband leaves you and you don’t have a job, how financial support he provides. are you going to support your children? Women with children won’t get away from their husbands when they “Too often, women view violence, including sexual vio- get abused because they are ones with financial support lence, as a fact of life. Under these circumstances women or the ones who pay the bills. sometimes choose or are pressured by their families or – Key informant interview (male), Koboko communities, not to report sexual violence to authorities.” – Key informant interview (male), Kyegegwa FIGURE 3.1 Legal and Justice Actors and their Roles COURTS JUDICATURE Hearing cases, considering evidence, determining cases, and passing judgment; issuing protection order referral DPP/RSA/PROSECUTOR CSOs Advise and provide guidance on matters of the law to Sensitize, identify GBV cases, advise, make referrals, police, survivors, and their families; sanction case files, follow up, testify, and facilitate related processes investigate and prosecute crimes and procure justice; and document and make referrals POLICE PROBATION/CBSD CFPU CID Mediate; reconcile; investigate; conduct social Investigate complaints, issue medical forms, inquiries; represent survivors in court, on the witness summon/pursue arrests and apprehend suspects, stand, and through testimony; document evidence; mediate, sensitize o enders, gather and secure issue case/care orders; monitor; and make referrals evidence, prepare file and submit to resident state attorney for legal advice, testify in court, LOCAL COUNCIL COURTS and make referrals Mediate, reconcile, pass judgment on cases within jurisdiction, document evidence, testify in court, HEALTH FACILITY and make referrals Conduct medical examination, complete medical legal form, testify, and make referrals COMMUNITY/FAMILY Identify, report, cooperate to document evidence, testify, and make referrals SURVIVOR Recognize violence, report, cooperate to document evidence, and testify in court CBSD = community-based service department; CFPU = child and family protection unit; CID = criminal investigation department; CSOs = civil society organizations; DPP = Directorate of Public Prosecution; RSA = resident state attorney. 3. Assessment Results 37 When a survivor does press charges, she is often prevailed sites continues to be riddled with deficiencies, ranging upon to withdraw them. The common practice is to settle from human resource gaps to a lack of logistical resources cases outside the formal justice system. Even when the for e ectively carrying out their role, such as a lack of police insist on investigating and prosecuting a case, there transportation. is often intense pressure on the survivor and her family to resolve the matter—i.e., settle the case—informally. Across all the study sites, the police do not have adequate Survivors and their families are usually encouraged to human resources and do not meet international standards accept compensation as a better option than pursuing in terms of the ratio of the police o cers to population. elusive justice. For example, according to the district police commander, Isingiro district has only 199 police o cers, 55 of which are “The condoning of GBV is expressed by the community in in the settlements. According to population demographics, some cases by not cooperating with the Police to give up there is only one police o cer for every 2,780 people, far o enders, even when the life of victims is in danger” below the internationally recommended ratio of one to 450. – Key informant interview (female), Adjumani “The police in the refugee settlements are understa ed “People would want to report cases of abuse and vio- and some even have no means to arrest perpetrators, lence. … but they also weigh the costs such as transport no transport and no holding cells. This has influenced for the complainant and sometimes for a witness and community member’s reluctance to report cases and also the uncertainty of the outcome against the material gain the increased reliance on community structures which in o ered by the perpetrator … they decide to come to an most instances do not serve the interests of the survivor agreement with the perpetrator.” and might lead to revictimization.” – Key informant interview (male), Isingiro – Key informant interview (female), Adjumani Local leaders, including RWC members, sometimes even In addition, there are serious deficits in the number of hide severe GBV cases—such as defilement and child women police deployed in the refugee and host communi- marriages. The absence of a witness protection law in ties. Across all study sites, only 16 percent of police o cers Uganda has aggravated this problem, which in some cases are women, which limits the police services available to has forced complainants to withdraw their cases out of fear. women. According to one woman participant in a focus In addition, for survivors living in remote villages, physical group discussion in Nakivale: access to the legal system may be di cult. If a survivor does not live near a police station, the travel required to “We also want policewomen on board at the police report a crime (as well as to seek medical treatment) can be station, we always find men when at the time we have a significant obstacle. problems as women and want to talk to fellow women.” INVESTIGATION AND PROSECUTION OF GBV CASES Another woman respondent in Isingiro remarked: The successful prosecution of GBV o enses heavily depends on e ective investigations that take a holistic “The challenge I have is that the police stations don’t approach to the gathering of evidence. The legal frame- have women whom we can open up to when we have work in Uganda mandates that the Uganda Police Force our complaints. When you come to the police station its conduct e ective investigations and evidence collection only men we find there and usually they don’t have time for cases of GBV. Across all surveyed districts, there are for us.” 137 police posts and stations. Study findings show that police capacity for fulfilling this mandate across the study 38 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts Participants reported that many of the police o cers are In addition, several police stations and posts lack basic inadequately trained in or oriented with GBV and/or have equipment, such as vehicles, medical examination forms, not received GBV sensitivity training to ensure appropriate and paper, which are necessary for conducting an e ective investigations or to support traumatized survivors. For GBV investigation. In addition, several police stations lack example, over half of the police posts (27 out of 46) and the capacity for collection, analysis, storage, and presen- 15 out of 47 police stations in the host communities have tation of forensic data, further compromising their ability reportedly not attended any specialized GBV or child pro- to assemble convincing evidence that will sustain a GBV tection (VAC) training over the last 12 months, which may case. The lack of transportation is cited as one barrier to be attributed to the frequent transfers and rotations. Some the successful investigation and follow-up of cases. Without participants report that police o cers are often indi erent means of transportation, police o cers cannot move from to the plight of survivors and are less inclined to meet them one place to another, a prerequisite for them to e ciently at a location where their privacy can be respected, and that discharge their functions. Yet even those that have access survivors are often retraumatized by having to repeat their to a form of transportation still face fuel-related challenges. stories multiple times. For instance, the district police commander of Isingiro is only given U Sh 900,000 for fuel expenses each month “Survivors may experience secondary victimization when with which to run operations in the entire district. attempting to report a rape; for example, survivors have been asked to give statements in public areas of police In addition, specialized equipment, including scene-of- stations, o cers have not believed them and refused to crime o cer kits, are in short supply, constraining the ability take statements, and o cers have blamed the victim for of investigative o cers to collect evidence at the scene of what they were wearing, being intoxicated, or being out a crime, a ecting the investigation of GBV—among other— late at night.” cases. For example, at some police posts, o cers report- – Key informant interview (female), Kyegegwa edly did not even have the forms used to record and collect evidence in GBV cases. Further, the lack of facilities and infrastructure makes it hard to e ectively investigate cases and protect the survivors in Study findings also indicate that most of the police posts both refugee and host communities. For example, several and stations have no facilities for handling survivors of GBV, police stations and posts lack counseling or interview especially as far as psychological support and rehabilita- rooms that guarantee privacy. When GBV survivors go to tion are concerned. For instance, at most police posts and a police station, information is first taken at the main desk, stations, there are no special shelters, nor are there special which is often surrounded by people waiting to see a interview spaces for the survivors in or outside the settle- detainee or to lodge a complaint. ments. When the need arises, interviews are conducted using improvised space. “I do not have space, but I sometimes improvise. There is a dairy shop around here [adjacent to the station struc- To improve the handling of GBV cases, some police stations ture] where I request for space when there are many peo- have created gender desks. For example, at Arua Central ple in this o ce. So, I take the survivors there and speak Police Station, five o cers run the desk. Unfortunately, they to them … and counsel them. Sometimes they get better have not received any special training on how to handle and resolve the issue and others don’t and so we refer such cases. A few o cers have attended workshops on them to the main police station for further management.” the subject but none have received specialized training. – Key informant interview (police o cer), Moreover, due to constant rotations, the police station loses Isingiro District o cers with experience and training. 3. Assessment Results 39 The Directorate of Public Prosecution is mandated to direct “Amid all the challenges; there is the aspect of with- police to investigate GBV cases, including cases of sexual drawals. The survivors will beg to withdraw, and you find violence; provide advice and guidance to the criminal that you become handicapped because even in court, investigation department on conduct of investigations, deci- witnesses will be required and if the survivor is not willing sions to prosecute, and what charges to register; provide to come forward to testify, there is not much this o ce legal assistance and support to GBV survivors; and ensure can do.” e ective and expeditious prosecution of perpetrators. The – Key informant interview (female), Adjumani directorate is represented at the district level by resident state attorneys and resident state prosecutors. However, “Witnesses of GBV cases rarely come up to testify, the performance of the O ce of the Director of Public and it is quite di cult since they are threatened in the Prosecutions is a ected by human resource deficiencies. community … for it’s an o ence to report.” While the sta in the resident district state attorney’s o ce – Key informant interview (male), Moyo must deal with several cases other than GBV, some district o ces only have two or three sta members. For example, In cases of rape, participants reported that the burden of Isingiro district has one state attorney and one prosecutor. proof is normally with the prosecution. However, due to These o cers are overstretched. In some cases, they are the lack of e ective referral and coordination mechanisms required to appear at di erent courts at the same time, between the police force (investigators), the Directorate of which is clearly not realistic. Public Prosecution (prosecutors), and other criminal justice service providers, many GBV cases are not successfully In addition, resident state attorneys often lack the prosecuted in a court of law. resources to complete their work expeditiously. For exam- ple, due to transportation constraints, most prosecutors LEGAL AID AND SUPPORT SERVICES are not able to meet with witnesses in preparation for court Legal services are an essential part of the survivor-centered hearings. Sometimes, GBV survivors must testify in court approach and should be part of a safe, nonstigmatizing, without receiving any pretrial guidance from a prosecu- multisector response to GBV. Legal aid services sta ed tor. Further, prosecutors and resident state attorneys do by trained personnel should be accessible to GBV survi- not conduct their own investigations—they rely on police vors and integrated into the general GBV referral system. investigations, which are often ine ective due to multiple Overall, access to legal aid services also remains a chal- challenges, as previously noted. lenge in both refugee and host communities. In particular, access to state-funded legal aid mechanisms (e.g., the State Another highlighted challenge is the absence of witness Brief Scheme, Law Development Centre clinics, and pilot protection programs. State capacity to protect survivors programs such as Justice Centers Uganda) is very limited and witnesses from retaliation during criminal trials is in refugee and host communities across the 11 districts virtually nonexistent across study communities. The silenc- covered by this assessment. ing of survivors by family and community members further weakens the chances of a perpetrator being prosecuted Some legal aid service providers—such as the and convicted. Survivors often experience societal pressure Humanitarian Initiative Just Relief Aid, FIDA, Lutheran to resolve cases through community leaders, particularly World Federation, Refugee Law Project, War Child Canada, when the perpetrator is a family member. Care and Assistance for Forced Migrants, and Uganda Law Society—actively promote access to justice for GBV survivors, especially by assisting in the litigation of cases 40 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts by watching briefs,13 o ering free legal representation, Findings show that only a small proportion of reported GBV and advising police on the presentation of cases and the cases go to court, and many that do fail to reach a conclu- profiling of evidence. Some have trained paralegals to sion. While the court may want to try GBV cases as required provide