The Israeli healthcare system is bracing to deal with the unthinkable possibility of pregnancies resulting from sexual assaults during captivity. In the June issue of the Israeli Medical Association's journal "HaRefuah," a review was published to instruct medical teams on addressing this "sensitive, difficult-to-comprehend, yet unavoidable matter."
The article, authored by retired Lt. Col. Dr. Leah Shelef, former head of the Air Force's psychology department and current dean of Sapir College's School of Social Work, and Prof. Gil Zalsman, director of the Geha Mental Health Center, aims to prepare caregivers for any situation. This includes cases where emotional or religious factors might prevent pregnancy termination or instances where captives struggle with the decision, requiring counseling.
Video: Released hostage Amit Soussana's message to the captives: Be strong! / Credit: Prof. Siegal Sadetzki.
The researchers emphasize that the study's intent is preparatory, not prompted by concrete information about pregnancies during captivity. Its goal is to understand the potential ramifications in advance.
Sexual violence against captives has been a topic of public discourse, particularly following the courageous testimony of released hostage Amit Soussana about enduring sexual assault while in captivity, as well as the accounts of Aviva Segal and Agam Goldstein Almog, and a UN report on the subject.
Post-traumatic stress and dissociation
The limited research available, focusing on Yazidi women assaulted by ISIS in Syria and Iraq, as well as rape victims from conflicts in Yugoslavia, Rwanda, and Ukraine, highlights various psychological issues faced by those who became pregnant from captivity-related assaults.
These include a high prevalence of post-traumatic stress disorder (PTSD), anxiety, depression, suicidal tendencies, severe dissociation (detachment), body image disturbances, and sexual dysfunction. Behavioral consequences like alcohol and drug abuse were also noted.
"Women with higher education and no prior mental health issues exhibited better post-traumatic growth, aided by appropriate and sensitive treatment. Estimated pregnancy rates after rape are around 5%, though the actual figure could be higher."
The risk of developing PTSD after such an assault is 6.2 times higher than for women not victimized by crime. When the assault is compounded by other traumas like physical attacks or torture, the incidence of depression, anxiety, and body image disturbances increases further.
A German study of 296 Yazidi survivors found that 67% suffered from body image disturbances, 53% from depression, 39% from anxiety, and 28% from dissociation. PTSD prevalence ranged from 39% to 57%, depending on the number of assaults endured.
However, women with higher education and no prior mental health issues exhibited better post-traumatic growth, aided by appropriate and sensitive treatment. Estimated pregnancy rates after rape are around 5%, though the actual figure could be higher.
The study on Yazidi women's coping mechanisms emphasizes that caregivers must prepare for all eventualities and respond empathetically and non-judgmentally. It also notes that late-term abortions (after 24 weeks) could be traumatic.
Dr. Shelef and Prof. Zaltzman state, "It is crucial to respect the victim's decision without paternalism or preconceptions. However, the transition from complete lack of autonomy during captivity to the freedom to decide about the pregnancy could be disorienting, necessitating counseling from the medical team if the survivor struggles with the decision."
