Through the Istanbul Convention, Sweden has committed itself to setting up easily accessible clinics that offer trauma care and specialized non-emergency support services for victims of sexual crimes throughout the country. Istanbul Convention Expert Group Grevio criticized Sweden in 2019 in order not to live up to this commitment.
Three years have now passed, which is the period of time given to States Parties to implement the recommendations and report back to the Committee. Three years have also passed since the commitment was made in the government declaration in 2019 that “more clinics will be set up for victims of sexual crimes”. The only thing that has happened in the area since then is that a reception for sex offenders, the Astateam in Umeå, has been closed.
Sweden’s Municipalities and Regions (SKR) confirmed in a report 2020 that the health service has insufficient knowledge of the care needs of victims of sexual offenses and that the lack of access to knowledge-based non-emergency medical care for victims of sexual offenses is great. This is due to the lack of basic education, specialist training, national care programs and specialist clinics that offer non-emergency care for sexually abused people. Instead, all primary care and psychiatry are assumed to be able to take care of the patient group, despite the lack of special training on non-acute health care needs for sexually abused people.
Today, victims of crime face a double violation: first by the perpetrator and then by society.
If you have been sexually abused, you can seek help from the emergency medical service up to four weeks after the violence. However, most vulnerable people do not seek emergency medical care, and then there are no special clinics to turn to.
In the agreement on suicide prevention between the government and SKR it is written that survivors of sexual violence and prostitution are in need of trauma care, and that non-emergency care is crucial for the treatment of, for example, post-traumatic stress disorder, PTSD, as the symptoms can manifest themselves much later.
It is also mentioned in the agreement on enhanced efforts for women’s health that care for sexually abused people needs to be strengthened both acutely and long-term in order to meet the needs of the survivor. Despite these surveys and recommendations, nothing has yet been done to increase access to specialized healthcare.
In parallel with the government own feedback to the Istanbul Convention’s Party Committee, a shadow report has been written by several of us organizations that meet this group daily. The shadow report “The Swedish government’s implementation of the Istanbul Convention” has been submitted to the committee prior to the UN review of how Sweden complies with the Istanbul Convention, which will take place this summer.
The report examines access to support, health care and trauma treatment for people who have been sexually abused in Sweden based on the articles of the Istanbul Convention. The conclusion is that the development has been stagnant for years and that there are still no special clinics, care programs and guidelines regarding non-emergency medical care for victims of sexual offenses. However, this is found in our neighboring countries Denmark, Norway and Finland.
Due to a lack of specialist clinics in regional health care, there are now more than 1,500 adults and children in line for care at Sweden’s only research-oriented specialist clinic for non-acute health care for the sexually abused: Wonsa’s specialist clinic. Gender is growing every day, and is 80 percent funded through donations, grants and volunteer efforts.
Sweden has a government like calls itself feminist, and equal care is an explicit goal. We now demand that Sweden and our elected representatives take the situation seriously, and act on the basis of their commitments to combat men’s violence against women through the Istanbul Convention. We who are behind the report make several demands to improve the living conditions of victims of sexual crimes and to enable the development towards human rights-based care. Our five most important requirements are:
1. Demanding responsibility. Human rights presuppose that everyone who has been the victim of violations must have access to appropriate measures to bring about a solution or redress, such as rehabilitation. Therefore, demanding responsibility that clarifies who is responsible is an important part of human rights.
SKR’s report also indicates that accessibility for patients in need of trauma treatment is low, as a result of an unclear division of roles and responsibilities. According to them, the way forward is, among other things, via a clearly defined assignment to relevant activities to meet the care needs of the patient group. We agree with this, and therefore demand that SKR ensures that the members (regions) take responsibility for the existing shortcomings.
2. The establishment of a national center for clinical method development, research and education. The center can develop treatment methods and prepare national guidelines for care regarding the patient group, as well as disseminate expertise to all regions.
We welcome them two motions presented to the Riksdag regarding the establishment of a national center (these will be debated on 13 June), and hopes that they will be adopted and implemented. It would be a concrete response to Grevio’s criticism and also create a long-term solution for survivors of sexual abuse.
3. Compulsory training of staff in primary care, psychiatry, child psychiatry and youth clinics. As there are no special clinics for this patient group, survivors often seek care for the symptoms that occur, and thus receive inadequate treatment. Through mandatory training in these areas, staff will be able to identify these patients.
4. Compulsory training of administrators at the Swedish Social Insurance Agency. Lack of understanding of sexual violence as a root cause of psychiatric diagnoses leading to sick leave drastically reduces the survivors’ ability to receive sickness compensation.
Today, victims of crime face a double violation: first by the perpetrator and then by society. By training administrators at the Swedish Social Insurance Agency, sexually abused people can receive a dignified treatment and a fair assessment before deciding on sickness compensation.
5. Compulsory training of administrators at the social services. As there are major shortcomings in the competence regarding sexual violence and its after-effects, both knowledge and sufficient investigative tools are lacking. The experience is therefore that it often lands on the personal commitment of the social service worker.
As a first instance regarding capturing sexually abused children, the competence is extra critical here, before these children become complexly traumatized adults who do not have access to their basic human rights.