Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

4.2. Key actors involved in the referral system

A referral system for GBV should involve a broad range of different stakeholders, including representatives from governmental and non-governmental organizations, including specialized women’s organizations. In countries with field presence of international organizations in the area of development or peace building/peacekeeping, relevant organizations should also be involved. Multi-sectoral initiatives work best at the local level, with agencies actually working together on a day-to-day basis (WAVE 2006).

The following sub-chapters provide an overview of key sectors and actors that should be involved in a referral system.

4.2.1  Specialized women support services

Participation of women’s organizations in the multi-sectoral response to GBV is of particular importance. These organizations often possess long-standing experience in the response to GBV. Further, because of their mandates as direct and specialized service providers they are well positioned not only to provide many services themselves, but also to accompany survivors throughout the entire process. They complement, but cannot be replaced by, general support services offered by public authorities (see section 4.2.2).

Specialized women’s support services for survivors of GBV may provide a broad range of services, including in particular women’s shelters, women’s helplines, women’s centres, providing various types of non-residential support, as well as services specialized for survivors of sexual violence. These organizations might serve survivors of GBV more broadly, or concentrate on survivors who have experienced specific forms of violence (such as intimate partner violence, trafficking or sexual violence) or belong to specific groups (such as migrant women, adolescent girls or sex workers).

Box 25: Minimum standards for specialized women’s services

Specialized women’s services should:

  • Be sufficiently spread throughout the country.
  • Be run by independent women’s organizations that are committed exclusively to the interests of women survivors and are not influenced by any state authority, political party, religious group or other institution.
  • Receive adequate financial support from the state.
  • Be specialized in two ways 1) especially targeted at women survivors and their children, and 2) specialized on violence against women as a gender specific form of violence.
  • Work alongside the principles of a woman-/survivor-centred, gender-sensitive and human rights-based approach.
  • Be run and provided by women, so as to support survivors’ empowerment and to enable them to overcome experiences of discrimination and subordination by men.
  • Be provided by professional staff trained on working with survivors of GBV, such as social workers, pedagogues, psychologists or therapists.
  • Be provided by properly employed and paid staff. Volunteers can be a necessary and valuable resource, but should be adequately trained and supported by employed staff.

Sources: Article 18 Istanbul Conventionand Explanatory Report, WAVE 2013

Women’s helplines may be the first contact point for survivors to receive information about available services and legal options. Therefore, helplines, which are widely-advertised public numbers that provide support, crisis interventions and referrals to face-to-face services such as shelters or the police, provide an important cornerstone of a multi-sectoral response to GBV. Women’s helplines should operate 24/7, be free of charge and anonymous, and serve survivors of all forms of GBV. All women in the country should have access to a helpline, so at least one national helpline should exist and provide support in all the main languages spoken in country, at least for a considerable amount of hours per week (WAVE 2013, CoE 2008, Article 24 Istanbul Conventionand Explanatory Report).

Women’s shelters are specialized in providing immediate and safe accommodation to women survivors of violence and their children. Furthermore, they provide comprehensive support and empowerment to help survivors to deal with their traumatic experience, to regain their self-esteem and to lay the foundations for a self-determined life. Shelters should be accessible 24/7. They need to apply special safety precautions, which includes risk assessment and safety planning in each individual case, keeping locations secret and technical security of the building in order to protect clients and staff, but also neighbours from violent attacks by perpetrators. Shelters should be available in a sufficient number in the country(Article 23 Istanbul Conventionand Explanatory Report, WAVE 2013). A commonly referred benchmark is one family place per 10 000 inhabitants (CoE 2008). An important part of the work provided by shelters is follow-up or after-case support, in order to assist women and girls in their reintegration after leaving the shelter. This requires consideration of existing risks, the client’s income generation and livelihood skills, alongside other factors. The reintegration process should be well managed, ensure safety to the woman and her children, and subsequently monitored by the caseworker.

Women’s centres (in some countries, also referred to as “women’s crisis centres” or “women’s counseling centres”) encompass all women’s services that provide non-residential support of any kind (psychosocial counseling, legal or other information and advice, practical support, court accompaniment, etc.) to women survivors of GBV and their children. These organizations play an important role in countries or regions where women’s shelters do not exist. Moreover, they provide advocacy and counselling to women that might not need accommodation but require other specialist support and advocacy (WAVE 2013).

Specialized support services for survivors of sexual violence are necessary in light of the traumatic nature of sexual violence, requiring a particularly sensitive response by trained and specialized staff.  These services include immediate medical care and trauma support, complemented by medium- and long-term psychological counselling, as well as immediate forensic examinations to collect evidence needed for prosecution. It is a good practice to carry out forensic examinations regardless of whether the matter will be reported to the police and to offer the survivor the possibility to have the samples taken and stored, so that the decision as to whether or not to report the rape can be taken at a later date.

Service providing organizations typically include (Article 25 Istanbul Convention and Explanatory Report):

  • Sexual violence referral centres specialized in immediate medical care, forensic practice and crisis intervention. These centres can be part of a hospital setting to respond to recent sexual violence and refer the survivor to specialized organizations for further support or specialist care.
  •  Rape crisis centres offering long-term help. Services may take the form of face-to-face counseling, support groups and contact with other services. They also accompany support during court proceedings. 

A commonly referred benchmark is one specialized support centre per every 200 000 inhabitants (CoE 2008, cited in Istanbul Convention - Explanatory Report).

Specialized support services for survivors of sexual violence might not exist in all countries in EECA. Where they do not exist, it is of particular importance that healthcare professionals, particularly gynecologists and forensic doctors, are trained to provide the required immediate medical care and trauma support (see section 3.2).

4.2.2 General support services

General support services refer to help funded and offered by public authorities, which provide long-term help and are not exclusively designed for the benefit of survivors only but serve the public at large. Besides health services, this includes housing, financial support and other social services, employment services, public education or child welfare. These services are complemented by women’s support services, which have specialized in providing support and assistance tailored to the needs of survivors of GBV. In particular, health and social services are often the first point of contact for survivors of GBV and therefore should be adequately resourced to respond to their long-term needs. Staff members should be trained on the different forms of GBV, the specific needs of survivors and how to respond to them in a supportive manner (Article 20 Istanbul Conventionand Explanatory Report).

4.2.3 Police and judiciary

Police and the criminal justice system are responsible to investigate, prosecute cases of GBV that constitute criminal offences under the respective national laws and to determine the criminal liability of the defendant. In some countries, police have the legal mandate to issue and enforce restraining orders. Civil courts decide on divorce and child custody proceedings and, in some countries, can issue protection orders that prohibit perpetrators from approaching the survivor. Depending on the circumstances of the individual case, claims for compensation for damages suffered by the survivor as a result of GBV may be decided before civil and/or criminal courts.

In order to enable survivors of GBV to access justice and to de facto enjoy their legal rights, it is necessary to train police officers, public prosecutors and judges on GBV and the response to violence. Further, survivors should have access to appropriate protection, free legal aid and be treated and interrogated in a sensitive, respectful way to avoid the risk of further traumatization. Separate waiting rooms in court buildings can help to avoid confrontation with the perpetrator.