legal aid support to GBV survivors. These organiza- by the law, such e orts can be thwarted by the conduct of tions are overstretched, however, and they have resource the prosecution, expert witnesses (police and medical), or challenges. In addition, the organizations have concen- the survivor. This study finds that some survivors reportedly trated their legal services on refugees, which defeats the decide to withdraw their cases for a variety of reasons, but integrated approach of ReHoPE and the Comprehensive especially societal pressure and financial remuneration. Refugee Response Framework, which requires that services in the areas with refugees be provided in an integrated Participants claimed that some court processes and rules manner. There are also questions regarding the sustainabil- are not centered on the needs of GBV survivors. For exam- ity of these services, which are largely project-based and ple, a survivor of sexual violence may testify and/or give rely on donor funding. evidence openly, recounting her experience. This subjects the survivor to intimidation—especially by the defense TRIAL AND SENTENCING attorney—as well as further stigmatization. In some cases, The magistrate courts have jurisdiction over hearing and a survivor must deliver her statement multiple times, often determining cases of domestic violence, but many sex- under extreme duress and in response to discriminatory ual o enses and GBV-related murders are heard at the and biased comments and questioning. High Court. The High Court, the Court of Appeal, and the Supreme Court of Uganda may also hear and determine Further, some trial practices, such as the confrontation of a GBV cases on appeal or if the o ense is particularly grave. survivor by the alleged perpetrator and lengthy trials, may However, the e ectiveness of the courts of judicature have a particularly negative impact on survivors, enhancing across the study sites is a ected by the limited financial the risk of retaliation and intimidation, and more generally and human resources at their disposal. For example, the resulting in the survivor’s loss of trust in the justice system. limited number of judicial o cers contributes to a backlog Participants also report that under the adversarial system of of cases, which a ects the speed of dispensing justice. The litigation, a survivor of GBV is not shielded from the public paucity of judicial o cers means that survivors, whether or her attacker. There is no requirement that such trials be from a host or refugee community, are forced to appear in heard in private (“in camera”), with such a decision depen- court multiple times; and such delays also mean additional dent on the judge or the persuasiveness of the prosecutor.14 expenses for survivors. For example, the magistrate’s court Compounding the problem, survivors of rape and other in Isingiro, which serves the entire district of 100,000 peo- GBV cases are often represented by inexperienced state ple, has only one grade-one magistrate—whose court has attorneys. only nine support sta members. The chief magistrate who oversees Isingiro High Court is the chief magistrate Court-issued sentences and penalties are reportedly “too of Mbarara; he is overstretched because he also acts as lenient” for some GBV-related cases, rarely deterring per- the registrar of the Mbarara High Court circuit. Also, at the petrators from committing additional GBV-related crimes. time of data collection of this study, there had been no In some instances, a perpetrator is merely “cautioned,” or chief magistrate in Moyo for over six months; cases could asked to apologize to the survivor. No specific legislative therefore not be prosecuted. 14. Measures to ease the pressure on survivors at trial usually revolve around ensur- ing nondisclosure of their identities to the media or the general public; limiting abu- sive and gratuitous questioning of survivors at trial; and ensuring that survivors can 13. A watching brief is a method normally used in criminal cases by lawyers to provide the best possible evidence at trial. This reduces the trial-related pressures represent clients who are not a direct party to the suit and to function as an observer. on a survivor while also complying with a defendant’s right to a fair trial. Prosecutors The method is normally used to help protect the rights and interests of the victim of a must be vigilant during a trial and raise objections to any inappropriate questions or crime or to protect a defendant from malicious prosecution. comments directed toward a survivor by the defense. 3. Assessment Results 41 provisions exist for the mandatory counseling or rehabilita- Participants also discussed the di culties refugees face in tion of perpetrators. accessing justice services arising from language barriers. Article 28 of the Ugandan constitution requires everyone Finally, study participants cite a lengthy litigation process as charged with a criminal o ence “be informed immediately, a barrier to accessing justice. Two key informants reported in a language that the person understands, of the nature of that the average timeframe for the completion of a GBV the o ence.” This is in addition to the right to “be a orded, case in court is three years. Most complainants give up without pay by that person, the assistance of an interpreter before the process is concluded due to time and cost if that person cannot understand the language used at the constraints, resulting in the collapse of their cases. trial.” Findings, however, indicate that translation and inter- pretation services at police stations and in courts of law for ACCESS TO COURTS the benefit of the ethnically diverse community of refugees Physical access to the courts remains a challenge. Most of are limited. the refugee and host communities in the 11 districts studied are in remote rural locations, far away from courts of law, To address this gap, both UNHCR and the Refugee Law posing challenges related to accessing the courts and the Project have trained interpreters in several languages, costs associated with seeking justice. For instance, the including English, French, Kiswahili, Lingala, Kirundi, distance from Imvepi Settlement to Arua Town, where the Kinyarwanda, Somali, Tigrinya, Juba Arabic, Dinka, Nuer, courts are found, is 80 kilometers (km), the distance from Acholi, and Madi. As one informant noted: the Rhino refugee settlement is 70 km, both by gravel road access. Similarly, Nakivale is 65 km from Mbarara and “Skilled interpreters can make the di erence between an 35 km from Isingiro Town. Oruchinga refugee settlement is individual client accessing justice, health care, psychoso- 70 km Isingiro Town and is also only accessible by gravel cial support, and being turned away.” roads. In Arua, for example, the chief magistrate indicated that because of the distance, sometimes by the time refu- However, as commendable as the work of both UNHCR gees get to court, their cases have been adjourned. and Refugee Law Project is, there still appears to be a high demand for translators and interpreters to be integrated To bring the justice services closer to beneficiaries in these into the formal state institutions that provide services to locations, some organizations are working closely with the refugees, such as the justice, law, and order sector and judiciary to use mobile courts, where the o cer moves into local governments. the settlement and conducts court proceedings from there. Reportedly, these courts not only bring justice services The cost of accessing justice involves a variety of expenses closer to the people but also educate communities on legal that users of justice services must incur, including formal procedures and the law. For example, mobile courts have fees (such as legal and court fees), costs associated with been introduced in all zones of the Bidi-Bidi Settlement to the medical examination, and transportation. Survivors are overcome the logistical challenges faced by refugees. The often asked to pay for their medical expenses and their local magistrate is brought in from Yumbe and creates a transportation costs to the police station during an investi- makeshift temporary courtroom at a selected site in the set- gation. The poverty that a icts some members of the refu- tlement. However, some informants observed that mobile gee and host communities makes it hard for them to a ord courts are only cost-e ective if properly planned and if such expenses. Additionally, police request payments to preparatory work is finalized to ensure that the proceedings handle cases. One focus group participant in Kyegegwa, for are on schedule. instance, decried the prevalence of the practice: 42 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “The police ask for money before they handle your The LCCs are not mandated with trying cases related to complaint. I lost the trust I had for them and I would rather sexual abuse and exploitation, but they are often the first take my complaint to the church elders.” and preferred point of help for survivors and have there- fore become the primary point of reporting. However, Similar sentiments were expressed in Arua: the LCCs—typically the first authorities to hear of a GBV case—are embedded in discriminatory social norms. These “It is better not to report cases to police because we think entities often deliver prejudiced decisions against women, the cases will not be solved fairly. Sometimes they ask for adjudicate cases beyond their authority, fail to refer GBV money to solve the issue. So, we better report them to cases to police, and encourage GBV survivors to keep clan leaders.” disputes within their family. In some communities, the LCCs have not been established; cases are frequently just As a result, when the complainants cannot a ord the disposed of by an individual local court rather than formally additional costs requested by o cers to handle the case, convening the LCC. some GBV cases go unresolved. In some instances, those who seek services from police confront challenges related INFORMAL JUSTICE MECHANISMS to informal procedures, for example, paying in food for a As a result of the problems associated with access to the suspect who has been reported to the police: formal criminal justice process, many survivors and their families rely on informal justice mechanisms. These infor- “Yes, I have reported my case to the police station. After mal mechanisms derive their power from social groups reporting my case the person was put in prison, but the or community structures, including specific ethnic or faith police told me that I should be bringing for the prisoner communities, rituals, and traditions; indigenous governance food every time all else he will be released. So, when I systems; and local community organizations. The informal missed one day, I found the prisoner had been released justice mechanism often has at its center leaders or deci- and the next day he was at my door laughing at me and sion makers who are chosen by the community. These said that you stopped bringing for me food and now I have leaders may preside in settings much like a court or may been released. In other words, the police did not help us.” operate in an altogether di erent type of environment, such as a community gathering place or a private home. In host LOCAL COUNCIL COURTS communities, the preferred informal mechanism includes Local council courts (LCCs) are supposed to be established religious and cultural leaders. Refugees mostly rely on in every village, parish, town, division, and subcounty in RWCs to resolve cases of GBV. Uganda.15 They are mandated with providing client-centered counseling to GBV survivors; recording complaints, including Overall, the informal justice mechanisms are perceived a survivor’s age, sex, and relationship to the perpetrator; to be less corrupt, less costly, more flexible, and able to hearing GBV cases; and ordering any of the following, provide fast resolution to disputes. These mechanisms depending on the nature of the case: caution and apology are accessible to and preferred by many survivors. Both to the survivor; community service; compensation; reconcil- refugees and members of host communities think that the iation; declaration; restitution; and referral to police and the outcomes of the informal justice mechanisms are of better magistrate court if the perpetrator is a repeat o ender, is quality than those of the formal mechanisms. likely to inflict further harm on the survivor, or if the degree and nature of the violence against women and girls warrant However, informal justice mechanisms may vary widely the involvement of the police and formal courts. in terms of their consistency with a survivor-centered approach, and may reflect discriminatory cultural, gender, and social norms—especially as such mechanisms may 15. This is according to the Local Council Courts Act of 2006 (section 3). derive their authority from community structures. Most of 3. Assessment Results 43 their members have limited exposure to gender-transfor- interventions designed for adult survivors to mative learning and human-rights-sensitive training. They meet the specific needs of children. can reemphasize gender norms that may not be in tandem with gender equality and human rights for survivors. They The psychosocial response to VAC cases at the tend to reinforce existing harmful social norms and may health-facility level remains poor, especially in retraumatize survivors. Proceedings are neither recorded host communities. nor monitored, and some decision makers can be manipu- lated. For example, some RWCs reportedly ask for payment Police and other justice, law, and order sector before they will sit to resolve a case. actors in these locations are constrained in terms of facilities to handle the cases, especially psychosocial support. Informal justice structures, Response services for such as religious and cultural structures and violence against children RWCs (in refugee settlements), are relied on to Child survivors of VAC and their families have specific resolve VAC cases. However, the best interests needs that require tailored responses and specialized of the child are rarely the primary consideration services. These unique needs must be considered in all in the decision-making process. aspects of a VAC response. There are serious gaps in terms of dealing with children who come into conflict with the law. KEY FINDINGS Most visible gaps relate to the lack of adequate facilities in the districts to deal with such juve- Cases of VAC are heavily underreported and niles, including detention and rehabilitation underprosecuted. facilities. Most of the health facilities in refugee-hosting areas do not have facility-level protocols for the Health/medical services clinical management of sexual violence; lack sta Access to specialized health care and treatment is an trained on the clinical care of sexual assault survi- essential component of a holistic care response to child vors, such as how to adapt medical examinations survivors of violence. Child survivors require medical and treatment for children; and often lack all of services that are appropriate for their sex, age, culture, the medical supplies required to provide compre- and community context. Child survivors in the study areas hensive care. mainly access medical or health services at public health facilities,16 where the nature and quality of services vary Late reporting of cases inhibits a survivor’s timely greatly (see appendix B). Services are available for free to access to services, especially for sexual assault, UNHCR-registered refugees. because many refugees and locals are unaware of how important the early reporting of cases is. Overall, assessment results show that most of the health facilities lack adequate infrastructure to o er comprehen- The follow-up care needs of survivors are often sive sexual violence-related services; do not have facility- neglected. Follow-up with survivors after their level protocols for the clinical management of sexual first visit is generally suboptimal. violence; lack sta trained on the clinical care of sexual There is limited guidance on how to adapt 16. Both government and development partners provide health services in refu- gee-hosting areas. In host communities and refugee settlements, health service case-response services and psychosocial provision is dominated by the government. 