Dedicated nurses play a key role in helping rape survivors in South Africa, yet their future is threatened by a funding crisis that has lurched from bad to worse

Up to a quarter of women in South Africa are raped. Most survivors never report the crime, yet those who seek support may fall under the care of people like Teddy Ceba and Mabel Qhathatsi, forensic nurses who provide health and criminal justice services in Free State province.

For more than a decade, Ceba and Qhathatsi have worked together at one of the country’s 55 Thuthuzela Care Centres, one-stop clinics that, operating at public hospitals or within communities, form a critical strand of South Africa’s anti-rape strategy.

“The oldest victim I have seen was a 89-year-old woman,” said Ceba. “The thugs broke into her house and raped her throughout the night. The youngest one since I worked here was four months – a baby boy molested by a family member. He was crying and the nanny realised something was wrong.”

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Forensic nurses like Ceba provide a vital service – statistics suggest their intervention in rape cases improves the chances of holding the perpetrator to account by 35% – yet their future is under threat. Government cuts are in the pipeline that, combined with restrictions surrounding donor support, will only compound a chronic funding shortage.

Untreated Violence, an analysis of rape crisis services published last week by Médecins Sans Frontières (MSF), found that only 27% of designated facilities across the country provide the comprehensive medical care required. That includes a forensic examination, HIV testing, tetanus and hepatitis B vaccinations, emergency contraception and mental health support.

Only 42% of the 265 specialist facilities consulted said all the necessary medical examinations and treatments were available. While all the facilities provided HIV testing, nearly three-quarters did not provide at least one of the essential services, and 20% did not offer a clinical forensic examination of survivors.

There was an especially marked lack of mental healthcare, with little more than a quarter of rape survivors having access to a psychologist. Yet one survivor told researchers: “I would be dead today if it wasn’t for the counselling I received after I was raped. We need to be able to get these services.”

Facebook Twitter Pinterest Forensic nurses assist victims of sexual violence through offering counselling and physical examinations and by testifying against perpetrators. Photograph: Courtesy of One World Media

Garret Barnwell, a Johannesburg-based clinical psychologist for MSF, said: “The prevalence of sexual violence is incredibly high, with dramatic health consequences, yet the provision isn’t anywhere near scratching the surface of the problem.

“The country faces a chronic funding problem at the very time it needs to be extending services. The current austerity agenda means it will be very difficult for the government to expand its sexual violence response.

“Donor money is becoming more restrictive because it is often tied to reducing HIV infection after rape. This means other health components tend to suffer. Mental health is often where the biggest burden lies.”

Amir Shroufi, deputy medical coordinator at MSF in Cape Town, said the latest research reveals huge gaps in the provision of services and staff, particularly nurses.

“The scale of the problem is absolutely enormous and the facilities that do exist do not provide comprehensive care.

“Many people give up trying to access services and describe the process of seeking out care and legal redress as being nearly as traumatic as the event itself,” he said.

“Some services are run almost entirely by volunteers and there are communities wholly dependent on one or two good people. Some hospitals are relying on one nurse who wants to address the need in this area.”

About 400 forensic nurses work across the country in rape support clinics, according to the South African Forensic Nursing Association.

But low pay and lack of recognition coupled with stress and long hours are causing many to leave. Forensic nurses are not recognised as specialists by the Department of Health and there is no financial incentive to undertake the necessary training.

Thapelo Thipe, a 33-year-old forensic nurse at a hospital in North West province, said he is considering leaving.

“I collect forensic evidence for sex crimes and we have a crisis centre for victims here. But how can I be an expert [in forensics] when the head council does not even recognise me? We get no extra money or support, we are not taken care of. I may as well return to being a casualty or general nurse.”

He added: “If more forensic nurses leave, more rapists will go free. But truly speaking, I’m tired of it, I feel overworked and the wages are low.”

The need for more specialist rape response nurses is acute. According to national data, there were 49,660 sex crimes reported to the South African police in 2016/2017, including 39,828 rapes. Experts have said that mass recruitment is necessary, yet only Free State University provides a one-year post graduate diploma in forensic nursing. Elsewhere, two-week training courses are offered coupled with on-the-job mentorships. It is not enough.

Specialist care

At the Thuthuzela Care Centre in Free State Province, Ceba and Qhathatsi counsel rape survivors about the potential health risks they face, including HIV infection, and prepare them for medical examination.

Patients are given a care pack so that they can shower, change into clean underwear and brush their teeth. The centre will help arrange for police to take a statement.

Specialised sexual offences courts staffed with prosecutors, social workers and police officers are located close to the centres, to ensure a seamless journey for the survivor through the criminal justice system. Yet funding remains a huge issue.

Facebook Twitter Pinterest Forensic nurses Teddy Ceba and Mabel Qhathatsi feature in a film by Simisola Jolaoso about their specialism. Photograph: Courtesy of One World Media

Kathleen Dey, the director of the Rape Crisis Cape Town Trust, which sees more than 3,000 rape survivors a year, said: “The government has not given any clear signs it will continue this project once foreign donor funding ends.

“Foreign donor policies are moving towards prevention and away from care, seeming to ignore the preventative role that care plays in the cycle of violence.”

She added that many donors are unwilling to subsidise services they see as the responsibility of the government.

The centres were designed and implemented by the National Prosecuting Authority together with the Department of Health and the South African Police Services. However, there is no integrated budgeting and the facilities rely heavily on external donors.

The entire NPA contribution is funded by USAid, while the health and counselling services rely on NGOs. Funding for counselling comes largely from the Global Fund, which provides grants in three-year cycles, the latest of which runs until 2019.

Lisa Vetten, a research fellow at the Wits City Institute in Johannesburg, said: “One of the difficulties for NGOs is that foreign funders, including the [UK’s] Department for International Development, withdrew their funding, claiming South Africa is a middle-income country that no longer requires assistance.

“Given the way our economy is shrivelling up and dying there is a real need for donors to rethink that decision. Some argue the government should be funding these services itself, but that is blatantly not going to happen.”

Last month, S&P Global Ratings downgraded South African local currency to “junk” status, citing a further deterioration in the country’s economic outlook and sending the rand tumbling.



“There is a crisis already unfolding. In April the new subsidies come into effect, and we fully anticipate there will be slashes across the board to domestic violence shelters and to rape crisis services,” said Vetten.

“We could see the disappearance of counselling and court support, which will only exacerbate the sense there is no value in reporting to the criminal justice system.”

Some nonetheless remain hopeful of making a difference against the odds. Eva Mogoma, 53, lives in Rustenburg, where it has been estimated that 11,000 girls and women are raped every year. She works in the emergency department of the Moses Kotame hospital and does not currently collect forensic evidence, but is studying pharmacology in her own time so that she can become a forensic nurse “even if there are no incentives”.

“We need forensic nurses to show people there is support, and so rapists know there are consequences,” said Mogoma. “Every day a woman or girl is raped. People don’t report it so it’s up to us to speak out and show people rape is not the end of life.”