Bujumbura – Salomé* still recalls the years of domestic violence she suffered at the hands of her ex-husband as a particularly dark period of her life. “I thought about killing myself, but I was afraid of leaving my children alone,” says the 23-year-old mother of five, who lives in Kirundo province in northern Burundi.

Hers is certainly not an isolated case. According to a government survey carried out in 2017, 36% of Burundian women aged 15-49 had experienced physical violence at least once in their lives. In 57% of such cases, the violence was inflicted by the woman’s husband or intimate partner. The survey also showed that 23% of women within the same age group had experienced sexual violence.

Against this backdrop, the Burundian health authorities have sought to integrate the management of gender-based violence into public sexual and reproductive health services through a project called Twiteho Amagara, which means “let’s take care of health” in Kirundi. The project, launched in 2019, provides emergency neonatal obstetrics care and training to health facilities.

With the support of the World Health Organization (WHO), the Burundian Ministry of Health has trained 120 health workers to know how to identify, treat and report instances of gender-based violence, as well as to raise awareness concerning prevention.

“Since I received this training, I know how to receive, listen and discuss with the victims of this kind of violence according to their particular individual situations,” says Oscar Adabashiman, an emergency nurse in Kirundo Province who was trained in 2021. “Then once the treatment has been completed, psychosocial care continues along with the legal proceedings.”

With funding from the European Union (EU), WHO has also provided health facilities with care kits consisting of anti-retroviral drugs and other medication for sexually transmitted infections as well unwanted pregnancies.

"In cases of gender-based violence, victims not only suffer injuries to their body that have a negative impact on their physical health, but they also suffer psycho-social damage,” says Dr. Eugénie Niane, who oversees reproductive, maternal and neonatal health at the WHO office in Burundi. “This is why an integrated approach to this issue is very important."

Overcoming stigma, particularly with regards to sexual violence, is critical to the success of any such approach. "It is very difficult to get victims to talk,” says nurse Adabashiman. “They are often very reluctant to tell us what they have experienced. So, we try to empathize with them and show them that what happened to them was not their fault.”

According to Dr Ananie Ndacayisa, director of Burundi’s National Reproductive Health Programme, such efforts are bearing fruit. “In the five provinces where the Twiteho Amagara project has been implemented, which together comprise 120 health facilities, cases that were not reported before are now reported and victims of gender-based violence are much more likely to go to health facilities for treatment,” he says.

Adabashiman is also optimistic. “Things are gradually changing, and we are happy about this,” he says. “It bodes well for the development of women and girls in our country."

In Salomé’s case, after yet another beating by her husband, she decided to seek help at her local health centre, where she received medical and psychosocial care, which she continued to be provided with after the emergency assistance. "I was well received, and I was able to get free treatment. I benefited from the advice of the doctors, who helped me get out of my trauma,” she says. “Little by little, I got better.” WHO