44 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts assault survivors, such as how to adapt medical examina- VAC cases at the health-facility level remains poor, espe- tions and treatment for children; and often do not have all cially in host communities. The clinical treatment of trauma the medical supplies required to provide comprehensive requires that specialized services be delivered by qualified care. For example, some lower-level health facilities in the mental health professionals, such as counselors, medical host communities are unable to provide services according social workers, psychiatrists, psychotherapists, and clinical to the guidelines due to a lack of supplies, including emer- psychologists, but most facilities in the study settings lack gency contraceptives, sexual assault forensic evidence kits, such human resources (see appendix E). and disposable clothing to give to survivors whose clothing must be collected as evidence. Respondents from all study At the community level, child survivors of violence and districts report frequent stockouts of emergency contra- their families receive varying levels of counseling services ceptives. This leaves survivors, especially adolescent girls, from the district, subcounty, and village-level statutory vulnerable to early and unwanted pregnancies, HIV, and duty-bearers, including health workers, police, probation other sexually transmitted infections. and social welfare o cers, community development o cers, teachers, local council authorities, and RWCs. In Assessment results indicate that some providers treat settings where NGOs have established GBV and child violence as a clinical problem and therefore rarely refer sur- protection programs, field sta provide basic psychosocial vivors to other critical services for healing and recovery. In interventions for child survivors of sexual abuse, including addition, most facilities lack youth- or child-friendly spaces life skills training and activities to support their reintegra- that o er confidentiality and privacy. tion into society and community life, as well as supportive counseling o ered during the case management process.17 Participants reported that most of the survivors rarely seek While these interventions are essential, they are rarely medical services or do so too late to receive key interven- incorporated into comprehensive child sexual abuse and tions, such as emergency contraception or PEP. Decisions trauma treatment frameworks to promote sustained health to not seek care and delays in care seeking often mean and healing outcomes. Most of the field sta who directly that evidence is lost and survivors are left open to the risk respond to child survivors are not trained mental health of unwanted pregnancies and sexually transmitted infec- workers; they have limited skills and knowledge regarding tions. Lastly, the follow-up care needs of survivors are often the assessment or response to symptoms of trauma that a neglected. Findings reveal that there is hardly any follow up child might exhibit. of survivors after the initial contact with the health facility. Health workers either do not have time to conduct follow Community-based structures, such as para-social workers, up due to limited sta ng and heavy workloads or do not child protection committees, and village health teams, play see this as their mandate or duty. a key role in providing psychosocial support services to survivors, including counseling, advising them in seeking Mental health and psychosocial support legal support, and linking them to NGOs for additional help. Exposure to violence can lead to serious psychological However, members of these structures are not su ciently health impairment. Children exposed to violence, particu- trained in or knowledgeable about the handling of the larly sexual abuse, need access to age-appropriate mental various mental and psychosocial e ects associated with health and psychosocial support interventions to promote exposure to violence nor the basic types of psychosocial their healing and recovery. However, in both refugee and interventions needed to ensure that children and their host communities, access to specialized services is limited. families receive correct information about abuse and have Guidelines on the clinical care of survivors require health the opportunity to explore their thoughts and feelings workers to provide practical care and support to survivors, including diagnosing and treating any VAC-related trauma. 17. Some of these NGOs include the Lutheran World Federation, Transcultural Psychosocial Organization, Médicines Sans Frontièrs, International Rescue However, this study finds that the psychosocial response to Committee, CARE International, Danish Refugee Council, and Save the Children. 3. Assessment Results 45 about the information—a process often referred to as Justice and legal aid services “psychoeducation.” Access to justice is essential for the protection of the rights of children. The key duty bearers and actors in the formal Most actors responding to cases of VAC, whether in a justice system include police, health care providers (who clinical or nonclinical setting, have limited skills needed to collect scientific evidence in cases of assault and sexual ensure that a child’s best interests are considered when violence), the community-based services department, the determining response and treatment, including how to directorate of public prosecution and courts of judicature, interview and communicate with the child, the inclusion of and local council courts (see figure 3.1). Religious, cultural, (nono ending) family members in the healing process, the and other informal justice structures, as well as RWCs (in short- and long-term safety needs of the child, appropriate refugee settlements), are also relied on to resolve VAC confidentiality and informed consent procedures, and the cases. Overall, access to justice remains a challenge for upholding of a child’s right to participation and informa- children exposed to violence in refugee and host communi- tion. Guidance is limited on how to adapt case response ties. Some of the gaps and challenges are discussed below. services and psychosocial interventions designed for adult survivors to meet the specific needs of girls and boys. CASE REPORTING Assessment results show survivors of VAC rarely report CHILD FRIENDLY SPACES FOR CHILDREN their experiences or interface with the formal justice system Child-friendly spaces have become a widely used approach for a variety of reasons, including lack of trust or faith in the to protect and provide psychosocial support to children. formal justice system, lack of access to legal aid services, Notably, some organizations, such as Save the Children, and fear of reprisal from perpetrators. Unsuccessful inves- Danish Refugee Council, and Lutheran World Federation, tigative follow-up and failure to prosecute GBV cases have established child-friendly spaces in refugee settle- contribute to an environment of impunity that marginalizes ments in response to the psychosocial support needs of survivors and discourages reporting and help-seeking children. Children from host communities can also access behavior. In addition, widespread practices, such as blam- these spaces. Children can use these spaces to spend ing the survivor, shame, stigma, fear of reprisals, and threats time with others, to draw, to play, and to reflect on their of rejection by family and the community, are powerful experiences. Children who require specialized support are deterrents to reporting. The insensitive attitudes of police identified and referred or linked to relevant service provid- o cers and lack of follow-up action also deter survivors ers and other child protection actors. Psychosocial support and families from coming forward or prevent them from is provided to children who need it. pursuing a case. “We usually do a child participatory assessment to know Findings indicate that many survivors, their families, and the issues a ecting them and how they want to improve communities prefer to settle VAC cases out of court. In them as children. We engage them in sports; we engage some cases, girls are pressured to keep quiet about the in focus group discussions with adolescent girls just to violence to protect the perpetrator; in other cases, par- have them talk about issues that a ect them and how ents will exploit the situation for financial gain: instead of best they themselves can handle these issues.” reporting an incident to authorities, parents might tell the – Female key informant, Kyegegwa district perpetrator to “come and negotiate.” In such cases, even when the police insist on prosecuting a case, not much is However, the outcomes or impact of child-friendly spaces, achieved because the survivor will not come to court to especially the social and emotional well-being of children, provide testimony, frustrating the process. has not been rigorously evaluated in the context of forced displacement. 46 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts “Survivors in the settlements are silenced by the fear of The police are perceived as being lax in pursuing evidence. stigmatization and fear of retaliation from perpetrators For example, some participants report that the police rarely and the situation is compounded by a general mistrust of visit crime scenes and even more rarely capture perpe- the systems and community leaders. The absence of a trators or follow up on cases. It is also common for police witness protection law in Uganda aggravated this prob- to refer survivors back to their families or local leaders to lem, which in some cases forced complaints to withdraw solve problems. cases because of fear.” – Male key informant, Kyegegwa There are also several challenges related to the collec- tion of forensic evidence, particularly for cases of sexual Findings show the number of police o cers in most set- violence. The first concerns timing, which is critical. Ideally, tlements to be inadequate for responding to the needs of evidence should be collected within the first 72 hours after an increasing population; and a dearth of female o cers in an assault. However, many survivors are late in reporting particular remains a barrier to children coming forward to incidents. Such lapses of time impact the collection and report incidents of sexual assault. quality of evidence. Therefore, even once initiated, the prosecution of a sexual violence case can be plagued by a INVESTIGATIONS AND PROSECUTION OF VAC CASES lack of evidence. Overall, the capacity to conduct investigations is weak; and the dismissal rate for cases of violence against women Survivors can also hamper the e ective investigation of and girls is far higher than the conviction rate, resulting in VAC cases. For example, there are reported cases of a girl- impunity for perpetrators of VAC. Poor institutional capacity child survivor of sexual violence refusing to cooperate with significantly compromises the quality of police investiga- the police, insisting that she will not leave the station until tions. Participants reported that the police lack adequate her “husband” is released. personnel and resources to consistently conduct e ective investigations and evidence collection for cases of VAC. LEGAL AID AND SUPPORT SERVICES Both refugee and host communities face challenges to “When these matters [GBV or VAC cases] are brought, accessing legal aid services. While access to legal services at times you find they don’t succeed because of poor is a general problem in Uganda, it is worse in refugee- investigation or at times you find witnesses are not sum- hosting districts. Uganda does not have a state-funded moned, which is the work of the police to summon these legal aid system that is designed for children. witnesses, and sometimes cases are dismissed on such grounds.” A few legal aid service providers play an important role in – Key informant interview (justice, law, and order the provision of legal aid and survivor-support services at sector representative), Kiryandongo the district and community level, providing legal aid services that include in-person (with attorney) legal counseling or “We are supposed to educate the refugees and neighbor- referral via settlement-based help desks; mobile clinics; a ing communities to avoid VAC and to report cases when toll-free hotline; alternate dispute resolution (mediation), they occur; but we do little because of lack of resources. including training community leaders on mediation tech- Even the little we do is not continuous but only when niques; and representation in court for civil or criminal we have facilitation from partners. Sometimes we do not cases. Volunteers are recruited and trained to support have transport to do community sensitization or even to legal referrals and provide information about services in follow-up the case. As a result, people lose interest and communities. War Child Canada conducts mediation and abandon the cases …” trains communities and community leaders to distinguish – Key informant interview (police o cial), Nakivale between criminal cases that must be addressed