By Dr Swati Jindal Garg
It could be an important step towards women’s emancipation. Delhi Commission for Women Chairperson Swati Maliwal’s comprehensive report to the Department of Health and Family Welfare has a host of recommendations, including that rape victims should be given priority and attended to by gynaecologists without delay. The recommendations also aim at curbing unnecessary delays in conducting medical examination of sexual assault victims at government hospitals.
The Constitution under Article 21 has an obligation to provide adequate healthcare to its citizens along with ensuring that appropriate physical and mental health services are available without discrimination and are accessible, acceptable and of good quality.
Recognizing the constitutional right of all persons to health, healthcare workers must obtain informed consent of the survivors/victims of sexual violence prior to conducting medical examinations or initiating medico-legal investigations. All medico-legal examinations and procedures must respect the privacy and dignity of the survivor. To realize the right to healthcare of survivors/victims, health professionals must also be trained to respond appropriately to their needs and that too in a sensitive and non-discriminatory manner by being respectful of the privacy, dignity and autonomy of each survivor. However, all this is easier said than done.
The World Health Organisation defines sexual violence as “any sexual act, attempt to obtain a sexual act, unwanted sexual comments/advances and acts to traffic, or otherwise directed against a person’s sexuality, using coercion, threats of harm, or physical force, by any person regardless of relationship to the victim in any setting, including but not limited to home and work”. Even though sexual assault as a form of sexual violence is a term often used synonymously with rape, it could include anything from touching another person’s body in a sexual way without the person’s consent to forced sexual intercourse—oral and anal sexual acts, child molestation, fondling and attempted rape.
In view of the current situation, the Delhi Commission for Women has taken cognisance of the alarming number of crimes against women and also claimed that one-stop centres (OSCs) in government hospitals are not functioning properly, leading to significant delays in conducting MLC (medico-legal case) examinations. The OSCs were initially set up under the One Stop Centre Scheme, a centrally sponsored scheme of the Ministry of Women and Child Development, Government of India. The OSCs were to be funded from the Rs 1,000 crore Nirbhaya Fund which was set up way back in 2013 to fund various schemes related to women’s safety. The basic purpose of OSCs was to provide integrated support and assistance under one roof to women who have experienced violence in the public or private spheres like family, community or workspace.
Any violence experienced by a woman can be of any kind, including physical, sexual, emotional, psychological or economic abuse, hence it was the intent of this scheme that women who are already aggrieved, should be provided integrated support— regardless of their age, class, caste, educational status, marital status, race and culture—under one roof. Such support includes access to a range of services like medical, legal, psychological and counselling support. Further, women who are facing violence in the form of attempted sexual harassment, sexual assault, domestic violence, trafficking, honour-related crimes, acid attacks or witch-hunting and approach the OSCs, are entitled to the provision of specialized services. These OSCs were also integrated with 181 and other helplines through which aggrieved women could be referred to the OSCs. Further, for girls below 18 years of age, institutions established under the Juvenile Justice (Care and Protection of Children) Act, 2000, and the Protection of Children from Sexual Offences Act, 2012, were also linked to the OSCs.
As per the latest reports, 595 OSCs have been made operational in the country, out of the total 728 that had been approved and they have helped over 1,90,000 women across the country. The largest number of OSCs are in Uttar Pradesh (75), followed by Madhya Pradesh (51) and Bihar (38). Even though the thought behind the OSCs was good, there have been reports of hiccups in implementation and management. In recent years, the government has faced vehement criticism in the light of its failure to ensure women’s safety and security and the same is evident from the increasing cases of assault, harassment and domestic violence. It has been argued that large amounts of money released under the Nirbhaya Fund, and earmarked for various schemes, have remained primarily underutilized and the OSCs continue to lack adequate resources that are imperative for their proper functioning. The OSCs that were claimed to also serve as educational resources for healthcare workers, lawyers and police officials are failing miserably and the hard reality is that women and girls continue to struggle to access legal, medical and psychological support all under one roof.
Another big hurdle in the proper functioning of OSCs is the lack of trained counsellors, failure to link centres with women helpline numbers in various states and a lack of awareness among women. All these have meant that OSCs’ reach has remained limited. Studies have also found that many OSCs have come to operate as centres of marriage counselling when faced with cases of domestic violence wherein the individuals involved, especially females, are pushed to come to a compromise. There have also been reports from various states, specially Haryana, stating the OSCs are creating more problems for women rather than solving them. Data has shown that the total number of cases that reach OSCs is only about 30% of the total crimes committed against women in the state. Further, as per government guidelines, each OSC is supposed to be located within two kilometres from a district hospital to ensure easy accessibility and ought to be equipped with amenities like telephone, beds, pillows, tables, medicines and clothing for women, besides providing other facilities like medical, legal, psycho-social and police assistance, video-conferencing and temporary shelter facilities. Needless to say that while some OSCs do fulfil these criteria, many others are operating out of two-three rooms from within police stations or the district secretariat and are inaccessible most of the time to the women who need them. Lack of basic amenities like food and beds, along with a disproportionate male presence in many centres, also forces women to leave after only a few days of living there, without getting the support they need. These problems get even more aggravated in cases where the alleged crime relates to sexual assault/rape, etc., as the victim is in need of immediate medical attention and tests so that critical evidence can be preserved.
In order to combat all these shortcomings in the functioning of OSCs, the Delhi Commission for Women had also issued notices to the Delhi government to ascertain the reasons behind problems faced by sexual assault victims in government hospitals and observed that certain hospitals like Guru Gobind Singh Hospital, Swami Dayanand Hospital and Hedgewar Hospital did not even have a OSC. The Delhi Commission for Women had also recommended setting up OSCs in each of these hospitals urgently so that integrated assistance could be provided to women affected by violence, and emergency and non-emergency access to a range of services, including medical, legal and counselling support, under one roof could be facilitated.
Maliwal’s comprehensive report and recommendations have sought an action-taken report from the Department within 30 days. The Delhi Commission for Women in its statement has also claimed that everyday around six rapes are reported in the capital, and considering the alarming number of crimes as well as the extent of trauma faced by sexual assault survivors, the support system for survivors must be urgently strengthened. The Commission has also observed that OSCs in government hospitals are not functioning properly, leading to significant delays in conducting the MLC examination in the government hospitals in Delhi. As per the Commission’s panel, “there are five stages where the survivors usually faced delays during their MLC—these were at the emergency room, while conducting UPT test of the survivor, while waiting for the gynaecologist, while sealing samples and during the documentation process.”
The Commission has also recommended that the survivors should be allowed to approach OSCs directly in order to reduce the delay in conducting the MLC, apart from other recommendations like reducing the delay in UPT tests, gynaecologists attending the rape survivors without any delay, sealing of samples during the MLC itself in order to prevent any contamination or tampering and quick documentation by the doctors. Maliwal, reportedly, said: “Sexual assault survivors suffer tremendously due to the ordeal they have been subjected to. It is unacceptable that they have to wait for over 6 hours for getting their MLC done….”
The journey of a 1,000 miles begins with the first step and these recommendations along with the stand taken by the Commission raises the hope for many sexual assault victims who have been battling the lethargy and inefficiency of the system.
—The writer is an Advocate-on-Record practicing in the Supreme Court, Delhi High Court and all district courts and tribunals in Delhi