Screening and care of sexual violence consequences among female asylum seekers

The project is implemented by Peyssonnel Primary Healthcare Centre (MSP Peyssonnel) in France. It began in 2019 and is currently ongoing.

We are a team of general practicionners leading a multi-professional primary care team in France. Since 2019, we have been running a mobile care action for asylum seekers directly to their place of administrative registration early after their arrival. This mobile action is coupled with multi-professional ambulatory care under the common system. We developed and evaluated a protocol for screening and treating sexual violence among asylum seekers, who are highly vulnerable, in their host country.

The aims of the project are:

• Enable and improve practices for screening and care of sexual violence among asylum seekers in their host country
• Produce evidence to support public authorities in making informed decisions about the prevention of sexual violence
• Strengthen training and education for primary care professionals in caring for these populations

Main activities of the Good Practice

• Reaching out ("Aller vers") to the most vulnerable, isolated women who are far from the healthcare system.
• Multi-professional care (social worker, health mediator, doctor) with the possibility of carrying out additional tests and dispensing medication early if necessary.
• Once health insurance has been acquired, referral to a multi-professional team (psychologist, gynaecologist, general practitioner, social worker etc.) to provide long-term care using an intercultural (including interpretation services) and participatory approach involving users in their care. From the start of care and throughout long-term follow-up, particular attention is paid to sexual violence (screening for the consequences of violence suffered before arrival, prevention of violence in the host country and care when appropriate).
• Setting up group workshops outside the consultation, such as discussion groups or sports activities, as part of a holistic approach to recovery.
• Evaluate practices through research programmes in order to improve care and provide evidence to support public authorities in making informed decisions about the prevention of sexual violence.
• Teaching interculturality and care of violence against women to future general practitioners

Elements which helped facilitate the implementation of the good practice

Close partnerships with institutions and all the actors involved in the reception and care of this population make it easier to develop these programmes. Our threefold activity as teacher, researcher and carer also helps.

Access to health insurance also provides global care. However, this health insurance is subject to a time limit on presence in the country, which hinders early treatment.

Partners involved

• Primary care centre ("Maison de santé Peyssonnel")
• Mobile Unit of Hospital care service for vulnerable people ("Permanence d'accès aux soins de santé")
• University Department of General Practice - CEReSS UR3279-Health Service Research and Quality of Life Center - Aix Marseille University
• National College of Teaching General Practitioners ("CNGE")

What challenges were encountered in delivering the project and how were they overcome?

Challenges

Professionals have to adapt to the legal context, which has an impact on the patients they care and which they do not control (access to housing, health insurance, recognition of refugee status, etc.).

Asylum seekers and refugees remains vulnerable and difficult to reach, so gathering the data needed to evaluate and improve programmes remains a complex task.

Asylum seekers and refugees remain vulnerable and difficult to reach. Developing care programmes and gathering the relevant evidence to evaluate and improve them remains a complex task.

How they were overcome

Teamwork, the respective expertise of the professionals, team and individual supervision by psychologists, the involvement of the project leaders in different institutions (university, hospital, learned societies) and networking with all the partners involved in the care of asylum seekers are all levers that enable the professionals to deal with the difficulties they encounter.

Results of the Good Practice

1. The overexposure of female asylum seekers to sexual violence in their host country has been documented
2. The factors associated with this violence have been identified
3. The lack of protection for women who have undergone genital mutilation has been noted.
4. Multi-professional care is currently being evaluated and preliminary data can be used (number of patients treated, number of professionals involved in treatment, timing of screening, rate of violence screened as part of the protocol [currently 45%], etc.).

In what way does the good practice meet one or more of the four objectives of the Global Compact on Refugees?

Objective 1: Ease the pressures on host countries

By organising early, rationalised care for the health needs of asylum seekers, our programme enables patients to be included in a coordinated care pathway, thereby limiting healthcare costs.

Objective 2: Enhance refugee self-reliance

Our primary care centre is one of the organisations involved in participatory health care experimentation, involving users in their health care project.

Next steps

The aim is to make these practices financially sustainable and to extend them in host countries by means of studies demonstrating the effectiveness of this type of scheme.

Are there areas in which support would be required to continue and/or scale up your good practice?

The funding of certain activities is not sustainable, with annual renewals subject to certain conditions.

The social and administrative environment in which women asylum seekers live also has an impact on their health, which professionals have to deal with.