through the formal system and cases that can be mediated. In addition, 3. Assessment Results 47 a legal advocate for the organization prepares and guides formal systems and tend to handle cases outside their juris- the survivor in the court process and advocates on behalf diction, increasing the risk that they will impose their own of the survivor throughout the legal process. To address the interpretation and position rather than protect the rights specific needs and constraints of the refugee community, and needs of survivors. Such an approach can inadvertently War Child Canada introduced mobile legal clinics to avoid pave the way to impunity. For example, interviewed groups refugees needing to travel long distances and/or incur travel discussed how cultural leaders prefer to deal with cases costs to access services. However, there are questions of incest and rape through mediation with the family; in regarding the sustainability of these services, which are case of rape, the family of the perpetrator is often invited largely project-based and reliant on donor funding. to financially compensate the family of the survivor without o ering further redress. TRIAL AND SENTENCING Study participants reported that some practices, such “However, accessing justice still meets challenges in as lengthy trials and the confrontation of a survivor with both settlements. The largest challenge is an adequate an alleged perpetrator, may have a particularly negative understanding of the laws and rights a orded to refugees impact on survivors, increasing the risk of retaliation and in Uganda by RWC leaders, the first actor notified after intimidation, and possibly resulting in the survivor’s loss of a crime had been committed. Often RWC leaders would trust in the justice system. Contexts where access to legal respond by utilizing cultural and traditional customs from aid services for survivors is limited and ad hoc aggravates their country of origin to address a case.” this situation. – Key informant interview (justice, law, and order sector representative), Adjumani Distances to courts of law also remain a problem for survivors in refugee and host communities. To address this CHILDREN IN CONFLICT WITH THE LAW problem, the judiciary has initiated the mobile court system The justice, law, and order sector institutions across study in the refugee settlements to enhance access to justice, sites continue to face challenges in meeting the needs of especially for refugees. Whether they are sustainable with- vulnerable groups in both host and refugee communities, out foreign donor support is another question. especially children in conflict with the law. INFORMAL JUSTICE MECHANISMS It is an international norm that children in conflict with Religious, cultural, and other informal justice structures, the law should to be separated from adults in detention as well as RWCs (in refugee settlements), are relied on to facilities. Such facilities should be adequate and conducive resolve cases of VAC. Their services are perceived as more to the child’s well-being and should take into consideration closely meeting the needs of child survivors than the criminal the vulnerability and fragility of children. This standard is justice system in terms of the immediacy with which they not met in refugee and host communities, where juvenile resolve problems, their focus on mediation and resolution detention and rehabilitation facilities are inadequate or rather than arrest and punishment, and their a ordability. entirely absent. Nonetheless, these mechanisms pose many risks to At Isingiro Police Station, there is what should be a sepa- survivors. Participants report that the actors in the informal rate detention room for juveniles, but the area’s children justice systems have a limited appreciation of international and family protection unit uses this same space during the human rights standards and that this a ects the delivery day for its o ce; it is only transformed into a cell at night. of justice. Issues of gender discrimination are evident both Children in custody are monitored only to the extent that within the composition of the administrative structures and they cannot leave the precinct station. At Kashwojwa Police the actual operations of the informal justice systems. In Post within the Nakivale refugee settlement, detained chil- addition, they are not systematically or e ectively linked to dren are kept in the space next to the reception desk. 48 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts There are no remand homes in any of the study districts, REFERRAL PATHWAYS except Arua. It is therefore common to have children detained alongside adults, increasing their risk of exposure KEY FINDINGS to multiple forms of violence. Even in Arua, where there is the Arua Regional Remand Home, the police still face chal- There is lack of standardized referral protocols lenges when dealing with children in custody. Even when with clear accountability and feedback mecha- a court remands a child to the home, there is no guarantee nisms for stakeholders from health, social wel- that a sta person will come to collect the child, even when fare, legal, and law enforcement sectors, as well requested to do so. as from members of local councils, community leaders, and psychosocial support providers. The courts lack the infrastructure—such as cameras— needed to appropriately try children accused of crimes, Referral mechanisms for GBV and VAC are not or to interview child witnesses who are victims of crime. functioning adequately and are perceived to be There are also gaps in the way cases involving juvenile ine ective at ensuring a continuum of support for o enders are handled by the police. In some cases, survivors of violence. children are reportedly tried as adults, and thereby denied the rights and procedures that would apply to them under Survivors are reluctant to seek services; and ser- the Children’s Act, which establishes family and children’s vices are poor or nonexistent at certain referral courts with friendly procedures and defines more condu- points. cive penal measures for children. Participants also indicate that, in some cases, police o cers Programming experiences show that survivors must be falsify the ages of children, recording them as being above linked to health, mental health, psychosocial, legal/justice, the age of 18 so that they will be tried as adults. This and security services through case management.18 This subjects children to criminal justice procedures that are necessitates inter- and intrasector coordination, including inconsistent with their vulnerability. If convicted, children the creation and monitoring of referral pathways, infor- face criminal sanctions that are neither appropriate nor in mation sharing, and participation in regular meetings with their best interest. representatives from the various sectors. The probation and social welfare services in the district, The National Referral Pathway for Prevention and Response which are necessary for handling cases that involve chil- to Gender-based Violence Cases in Uganda (MGLSD 2013) dren, are inadequate. Under the Children Act’s, probation outlines roles and responsibilities of the key duty bearers and social welfare o cers are expected to present to and actors and what services are available at di erent the court a social inquiry report on a child who is on trial. referral points. At the district level, key actors in the referral The report is supposed to indicate “the social and family process include the community-based service department, background, the circumstances in which the child is living the district health department, clinical providers, police, and the conditions under which the o ence was commit- local councilors (locally elected o cials), courts, NGOs, ted.” Unfortunately, such reports are rarely prepared or religious and cultural leaders, and donors. All duty bearers presented. along the referral pathway are obliged to ensure timely access to services by survivors. 18. Case management provides a system for coordination among all actors involved with a survivor so that everyone can work together and understand their respective roles. Regardless of how many or how few services are available in a community, and who provides them, coordination is essential. 3. Assessment Results 49 BOX 3.1 Bottlenecks in the Referral Pathway Separate multisectoral guidelines exist to address There are varying understandings around what the GBV and VAC in schools, but there are no multi- entry point into the referral system should be. sectoral guidelines to address GBV and VAC in all settings other than those in “Reporting, Tracking, Religious leaders and teachers are often not Referral and Response Guidelines on Violence involved in conversations around reporting, which Against Children in Schools” (Ministry of Education is viewed as a constraint. and Sports 2014). Financial costs related to reporting and accessing There is a poor understanding of the importance of services at referral points remain a key impediment. urgent bidirectional referrals, specifically between They include travel and other costs associated with police and health, or how important it is to deter- accessing services from various service points. mine if a case involves of sexual violence (and is therefore to be considered a criminal case). Stakeholders in both refugee settlements and host commu- l and duplicate mechanisms for di erent categories of survi- nities noted that some mechanisms exist to refer and link vors, with insu cient integration of multisectoral guidelines GBV and VAC survivors to services. For example, bidirec- and standard operating procedures for GBV and VAC. tional referrals occur between the health facilities and the Formal referral networks that integrate across services police. In addition, health and legal service providers and are virtually nonexistent. Consequently, most survivors are duty bearers, especially in refugee settlements, sometimes unable to access an essential package of multisectoral refer survivors to other providers (mainly NGOs) for psy- services—health care, mental health care, psychosocial chosocial and livelihood support and other social services. support, and justice/legal services. In refugee settlements, referrals are accessed primarily as walk-in clients at various service points through NGOs/ Further, given that GBV providers in refugee settlements United Nations o cers, RWCs, and focal persons for GBV, are overwhelmingly NGOs specializing in a variety of as well as toll-free hotlines that women and girls can call if services, linkages between them and other critical compo- they need support. nents of the governmental sector are even more crucial. Nearly all of such NGOs have cases referred to them and However, in both refugee and host communities, referral refer cases to other providers regularly and constantly. mechanisms do not function adequately and are perceived However, the overwhelming portion of referral arrange- as ine ective at ensuring a continuum of support for ments are “informal” and primarily based on networks survivors of violence. Some of the identified gaps include among individuals across organizations and institutions the lack of standardized referral protocols with clear rather than formalized institution-to-institution protocols. parameters of responsibility, accountability, and feedback Further, referral pathways in the settlements are discon- mechanisms, particularly in host communities; poor case nected from those at the district level. tracking; and limited follow-up of survivors to ensure that they promptly receive needed services. Existing protection Study findings also indicate challenges related to the mechanisms remain fragmented, often creating paralle reluctance of survivors to seek services and concerns over 50 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts the quality of services at various referral points, especially health facilities, community development departments, and in the government system. Some participants claimed, others). Since 2012, UNHCR and partners have used a GBV therefore, that referral is a problem, not in terms of the lack management information system—GBVMIS—in multiple of a system but in the lack of ability to ensure the delivery refugee settings; however, there is no interoperability of quality services. Implicit in all recommendations is the between that system and the GBV database. need to ensure that services and sites throughout the refer- ral chain are appropriate and responsive to the needs and In the health sector, GBV is reported using the Health realities of women and children experiencing violence. Management Information System’s “105 form,” which records GBV under the category of trauma or injury. The Further, the current application of the 70:30 principle, form also collects data on sexually transmitted infections which requires that 30 percent of the refugee response and miscarriages due to GBV. However, the form does not be allocated to host communities, remains unclear and link the provision of emergency contraceptives or contra- inconsistent. For example, participants reported that some ceptive use with the experience of GBV, nor does it collect service providers in refugee settlement are occasionally data on the number of unintended pregnancies that result constrained by organizational policies requiring them to such incidents. This disconnect results in a lack of reliable provide specific services solely to refugees. data on the number of GBV cases, the provision of health and family planning services, referrals, and family planning “I need to attach an attestation card [refugee reference outcomes—all of which limits the ability of decision makers number], it needs to be signed. Survivors must have a to plan and allocate resources to GBV and family planning number identifying them as a refugee, implying that a programs. The Uganda National Child Helpline is used for survivor who is a national even when referred may not collecting of VAC-related incident administrative data, but have that leverage.” it has not been e ectively rolled out in all districts. On the – Key informant interview (female), Isingiro other hand, UNCHR began rolling out the Child Protection Module in proGres V4 in refugee settlements in 2019— In terms of coordination mechanisms, all districts have a a parallel child protection case management information combination of disparate coordination groups, including and incident tracking system.19 ones addressing female genital mutilation, tra cking in persons, gender, children, specific groups of vulnerable Participants recommended that these case management children, GBV, and general protection. Such groups are systems be merged, harmonized, and linked with other often promoted and supported by various development systems, including, EMIS, the education management partners, with limited government coordination. information system; OVCMIS, the orphans and vulnerable children management information system, also managed by the Ministry of Gender Labour and Social Development); INFORMATION SYSTEMS CRVS, civil registration and vital statistics, supported by Currently, Uganda’s data collection systems are fragmented UNICEF; and justice, law, and order sector institutions— and used only sporadically in the refugee-hosting districts. Uganda Police Force, Directorate of Public Prosecution, The Ministry of Gender Labour and Social Development has and the judiciary—which themselves need to be linked and taken steps to improve GBV data and reporting through integrated with one another. Integration and/or harmoni- the development and implementation of the national GBV zation of data systems and collection processes will not database, also managed by the ministry. The database aims only reduce fragmentation and improve reporting but will to collect, store, and analyze GBV incident data across all also support more e ective and coordinated responses to districts. It uses the GBV incident report form to ensure 19. UNHCR Monthly Protection Update Child Protection that consistent data are collected by all actors (e.g., police, is available at https://reliefweb.int/report/uganda/ unhcr-monthly-protection-update-child-protection-cp-november-201. 