Accessing care after sexual violence during a humanitarian crisis: Understanding care‑seeking patterns in North Kivu, Democratic Republic of the Congo
Reinholdz, Hanna LU
(2026)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- Background: Offering care and support to survivors of sexual violence is crucial in order to support their healing and recovery. Yet, accessing care is often challenging for survivors and especially in humanitarian settings. North Kivu, a province in the eastern part of the Democratic Republic of the Congo, has been ravaged by conflict and violence for several decades and is one of the worst humanitarian crises in the world. The aim of this thesis is to examine and explore care-seeking patterns, factors influencing timely access to care, as well as barriers and enablers to care-seeking for survivors of sexual violence in North Kivu.
Methods: In Paper I and Paper III cross-sectional study designs were used to examine file-based... (More) - Background: Offering care and support to survivors of sexual violence is crucial in order to support their healing and recovery. Yet, accessing care is often challenging for survivors and especially in humanitarian settings. North Kivu, a province in the eastern part of the Democratic Republic of the Congo, has been ravaged by conflict and violence for several decades and is one of the worst humanitarian crises in the world. The aim of this thesis is to examine and explore care-seeking patterns, factors influencing timely access to care, as well as barriers and enablers to care-seeking for survivors of sexual violence in North Kivu.
Methods: In Paper I and Paper III cross-sectional study designs were used to examine file-based data containing information about survivors of sexual violence who had accessed care, collected as part of routine activities within the organisation Médecins Sans Frontières’ activities in North Kivu. Descriptive statistics as well as logistic regression models were used in the analyses. In Paper II a qualitative study design was applied. Focus group discussions with community members in different areas within the study settings were conducted and analysed using qualitative content analysis.
Results: Age, sex and displacement status as well as referral pathways impact timely access to care. Lack of knowledge and fear of social consequences were the main reported barriers among survivor who accessed care and also perceived as main barriers among community members. Community members also highlighted lack of adapted healthcare facilities and respectful healthcare staff as key barriers for survivors of sexual violence to access care. Misconceptions around timing of care seeking and healthcare needs for survivors of intimate partner sexual violence could also prevent care-seeking.
Conclusion: Understanding variations in care-seeking behaviours and specific barriers experienced by the target population is key and response to survivors of sexual violence needs to be adapted to different groups of survivors using tailored models of care and entry points and targeted awareness raising messages and methods. Specific attention needs to be paid to misconceptions, harmful narratives and harmful social norms in the population which might hamper care-seeking. Raising awareness, reducing stigma and harmful actions by husbands and other community members, and ensuring that healthcare services are respectful and accessible for all survivors are key actions to improve access. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/001b4431-d250-4acc-a903-fb72ec5ab3dc
- author
- Reinholdz, Hanna
LU
- supervisor
- opponent
-
- Professor Hossain, Mazeda, Nottingham Trent University
- organization
- publishing date
- 2026
- type
- Thesis
- publication status
- published
- subject
- keywords
- Sexual Violence, Democratic Republic of the Congo, Access to care, Violence against Women, Gender-based violence, Sexual abuse
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 20206:120
- pages
- 105 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/66376374379
- defense date
- 2026-09-25 13:15:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-918-1
- language
- English
- LU publication?
- yes
- id
- 001b4431-d250-4acc-a903-fb72ec5ab3dc
- date added to LUP
- 2026-08-10 10:00:22
- date last changed
- 2026-09-04 12:19:17
@phdthesis{001b4431-d250-4acc-a903-fb72ec5ab3dc,
abstract = {{Background: Offering care and support to survivors of sexual violence is crucial in order to support their healing and recovery. Yet, accessing care is often challenging for survivors and especially in humanitarian settings. North Kivu, a province in the eastern part of the Democratic Republic of the Congo, has been ravaged by conflict and violence for several decades and is one of the worst humanitarian crises in the world. The aim of this thesis is to examine and explore care-seeking patterns, factors influencing timely access to care, as well as barriers and enablers to care-seeking for survivors of sexual violence in North Kivu.<br/><br/>Methods: In Paper I and Paper III cross-sectional study designs were used to examine file-based data containing information about survivors of sexual violence who had accessed care, collected as part of routine activities within the organisation Médecins Sans Frontières’ activities in North Kivu. Descriptive statistics as well as logistic regression models were used in the analyses. In Paper II a qualitative study design was applied. Focus group discussions with community members in different areas within the study settings were conducted and analysed using qualitative content analysis.<br/><br/>Results: Age, sex and displacement status as well as referral pathways impact timely access to care. Lack of knowledge and fear of social consequences were the main reported barriers among survivor who accessed care and also perceived as main barriers among community members. Community members also highlighted lack of adapted healthcare facilities and respectful healthcare staff as key barriers for survivors of sexual violence to access care. Misconceptions around timing of care seeking and healthcare needs for survivors of intimate partner sexual violence could also prevent care-seeking.<br/><br/>Conclusion: Understanding variations in care-seeking behaviours and specific barriers experienced by the target population is key and response to survivors of sexual violence needs to be adapted to different groups of survivors using tailored models of care and entry points and targeted awareness raising messages and methods. Specific attention needs to be paid to misconceptions, harmful narratives and harmful social norms in the population which might hamper care-seeking. Raising awareness, reducing stigma and harmful actions by husbands and other community members, and ensuring that healthcare services are respectful and accessible for all survivors are key actions to improve access.}},
author = {{Reinholdz, Hanna}},
isbn = {{978-91-8021-918-1}},
issn = {{1652-8220}},
keywords = {{Sexual Violence; Democratic Republic of the Congo; Access to care; Violence against Women; Gender-based violence; Sexual abuse}},
language = {{eng}},
number = {{20206:120}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Accessing care after sexual violence during a humanitarian crisis: Understanding care‑seeking patterns in North Kivu, Democratic Republic of the Congo}},
url = {{https://lup.lub.lu.se/search/files/257950205/Avhandling_Hanna_Reinholdz_LUCRIS_med_papers.pdf}},
year = {{2026}},
}