Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala


  • Peninah Kansiime Department of Social Work, University of Newcastle, Australia
  • Claire van der Westhuizen Alan J Flisher Centre for Public Mental Health, University of Cape Town
  • Ashraf Kagee Department of Psychology, Stellenbosch University



In Uganda, over 1.3 million refugees have fled armed conflicts from neighbouring countries, with about 251 730 refugees from the Democratic Republic of Congo (DRC) alone. In this article we report on a qualitative research study on the help-seeking behaviour of Congolese male refugee survivors of conflict-related sexual violence (CRSV) living in Kampala, Uganda. We recruited 10 Congolese male survivors of war-related rape and 6 Ugandan service providers (psychologists, social workers and physicians) who participated in individual interviews focused on barriers and facilitators to care seeking in Kampala, Uganda. We found that the major barriers to help-seeking were socio-cultural and political factors, health system and infrastructural barriers, poverty and livelihood barriers, physical effects of CRSV, fear of marital disharmony and breakup, and self-sufficiency The major facilitators were social support, symptom severity, professionalism among service providers, availability of free tailored services and information, education and communication. On the basis of our findings, we recommend that a multidisciplinary and multisectoral approach is important to address these barriers. In addition, we suggest that the Ugandan government should develop legislation and health policies to create protection for men who have experienced sexual violence.

Keywords: armed conflict; conflict-related sexual violence; male refugee survivors; help-seeking; physical and mental health; barriers; and facilitators

Author Biographies

Peninah Kansiime, Department of Social Work, University of Newcastle, Australia

PhD Candidate

Claire van der Westhuizen, Alan J Flisher Centre for Public Mental Health, University of Cape Town

Postdoctoral Research Fellow

Ashraf Kagee, Department of Psychology, Stellenbosch University



Africa Research Bulletin (2011) Democratic Republic of Congo: FARDC accused of rape. Africa Research Bulletin, 48, 18701B-18701C.

Agaba, J. (2016) Men increasingly falling rape victims too. New Vision, 19 August 2016. [Accessed on October 5, 2016 at]

Akinsulure-Smith, A. M. (2014) Displaced African female survivors of conflict-related sexual violence: Challenges for mental health providers. Violence against Women, 20, 6, 677-694.

Anholt, R. (2016) Understanding sexual violence in armed conflict: cutting ourselves with Occam’s razor. Journal of International Humanitarian Action, 1, 1, 6. [Accessed on May 16, 2017 at]

Ba, I. and Bhopal, R. S. (2017) Physical, mental and social consequences in civilians who have experienced war-related sexual violence: A systematic review (1981-2014). Public Health, 142, 121-135. doi:10.1016/j.puhe.2016.07.019

Bastick, M., Grimm, K. and Kunz, R. (2007) Sexual violence in armed conflict. Global overview and implications for the security sector. {Accessed on 12 January 2017 from Geneva Centre for the Democratic Control of Armed Force at[1].pdf]

Campbell, R., Dworkin, E. and Cabral, G. (2009) An ecological model of the impact of sexual assault on women’s mental health. Trauma Violence Abuse, 10, 3, 225-246.

Carpenter, R. C. (2006) Recognizing gender-based violence against civilian men and boys in conflict situations. Security Dialogue, 37, 1, 83-103. Doi:10.1177/0967010606064139

Christian, M., Safari, O., Ramazani, P., Burnham, G. and Glass, N. (2011) Sexual and gender based violence against men in the Democratic Republic of Congo: Effects on survivors, their families and the community. Medicine, Conflict and Survival, 27, 4, 227-246.


Clark, J. N. (2014) A crime of identity: Rape and its neglected victims. Journal of Human Rights, 13, 2, 146-169.

Clifford, C. (2008) Rape as a weapon of war and its long-term effects on victims and society. Paper presented at the 7th Global Conference Violence and the Contexts of Hostility, Budapest, Hungary (May 2008).

Cohen, D. K. and Nordas, R. (2014) Sexual violence in armed conflict: Introducing the SVAC dataset, 1989-2009. Journal of Peace Research, 51, 3, 418-428. doi:10.1177/0022343314523028

Cohen, D. K. and Nordås, R. (2015) Do states delegate shameful violence to militias? Patterns of sexual violence in recent armed conflicts. Journal of Conflict Resolution, 59, 5, 877.

Davies, M. (2002) Male sexual assault victims: A selective review of the literature and implications for support services. Aggression and Violent Behavior, 7, 203-214. doi:10.1016/S1359-1789(00)00043-4

Dolan, C. (2010) War is not yet over: Community perceptions of sexual violence and its underpinnings in Eastern DRC. London: International Alert.

