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Health Care Providers > Sexual Assault > Seeking Informed Consent

How do survivors approach the health system

Survivors of sexual assault may report to you either directly or they may be brought to you by the police. Before you do a full medical examination, consent of the survivor needs to be sought. This is a legal requirement as per section 164 (A) of the Criminal Procedure Code.

Not all women who come to you might want to be examined or report the crime. Sexual assault carries with it a lot of stigma and is hence under-reported. Some survivors may come to you just for medical treatment and might not want to register a case with the police. It is hence important to ensure that the survivor's rights are protected and that s/he is not forced to do something against their will. Consent must hence be sought not just to treat the patient, but also to do an examination and to inform the police about the case. Please remember that the survivor may refuse to grant consent at any or all of these levels and it is your duty to honour her decision.Survivors of sexual assault may approach the health system in several ways, for several different reasons, either with or without the police. Below are some of the scenarios that might arise in your clinic/hospital along with what you are required to do in each case.

A survivor approaching the health system with the police: When a survivor reports to the police station to file a complaint, she is invariably brought the hospital for a medico-legal examination. Even so, you need to follow some steps
1.    You must take the consent of the survivor before performing any procedures or conducting an examination and
2.     inform of their right to refuse medical examination.
3.    Along with medico-legal documentation, examination and evidence collection, you are also required to provide such a survivor with medical care.
4.     Provide a copy of medical report free of cost to the survivor, separate from police copy

A survivor approaching the health system without the police:
1) Only for treatment: A survivor might come to the health facility only to access treatment for his/her injuries, arising out of the assault or to obtain STI prophylaxis or Emergency Contraception. S/he might not want to undergo a medical examination, nor file a police complaint. In such a situation, you must do the following:
- explain to the survivor the importance of filing a police case and the importance of collecting medical evidence as it can serve as evidence in the court of law, should s/he choose to pursue the case at a later stage.
- However, if s/he persists and is not ready to undergo an examination or file a complaint, please respect her decision, provider her with treatment and refer her to appropriate services.
- An informed refusal must be documented by the doctor in such cases, stating the information that has been provided to the survivor and the fact that she has refused, along with a signature of the survivor herself.
- It is mandatory to make a medico legal case in case of every case of sexual assault under the Criminal Law Amendment 2013. Inform the survivor that this is something that you have to do under the law, however, she can refuse to file a case if the police approach her.

2) For treatment and for evidence collection, but not for logging a police complaint. Someone who has been sexually assaulted might not be in a position to make a decision regarding filing a police case immediately. S/he might want to consult with family and take some time to make the decision. However,
- she must be explained that since medical evidence is lost quickly, it may be useful to get examined and keep the evidence stored, and then she could make her decision about making a police complaint.
- Once again, make an MLC.
- You should also document that the survivor needs time to think about making a case and has requested the hospital to preserve the samples until then. Inform her of the quick degradation of the samples and that she should inform whatever her decision is to the hospital within a week. Till such time, the hospital is obligated to preserve the samples.

3) For treatment, evidence collection and to file a police complaint: As per the Criminal Law Amendment Act 2013, police requisition is NOT required to conduct a medical examination and evidence collection. In fact turning away a survivor for want of a police requisiton is punishable by law. In case a survivor reports to you directly, and consents to a medical examination as well as treatment, please go ahead and do the needful. If she wants to file a police case as well, you can ask the police station nearest to the hospital and facilitate lodging of the complaint. The police can be called to the hospital itself, or to any other place that the survivor is comfortable giving a statement in.
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