Critical gaps in the treatment of survivors of domestic and sexual violence are placing thousands of women at serious physical and psychological risk in Papua New Guinea (PNG), health experts warn.
In a recent report, Médecins Sans Frontières (MSF) - the largest provider of specialized medical and psychosocial services to survivors of family and sexual violence in the country - highlights the "urgent, unmet medical and emotional needs of survivors of gender violence" in this half-island nation.
The international health NGO said it had seen more than 11,000 survivors of family and sexual violence in PNG, including 2,000 survivors of sexual violence, between January 2008 and October 2011.
In Lae, Morobe Province, between January 2008 and October 2011, MSF and Angau Hospital treated 6,869 survivors of intimate partner violence - the equivalent of 149 a month - and 1,599 survivors of sexual violence (35 per month).
In Tari, Hela Province, from September 2009 to October 2011, MSF and Tari Hospital reported 1,471 survivors of intimate partner violence or 59 per month and 398 survivors of sexual violence or 16 cases per month.
"The problems have always been there but we did not have any concrete data and information. Now that MSF has moved into the country, the situation is becoming much clearer," Ume Wainetti, head of the Family and Sexual Action Committee, a government programme set up to address gender violence, told IRIN.
PNG, with more than six million inhabitants, is known for its high rate of gender-based violence.
According to the PNG Law Reform Commission, 70 percent of women in PNG say they have been physically abused by their husbands. That number reaches 100 percent in some parts of the country.
And though domestic violence is a criminal offence, it continues to be viewed as a private matter and rarely addressed in public, according to the Social Institutions and Gender Index of the Organization for Economic Co-operation and Development.
Over the years, when survivors sought care at hospitals or health centres, their specific medical and psychological needs were not recognized.
"Survivors with serious physical injuries will have their wounds tended to and will be sent back home. Their less visible health needs, with negative and potentially fatal long-term consequences, are completely neglected by Papua New Guinea's healthcare services.
"This neglect is causing suffering and, at times, putting lives at risk," MSF said in its report.
Joan* fled her home in the capital, Port Moresby, in late 2011, leaving her four children and their abusive father, a senior government official, with a broken arm, after living a life she described as hell.
"We survived on the little income I was earning from the ice blocks I was selling. My children and I never saw his wages. When I inquired, I was bashed up and told to shut up. He drank and gambled a lot," the 30-year-old said from her Chimbu village where she is recovering in her family home.
MSF recommends that the National Department of Health take charge of policy-making and set up treatment protocols and guidelines for survivors, implement operational guidelines, provide support to family support centres, and waive fees for treatment of survivors of family, sexual violence and child abuse.
And while the government is aware of the problem, it has no reliable data to work on. The most recent is about 20 years old and was gathered by the Constitutional Law Reform Commission, which works on new legislation for the government before parliament passes it.
However, it has moved to address gender violence, albeit slowly, both at the political and administrative levels.
"Already parliament had passed the Lukautim Pikinini Act, to protect children from all forms of abuse. In 2002, it also passed amendments to the Criminal Code, to protect women from domestic and sexual violence, even marital rape, but we still have problems with enforcement. The Family Protection Bill is still awaiting parliament to pass it. Hopefully this will be done next year," Wainetti said.
At the administrative level, all major hospitals in the country set up family support centres to provide medical and psychological services but they are operating with unskilled staff and on very small budgets.
"We have already provided training to staff at Mendi, Mt Hagen, Vanimo, Goroka, Nonga and Kudjip hospitals. We are training staff right now at Buka, Alotau and Wabag hospitals," Patrick Almeida, medical coordinator of MSF, said.
Meanwhile, a lack of financial support has seen the closure of a number of shelters for abused women in PNG. Of four in the capital, only one can provide services effectively.
"The problem is bad. We pretend that it is not there," Wainetti said.
*Not her real name