Healing the wounds of abuse: A day at a GBV recovery centre
Counsellor Agoya Peris Mukangi works with two sisters during a play therapy session at the recovery centre at the Coast General Teaching and Referral Hospital in Mombasa on December 9, 2024.
What you need to know:
- Nation.Africa spent over 10 hours at Mombasa county’s first GBV Recovery Centre for a frontline view of sexual violence on the Coast.
- Out of eight patients, six were under 18; the youngest are two sisters aged three and two years old.
It’s before 9am and the centre isn’t fully open yet – the floors are still wet from mopping and only some staff members are on-site – when the first patients timidly enter the Gender-Based Violence Recovery Centre at Coast General Hospital.
Located inside the Coast General Teaching and Referral Hospital – a public hospital in Mvita, Mombasa – the centre is a jointly funded, private-public partnership between the hospital and the International Centre for Reproductive Health, Kenya, a Mombasa-based nongovernmental organisation (NGO).
The centre is fully integrated into the hospital, providing a typically vulnerable population with free wrap-around services for gender-based violence (GBV), including medical care, legal assistance and five mental health counselling sessions over the course of 10 weeks.
The hospital waives patients’ costs and pays for the centre’s maintenance fees, medical supplies and the salary of one nurse. The NGO pays for three full-time staff members, advocacy activities and oversees data collection.
When it opened in 2007, it was Mombasa’s first gender-based violence recovery centre and has since served as a model for public healthcare centres in Mombasa, says Itai Farah, Mvita sub-county’s coordinator for anti-GBV initiatives. The Voice spent over 10 hours shadowing staff, for a glimpse into what a typical day is like on the frontlines of sexual and gender-based violence on the coast.
By the end of the day, staff will have attended to eight GBV survivors and their families, 13 people in total. All but two were children. The grim reality is 80 per cent of those who attend the centre are minors.
Mondays always busy
Two sets of families arrive in quick succession: a 50-year-old street vendor with her nephew and a 16-year-old boy coming for a follow-up therapy session. Mondays are always busy because of the ‘weekend gap,’ say staff. The hospital is level five. Survivors can be seen 24/7 in the emergency room by staff trained to handle sexual assault, but the centre itself operates Monday to Friday during business hours. Weekend patients are told to return on Monday.
Grace* and her child are the first to arrive, their ER paperwork at the ready. She makes a modest living, selling fried fish and mandazi on the street to support her seven children – three, including the boy with her, are her brother’s, who she took in after he died nine years ago. She considers him her son. “I took them like my children,” Grace says. “I love them.”
Wearing a blue dress and matching headscarf, her face is tired and anxious as she carefully presents her son’s documents to Pricillar Chigulu, the centre’s clinician. The boy stares blankly ahead, swinging his feet. His birth certificate says he is 14, but he looks much younger, closer to 10 and is only in class four in school. Pricillar suspects the document might have been forged, but goes by the official record, carefully writing 14 in the patient ledger.
Vulnerable victim assaulted
One Saturday, Grace learned her son had been defiled after he returned from an unusually long absence, and was uncharacteristically “dull” for two days. He refused to play or talk to anyone and sat down next to me, putting his head between his knees, she said.
With gentle prodding, her son confessed their neighbour, a 55-year-old man who sells changa’a – a potent type of illicit homebrewed spirit – had led him to a room and sodomised him. “I cried. I couldn’t say anything,” said Grace, tears welling up. “He was raped on a Friday, then the rapist raped him again on Saturday.”
Preventing HIV
The family immediately went to the police, who referred them to the hospital, where staff gave the child prophylaxis – an emergency type of medication that can prevent HIV infection after exposure. The boy was seen within the crucial 72-hour window of the assault, when post-exposure prophylaxis is effective and forensic evidence is still fresh, but Grace is fearful the weekend’s rapes might not have been the first time. The neighbour was friendly with the family and frequently asked Grace’s son to run errands for him.
“I’m praying to my God, so that the boy – may God stand with the boy not to have HIV,” she said, her voice breaking.
Once Pricillar finishes the paperwork, she talks to Grace, providing psychosocial support and explaining how the centre will help her son. She then interviews the boy.
Recovery centre staff employed by an NGO: Counsellor Agoya Peris Mukangi (left), Clinician Pricillar Chigulu (centre) and paralegal Agnes Karanja outside the centre at the Coast General Teaching and Referral Hospital in Mombasa on December 9, 2024.
Emergency room staff already did a physical exam and collected evidence, but Pricillar needs to re-examine him to fill out the post-rape care form (PRC) – a crucial legal document submitted as evidence in court cases. Ideally, she said, the first technical medical person who sees the patient is supposed to fill out the PRC. But in this case, it wasn’t done. “It can be traumatising to keep making them talk about the story,” said Pricillar.
However, she doesn’t have a choice, the PCR includes detailed body diagrams, which must be marked showing assault injuries. Pricillar might also be called to testify in court. She tests the boy for HIV and gives him more prophylaxis tablets – he’ll need to take the medication for another 25 days.
Grace sits outside the exam room staring at the closed door, waiting. It’s 1:20pm and she hasn’t eaten anything; all her money went to getting to the centre. “We haven’t even taken tea, but I’m happy,” she said.
The hunger doesn’t matter because her son will get the right treatment. There is anger in her frail frame. Grace, who suffers from heart failure and diabetes, wants people to know what has happened to her son. “I want it everywhere, so that everybody can know what is going on,” she says, adding she especially wants potential perpetrators to hear of her case and be scared.
The neighbour was arrested by police over the weekend. Grace is not confident he will be convicted, but she is determined that her son will keep coming for treatment, even if lack of money means they have to walk to the centre. “Even without taking a car, I’ll be here with my son,” she says, crying, yet resolved, “so that we do what is supposed to be done.”
