The South African township of Khayelitsha is on the frontline of a humanitarian crisis of staggering proportion. With one of the highest rates of sexual violence in the world outside of a conflict zone, it is estimated that 1 in 3 children living in Khayelitsha suffers serious sexual abuse or rape by the age of 18.
Khayelitsha is an informal settlement that was established during the apartheid era. It is the second largest township in South Africa with an estimated population of 1.5 million residents, 99% of which are Black African. Khayelitsha has an unemployment rate of 39% and a 36% rate of completion of secondary school. Sexual violence is a contributing risk factor in the high HIV/AIDS rates among females in South Africa. 20-40% of the population in Khayelitsha has HIV/AIDS, with tuberculosis as a common secondary diagnosis, leaving many children without parental supervision and therefore more vulnerable to abuse.
There is limited infrastructure in place in Khayelitsha to address the sexual violence. Police forces are overburdened and notoriously mishandle rape cases, and effective community emergency intervention facilities are lacking. Though apartheid is over 20 years past, interviewed residents often endorse the sentiment that little has improved in Khayelitsha in regards to opportunity and safety.
Research on rape and implementation of interventions are difficult for several reasons. Cultural definitions of rape vary, making it difficult to classify in questionnaires. Issues around stigmatization introduce bias into most studies. Data cannot easily be gathered at a community level because of corruption in the criminal justice system, where a rape docket can be ‘lost’ for a bribe of as little as $3 USD. Children are often unable to report abuse and access services due to dependence on their abusers. The South African Police reported that in 2001, children were the victims of 41% of all rapes reported in the country—1/3 of which were committed by a close relative.
Targeting a problem of this enormity and complexity is formidable. Concurrences of factors that contribute to sexual abuse are present in Khayelitsha and must be considered when planning interventions. Such risk factors include poverty, poor housing infrastructure with public latrines, rampant violence, and high rates of alcohol abuse. Interventions targeting child rape will require a collaborative partnership between many sectors to address the breadth of risk factors. In addition to preventative measures, there is a need for more post-exposure health services and counseling for children who have been raped.
There is currently only one center in Khayelitsha offering a safe house and counseling services to children who have been raped or sexually abused. Nonceba Family Counseling Centre (nonceba.org) offers holistic care through its abuse prevention education and counseling and support services. Nonceba reaches an estimated 5,000 children per year and hopes to expand services, contingent on donations.
Addressing the sexual violence that affects such a large proportion of children in Khayelitsha should be a public health priority. It will require multi-sectoral provision of services to address the root causes and sequelae of child rape. Such capacity building will benefit the wider Khayelitsha community and an under-served demographic of children who urgently need assistance.
Katrina Luthy-Kaplan is an MSc in Public Health candidate at the London School of Hygiene and Tropical Medicine, with a focus on health services management and global disability.
Editor’s Note: This article is the latest in our monthly series of commentaries highlighting honorable mentions from the 2015 Global Health Untold Stories contest sponsored by Global Health NOW and the Consortium of Universities for Global Health.