Incidence of sexual violence among female asylum seekers

In 2021, there were 535,000 new asylum seekers in the European Union, 31% of whom were women. In France in the same year, 18,768 women over the age of 18 applied for asylum for the first time. The World Health Organisation reports that women fleeing war or persecution are particularly vulnerable to sexual violence (SV) shortly after arriving in their host country.

The aim of this study was to provide an estimate of the incidence of sexual violence suffered by female asylum seekers who had arrived in France less than two years earlier. The source population was identified by the Office Français de l'Immigration et de l'Intégration (OFII) and specifically concerned women registered with the prefecture of the southern region. Between 1 October 2021 and 31 March 2022, 1,299 women were identified by OFII as being eligible to take part in this study. Between those who could not be contacted, those who refused to take part and those who did not turn up for their first appointment, 273 women were finally included in the study. The decision was also made not to restrict the study cohort to women staying at the shelters, in order to avoid selection bias.

A survey to determine what had been suffered

The questionnaire study was conducted over a period of six months. Qualified interviewers called eligible women to introduce the study and arrange an appointment at one of the partner hospitals. They explained that the aim was to study the living conditions of asylum seekers in their host country and their potential exposure to sexual violence. If the women did not wish to travel, they were offered a confidential telephone appointment instead.

After establishing their socio-demographic profiles (age, dependent children, relationship with a partner in France, geographical origin, level of education, source of income and accommodation for most of the previous year), four questions were asked about the occurrence of exhibitionism, sexual assault, rape and attempted rape in the previous year. A positive response to one of these four questions was sufficient for a participant to be considered a victim of sexual violence. The researchers also took into account whether the women had already experienced sexual violence, in particular rape or genital mutilation, before arriving in France.

A key factor: access to accommodation

In France, 0.26% of women report having been raped in the past year, which is more than 18 times lower than the number of cases reported by the female asylum seekers included in the study. Similarly, the annual incidence of sexual violence (2.9%) and rape or attempted rape (0.31%) in the general population is at least 9 times lower than that observed in our study. The results of the conducted study seem to indicate that women seeking asylum are more frequently exposed to sexual violence than the general population. It should be noted, however, that with the limited number of women taking part (273 out of 1,299 eligible), it is possible that the sexual violence in the study was overestimated by the greater participation of SV victims who may have felt more concerned. It is also possible that the incidence was underestimated because some women did not wish to take part, explaining that they did not want to talk about the sexual violence they had experienced. For others, their partner did not want them to take part.

The results also highlight the role that accommodation plays in this context. Nearly one in three of the women included in the study had not received housing assistance in the previous year.  A significant association was found between this condition, lack of housing assistance, and the occurrence of sexual assault. Through this study, the researchers have shown that women seeking asylum are overexposed to sexual violence. This overexposure to sexual violence appears to be even higher among women without a partner present in France, those from West Africa and those who have already suffered sexual violence before arriving in France.

The importance of access to primary healthcare

The study was conducted by doctors from the Department of General Medicine at Aix-Marseille Université. This department trains interns in the speciality of general practice, and conducts clinical research focused on the quality of primary care provided to patients and the efficiency of healthcare systems. The areas of research are adapted to the context of the Provence-Alpes-Côte-d'Azur region, the issues affecting vulnerable patient populations (precariousness, migration, interculturality, addictovigilance, multimorbidity), and the contemporary health context (vaccination, scientific controversies, uncertainty and medical decision-making, pharmacovigilance). The department is made up of practising GPs affiliated to various research units, and has partnerships at local, national and international level, in particular with the Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), which contributed to this article.

This ground-breaking public health survey highlights the importance of access to primary healthcare for the entire population. Primary healthcare ensures that everyone receives comprehensive, high-quality care. According to the WHO and UNICEF, it is an approach to health that considers society as a whole and aims to ensure the highest possible level of health and well-being and its equitable distribution by prioritising people's needs as early as possible throughout the health care chain. A pathway from health promotion and disease prevention to treatment, rehabilitation and palliative care, staying as close as possible to people's everyday environment.

In the case of this study, less than one in ten women consulted a doctor or the police following the violence. More than half of the women who had suffered violence did not seek help at all. Following their participation in this study, all the women were offered health care in line with the WHO and UN Refugee Agency recommendations on sexual violence, i.e. care provided by experienced primary care services close to their place of residence. Women who so wished could also benefit from protection measures in collaboration with the OFII.

Preventing sexual violence when migrant women arrive in France is therefore a major public health issue. The results of this study provide invaluable information for implementing public policies to prevent, and detect if they cannot be prevented, sexual violence among asylum seekers.