3. Assessment Results 51 incidents of violence against women and girls and move Economic empowerment programs are not toward the formation of a single data protection system. always coupled with gender/social norm change components to reduce potential negative consequences. MONITORING AND EVALUATION Participants expressed the need for better monitoring and Despite the recognition of overlapping risks and evaluation (M&E), especially of GBV and VAC programs intervention opportunities, GBV prevention and in both refugee and host communities. Calls for improved child protection programming continues to occur M&E also reflect concerns and questions about the qual- separately or in silos in both refugee and host ity of the services being delivered. There is an overall communities. perception among the key informants interviewed that current M&E of GBV and child protection interventions is focused on outputs, while little is known about the quality Preventing GBV—to stop it from happening in the first of the services provided or of the outcomes and impacts of place—is a key priority in the context of host and refugee programs. Information on the e ects of existing programs communities. E ective GBV prevention requires holistic is also seen as limited, irregular, and not su ciently sys- interventions to tackle the multiple drivers of GBV at the tematic to demonstrate linkages between services, referral di erent levels of the socioecological model. The mapping pathways, and outcomes. The findings underscore the reveals that most of the GBV prevention interventions need for GBV interventions to be followed up on, not just mainly center on changing values and norms that underpin with impact evaluations, but also with in-depth analyses of GBV through community mobilization and awareness- the mechanisms for success or failure. This would allow for raising and economic empowerment for women and girls a better understanding of scalability, viability, and impact of (see appendix C). contextual factors, including program implementation (e.g., expertise and human resources), as well as buy-in from Awareness-raising interventions donors, local leaders, and a ected populations. A wide range of NGOs are implementing activities aimed at increasing community awareness of GBV and promoting gender equality and nonviolence in both refugee and host ASSESSMENT OF GBV AND VAC communities. Activities include mass media campaigns; PREVENTION PROGRAMS the distribution of information, education, and communi- cation materials; and community-based education ses- GBV prevention programs sions. Mass media campaigns often employ one or more platforms, such as television and radio (announcements KEY FINDINGS and programming), print media (including newspapers, billboards, posters, and flyers), and cellular text messaging. There is limited adherence/fidelity to implement- For example, the Action for Human Rights and Education ing and scaling up models of GBV prevention Initiative–Uganda is currently running the “We Can” cam- that have been rigorously evaluated through paign in the West Nile districts of Arua, Koboko, Yumbe, national systems and local structures. Moyo, and Adjumani. The campaign is aimed at changing social attitudes and beliefs that promote the perpetration GBV risk mitigation and prevention strategies are of GBV. The campaign utilizes an innovative model that not widely embedded in existing services and links awareness-raising with the creation of a mass move- institutional responses. ment of people (“change-makers”) who publicly denounce GBV. Each change-maker commits to recruiting 10 others into the mass movement. There are currently over 17,000 change-makers in the West Nile region. 52 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts In addition, some programs work with religious and com- Language barriers and low literacy levels among many munity leaders, as well as a broad range of other actors, to women and girls in the refugee/displacement context pres- foster community discussions on GBV issues and increase ent key challenges to the delivery of e ective messaging awareness of existing GBV services—often as part of on issues such as GBV and sexual and reproductive health broader community-based GBV prevention programs. The that would enable their access to services. Information, assessment shows that working with cultural and religious education, and communication materials that are in English, leaders as change agents rather than as target audiences such as messaging boards, are not accessible to many refu- for partner interventions expands the community resource gee women and girls from several ethnic groups spanning base, promotes e cient resource use through the utiliza- national boundaries. The limited number of refugee women tion of existing trusted systems, and promotes sustainable and girls with language and literacy skills also means that programming. there is a relatively small pool of potential candidates for community-based roles (e.g., community-based facilitators, Some programs are focused on addressing the low levels volunteer health trainers, and change agents), which are of legal literacy by advancing knowledge about the laws critical to the delivery of the community-based GBV mobili- regarding violence against women and girls; harmful prac- zation and prevention model. The use of translators for the tices; and rights, laws, and policies regarding sexual and delivery of training and capacity-building inputs has report- reproductive health. Most of the programs target commu- edly been a partially e ective solution. nities, duty bearers, and religious and cultural leaders, with a particular emphasis on reaching women and girls facing Social norm change intersecting forms of discrimination. Common approaches Community mobilization has also been employed by some include ensuring that relevant laws are simplified and trans- organizations to transform the social norms that foster lated and using multimedia and innovate approaches, such violence against women. This approach relies on building as drama, brochures, radio, social media, and curriculum up networks of people and leaders within communities who supplements, to disseminate key laws. will work together to create an environment in which vio- lence is no longer seen as socially acceptable. For exam- Findings, however, reveal several gaps and challenges. ple, UNHCR and partners (e.g., Danish Refugee Council, First, most of the awareness-raising activities are neither Lutheran World Federation, and Humanitarian Initiative Just rigorously planned nor grounded in well-articulated Relief Aid) have been supporting interventions aimed at theories of change. In addition, the e ectiveness of behavior and social norm change, utilizing evidence models awareness-raising and sensitization programs are limited including the SASA! methodology,20 which utilizes a struc- by funding cycles that only allow for short-term interven- tured community engagement approach to guide entire tions promoting behavioral changes. Sustaining behavior communities through the stages of change in addressing change is often problematic after the funding for project underlying beliefs, social norms, and attitudes that perpetu- activities ends. Further, while awareness-raising e orts are ate violence against women and girls.21 creating a demand for services, access to services remains a challenge. Several service-related gaps—such as lack of 20. The SASA! methodology utilizes a structured community engagement and phased approach to address underlying beliefs, social norms, and attitudes that per- safe spaces for survivors at police stations and a lack of petuate violence against women and girls. A cluster randomized controlled trial of the essential health supplies—prevent people motivated by an SASA! methodology in Uganda revealed a 52 percent reduction in intimate partner violence against women in SASA! communities. awareness program from receiving actual GBV services. In 21. Evidence has shown that standalone programming solely targeted at men are less e ective. Placing the responsibility for change on men alone perpetuates gender such circumstances, communities can begin to lose confi- inequality. Placing a duty on men for social norms change further reinforces patriar- dence in the program’s messaging and integrity. chal values, beliefs, and practices that promote male privilege and the perceived role of men in society. Hence, there is a need for a whole-society approach that engages all key segments, such as traditional and religious leaders, boys and men, and women and girls, to promote positive skills and behavior change through enhanced accountability at the individual, relationship, and community levels. 3. Assessment Results 53 Other evidence-based models, such as the “Zero Tolerance taken through a series of training modules, mentorship, Village Alliance” intervention, have also been adapted and coaching, and dialogue sessions. Over 2,100 men and implemented in refugee settlements. Evidence indicates boys have been trained in this program across the refugee that this type of model is e ective at moderating negative settlements of West Nile region and Lamwo in Acholi sub- gender attitudes and beliefs related to GBV; positively region, northern and southwestern Uganda, who have then changing perceptions of community GBV norms; reduc- mentored and supported over 11,000 other men and boys. ing the occurrence of physical IPV (for men and women), sexual IPV (for men), nonpartner physical violence (for men Socioeconomic empowerment and women), and nonpartner sexual violence (for women); Economic vulnerability is a key driver of GBV, and promot- engendering a more comprehensive understanding of rape; ing women’s economic empowerment is fundamental to and increasing awareness of GBV interventions (Undie et reducing vulnerability. Several organizations, including the al. 2016). However, the model is less e ective at changing Lutheran World Federation, the Danish Refugee Council, negative male attitudes toward women’s sexual autonomy AVSI, BRAC, Oxfam, and CARE International, are imple- in intimate partnerships (Undie et al. 2016). menting activities focused on addressing the socioeco- nomic vulnerabilities that predispose women to GBV in Overall, most behavioral and social norm change activities refugee settlements. Activities include the provision of cash among refugees are not embedded in a comprehensive transfers, village savings and loan associations, life skills approach toward addressing core drivers and risk factors training, vocational skills training, and livelihood support. of GBV and VAC, nor are they adapted to national systems Some organizations combine two or more approaches to and structures. In addition, while the use of evidence-based address multiple socioeconomic insecurities. For example, models is commendable, less attention has been given the Lutheran World Federation’s support to women farmer to the issue of intervention fidelity, rendering some of the groups uses a combination of cash grants, seed vouchers, models less e ective. Lastly, sustained behavior and norm and training to improve agronomic practices with a village changes are constrained by the constant influx of refugees. savings and loan association start-up. Engaging men and boys Other organizations have built innovative mechanisms to Several organizations have targeted men and boys as address gaps in specific approaches to women’s socio- agents of change in challenging established gender norms. economic empowerment. For example, based on the gaps Interventions by these organizations focus on promoting in the village savings and loan association methodology, gender-equitable relationships between men and women CARE International decided to link women and youth by engaging men in discussions that explore rigid and groups to formal financial services that are less prone to harmful ideas of masculinity, enable critical reflection about risks of fraud and collapse. An evaluation of the CARE gender roles and norms, challenge the unequal distribution program reveals that beneficiary groups continue to work of resources, and redress power imbalances. with formal financial institutions even after support initia- tives end. The model has been adopted by other promoters The approaches range from participatory group education of village savings and loan associations, although some of to using peer-based methodologies. For example, CARE these organizations rushed the linkage approach, putting International in Uganda uses the “Role Model Men and women and youth groups at risk of being exploited by Boys” approach to explore constructions of masculinity in formal financial institutions (CARE International 2018). its contexts and how it a ects well-being and relationships. Participants reflect on unequal power relations, gender Nonetheless, economic empowerment programs are not roles, and rigid social norms that impact the behavior of always coupled with gender/social norm change com- women, girls, men, and boys. Selected men and boys are ponents to reduce potential negative consequences. In 54 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts addition, there are only a few programs that directly target However, there is currently a lack of robust