Late in the afternoon, the pair leave with a referral form for the police station to which the family reported the assault. The next step is to complete the P3 form.
Pricillar estimates that from a medical evidence perspective, Grace’s son’s case has a 50-50 chance of succeeding in court. “He came on the same day [of the assault], but he had washed.”
Many patients come after 72 hours, she says. “It’s quite disappointing.”
Pricillar is used to difficult cases, having worked in the sector for five years but says this case “lingers”. The boy showed signs of being intellectually disabled, with a history of delayed milestones, having been born prematurely. “The aspects of vulnerability have come out because of his mental situation and the fact that he’s an orphan, having been neglected by the biological mother, living with relatives,” she says.
About half of the centre's cases involve a vulnerable victim, often assaulted by someone close to them, “either a relative, a neighbour or a friend,” she says.
The work is emotionally gruelling and sometimes “overwhelming,” especially during counselling sessions, when you must be empathetic, says Pricillar. “You end up sharing the emotions with them.”
However, she is deeply passionate about the work, having grown up last-born in a polygamous family, witnessing physical, emotional and verbal abuse. The 2023 assault of someone she was close to, and resulting delays in justice further motivated her. “Legal is the problem. I can tell you, from my experience and even from the testimonies of the guardians and survivors, who come here, clearly there is a gap.”
The centre’s survivors are poor with no bargaining power, she says. Perpetrators can buy their way out of trouble and cases frequently settle informally through kangaroo courts, outside the legal system. “That also affects us as medics; you get discouraged. You feel like the PRC was picked, nothing happened. What am I even doing here?”
Unclaimed PRC forms
In a secure, locked storage room, shelves are filled with PRC kits and forensic samples packed in manila envelopes. Some, says Rebecca Nyandia – a nurse who works at the centre and does forensic collection – have been in the room for years. “Police, they don’t even sometimes come,” Rebecca says.
Occasionally, she says, police will collect the evidence at the last minute during the court proceedings – they’re supposed to collect the forensic samples with the PRC form.
Rebecca estimates that sometimes less than half of the PRC forms that staff complete in a month are taken by police – the rest stay in the storage room. As long as the samples were packed dry, they remain “potent.” Just before 10am, a police officer arrives to collect four PRC forms.
Successful convictions
Officers frequently come on Monday, says Agnes Karanja, the centre’s paralegal. Agnes’s cell phone rings constantly throughout the day, as she coordinates with police and survivors, ensuring they know when to go to court. Sometimes, she testifies on behalf of minors, especially if the perpetrator is a relative.
Having a paralegal has helped ensure about 55 per cent of the centre’s cases of sexual violence make it to court in recent years, according to numbers provided by the NGO. Since opening in 2007, 60 of the centre’s cases have resulted in convictions, including life imprisonment, says Agnes. The process is slow, she stresses. “We have cases from way before 2020 and judgment has not been done.”
Most people initially want to pursue legal action, especially if children are involved, but survivors often get tired during the process and stop going to court, she says. “This is why we are there,” she says, “we keep on encouraging them: ‘It’s good just to go.’”
But she says there are financial barriers. “I find myself even paying for transport for some of them so that they’re able to go.”
Victims cannot afford to come for free therapy. Transportation costs also prevent many survivors from accessing free therapy. The centre has a poor retention rate for counselling because of that financial burden, says Abigael Sidi, a senior programmes officer at the NGO. “Most of them come for one or two sessions.”
At 10.09am, two parents and their seven-year-old son arrive for their first therapy session. Two days before his seventh birthday, their son was violated by another student at the madras, says the father, who the Voice is calling Azan. As a parent, it crushed me, says Azan. “We both felt too much pain – me and the mother.”
A child violated by another minor
He learned his son had been defiled, when good Samaritans who witnessed the assault brought the boy home. The family was told the 14-year-old perpetrator had been beaten by a mob and taken to a police station. The biggest shock for the family was that the assault happened inside a mosque, somewhere they thought was safe for their child. Azan finds speaking about the assault painful, but the centre’s therapy session helped, he says. “It’s a small process of me releasing the tension and the anger that was building up in my chest – that I’ve been carrying in my chest.”
He wants other parents to know that cases like his family’s should not be kept quiet. “We should talk about it. And the victim, they should not keep him in the house. They should bring him to therapy, so he can get help for his future,” says Azan, adding victims can later become perpetrators if they are not helped.
While Azan and his wife speak to the counsellor, their son waits in the play therapy room. It is the county’s only child therapy centre in a public hospital. When the family leaves, the boy’s shy smile reveals two missing front teeth as he waves goodbye to staff. The family’s hope for their son: “To live a normal life, the way God has written his book for him to live.”
Youngest survivors
Also in the play therapy room are two sisters aged two and three years old – both were defiled. The girls pull out every toy they can, making a mess, before Agoya Peris Mukangi, the centre’s counsellor joins them for a session. Often, Peris says, the state of the room gives insight to young children’s mental state. “They had thrown everything. Everything, everywhere; that tells you that there is still work to be done,” she says.
It’s the sisters’ second time at the centre and by the end of the session, they are laughing and jumping on Peris, as they help her clean up, before leaving with their father. The final patients of the day are a girlfriend and boyfriend, both 25, who got into a physical fight with a knife. While the bulk of those the centre sees are victims of sexual violence, the centre also deals with cases of physical violence. Once they leave, staff begin closing up and depart.
Peris lingers behind to do paperwork and rest. It’s 5.30pm and she hasn’t eaten since breakfast. Some cases can hit really hard, your heart is heavy and you want to explode, she says. “That is why, at a time like now, you just have to sit back, meditate and just breathe in and breathe out.”
*Name changed for privacy reasons.