Dolan, C. (2014) Into the mainstream: Addressing sexual violence against men and boys in conflict. Paper presented at the Overseas Development Institute, London (14th May 2014)

Drumond, P. (2015) Sexual violence against men during conflicts: Bridging the gap between theory and practice. [Accessed on 3 April 2017 at]

Drumond, P. (2016) Conflict-related sexual violence. In J. Steans and D. Tepe-Belfrage (Eds.) Handbook on Gender in World Politics. Oxford: Edward Elgar Publishing (pp. 206-214)

Durick, H. E. (2013) Post-conflict development in Northern Uganda: The importance of holistically addressing sexual and gender-based violence. University of Tennessee Honors Thesis Projects. [Accessed on 12 September 2016 at

Gale, N. K., Heath, G., Cameron, E., Rashid, S. and Redwood, S. (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117, 1471-2288. DOI: 10.1186/1471-2288-13-117

Godia, P. M., Olenja, J. M., Lavussa, J. A., Quinney, D., Hofman, J. J. and Van den Broek, N. (2013) Sexual reproductive health service provision to young people in Kenya: Health service providers’ experiences. BMC Health Services Research, 3, 1, 476. doi: 10.1186/1472-6963-13-476

Haer, R., Hecker, T. and Maedl, A. (2015) Former combatants on sexual violence during warfare: A comparative study of the perspectives of perpetrators, victims, and witnesses. Human Rights Quarterly, 37, 3, 609.

Harris, L. and Freccero, J. (2011) Sexual violence: Medical and psychosocial support. Berkeley, CA: Human Rights Center, University of California.

Harvard Humanitarian Initiative (2009) Characterizing sexual violence in the Democratic Republic of the Congo. Profiles of violence, community responses, and implications for the protection of women. Final report for the Open Society Institute. [Accessed on 16 April 2015 at].

Hebrew Immigrant Aid Society (2014) Triple jeopardy: Protecting at-risk refugee survivors of sexual and gender-based violence. [Accessed on 9 November 2016 at report]

Jewkes, R., Sen, P. and Garcia-Moreno, C. (2012) Sexual violence. In L. L. D. Etienne, E. G. Krug, J. A. Mercy, A. B. Zwi, and R. Lozano (Eds.), Executive summary: A research agenda for sexual violence in humanitarian, conflict and post-conflict settings. Switzerland: World Health Organization (pp. 149-181)

Kansiime, P. and Tusasiirwe, S. (2017) Social work practice with war-related humanitarian refugees through the Refugee Law Project in Uganda. In M. Gray (Ed.) The handbook of social work and social development in Africa. London: Routledge (pp. 341-351)

Kigozi, F., Ssebunnya, J., Kizza, D., Cooper, S. and Ndyanabangi, S. (2010) An overview of Uganda’s mental health care system: Results from an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS). International Journal Of Mental Health Systems, 4, 1, 1. 4doi:10.1186/1752-4458-4-1

Kinyanda, E., Musisi, S., Biryabarema, C., Ezati, I., Oboke, H., Ojiambo-Ochieng, R. and Walugembe, J. (2010) War related sexual violence and its medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study. BMC International Health and Human Rights, 28. doi:10.1186/1472-698X-10-28

Kira, I. A. and Tummala-Narra, P. (2015) Psychotherapy with refugees: Emerging paradigm. Journal of Loss & Trauma, 20, 5, 449-467. doi:10.1080/15325024.2014.949145

Kithima, B. P. (2016) Men can be raped too. Kampala: Refugee Law Project.

Kohli, A., Makambo, M. T., Ramazani, P., Zahiga, I., Mbika, B., Safari, O. and Glass, N. (2012) A Congolese community-based health program for survivors of sexual violence. Conflict & Health, 6, 1, 6-14. doi:10.1186/1752-1505-6-6

Leatherman, J. L. (2007) Sexual violence and armed conflict: Complex dynamics of Re-victimization. International Journal of Peace Studies, 12, 1, 53-71.

Leatherman, J. L. (2011) Sexual violence and armed conflict. Cambridge: Polity Press

Linos, N. (2009) Rethinking gender-based violence during war: Is violence against civilian men a problem worth addressing? Social Science & Medicine, 68, 8, 1548-1551.

Loncar, M., Henigsberg, N. and Hrabac, P. (2010) Mental health consequences in men exposed to sexual abuse during the war in Croatia and Bosnia. Journal of Interpersonal Violence, 25, 2, 191-203.

Longombe, A. O., Claude, K. M. and Ruminjo, J. (2008 Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: Case studies. Reproductive Health Matters, 16, 31, 132-141. doi:10.1016/s0968-8080(08)31350-0

Médecins sans Frontières (2009) Shattered lives: Immediate medical care vital for sexual violence victims (2nd ed.). Brussels: Médecins Sans Frontières.