evidence about men. Because of the complexity of gender identities and the e ectiveness, cost, scalability, and sustainability of such relationships, the failure to engage men in women’s eco- community-based child protection mechanisms. nomic empowerment interventions can sometimes lead to negative impacts on beneficiaries. Parenting and caregiver support Some parenting programs have been implemented to Participants suggested that it is important for economic reduce VAC and promote child development, especially empowerment programs to target family members and in refugee settlements. NGOs such as the Association husbands with specific training aimed at challenging estab- of Volunteers in International Service, Lutheran World lished gender norms and to encourage mutual understand- Federation, Agency for Technical Cooperation and ing among household members and behavioral change Development, Redeemer Children’s Home, Save the among men in support of their wives or other female Children, and the Danish Refugee Council have developed relatives seeking economic empowerment or creating and implemented parenting programs, usually delivered in a business. The promotion of positive masculinities can groups. Sessions focus on issues such as brain develop- lead to the creation of healthier relationships and a more ment, empathy, positive communication, positive discipline, gender-equal division of tasks. supportive guidance, and routines. Parents and caregivers have the opportunity to share their feelings and fears about child care and are guided on how to be more tolerant and VAC prevention programs accepting of children, a norm that helps prevent VAC. Several organizations have taken steps to address the drivers of VAC in both refugee and host communities. AVSI developed and implemented a parenting training Approaches to prevention cluster into four areas, outlined program in Kyangwali and Omugo Refugee Settlements to the INSPIRE package:22 (1) changing norms and values; equip both young and older parents with parenting skills, (2) parent and caregiver support; (3) education and life skills to help them understand who they are, reflect on their training; and (4) income and economic strengthening (see parenting responsibilities, and adopt positive (authorita- appendix C for a complete list). tive) parenting behavior. AVSI utilizes a parenting skills model that comprises five modules built on the hypothesis Changing norms and values that parenting skills training increases knowledge among Changing attitudes and norms is key to preventing VAC participants, which translates into improved parenting in refugee and host communities. Cognizant of this, sev- behavior and ultimately results in the improved well-being eral organizations are undertaking interventions aimed of children, including those living in extreme conditions of at raising awareness and reducing social tolerance for poverty, abuse, and conflict. VAC. The main methods and approaches employed include the distribution of information, education, and One key informant who attended the training reported communication materials; group-based education; and that the program has led to a considerable reduction community-based campaign activism. Regarding the latter, in harsh parenting practices and improved parent-child some organizations have established or support existing relationships. community-based child protection structures—such as RWCs, para-social workers, child protection committees, and peacebuilding committees—to mobilize and engage communities in identifying and addressing protection risks. 22. The INSPIRE package includes seven strategies that together provide an overar- ching framework for ending violence against children. 3. Assessment Results 55 “I used to beat my children. I was confident that the only Ensuring safe and enabling school way to teach them something was by using physical pun- environments ishment, but I was wrong. Today my relationship with them Access to quality education can protect against both has changed. My children don’t fear me anymore and I victimization and perpetration of certain forms of vio- enjoy spending time with them. I tell stories about our lence. Therefore, a few programs have been developed home and what we left there; I want them to be responsi- to promote educational access and quality of learning for ble because they are the future of our country.” children in refugee and local host communities—in line with – Key informant interview (female), Kikuube District the Uganda Education Response Plan for refugees and (formerly Hoima District) host communities. Specific interventions have focused on constructing new classrooms, building gender-sensitive Nonetheless, the assessment did not come across any par- sanitation facilities, training teachers, and providing scho- enting program that is combining parenting education with lastic materials. However, the need remains enormous. For norm trainings, even though there is evidence suggesting example, where schools are present, they are few, con- that such programs improve parent-child interactions and gested, far away, and have a high student-to-teacher ratio, reduce abusive punishments. These programs have not leaving learners demotivated and hampering retention and been rigorously evaluated to determine how exactly they progression. reduce VAC. “NGOs have done a lot with training teachers in keeping Economic empowerment of vulnerable children free from violence … I am happy that DRDIP is households coming in to address the issue of infrastructure in schools Organizations such as the Danish Refugee Council and because partners have done little in ensuring that the Save the Children implement household economic existing infrastructure promotes the safety and well-being strengthening interventions to reduce the economic of learners.” vulnerabilities of families and empower them to provide for – Key informant interview (male), Adjumani the essential needs of the children under their care. This includes providing cash transfers and income-generating Some programs have focused on ensuring safe and activities to families. Notably, existing interventions loosely enabling school environments, including using peer-based combine income and economic strengthening with training methodologies to empower children, educating them about in positive parent-child relationships. The interventions their rights and responsibilities, training senior men and do not systematically integrate gender equity, gender- women teachers on VAC prevention and response, train- transformative activities, or social norm training and, ing teachers on alternatives to corporal punishment, and according to some study participants, consequently put working with schools to enforce the professional code of children at greater risk of victimization. conduct for teaching and nonteaching sta . A few interven- tions focus on developing children’s life skills and building “The work our partners do is great. When one tells a story knowledge around safe behaviors. For example, the about what they are doing, the first impression is that they International Rescue Committee is implementing the Girl strengthen the families, but if you go deep to find out how Shine model and resource package in Imvepi and Omugo the income is being used, you will find that girls are still refugee settlements. The intervention provides girls with being marginalized. Though income increases, they still the skills and knowledge required to identify types of GBV prefer to take boys to school and girls are married o .” and seek support services if they experience or are at risk – Key informant interview (female), Isingiro district of GBV.23 23. Available at https://resourcecentre.savethechildren.net/library/girl-shine. 56 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts However, less has been done to train and mentor program “We also get children to foster parents. However, for sta and teachers to adapt their learning environment, example, if a refugee child says that they don’t want equip schools, and adapt their learning materials to be to stay with a foster parent, we get them another one inclusive. Participants also observed that most of the immediately because we have children who do not have programs focus on improving access and quality of primary parents and in case we find out that the child is su ering education. There are very few postprimary education initia- in the hands of one guardian we can always assign them tives in refugee and host communities. another.” – Key informant interview (male), Kiryandongo Family tracing and reunification Child-family separation is known to increase the risk of “We have formed various parent support groups within VAC. In refugee-hosting communities, the Ugandan govern- the community, and these support the implementation of ment’s district-level community-based service department our child protection activities. We have foster parents for facilitates and supports family tracing and reunification of unaccompanied refugee children. So, for the foster par- separated children. However, the department is under- ents and other parents and caregivers especially for the sta ed and underfunded, posing challenges to the process, refugee families, we bring them together in parent sup- which involves substantial logistical requirements that port groups and we always engage them in dialogues and should be sustained over a long period of time. Within train them on parenting after identifying their challenges.” refugee settlements, family tracing and reunification – Key informant interview (female), Kiryandongo programming for separated children is mostly done by the International Committee of the Red Cross. However, participants identified several gaps and chal- lenges in providing care for unaccompanied or sepa- Alternative care for unaccompanied and rated children. For example, some participants reported separated children that foster families often receive inadequate support; All unaccompanied or separated children are identified and potentially hampering child protection outcomes. In addi- registered upon arrival at the various reception centers; tion, children in foster care are often discriminated against they are then referred to designated child protection part- within the foster family, such as being assigned domestic ners for a best-interest assessment. In the study communi- tasks and not having access to schooling. Cash grants ties, most are placed in foster care arrangements. UNHCR provided to foster families can create tensions and increase neither encourages nor promotes the institutional care of the risk of IPV. Lastly, the assessment showed that e ec- unaccompanied or separated children. tive foster care for unaccompanied or separated children requires improved cultural sensitivity and additional support Working with the district-level police, child and family pro- and training for professionals and foster families to be able tection units, and the probation and welfare o cers, orga- to adequately support the complex needs of these children. nizations such as Inter-AID identify and place children with foster parents. Social workers assess foster parents and the Participants acknowledged the need to organize better care arrangement through interviews and home visits and support for foster families given the context and their provide counseling to the foster parents on their roles and vulnerability, noting that families might not be ready or responsibilities. Foster parents and receiving communities equipped to receive children who have experienced receive support in the form of regular monitoring visits as trauma. They recommended that the refugee community be a follow-up by child protection sta and caseworkers. For involved in the identification of foster families and pointed example, Inter-AID operates a foster parenting program that to the need for more robust monitoring mechanisms and places children with families, which is often followed by the capacity to follow up on cases and to identify and prevent building of houses for these families. Several unaccompa- cases of abuse and violence. nied and separated children have been placed with foster families with excellent results. 3. Assessment Results 57 4 Conclusions 58 59 G ender-based violence (GBV) and violence against profoundly ill-equipped to support and assist survivors. children (VAC) are widespread in refugee-hosting Moreover, the long distances from the settlements to where communities. The assessment shows that GBV the services are o ered often prohibit optimal access to and VAC are pervasive in refugee-hosting communities and such services. Consequently, most survivors are unable identifies perceived drivers and risk factors associated with to access an essential package of multisectoral services— victimization. The most common form of GBV is intimate health care, mental health care, psychosocial support, and partner violence (IPV). In general, the drivers of GBV and justice/legal services. In some cases, utilization of services VAC in the host communities are similar to those docu- is limited to seeking one of the available services—for mented in refugee settlements in Uganda (see UNHCR and example, a survivor may seek health services but may not OPM 2019; Global Women’s Institute et al. 2019; Sengupta follow up on referrals to law enforcement or psycho- and Calo 2016). For example, poverty and the lack of social services. This is attributed to gaps and bottlenecks in livelihood opportunities, substance abuse, and cultural and the existing referral systems, including the lack of stan- gender norms are identified as key drivers of GBV and VAC dardized referral protocols, poor case tracking, and limited in both refugee and host communities. follow-up with survivors to ensure they promptly receive needed services. Poor initial experiences with service GBV and VAC are closely interlinked. The rapid assess- providers and perceptions among survivors regarding the ment identifies several intersections between GBV and quality and safety of services are also identified as barriers VAC, consistent with other studies. For example, poverty, to follow-up care and/or utilization of other referrals across alcohol, and substance abuse are linked to violence against study sites. Specific identified gaps in terms of prevention children, as well as with IPV. In addition, both GBV and VAC and response are described below. are buttressed by social norms that appear to deem such violence normal, acceptable, or even justified. IPV is also Health sector response. Access to high quality, confiden- found to be closely linked with both physical and psycho- tial, and integrated health care services is a critical and logical violence against children. Findings indicate that life-saving component of a multisector response. However, children in households where women experience IPV are findings indicate that the majority of survivors in both perceived to be at a higher risk of VAC. Despite the recog- hosting and refugee communities rarely seek medical assis- nition of overlapping risks and intervention opportunities, tance. Even among those who do seek health care, miscon- GBV and child protection programming continues to occur ceptions around the nature of risk faced and the necessary separately or in silos in refugee and host communities, with preventative treatment results in late reporting. In addition, di erent funding streams and actors. For example, di erent most of the lower-level facilities lack sta trained in the partners are implementing parallel norm changes for GBV clinical management of sexual assault survivors and the and VAC even where there are strong normative overlaps, necessary medical supplies to treat survivors of violence, which is very ine cient. particularly sexual violence. In most cases, survivors are referred to higher-level facilities—health center (HC) IVs and GBV and VAC prevention and response in refugee and referral hospitals—many of which are located far from the host communities remains inadequate. Overall, e ective refugee and host communities, creating a barrier to access- GBV and VAC case management continues to be under- ing services. Follow-up services are scarce; after the initial mined by the lack of accessible, integrated services and treatment, most survivors are never contacted again. reporting mechanisms; weak institutional capacity across sectors (justice, health, education, and social welfare); and Mental health and psychosocial support. Respondents the absence of e ective coordination of services in all identified a dearth of psychosocial services to address refugee-hosting districts. For example, medical services trauma as the largest GBV-related programming gap, partic- and the justice system, including police and the courts, are ularly in host communities. 