RESUMO
Introduction: Sexual assault rises as a global public health in conflict-affected populations where chaos prevails and gender based violence becomes as a strategy of war. The health effects of sexual violence include unwanted pregnancy, unsafe abortion, sexually transmitted infections [STIs], physical and psychological trauma, and social stigma. Training health care providers [HCPs] has been prioritized by humanitarian actors globally to improve the quality clinical care to survivors of sexual violence. However, few studies have evaluated the effectiveness of training interventions in refugee and post-conflict settings. Methods: A four to five days "training of trainers" [ToT] was provided to relevant community health workers, nurses, midwives, doctors and other relevant field workers working in conflict-affected environments in Jordan, Turkey, Syria and Lebanon using the "Clinical care for sexual assault survivors [CCSAS] multimedia training tool" developed by International Rescue Committee [IRC]
Results: Overall, six ToTs took place; they included general practitioners, obstetrician/gynecologists, pediatricians, psychologist, forensic physicians, nurses, social workers, midwifes, and program officers. In Jordan, 50 participants [two groups of 25] have completed the training; the group improved by 142% on average at post-test in knowledge and attitudes to care for survivors [25% on average of correct answers at pretest, 60.5% on average at posttest]. A second ToT in Jordan included 22 participants who have improved by 57.6% on average [50.3% vs. 79.3%]. The third ToT in Turkey included 13 participants who have improved by 47% on average [38.5% vs. 56%]. A forth ToT took place in Lebanon where 19 participants have improved by 62.5% on average [56% vs. 91%]. The fifth ToT in Syria, included 18 participants who have improved by 46.2% on average [52% vs. 76%]. And the sixth ToT took place in Turkey where nine participants have improved by 82.6% on average [46% on vs. 84%]
Discussion: All participants have successfully completed the training and showed improvement at the posttests. However, key challenges and limitations identified included logistics at the preparation and recruitment stages, language barrier and differences in cultural or religious views. Key barriers to quality care identified included poor or lack of access to services, lack of trained staff, lack of privacy and confidentiality and lack of essential resources and treatment including emergency contraception and HIV post-exposure prophylaxis [PEP] as well as unclear referral mechanism. Action plans were developed by participants to address these barriers and follow-up to evaluate progress was planned
Conclusion:The CCSAS multimedia training tool showed an initial positive impact and has demonstrated effectiveness in promoting compassion and competence among trained HCPs and improving quality of clinical care for sexual assault survivors in such humanitarian settings. On-going technical and psychosocial support, long-term behavior change interventions, supply chain management, monitoring and evaluation, and interventions to raise awareness and identify survivors of sexual assault are needed in addition to the training to ensure quality clinical care is delivered to sexual assault survivors