Survivors of sexual violence are at high risk of developing mental health problems due to their pre-migration experiences and limited psychosocial supports within resettlement contexts (Yohani & Hagen, 2010). Understanding the unique challenges and needs of women survivors of sexual trauma will help health service providers prevent re-traumatization and provide appropriate support to refugee women. Social support can moderate the impact of trauma, reduce the severity of symptoms and facilitate the recovery process (Pottie et al., 2016; Sippel et al, 2015).
If women try to talk about the abuse and are told to “just forget it and get on with your life,” they may feel isolated and silenced.
If women engage in a new relationship or are in an existing relationship with someone who is emotionally, physically or sexually abusive, it worsens the effects of the original trauma. It also doesn't allow them the safety they need for healing.
For many refugee women, discrimination is an everyday experience. Discrimination causes stress, which is especially hard on women who are already traumatized. For racialized women and lesbians, racism and homophobia add to the lack of safety.
Economic disadvantage often limits women's life choices, adding to the problems.
Without support and understanding, women continue to feel guilty and ashamed. This can lead to isolation, depression and a risk of self-harm.
With adequate social and emotional support, many survivors of sexual trauma learn to cope and their distress usually decreases over time (Ford-Gilboe et al., 2009; Yohani & Okeke-Ihejirika, 2018). Trauma-informed care is a promising approach that health and social service providers can use to help immigrant and refugee women without pathologizing them.
Clinicians should apply its principles to all services for immigrant and refugee women. (See Module 5 for information on trauma-informed care.) There is also a need to increase awareness and understanding of the consequences of sexual violence and how they may be addressed in newcomer communities to reduce stigma, encourage help-seeking and promote the mental health of survivors.
Refugee and immigrant women who are survivors of gender-based violence can be vulnerable to further exploitation and victimization in Canada. Migrant women experiencing IPV may be apprehensive about discussing domestic abuse.
Some immigrant women report that it is better for family doctors to ask and continue to ask in situations where there may be indications of IPV (Ahmad et al., 2009), however it is not advised that health care providers specifically screen for IPV (Pottie et al., 2011).
A provider who builds trust, uses a friendly approach without judgment and is aware or open to cross-cultural understandings can help facilitate open discussions with immigrant and refugee women around issues of gender-based violence and IPV (Ahmad et al., 2009; Godoy-Ruiz et al., 2015).
If a patient discloses to me that they have been subject to intimate partner violence, I will absolutely sit down and resonate with him or her and apologize that they've gone through that experience. And I'll thank them for sharing that with me and I'll tell them that we have a lot of time to discuss if they choose. The next step is important to say as a health care provider, it's difficult, but to say that if there are children involved in the scenario and if children have been witness to this experience of violence at home that, as a health care provider, I do have a legal obligation to call the Children's Aid Society. And that really opens up and allows the transparency amongst what I have a legal obligation to provide and sharing that with a patient. If there's a safe space and a confidential space that they're aware of, there will be further appointments obviously that are offered and further options that the patient can take. One being explaining the law in Canada and talking to them that this is in fact illegal. And a legal route could be taken then to address the circumstance with law enforcement if they wanted. That could be documenting injuries, getting a restraining order. Also we could think about health care related effects: Documenting injuries for those purposes and treating injuries as well as HIV, STI testing if some sexual assault has occurred. And it would be really important to give the patient a safety plan if in fact they have disclosed to you and you're having a further discussion around their safety. And the next thing to do would be talking about steps that we could take for further appointments. Maybe the initial disclosure is all they want to share within that appointment, but there could be further steps to take, additional counselling, some support and services. So it really is very patient-guided and a lot of it is really step by step and some of it is not algorithmic, but it's really focused on the patient and what direction they want to take and really ensuring that their safety is paramount.