60 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts 4. Opportunities for Joint Programming 61 The capacity to diagnose and treat trauma associated with children, has not been rigorously evaluated in the context exposure to violence remains low in most health facilities of forced displacement. located in refugee and host communities. Most facilities lack key personnel who can handle such issues, such Safety and security (protection) services. The capacity of as medical social workers, psychotherapists, and clinical the police to prevent, investigate, prosecute, and punish psychologists. In addition, there is limited use of structured GBV crimes and to protect and support survivors remains therapeutic interventions, such as cognitive-behavioral low across the study sites. Most police stations and posts treatment therapy for trauma across government and lack adequate personnel and resources to e ectively nongovernmental organizations. Child-friendly spaces have address the security and safety needs of VAC and GBV become a widely used approach to protect and provide survivors. The problem is exacerbated by the absence of a psychosocial support to children, but their outcomes or robust system that allows survivors to access safe shel- impact, especially on the social and emotional well-being of ter when they do not feel safe returning to their place of residence. 62 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts Justice and legal aid services. Only a small fraction of Weak and parallel information management systems GBV and VAC cases are reported and prosecuted through and data. Information management systems for GBV the legal system; even fewer result in conviction. Factors and VAC are fragmented and sporadically utilized in the hindering the prosecution of GBV cases include challenges refugee-hosting districts. In addition, the overall percep- arising out of the initial phases of GBV-related investigation, tion among the key informants interviewed is that current costs associated with accessing justice, and distance to monitoring and evaluation of GBV and child protection courts. All justice, law, and order sector institutions have interventions focus on outputs, while little is known about serious logistical and human resource deficiencies, which the quality of the services provided or the outcomes and negatively impacts their capacity to e ectively and e - impacts of programs. ciently discharge their functions. For example, the quality of police investigations is hampered by a dearth of o cers GBV and VAC prevention programs. E ective prevention with specialized skills in handling GBV cases and a lack of of GBV and VAC requires multiple interventions at multiple basic equipment, such as vehicles, medical examination levels (individual, interpersonal, community, and societal). forms, and paper, which are necessary for conducting an While some prevention programs exist in refugee and e ective GBV investigation. In addition, access to legal aid host communities, participants identified several gaps. For services also remains an enormous challenge. While some example, only a few interventions focus on addressing VAC nongovernmental organizations are o ering legal services, and GBV drivers at various levels through an integrated they are overstretched and mainly support the refugee and multipronged approach. In addition, there are few communities. Finally, because of problems associated with socioeconomic empowerment programs for women and accessing the formal criminal justice system, many survi- adolescent girls. Finally, there remains a limited body of vors and their families do not report cases, or they rely on evidence on the e ectiveness of GBV and VAC prevention informal justice mechanisms. programs, interventions, and strategies, especially among refugee populations. Coordination and referral systems. Problems of coordi- nation across all the di erent actors and sectors constitute Funding gap and donor-driven funding. In the absence another key obstacle to e ective GBV and child protection of strong government investment in GBV prevention and programming. In addition, while the role of referrals in response, donors and nongovernmental organizations facilitating access to multisectoral GBV services is recog- are filling the funding gap by implementing GBV projects nized, the e ectiveness of the referral system across study and/or providing direct funding to district governments, sites continues to be undermined by the lack of standard particularly in refugee communities. District authorities protocols that stipulate clear roles and responsibilities, greatly appreciate and value donor-funded projects, and insu cient resources, inadequate services at referral many respondents reported that close coordination with points, and the reluctance of survivors to seek services. donors and NGOs enables them to implement GBV and Even the proximity of these institutions to address GBV and child protection programs. However, the sustainability of VAC remains an issue. these donor-driven programs is an issue. 4. Opportunities for Joint Programming 63 5 Recommendations 64 65 1. Mitigate and prevent GBV and VAC risks in develop- Strengthen coordination and referral mechanisms that ment responses to forced displacement. Awareness is are necessary to support e ective case management growing that the humanitarian model of care and mainte- and to ensure that survivors are identified, that their nance is unsustainable over the long term and that forced needs are correctly assessed, and that they receive displacement requires a development response to comple- cross-sectoral support. Protocols should be devel- ment humanitarian assistance. However, emerging evidence oped and implemented to establish clear referral and indicates that if appropriate safeguard measures are not accountability mechanisms within and across sectors instituted, development projects can exacerbate existing so that survivors know where to go to receive assis- risks of GBV and VAC or create new ones. For example, tance, and that they receive it promptly. In addition, the projects create changes in the communities in which they coordination mechanism among and between multi- operate and can cause shifts in power dynamics between sectoral and interagency GBV and child protection community members and within households. Therefore, actors should be strengthened at the local level. development projects such as Uganda DRDIP should consider the potential negative impacts and implement Build community capacity where possible, especially measures across the program to mitigate any VAC and among local leaders and refugee welfare committees GBV-related risks that could result from project activities or so that they can handle cases of GBV and VAC appro- exacerbate those that already exist in the community. priately and refer cases to formal services as required by the referral pathways. 2. Strengthen and enhance multisectoral services at all levels. E ective gender-based violence (GBV) and violence 3. Scale up evidence-based family and community-based against children (VAC) case management continues to violence prevention mechanisms in both refugee and be undermined by weak institutional capacity across key host communities. The range of drivers and risk factors for sectors of justice, health, education, and social welfare. VAC and GBV at the various levels of the socioecological Specific activities could focus on strengthening the case framework needs to be addressed through a multipronged management capacity of GBV and child protection actors approach, reflecting recent evidence of what works. Such and duty bearers across these key sectors to ensure that an intervention could aim to: survivors access quality essential services, including: Change social norms that deem violence against Provide technical training and mentorship to build the women or violence against children to be acceptable capacity of duty bearers and actors to manage, coordi- through community-based violence prevention pro- nate and refer survivors to relevant services; improve grams. Evidence-based community mobilization and confidentiality and cultural sensitivity in the delivery social norm change approaches such as the SASA! of services; and adhere to existing national and inter- methodology should be adapted or contextualized and national standards, guidelines, and protocols (see implemented by district/local government structures appendix A). At a minimum, relevant sta involved in for scale and sustainability. This may require, over the the provision of services to GBV and VAC survivors in short and long-term, building the capacity of govern- the areas of health, psychosocial support, legal advice, ment structures and duty bearers, such as probation and security should be trained in survivor-centered and social welfare o cers and community development trauma-informed approaches. o cers, through training and mentorship to ensure e ective implementation and institutionalization. Ensure that the various actors and institutions have the facilities and logistical capabilities they need to e ec- Develop and implement parenting programs to pre- tively execute their mandates. vent intimate partner violence and child maltreatment that teaches parents to build nurturing relationships with their children and to use appropriate nonviolent 66 Gender-based Violence and Violence Against Children Prevention and Response Services in Uganda’s Refugee-Hosting Districts discipline as key to the prevention of violence against 4. Consider and address intersections between GBV and women and girls. Such programs should build on and VAC. The nexus between GBV and VAC highlight the need take into account the Ministry of Gender Labour and for greater collaboration and integrated programming to Social Development’s national parenting guidelines as address both forms of violence. There is a need to break well as those of United Nations (UN) agencies. conceptual “silent spaces” across GBV and child protection programming while also recognizing that in some instances Support economic and social empowerment for women the two fields call for dedicated approaches focused on and adolescent girls because the relationship between areas of common ground, when possible (e.g., addressing violence against women and girls with poverty and eco- shared risk factors—including social norms—that underpin nomic insecurity are well documented. Promoting wom- both forms of violence and preparing service providers en’s protection through strategic interventions, including to address both GBV and VAC). In addition, e orts should livelihood and economic opportunities, is critical to be made to assess the added value of coordinated e orts reducing GBV vulnerability. Adolescent girls experience to prevent and respond to these forms of violence in an specific vulnerabilities, and evidence-based interven- integrated way. tions focused on building the livelihoods and life skills of adolescent girls, such as the BRAC’s Empowerment and 5. Bridge the humanitarian–development divide in GBV Livelihoods for Adolescents model, could be adapted or and child protection programming. The gap between the contextualized and then implemented under the liveli- humanitarian and development responses to addressing hood component of the Uganda Development Response GBV- and VAC-related risks must be reduced through to Displacement Impacts Project (DRDIP). deliberate e orts. The Comprehensive Refugee Response Framework underscores the need to shift from a mainly Develop and implement school-based violence preven- emergency focus to a more sustainable, integrated tion programs because school environments in refugee approach that addresses immediate humanitarian needs and host communities remain hot spots for VAC. They as well as to longer-term investments toward recovery and also provide ideal environments for challenging harmful development. It also provides important entry points and social and cultural norms (standards or patterns that are opportunities for humanitarian and development actors to typical or expected) that tolerate violence toward oth- work together to contribute to the building of an integrated ers (e.g., GBV). School-based violence prevention pro- protection system that ensures a more integrated and grams should focus on developing children’s life skills, sustainable GBV and VAC prevention and response. For building knowledge around safe behaviors, challenging example, humanitarian and development partners could social and cultural norms, promoting equitable relation- work together to ensure the integration of information ships, and developing the skills of teachers to promote systems and reporting in addition to referral pathways and positive interactions with children. Some nongovern- case management. The humanitarian–development nexus mental organizations (NGOs) and UN agencies have and commitment to the “New Way of Working”25 provides piloted successful school-based violence prevention another opportunity for humanitarian and development programs, such as the UNICEF’s child-friendly-schools actors to work collaboratively (i.e., to break down silos), model and Raising Voices’ “Good School” toolkit, which including aligning funding and financing modalities to could be easily replicated and scaled up in refugee and strengthen district- and national-level systems to address host communities. These programs should also support the protection needs of refugee and host communities. the roll-out of the Ministry of Education and Sports’ “Reporting, Tracking, Referral and Response Guidelines on Violence Against Children in Schools” (2014).24 25. The New Way of Working, or NWOW, is an approach promoted by the UN Joint 24. The ministry’s guidelines complement the child-friendly-schools model and Steering Committee to advance humanitarian and development collaboration. The are designed to improve reporting by children and school o cials of incidents of approach calls on humanitarian and development actors to work together collabo- violence against children/girls and to be integrated with the broader district referral ratively, based on their comparative advantages, toward “collective outcomes” that and response systems. reduce need, risk, and vulnerability over multiple years (UN OCHA 2017). 