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Differences in sexual violence against younger and older adults in complex humanitarian settings : a retrospective analysis from Médecins Sans Frontières in 2019-24

Van Boetzelaer, Elburg ; Biru, Tesfahun ; Idris, Amina ; Keating, Patrick ; Staunton, Marion ; Escobio, Favila ; Pellecchia, Umberto ; Van de Kamp, Judith ; Baidjoe, Amrish and Nickerson, Jason W. , et al. (2025) In The Lancet. Global health 13(12). p.2061-2070
Abstract

BACKGROUND: Sexual violence against older adults in humanitarian settings is poorly documented, leading to gaps in prevention and delivery of support services. This study aimed to document differences in assault characteristics between younger and older adults, by sex and displacement and disability status and region. METHODS: This retrospective, descriptive observational, multi-country study included survivors aged 20 years or older who accessed sexual violence services supported by Médecins Sans Frontières in humanitarian settings across 11 countries between Nov 1, 2019, and Nov 1, 2024. Assault characteristics (context and circumstances of the assault and perpetrator characteristics) were compared between younger (20-49 years) and... (More)

BACKGROUND: Sexual violence against older adults in humanitarian settings is poorly documented, leading to gaps in prevention and delivery of support services. This study aimed to document differences in assault characteristics between younger and older adults, by sex and displacement and disability status and region. METHODS: This retrospective, descriptive observational, multi-country study included survivors aged 20 years or older who accessed sexual violence services supported by Médecins Sans Frontières in humanitarian settings across 11 countries between Nov 1, 2019, and Nov 1, 2024. Assault characteristics (context and circumstances of the assault and perpetrator characteristics) were compared between younger (20-49 years) and older survivors (50 years and older) stratified by sex and region using regression analyses. Among older survivors, analyses were mutually adjusted for age group, displacement, and disability status. FINDINGS: We included data from 35 248 survivors who accessed care in the study (33 548 [95·2%] survivors were aged 20-49 years and 1700 [4·8%] were aged 50 years or older). 34 007 (96·5%) participants were female and 1241 (3·5%) were male. Rape was the most frequently reported type of sexual violence across sexes and age groups, including in older female survivors compared with younger female survivors (odds ratio [OR] 2·01 [95% CI 1·34-3·22]). Compared with their younger counterparts, older female survivors were more likely to report assault during armed attacks (OR 1·85 [95% CI 1·65-2·07]), by multiple assailants (OR 1·66 [1·50-1·84]), by armed groups (OR 1·21 [1·09-1·34]), while gathering food or wood (OR 1·51 [1·36-1·68]), and with regional variation, and less likely to report sexual violence from an intimate partner (OR 0·29 [0·23-0·36]). Older male survivors were more likely to report sexual violence other than rape (OR 2·85 [95% CI 1·51-5·07]), and to report a female assailant (OR 1·65 [1·01-2·78]). Older female survivors with disabilities were more likely to report sexual violence from an intimate partner (adjusted [a]OR 3·57 [95% CI 1·42-7·84]), and repeat assaults by the same assailant (aOR 4·01 [1·68-8·57]). INTERPRETATION: This study reveals distinct patterns of sexual violence among older women, particularly assaults by multiple unknown armed assailants during survival tasks, and among older men, whose experiences often fall outside dominant sexual violence narratives. Disability and displacement further compound the vulnerability of older adults, influencing the type, context, and recurrence of violence. Findings underscore the urgent need for age-sensitive and disability-sensitive sexual violence support strategies in humanitarian settings.None. TRANSLATIONS: For the Arabic, Spanish and French translations of the abstract see Supplementary Materials section.

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Contribution to journal
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published
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in
The Lancet. Global health
volume
13
issue
12
pages
2061 - 2070
publisher
Lancet Publishing Group
external identifiers
  • pmid:41110454
  • scopus:105021932114
ISSN
2214-109X
DOI
10.1016/S2214-109X(25)00318-3
language
English
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yes
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Publisher Copyright: Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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581351d7-02bc-4064-a22a-c214dbb91636
date added to LUP
2026-01-16 16:34:15
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2026-01-20 11:46:02
@article{581351d7-02bc-4064-a22a-c214dbb91636,
  abstract     = {{<p>BACKGROUND: Sexual violence against older adults in humanitarian settings is poorly documented, leading to gaps in prevention and delivery of support services. This study aimed to document differences in assault characteristics between younger and older adults, by sex and displacement and disability status and region. METHODS: This retrospective, descriptive observational, multi-country study included survivors aged 20 years or older who accessed sexual violence services supported by Médecins Sans Frontières in humanitarian settings across 11 countries between Nov 1, 2019, and Nov 1, 2024. Assault characteristics (context and circumstances of the assault and perpetrator characteristics) were compared between younger (20-49 years) and older survivors (50 years and older) stratified by sex and region using regression analyses. Among older survivors, analyses were mutually adjusted for age group, displacement, and disability status. FINDINGS: We included data from 35 248 survivors who accessed care in the study (33 548 [95·2%] survivors were aged 20-49 years and 1700 [4·8%] were aged 50 years or older). 34 007 (96·5%) participants were female and 1241 (3·5%) were male. Rape was the most frequently reported type of sexual violence across sexes and age groups, including in older female survivors compared with younger female survivors (odds ratio [OR] 2·01 [95% CI 1·34-3·22]). Compared with their younger counterparts, older female survivors were more likely to report assault during armed attacks (OR 1·85 [95% CI 1·65-2·07]), by multiple assailants (OR 1·66 [1·50-1·84]), by armed groups (OR 1·21 [1·09-1·34]), while gathering food or wood (OR 1·51 [1·36-1·68]), and with regional variation, and less likely to report sexual violence from an intimate partner (OR 0·29 [0·23-0·36]). Older male survivors were more likely to report sexual violence other than rape (OR 2·85 [95% CI 1·51-5·07]), and to report a female assailant (OR 1·65 [1·01-2·78]). Older female survivors with disabilities were more likely to report sexual violence from an intimate partner (adjusted [a]OR 3·57 [95% CI 1·42-7·84]), and repeat assaults by the same assailant (aOR 4·01 [1·68-8·57]). INTERPRETATION: This study reveals distinct patterns of sexual violence among older women, particularly assaults by multiple unknown armed assailants during survival tasks, and among older men, whose experiences often fall outside dominant sexual violence narratives. Disability and displacement further compound the vulnerability of older adults, influencing the type, context, and recurrence of violence. Findings underscore the urgent need for age-sensitive and disability-sensitive sexual violence support strategies in humanitarian settings.None. TRANSLATIONS: For the Arabic, Spanish and French translations of the abstract see Supplementary Materials section.</p>}},
  author       = {{Van Boetzelaer, Elburg and Biru, Tesfahun and Idris, Amina and Keating, Patrick and Staunton, Marion and Escobio, Favila and Pellecchia, Umberto and Van de Kamp, Judith and Baidjoe, Amrish and Nickerson, Jason W. and Dada, Martins and Franco, Oscar H. and Caleo, Grazia and Verputten, Meggy and Browne, Joyce L. and Reinholdz, Hanna}},
  issn         = {{2214-109X}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{2061--2070}},
  publisher    = {{Lancet Publishing Group}},
  series       = {{The Lancet. Global health}},
  title        = {{Differences in sexual violence against younger and older adults in complex humanitarian settings : a retrospective analysis from Médecins Sans Frontières in 2019-24}},
  url          = {{http://dx.doi.org/10.1016/S2214-109X(25)00318-3}},
  doi          = {{10.1016/S2214-109X(25)00318-3}},
  volume       = {{13}},
  year         = {{2025}},
}