Meger, S. (2016) A preliminary typology of wartime sexual violence. In Rape Loot Pillage: The Political Economy of Sexual Violence in Armed Conflict. New York: Oxford University Press (Chapter 3)

Mezey, G. C. and King, M. B. (2000) Male victims of sexual assault. Oxford: Oxford University Press.

Mukwege, D. M. and Nangini, C. (2009) Rape with extreme violence: The new pathology in South Kivu, Democratic Republic of Congo. PLoS Medicine, 6, 12, 1-5. doi:10.1371/journal.pmed.1000204

Nelson, B. D., Collins, L., Van Rooyen, M. J., Joyce, N., Mukwege, D. and Bartels, S. (2011) Impact of sexual violence on children in the Eastern Democratic Republic of Congo Medicine, Conflict and Survival, 27, 4, 211-225. doi:10.1080/13623699.2011.645148

Onsrud, M., Sjøveian, S., Luhiriri, R. and Mukwege, D. (2008) Social issues in reproductive health: Sexual violence-related fistulas in the Democratic Republic of Congo. International Journal of Gynecology and Obstetrics, 103, 265-269. doi:10.1016/j.ijgo.2008.07.018

Onyango, M. A. and Hampanda, K. (2011) Social constructions of masculinity and male survivors of wartime sexual violence: An analytical review. International Journal of Sexual Health, 23, 4, 237-247. doi:10.1080/19317611.2011.608415

Refugee Law Project (2012) They slept with me: Community reactions. [Accessed on 16 January 2017 at]

Ritchie, J. and Spencer, L. (1994) Analyzing qualitative data. In A.Bryman and R. G. Burgess (Eds.) Qualitative data analysis for applied policy research. London: Routledge (pp.173-194).

Saldaña, J. (2013) The coding manual for qualitative researchers (2nd ed.). London: SAGE.

Sandesh, S. (2010) Lost in translation: UN responses to sexual violence against men and boys in situations of armed conflict. International Review of the Red Cross, 92, 877, 259-277. doi:10.1017/S1816383110000020

Sivakumaran, S. (2007). Sexual violence against men in armed conflict. European Journal of International Law, 18(2), 253-276. doi:10.1093/ejil/chm013

Solangon, S. and Patel, P. (2012) Sexual violence against men in countries affected by armed conflict. Conflict, Security & Development, 12, 4, 417-442. doi:10.1080/14678802.2012.724794

St.Germain, T. (2012) Sexual violence and armed conflict: Gender, society, and the state. Wagadu: A Journal of Transnational Women’s & Gender Studies, 10, 1-15.

Tol, W. A., Stavrou, V., Claire Greene, M., Mergenthaler, C., van Ommeren, M. and Moreno, C. G. (2013) Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions. Conflict & Health, 7, 1, 1-9. doi:10.1186/1752-1505-7-16

Tewksbury, R. (2007) Effects of sexual assaults on men: Physical, mental and sexual consequences. International Journal of Men’s Health, 6, 1, 22-35. doi:10.3149/jmh.0601.22

Trenholm, J. E., Olsson, P. and Ahlberg, B. M. (2011) Battles on women’s bodies: War, rape and traumatisation in eastern Democratic Republic of Congo. Global Public Health, 6, 2, 139-152. doi:10.1080/17441690903212065.

Ullman, S. E. (2007). Mental health services seeking in sexual assault victims. Women & Therapy, 30(1/2), 61-84. doi:10.1300/J015v30n01_04

Ullman, S. E., Foynes, M. M. and Tang, S. S. S. (2010) Benefits and barriers to disclosing sexual trauma: A contextual approach. Journal of Trauma & Dissociation, 11, 2, 127-133. doi:10.1080/15299730903502904

Ullman, S. E. and Peter-Hagene, L. (2014) Social reactions to sexual assault disclosure, coping, perceived control, and PTSD symptoms in sexual assault victims. Journal of Community Psychology, 42, 4, 495-508. doi:10.1002/jcop.21624

United Nations High Commissioner for Refugees (2016) Uganda Fact Sheet February 2016. [Accessed on 29 June 2016 at].

United Nations High Commissioner for Refugees (2018) Inter-agency Emergency Update on the DRC Situation #16. [Accessed on 20 March 2018 at]

United Nations High Commissioner for Refugees and Refugee Law Project (2012) Working with men and boy survivors of sexual and gender-based violence in forced displacement. Need to Know Guidance 4. Geneva: United Nations High Commissioner for Refugees.

Women’s Refugee Commission (2016) Mean streets: Identifying and responding to urban refugees’ risks of gender-based violence. Men and boys, including male survivors. [Accessed on 4 May 2017 at]




How to Cite

Kansiime, P., van der Westhuizen, C., & Kagee, A. (2018). Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala. Social Work and Social Sciences Review, 19(3), 152-173.