5. Conclusions 67 References Care International. 2017. GBV Experiences of South Sudanese Women and Horn, R., E. S. Pu er, E. Roesch, and H. Lehmann. 2014. “Women’s Girls on the Run to Uganda: A Case Study from Busia to Imvepi. Arua Perceptions of E ects of War on Intimate Partner Violence and Gender District, Uganda. 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Population Council. https://www.popcouncil.org/uploads/pdfs/2016RH_ Economic Impact of Refugee Settlement in Uganda. Policy Report. SGBVPreventionUgandaZTVA.pdf. Kampala: United Nations Food Program. References 69 Appendixes 70 71 APPENDIX A. LIST OF DOCUMENTS REVIEWED National level Statutory instruments Legal and Policy Documents The Domestic Violence Act Regulations, 2011 (Statutory Children’s Act Cap 59, amended in 2016 Instruments No. 59) Local Government Act, 1997 The Children (Family and Children Court) Rules (Statutory Instrument No. 592) Police Act, 2000 Employment (Sexual Harassment) Regulations, 2012 Penal Code Act, Cap 120, as amended (Statutory Instrument No. 15) Local Council Courts Act Standards, guidelines, and regulations Constitution of the Republic of Uganda 1995, as Ministry of Gender, Labour and Social Development. amended 2013. Guidelines and Procedures for the Operation of Shelters in Uganda. Sexual O ences Bill, 2011 Medico-legal Manual, 2014 Domestic Violence Act, 2010 FIDA-U and the Judicial Studies institute. 2011. Judicial Magistrates’ Courts Act, 2007 (amendment) Training Manual on Sexual and Gender-Based Violence. Prevention of Tra cking in Persons Act, 2009 Center for Domestic Violence Prevention (CEDOVIP) Employment Act and Uganda Police Force. 2007. Responding to Domestic Violence: A Handbook for the Uganda Police National Policy and Action Plan on Elimination of Force. Gender-Based Violence in Uganda, MGLSD, 2016 Raising Voices. 2008 SASA! Activist Kit for Preventing National Strategic Plan on Violence Against Children Violence against Women and HIV. in School, 2015–20, and guidelines on the reporting, tracking, referral, and response of violence against children in school 72 Appendixes International level World Health Organization. 2014. Health Care for Convention on Elimination of all Forms of Discrimination Women Subjected to Intimate Partner Violence or Against Women, 1979 Sexual Violence: A Clinical Handbook. RHR/14.26, field testing version (September). United Nations Convention on Rights of the Child, 1989 World Health Organization and United Nations High Declaration on Elimination of Violence Against Women, Commission for Refugees. 2004. Clinical Management 1993 of Survivors of Rape: Developing Protocols for Use with Refugees and Internally Displaced Persons. United Nations Security Council Resolutions 1325 and 1820 International Conference on the Great Lakes Region (ICGLR). 2006. Protocol on Sexual Violence against Standards, guidelines, and protocols Women and Children. http://www.peaceau.org/uploads/ final-protocol.sexual-violence-en-rev-2.pdf. Inter-Agency Standing Committee (IASC). 2005. Guidelines for Gender-Based Violence Intervention Other documents in Humanitarian Settings. https://gbvguidelines.org/ wp/wp-content/uploads/2015/09/2015-IASC-Gender- Butchart, A., and S. Hillis. 2016. Inspire: Seven based-Violence-Guidelines_lo-res.pdf. Strategies for Ending Violence Against Children. World Health Organization. Sphere Association. 2018. The Sphere Handbook: Humanitarian Charter and Minimum Standards in International Rescue Committee. Updated 2014. Humanitarian Response, Fourth Edition. Geneva. www. GBV Emergency Toolkit. spherestandards.org/handbook. United Nations Children’s Fund. 2014. Communities International Rescue Committee (IRC) and the United Care: Transforming Lives and Preventing Violence. Nations Children’s Fund. 2012. Caring for Child Survivors of Sexual Abuse: Guidelines for Health and Psychosocial Service Providers in Humanitarian Settings. https://resourcecentre.savethechildren.net/ library/caring-child-survivors-sexual-abuse-guide- lines-health-and-psychosocial-service-providers. Appendixes 73 APPENDIX B. SERVICES PROVIDED IN REFUGEE AND HOSTING COMMUNITIES TABLE B.1 Number of Institutions Mapped Health Facilities Legal/Justice Actors Refugee Host Refugee Host Civil Society District Settlement Community Settlement Community Organizations Schools Total Adjumani 14 13 11 7 6 2 53 Arua 11 6 9 5 20 2 53 Hoima 5 7 3 8 8 1 32 Isingiro 1 18 1 19 7 2 48 Kamwenge 0 13 0 14 5 2 34 Kiryandongo 3 7 2 7 3 2 24 Koboko 1 13 4 11 9 2 40 Kyegegwa 2 7 1 7 9 2 28 Lamwo 2 16 1 10 5 2 29 Moyo 6 17 4 4 12 2 45 Yumbe 18 16 3 8 23 2 70 Total 61 135 38 101 102 21 469 TABLE B.2 Availability of Health Services for Gender-based Violence and Violence Against Children Refugee Settlement Host Community HC IV HC III HC II Hospital HC IV HC III HC II (n=2) (n=31) (n=28) (n=2) (n=9) (n=57) (n=67) Forensic examination and documentation 2 19 11 2 6 48 25 HIV testing services. 2 31 28 2 9 54 55 Postexposure prophylaxis 2 30 18 2 9 53 16 Pregnancy testing 2 31 26 2 9 53 46 Emergency Contraception 2 31 24 2 9 47 43 Abortion counseling and information 2 30 27 2 7 44 48 Postabortion care 2 30 22 2 9 47 44 Vaccination for hepatitis B and tetanus 2 31 27 2 8 47 42 Screening for sexually transmitted infections 2 31 27 2 9 53 48 Treatment for sexually transmitted infections 2 31 25 2 9 53 57 Trauma counseling 2 31 27 2 8 52 44 Evaluation and treatment of injuries 2 30 27 2 9 54 51 Referrals 2 31 25 2 9 51 54 Completion of medical form 2 22 20 2 9 53 28 Legal representation 2 17 8 1 9 31 12 HC = health center. 74 Appendixes TABLE B.3 Availability of Essential Medicines Refugee Settlement Host Community HC IV HC III HC II Hospital HC IV HC III HC II Essential Medicines (n=2) (n=31) (n=28) (n=2) (n=9) (n=57) (n=67) Emergency contraceptive pills 1 25 20 2 7 37 26 Postexposure prophylaxis to prevent HIV 2 28 14 2 9 52 12 Antibiotics to prevent and treat sexually 2 31 26 2 8 53 56 transmitted infections Antibiotics for wound care 2 31 22 2 7 54 56 Hepatitis B vaccine 1 27 14 2 4 24 18 Tetanus toxoid 2 28 23 2 7 51 49 Analgesia (e.g., Panadol, aspirin) 2 30 26 2 7 54 57 TABLE B.4 Availability of Medical Equipment Refugee Settlement Host Community HC IV HC III HC II Hospital HC IV HC III HC II Essential Equipment and Supplies (n=2) (n=31) (n=28) (n=2) (n=9) (n=57) (n=67) HIV rapid test kit 2 30 26 2 9 53 52 Pregnancy test kit 2 31 24 2 9 50 28 Speculum (preferably plastic and disposable, only adult sizes) 2 26 19 2 8 44 22 High vaginal swabs 2 20 7 2 5 29 8 Needles and syringes 2 30 25 2 7 55 44 Supplies for universal precautions (gloves, box for safe 2 27 26 2 7 52 47 disposal of contaminated and sharp materials, and soap) Paper bags for collection of evidence 0 9 9 1 1 15 5 Paper tape for sealing and labeling containers and bags 1 15 9 1 4 20 6 Sterile medical instruments (kit) for repair of tears, and suture 1 27 17 2 7 42 20 material Autoclave to sterilize equipment 2 28 18 2 6 36 23 Appendixes 75 TABLE B.5 Accessibility to GBV and VAC Services at Health Facility Level Refugee Settlement Host Community Hospital HC IV HC III HC II Hospital HC IV HC III HC II (n=0) (n=2) (n=31) (n=28) (n=2) (n=9) (n=57) (n=67) Does the facility o er interpreters for refugees who may not speak English or the local language? Yes 0 0 28 14 0 5 33 18 No 0 2 3 14 2 4 24 49 GBV = gender-based violence; HC = health center; VAC = violence against children. TABLE B.6 GBV- and VAC- Related Services Provided by Police Refugee Settlements Host Communities Service Station (n=5) Post (n=33) District (n=8) Station (n=47) Post (n=46) Statement-taking and documentation 33 5 44 46 7 Investigation 32 5 40 46 7 Collection of forensic evidence 18 4 25 30 7 Storage of forensic evidence 16 4 18 13 7 Ensuring the safety of the survivor 28 5 34 35 6 Witness protection 26 5 28 26 5 Issuing the police medical report form 29 5 39 39 7 Psychosocial counseling 28 5 39 43 6 Others 4 0 5 6 1 GBV = gender-based violence; VAC = violence against children. 76 Appendixes APPENDIX C. ORGANIZATIONS PROVIDING GBV PREVENTION SERVICES Services Provided Raising Parental Education Increasing Economic Promotion of Incorporation Community Programs and the Political Empowerment Sexual and of Men and Awareness Support Groups for Participation and Reproductive Boys as Transformation Behavior of and Families A ected and Influence Livelihoods for Health and Agents of of Norms and Change Sensitization by Domestic Name of CSO/NGO of Women Women Rights Change Behavior Communication Toward GBV Violence Adjumani District Tutapona √ Danish Refugee Council √ √ √ √ √ √ Refugee Law Project √ √ War Child Canada √ √ √ √ √ Save the Children √ √ √ √ √ Windle Trust Uganda √ √ √ √ Arua District Danish Refugee Council √ √ √ √ √ √ Médicines Sans √ Frontièrs AVSI International Services of Volunteers √ √ √ √ √ √ Association FIDA Uganda √ Save Children √ √ Oxfam √ √ √ √ Child’s Voice √ International Aid √ Services Care International √ √ √ √ √ √ √ √ Transcultural Psychosocial √ √ √ √ Organization Andrea Foods √ √ √ √ √ √ √ International Rural Initiative for Community √ √ Empowerment Youth With a Mission √ √ √ √ √ Welthugerhilfe √ √ √ √ √ √ PAG Social √ √ √ Development Services Plan International √ Uganda ZOA West Nile Program √ √ √ √ √ Humming Bird Action for Peace and √ √ √ Development Caritas Arua √ √ √ √ √ √ (continued) Appendixes 77 Services Provided Raising Parental Education Increasing Economic Promotion of Incorporation Community Programs and the Political Empowerment Sexual and of Men and Awareness Support Groups for Participation and Reproductive Boys as Transformation Behavior of and Families A ected and Influence Livelihoods for Health and Agents of of Norms and Change Sensitization by Domestic Name of CSO/NGO of Women Women Rights Change Behavior Communication Toward GBV Violence Hoima Kwatanima Women √ √ √ √ √ √ √ √ Farmers Group Action Africa Help (AAH) √ Humanitarian Initiative √ √ √ √ √ √ Just Relief Aid (HIJRA) Windle International √ Uganda Lutheran World √ √ √ Federation Norwegian Refugee Council (NRC) American Refugee √ √ √ Committee Save the Children √ Isingiro American Refugee √ √ √ √ √ √ √ Committee Care and Assistance for √ √ √ Migrants (CAFOM) HIJRA Humanitarian √ √ √ √ √ √ Initiative Just Relief Aid Refugee Law Project √ √ √ √ √ √ √ (Legal aid) Windle International √ Uganda Kamwenge Lutheran World √ √ √ √ √ √ √ Federation Save the children √ ACCORD √ √ √ √ √ √ √ World Vision √ √ √ √ √ √ √ Kiryandongo Danish Refugee Council √ √ √ √ √ √ Save The Children √ Real Medicine √ √ √ √ √ Foundation (RMF) Agency for Cooperation in Research and √ √ √ √ √ √ √ Development (ACORD) (continued) 78 Appendixes Services Provided Raising Parental Education Increasing Economic Promotion of Incorporation Community Programs and the Political Empowerment Sexual and of Men and Awareness Support Groups for Participation and Reproductive Boys as Transformation Behavior of and Families A ected and Influence Livelihoods for Health and Agents of of Norms and Change Sensitization by Domestic Name of CSO/NGO of Women Women Rights Change Behavior Communication Toward GBV Violence Koboko Community Empowerment and √ √ √ √ √ √ Rehabilitation Initiative to Development (CERID) PICOT √ √ √ ACAV √ Humanitarian Assistance and √ √ √ √ √ √ √ √ Development Services AFORD √ √ Koboko Civic Society √ √ √ √ √ √ √ Network Kids Uganda √ Kyegengwa ACORD √ √ √ CEDO √ √ √ √ Danish Refugee Council √ √ √ √ √ √ Oxfam √ √ √ √ Save the Children √ √ Windle International √ Uganda World Vision √ Lamwo War Child √ √ √ √ √ Lutheran World √ √ √ √ Federation American Refugee √ √ √ √ √ √ Committee Transcultural Psychosocial √ √ √ √ √ √ √ √ Organization (continued) Appendixes 79 Services Provided Raising Parental Education Increasing Economic Promotion of Incorporation Community Programs and the Political Empowerment Sexual and of Men and Awareness Support Groups for Participation and Reproductive Boys as Transformation Behavior of and Families A ected and Influence Livelihoods for Health and Agents of of Norms and Change Sensitization by Domestic Name of CSO/NGO of Women Women Rights Change Behavior Communication Toward GBV Violence Moyo ADRA √ √ MTI √ √ √ √ √ Moyo Babies Home √ Lutheran World √ √ √ √ √ √ √ √ Federation Windle International √ Redeemer Children's √ √ √ √ √ √ √ √ Home ACTED √ √ √ √ Global Women Water √ √ √ √ √ √ √ √ Initiative Moyo Aids Heros √ √ √ √ √ √ Association Genex Agro Business √ √ Yumbe Danish Refugee Council √ √ √ √ √ Save the Children √ Windle International √ Real Medicine √ √ Foundation War Child Holland √ √ √ √ √ √ √ √ Plan International √ Catholic Relief Services √ War Child Canada √ √ Transcultural Psychosocial √ Organization International Rescue √ √ √ √ √ √ √ Committee Red Cross Uganda √ √ √ √ √ √ √ ACORD √ √ √ √ √ √ √ DCA √ √ American Refugee √ √ √ √ √ √ √ Committee Mercy Corps √ √ √ √ Norwegian Refugee √ √ √ √ √ Council World Vision √ CSO = civil society organization; GBV = gender-based violence; NGO = nongovernmental organization. 80 Appendixes This work was supported by the State and Peace Building Fund, the Disaster Risk Finance for Resilient Livelihoods—the Global Trust Fund between SIDA Headquarters and the World Bank, and the Government of Norway.