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Table 2 Overview of Findings

From: “Most of the cases are very similar.”: Documenting and corroborating conflict-related sexual violence affecting Rohingya refugees

Theme Sub-theme Relevant Data
Conflict-related Sexual Violence Experienced by the Rohingya in Myanmar Sexual violence accompanied by other violent acts There was a woman in her probably late 40s but these women even in their late 40s looked like they were 70 and 80. She was there with her granddaughter. She had been raped and beaten and she saw her daughter and son killed. And the grandchild was the only one she had left.… And she was very disabled from the beatings, she could barely walk. Her back and her legs suffered severe injuries.” A nurse working in Cox’s Bazar in 2017
Men and women separated; killing the men, raping the women “When the Myanmar military would come to a village, they would immediately split the men and the women into two groups and they would pretty much immediately kill the men in front of the family and bury them in mass graves, and then the women would most likely be raped at that time and then either ... moved to a different section or ... out of that village.” A nurse working at a primary health clinic in Kutupalong camp in 2018
Sexual violence perpetrated by the Myanmar military, men in uniform, or police “It was the military … those who are associated with the army of that country.” A psychosocial support officer and case manager working in Balukahli camp since 2018
“About those who perpetrated them [the rapes], they said that [it was] a group of military people.” A clinical psychologist working with Rohingya refugees since 2017
“She started crying and talked to me about her experience of rape at the hands of the military, the Myanmar military.” A nurse practitioner working at an outpatient clinic in Kutupalong camp in 2017
Sexual violence committed by multiple perpetrators “Her age is between 42 to 45 years. The situation was the same, 25 militaries attacked their home at night all of a sudden. After the attack, the men of the house ran to the hill near the river, escaping through the kitchen door. After the men ran away, the woman was alone … her son was hiding in [the] poultry house. For that [her son hearing her gang rape while hiding] she is still ashamed and wishes to die. This woman is also a victim of gang rape by three military [men]. Her physical condition was so bad that it was beyond describable in words. Her uterus was very badly damaged. It used to bleed a lot after every few days. And she had a lot of pain.” A paramedic and psychosocial support officer working in Cox’s Bazar since 2017
Forced witnessing of acts of violence (including sexual violence) against family and community members “‘They [Myanmar military/security forces] took our young girls and they were raping them.’ They [Rohingya survivors] had seen and hear[d] probably this happening, and there was very little they could do about it.” A volunteer physician working in Cox’s Bazar in 2018
“When they were in Myanmar, they, a group of men who had uniform look like a police or army something like that, came to their house and … they were raped in front of their family.” A nurse midwife working in Kutupalong camp in 2017
Disclosure of Experiences of Sexual Violence Experience disclosed to health professional due to trust. Because I knew that there was a history of sexual violence among the population, I was alert to the possibility of that. And then I asked ... if she had had any problems with the military, or with anybody, when she was leaving Myanmar. And she hesitated a minute and then she started crying and said that she and I think around 14 other women had been taken and locked into a house, and that they were all gang raped. And some of them did not survive, but she was able to survive. She was now 40 years old.”
A nurse practitioner working at an outpatient clinic in Kutupalong camp in 2017
History of sexual violence discovered during sexual and reproductive health, pregnancy-related care; sexual and reproductive health (SRH) and pregnancy-related care not often available for sexual violence survivors prior to arrival in Cox’s Bazar “I had a young woman.… She was probably in her early 20s or so. Came in with complaints of severe abdominal pain and vaginal discharge. Just on exam and everything else, it was quite certain that she had an STD, an STI of some sort and we did a quick pregnancy test and the pregnancy was.… She was very ill. She was most likely septic.… So we treated her with antibiotics and we watched her for the rest of the day.... She was in the clinic with us for about eight hours while we were taking care of her and during that time, first, she asked me if there was anything that could be done about the pregnancy. And this was not a common question in that camp, particularly. It’s not a culturally accepted option. So, we talked a little bit more and then I realized that the source of her question was she was raped by one of the Myanmar military personnel. That’s how she contracted the STI and also became pregnant.” An emergency room physician working in Cox’s Bazar in December 2017
“She was pregnant while she was visiting us in the clinic and she had been raped and she knew that this was a child of a soldier who she absolutely did not want to carry the baby….
