One in four adult women in the West is sexually attacked during her lifetime. A similar number of girls suffer sexual abuse in childhood, along with one in six boys. Very few seek medical, psychological or emotional help, and even fewer file police complaints.
Because victims are often too ashamed or frightened to speak out, Dr. Sagit Arbel-Alon, a senior obstetrician-gynecologist at the Hadassah Medical Center in Jerusalem, asks every patient she sees whether they have ever suffered sexual violence. For some, this “permission” to recount a buried horror opens floodgates. But other responses are like this one by a woman in her twenties: “Oh, no, nothing like that’s ever happened to me!” she replied. “Once, a few years ago, a man grabbed me on my way home from school, tore my T-shirt and dragged me into an alley. He was opening his pants when he heard someone coming, and ran off. Yes, it was awful. But, as you see, I’ve never been sexually abused.”
Sexual abuse is any sexual act or behavior imposed on anyone without their consent, says Dr. Arbel-Alon. “It is a sexualized form of violence, consciously designed to terrify, a crime intended to humiliate and control the victim. The prevailing societal understanding that most rapes are committed by sexual perverts or those unable to control their urges has been repeatedly refuted.”
Dr. Arbel-Alon directs Hadassah’s Bat Ami Center for Victims of Sexual Abuse, a specialized multidisciplinary treatment center for victims (or, in empowerment terms, survivors) of sexual abuse. The only such hospital-based center in Jerusalem and southern Israel, it opened in May 2009 and in its first two-plus years, has treated 400 people, aged 2 to 75.
“The sharp, ongoing rise in numbers seeking help here demonstrates that officially acknowledging sexual assault encourages its survivors to seek medical attention and emotional succor,” explains Tamar Siegel, head nurse of Bat Ami.
Bat Ami’s origins date back more than a decade to a pioneering group of Hadassah nurses, social workers and doctors, organized into a special sexual abuse response team by Nava Braverman, then-chief delivery room nurse. “Every member, from the most senior gynecologists, volunteered his or her time as an on-call responder,” says Dr. Shlomo Mor-Yosef, Hadassah Medical Organization director-general. “The team’s passion was uncontainable.”
Team members convinced Hadassah’s administration that the need was too critical to ignore, finding a strong advocate in hospital manager Dr. Yuval Weiss. “Community outreach and women’s health issues are an essential part of Hadassah’s mission,” he says. “They are vital components of providing quality patient care.”
Increasingly, police officers, medical personnel and rape crisis center staffers referred sexual abuse victims to Hadassah. Eventually, the Health Ministry came on board with funding to match Hadassah’s; private donations form a vital part of the modest budget. The team’s outreach was formalized in an organized center, its staff trained in fundamentals of forensic medicine and social, emotional and legal aspects of sexual abuse.
“This transformation into an official center affirms the medical profession’s recognition that sexual assault and rape must be treated,” says Dr. Arbel-Alon. “Its prevalence and medical implications constitute health problems as severe as coronary heart disease, with morbidity and mortality rates that can’t be ignored.”
Approximately half of all psychiatric patients were sexually abused during childhood, she notes. Chronic stomach pains, recurrent pelvic infections, eating disorders, repeated emergency room visits and avoidance of or aversion to medical examinations are among many other expressions of deteriorating general health following rape or sexual abuse. One in five rape survivors attempts suicide sometime in his or her life, and others talk constantly of wanting to die.
It is this understanding of the impact of sexual abuse that informs all aspects of Bat Ami. “Our fundamental philosophy is that the victim and her or his needs are central,” says Dorit Greenspan, Bat Ami’s chief social worker.
It is Greenspan or another Bat Ami social worker who brings sexual abuse victims from Hadassah’s hectic emergency room through a discreet side corridor into Bat Ami’s tranquil sitting area, with its armchairs, round table and coffee corner. The examination room, equipped for medical and forensic examination and documentation for the police and prosecutor’s office, is adjacent. A shower and clean underwear await victims at the end of what can be a five- to six-hour process.
“We encourage the victim to decide who escorts her or him through each stage of examination, sample-taking and statement,” says Greenspan. “It is the victim who paces the questioning, indicates what he or she can endure in the examination and decides whether to lodge a police complaint—something we promote but never force. We ensure that survivors know their options. Forensic evidence can be gathered from their bodies by Bat Ami nurses, we tell them, even if they are not yet willing or able to talk to the police. This allows the decision about pressing charges to be delayed until the victim is more stable.”
Hadassah’s laboratory fast tracks results for Bat Ami patients. “There is a 72-hour window of opportunity after an attack, when pregnancy can be prevented and medication can minimize sexually transmitted infections, including AIDS,” says Siegel. “We ensure the patient’s health fund provides any necessary follow-up medications, without victims having to answer further questions.”
Along with medical and forensic care, immediate and appropriate counseling is at hand. “Psychological care can be as critical as medical attention,” says Dr. Arbel-Alon. “Sexual abuse shakes basic understanding of personal safety and can result in short- and long-term physiological and emotional disturbances. Clinical studies show that the initial post-rape contact is a critical factor in the victim’s rehabilitative potential.”
The team also ensures that the victim relates her or his story no more than once, gathering police investigators along with medical personnel at Bat Ami. “There is no runaround for the survivors, no need to relive their shame and fear with repeated telling,” says Greenspan. “They tell their story in the safety of Bat Ami—not in a busy ER, with only a curtain separating them from the next patient.”
Although similar basic procedures are followed with each patient, every sexual assault is different, says Dr. Arbel-Alon. “Every victim brings his or her own set of values, personal story of attack, unique emotional responses and issues to be addressed. Our treatment approach for a young Arab girl with the guillotine of ‘family honor’ hanging over her is very different from that for a married ultra-Orthodox man who sneaks out to us at night to prevent his family and fellow kolel students knowing he has been raped. The many clinical, administrative and human decisions we make in treating each patient often have a definitive and lasting influence on their future.”
At present, the Bat Ami staff see about 16 victims a month, at least one of them male. The average age of adult patients is 27 and, of children, 11. Some are Arab but the majority are Jewish. A third are disabled or come from poor socioeconomic backgrounds. In 70 percent, the perpetrator is someone the victim knows.
The emotional burden on the staff is heavy. “We have to ask intimate questions, touch victims who don’t want to be touched and perform invasive tests,” says Dr. Arbel-Alon. “We have patients recoil from us in terror. We see abused teenagers whose profiles match those of our own daughters.”
Alongside its care of victims, Bat Ami has a secondary agenda: raising awareness of sexual assault among health care professionals as well as the population at large. An early success is the addition of a course on treating sexual assault victims to the training of obstetrician-gynecologists and midwives.
In summer 2010, a daylong symposium, held at Bat Ami to mark its first year, was attended by over 100 medical professionals, legal experts, social workers and others. Among them was Knesset Member Rachel Adatto, a gynecologist and lawyer. “Bat Ami is doing sacred work,” she said. “It should be a model for other rape treatment centers.”
The symposium’s keynote speaker was Israel’s Supreme Court president, Dorit Beinisch. “It is impossible to exaggerate the importance of this center,” she said. “[For too long] there’s been no support for those who complained [of sexual abuse, and] victims of sexual crimes were stigmatized. The common view was that if a woman had been attacked sexually, she probably asked for it.”
A social revolution has taken place in recent years, Beinisch continued, changes have come not from the top but from the grass roots, and “victims of sexual crimes are treated with far more dignity and sensitivity, rather than being blamed for ‘inviting’ the attacks on their bodies and souls…. But…there is still stigma…and Hadassah has taken upon itself a heavy responsibility.”