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Sexual assault units: ‘This will be one of the most traumatic events in their lives’

Many young women still don’t report sexual violence perpetrated by men they know, even though they may tell their friends about it

This time last year, the Central Statistics Office published the results of its Sexual Violence Survey 2022, revealing that four in 10 adults reported experiencing sexual violence in their lifetimes, with women experiencing almost twice the levels of sexual violence as men.

“The data from the CSO survey highlighted that sexual violence is more common that many would have thought,” says Prof Maeve Eogan, the national clinical lead for Sexual Assault Treatment Unit services in Ireland and an obstetrician and gynaecologist at the Rotunda Hospital in Dublin.

She is adamant that, as a society, we need to acknowledge this prevalence. “We need to make every attempt to not just respond when people ask for help, but also to discuss it in schools, sports clubs and workplaces so people feel more confident to disclose their experience and access the care and support they need.”

Prof Eogan adds that healthcare providers need to remember that, no matter what reason people are there, many have sexual violence in their past or even their present and that this may influence how they negotiate their healthcare journey or respond to particular interventions or examinations. “The impact of sexual violence continues for many years afterwards,” she says.

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Aideen Walsh, co-ordinator of the paediatric forensic medical unit at Children’s Health Ireland at Tallaght University Hospital, says that there has been an increase in the number of young people reporting sexual harm by another young person. “It can start as investigative play and develop into sexual harm. The question is, how is this managed if the perpetrator is under the age of criminal responsibility? We need to be able to respond to a child’s disclosure or concern in an appropriate way,” she says.

Walsh says sexual violence includes more than rape or contact sexual assault. “It can also be inappropriate touching and misunderstanding of consent.”

Eogan adds: “It can be people not knowing they can say no. You can consent to kiss someone but not want to have penetrative sex. Consent has to be ongoing, mutual and freely given and just because someone consented last week, doesn’t mean that they consent now.”

GPs and medical staff in hospital emergency departments are obliged to report incidents of sexual violence in children to Tusla, the child and family agency, whose job it is to carry out safety assessments and decide whether the child needs to attend the paediatric forensic medical unit. “It’s also important that we call out inappropriate behaviour when we see it,” says Eogan. “This is the crux of much of the ‘bystander’ interventions that are now in a range of training programmes.”

Dr Daniel Kane, forensic medical examiner at the sexual assault treatment unit in the Rotunda, says 15-20 per cent of people who attend for acute care at a sexual assault treatment unit don’t know if something has happened or not. This can be because they experienced an episode of memory loss due to known or unknown alcohol or drug use. It can also be because they need to tease out what happened as they don’t know if what they experienced is a sexual crime or not. Shockingly, many young women still don’t report sexual violence perpetrated by men they know ,even though they may tell their friends about it.

“This will be one of the most traumatic events in their lives and it’s very important that people are met with compassion,” says Kane.

The three healthcare professionals were speaking at an event to celebrate the legacy of the late Dr Moira Woods, who became the first medical director of the sexual assault treatment unit at the Rotunda Hospital in 1985. At that time, it was the first sexual assault treatment unit in Europe. And while it was originally set up to support adult women who were sexually abused, many teenagers and children were brought to the hospital by teachers, social workers and parents at a time when sexual abuse was a shameful secret in Irish society.

“The team saw 129 people in the first six months and a huge number were under the age of 16. New cases of sexual abuse were presenting daily,” says Eogan.

Now, almost 40 years later, there are six sexual assault treatment units in Ireland. “The aim is that no one is more than three hours away from a sexual assault treatment unit, and 90 per cent of those who need a forensic examination will be seen within three hours of a request,” says Eogan.

Staffed 24 hours a day seven days a week, these units are in Letterkenny, Cork, Waterford, Galway and Mullingar, with a small out-of-hours unit in Limerick. There are sexual assault treatment services for children in Dublin (The Laurels Clinic at CHI at Tallaght), Galway (CASATS, Willow Centre, Tuam Road, Galway City) and in Cork (The Family Centre, St Finbarr’s Hospital). All services are free and confidential.

“Our aims are the same as they were in 1985 – to provide forensic examination and treatment for rape victims, to improve the environment for examination and counselling and to alleviate the unpleasant aspects of the legal process – although we haven’t achieved the last aim yet,” says Eogan. Anyone keen to understand the shocking retraumatisation of victims of sexual violence by the legal process would be advised to read solicitor Sarah Grace’s book, Ash + Salt: From Survival to Empowerment After Sexual Assault or watch her recent interview on The Tommy Tiernan Show.

“It’s important for us to highlight that our services exist and we will respond to your needs with support from the Rape Crisis Centre. It can be very lonely and isolating experience. You may judge yourself or be in receipt of pejorative comments from friends. It’s important that people are listened to and heard, that they can get a forensic examination so we can assist with the detection and prosecution of evidence,” says Eogan.

The Rape Crisis Centre provides counselling and support to people who have experienced sexual violence and trained volunteers will attend a sexual assault treatment unit with anyone who requests this service. The Rape Crisis Centre also operates a national freephone 24 hour phone line on 1800-778888. Those attending a sexual assault treatment unit can opt for forensic examination (to be held as evidence for a future court case) with or without the involvement of An Garda. Forensic examinations are best done within 72 hours of the incident but can be done up to seven days later. Those who attend can also opt for a health check or assessment without a forensic examination. Emergency contraceptives, post-exposure preventative screening and treatment for sexually transmitted diseases are also provided.

In 2023 more than 1,000 people attended a sexual assault treatment unit in Ireland for care, almost half of whom came first reported their experience of sexual violence to An Garda. About 90 per cent of these people were women and 56 per cent were under the age of 25.

Walsh says children often delay reporting sexual abuse. “About 20 per cent of our cases come for forensic examination and the other 80 per cent are for non-acute examinations.” The supports for young people include various types of therapy and group work for teenagers and parents.