And she felt certain that she was going to be shunned and essentially cut off from all of her support network and she didn’t really want to keep the baby, but again, she had no options.” An emergency nurse working in satellite health clinics in December 2017
“One evening, my midwives came back with one nine months pregnant lady’s case and they were saying that she never had any antenatal check up.… what we revealed there was, she was raped nine months ago and just because it’s a matter of shame to disclose it within their community, or to come to the facility here, they kept her inside the house, she didn’t receive any antenatal check-up or anything. And now she is nine months pregnant, I mean, as a consequence of that rape.” A medical officer at a health post in Camp 17 in 2018
Observed increases in pregnancy and birth rates as a result of sexual violence “Of course, they had no way to check if they are pregnant or not and by the time they notice, it’s already 20 weeks and that was a time they come to the clinic. That was in November, because the crisis happened the end of August and most of the incidents happened the end of August up to beginning of September.” A nurse midwife working in Kutupalong camp in 2017
Many of these women lost their husband and they were pregnant. [Health care workers asked] is it your husband’s child, do you think, or is this maybe a child of one of the rapes or something? None of them would talk to us about that at that point. None. They would not admit to being raped at all. It was such a stigma that no one was talking about that.” A pediatrician working in Cox’s Bazar in 2017 and 2018
“Basically anyone at that period of time that lived had a baby [was pregnant] ... that was the assumption. The assumption was that it was rape. In my trauma training, it’s not always in the best interest of the patient to ask them. So, I generally didn’t ask them if that was what had happened, because I was trying not to re-traumatize them.” A physician working in Kutupalong camp in 2018
Seeking pregnancy termination, complications from unsafe abortions and need for post-abortion care “[They had had] failed attempted terminations when they came.… [The staff] would call me because the patients were very unwell. At that point, obviously, we didn’t really discuss what had happened in terms of whether they were, who was responsible for that. We didn’t know, but we definitely saw a significant number of termination[s] … self-induced terminations of pregnancy when we were there”. A physician working with Rohingya refugees in 2017 and 2018
“The midwife came and said, ‘Madam, a patient ... has come, she wants [to have a] miscarriage, which means she does not want to keep the baby anymore … she … [wants to] have an abortion.... What can I say?.... When I started talking to that woman, she would burst into tears.... After asking her some questions deeply, like, ‘Why do you want to ruin the baby?’ She was told the Islamic thing that it is a great sin to ruin a baby. Then we would see that many became [emotional] and one or two [women were] saying that ‘I have a child; it is not mine and I ... I was not even married. I don’t want to keep this baby.’” A clinical supervisor and health post manager in Balukahli camp since 2018
Sexual Violence Experienced by Gender Diverse Patients Sexual violence against hijra and transgender people “Those who became victims among the gender diverse population [hijra, transgender], they became such victims even [in Myanmar] ...They were victims of different type[s] of teasing, they were victims of different types of harassment. But what they feared … the most [in Myanmar] was that they … [would be] killed…. Those groups [Rohingya ‘thugs’ in Bangladesh] used these people [coerced the hijra into sexual acts] [by threatening] to rape the sisters…[or] to rape his mother.” A coordinator of services for male and transgender Rohingya survivors since 2018
Mental Health Status of Survivors Evidence of depression and post-traumatic stress disorder (PTSD) in survivors “To make them talk, it takes time to get started and, of course, they cry. Also, they say I want to die, or I want to commit suicide, this kind of a thing.” A nurse midwife working in Kutupalong camp in 2017
Patients exhibiting trauma behaviorally and via oral narratives “I found her absent-minded. She didn’t look at me, didn’t talk, and only kept on crying. I observed different kind(s) of abnormal behavior.” A paramedic and psychosocial support officer working in Cox’s Bazar since 2017
“Most of the stories of trauma came from the patient’s mouth, like, ‘This is what happened to me,’ not necessarily ‘This is an injury, here are the scars.’ They said the trauma stories. I tried to have them express it as often as I could because my philosophy [is that for] patients who have gone through this, it’s part of the healing. We might be the only person that they might be able to narrate this story to. Whenever I had the opportunity or if I wasn’t as busy, I would try in a mindful way, just kind of ask the patient if they would be willing to share what happened…. I’m not a psychologist, I’m not a clinical psychiatrist, but I felt like I had to act like one for a lot of the patients because they’re coming in with vague symptoms like ... muscle aches or stomach pain. That’s sometimes somatization of trauma. That was an often thing that we saw as well.” A volunteer physician working in Cox’s Bazar in 2018
Psychosomatic manifestation of trauma “We try to identify the causes in medical science like blood loss or nutritional deficiency, it could be seen that those were not found. But … [if] she is feeling weak … or cannot concentrate in anything, then we would assume that it was a psychosomatic disorder and of course it was a mental disorder and surely they were suffering from some mental problem.” A clinical supervisor and health post manager in Balukahli camp since 2018
“[Rohingya patients were] very depressed, of course, and sometimes when the pregnancy is advanced ... so, people who cannot have abortion, they stay in the shelter until they deliver. I often got the call at middle of the night saying they are crying for abdominal pain or something like this. But ... I was pretty sure it was from PTSD, and because she didn’t have any sign during day, it was completely normal pregnancy, so I think it’s from mental.” A volunteer physician working in Cox’s Bazar in 2018