从利益相关者角度探讨面临性别暴力的寻求庇护者获得专业医疗保健的情况：一项定性研究
Understanding access to professional healthcare among asylum seekers facing gender-based violence: a qualitative study from a stakeholder perspective.
作者信息
Rodella Sapia Mirjam D, Wangmo Tenzin, Dagron Stéphanie, Elger Bernice S
机构信息
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
出版信息
BMC Int Health Hum Rights. 2020 Sep 21;20(1):25. doi: 10.1186/s12914-020-00244-w.
BACKGROUND
When it comes to gender-based violence (GBV), migrant women and girls represent the most vulnerable group. GBV can happen at any stage of migrants' flight and/or during the asylum process. It has severe consequences on their life and health. Victims therefore need timely access to healthcare. This study explores the context GBV victims face when they seek refuge in Switzerland.
METHODS
Qualitative methodology was used where we conducted five semi-structured focus groups and three interviews. A total of sixteen stakeholders participated in the study. They were either involved in the asylum process or provided healthcare to asylum seekers. We analyzed the data using framework analysis.
RESULTS
Study participants noted lack of confidence of the GBV victims in the legal and in the healthcare systems as major barriers to disclosure of GBV. Since only GBV exerted before fleeing the home country gives the right to asylum, they pointed out that victims do not disclose GBV that took place after they left their home country. Language was identified as a barrier to disclosure of GBV as well as to healthcare access. Continuity of care at the moment of transfer from federal to cantonal (i.e. state) accommodations is another issue that was deemed critical. Study participants felt that health professionals must be trained to identify GBV victims. The first-contact caregiver available to these victims was deemed as the most competent professional that could act as a "GBV coordinator".
CONCLUSION
In Switzerland, access to healthcare is guaranteed to all asylum seekers on a legal and structural level. Yet, health seeking by GBV survivors is hindered by factors such as lack of confidence in the legal system, trust in health providers, and continuity of care during the asylum process. Building trust in legal institutions, health structures, and professionals should be enhanced to facilitate disclosure and to strengthen resilience. This includes a healthcare system with competent professionals, support with language and cultural needs, as well as seamless continuity of care beyond cantonal borders.
背景
在基于性别的暴力（GBV）方面，移民妇女和女孩是最弱势群体。基于性别的暴力可能发生在移民逃亡的任何阶段和/或庇护程序期间。这对她们的生活和健康造成严重后果。因此，受害者需要及时获得医疗保健。本研究探讨了基于性别的暴力受害者在瑞士寻求庇护时所面临的情况。
方法
采用定性研究方法，进行了五次半结构化焦点小组讨论和三次访谈。共有16名利益相关者参与了该研究。他们要么参与了庇护程序，要么为寻求庇护者提供医疗保健服务。我们使用框架分析法对数据进行了分析。
结果
研究参与者指出，基于性别的暴力受害者对法律和医疗系统缺乏信心是披露基于性别的暴力行为的主要障碍。由于只有在逃离原籍国之前遭受的基于性别的暴力才赋予获得庇护的权利，他们指出，受害者不会披露离开原籍国后发生的基于性别的暴力行为。语言被确定为披露基于性别的暴力行为以及获得医疗保健服务的障碍。从联邦住所转移到州住所时的医疗连续性是另一个被认为至关重要的问题。研究参与者认为，卫生专业人员必须接受培训，以识别基于性别的暴力受害者。这些受害者可获得的首次接触护理人员被认为是最有能力担任“基于性别的暴力协调员”的专业人员。
结论
在瑞士，从法律和结构层面保障了所有寻求庇护者获得医疗保健服务的权利。然而，基于性别的暴力幸存者寻求医疗服务受到诸多因素的阻碍，如对法律系统缺乏信心、对医疗服务提供者的信任以及庇护程序期间的医疗连续性。应增强对法律机构、医疗结构和专业人员的信任，以促进披露并增强复原力。这包括一个拥有称职专业人员的医疗系统、对语言和文化需求的支持，以及超越州界的无缝医疗连续性。
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