Sexual violence associated with international travel Free

We read with great interest the systematic review by Wyler et al., published recently in this journal.¹ This comprehensive review of literature pertaining to mortality arising from injuries in travellers highlighted the importance of discussing the hazards of road traffic collisions, drowning and homicide in the pre-travel consultation. While the review by Wyler et al.¹ focuses on fatal injuries arising in these three settings, we wish to draw attention to an oft-overlooked category of travel-related traumatic injury.

Sexual assault and rape during international travel, which may occur in isolation or in association with homicide, was the subject of an invited symposium presentation by one of the authors (A.H.) at the CISTM16 conference in Washington DC. While research in this area is sparse, a retrospective review of patients cared for at dedicated forensic medical services revealed that 9% of victims had experienced sexual violence while travelling outside the Republic of Ireland.² A previous letter to this journal discussed the hidden phenomenon of in-flight sexual assaults and suggested ways in which the airline travel industry should prevent and respond to such distressing incidents.³ Kennedy and Flaherty⁴ pointed to the reluctance of individuals to disclose their experiences of sexual violence and suggested that this may be magnified in the context of international travel.

Wyler et al.¹ correctly state that travellers may engage in more risky sexual behaviour when they travel abroad. We have previously argued that, while sexual violence is never the victim’s fault, alcohol and recreational drugs can increase the vulnerability of travellers to sexual assault and rape.⁴ The facilitation of sexual assaults through illegal use of psychotropic drugs such as benzodiazepines, gamma-hydroxybutyric acid and ketamine is widespread and should inform pre-travel health advice given to vulnerable travellers. Young female travellers, lone travellers, nightlife leisure tourists, members of the LGBTQIA+ community and humanitarian aid workers face a higher risk of sexual assault and would benefit from targeted pre-travel counselling.⁴ We have previously underlined the importance of providing HIV post-exposure prophylaxis in a timely manner following rape, and no later than 72 hours after exposure.⁴ In the context of international travel, PEP may be difficult to obtain in many locations, underscoring the added trauma experienced by travel-related victims of sexual violence and the complexity of providing appropriate care to them in an unfamiliar setting abroad.

The unique vulnerability of refugees, asylum seekers and undocumented migrants to sexual violence at various stages of their journey has been highlighted in the literature and is worthy of systematic review by travel medicine clinicians with expertise in migrant health. A study of 240 asylum seekers, mostly young males originating from North and West Africa who attended a public health service in France, for example, found that 37% of women and 4% of men were victims of sexual violence, more often committed by family members or partners.⁵ Rape as an illegal weapon of war has once again come into sharp focus with the ongoing military conflict in Eastern Europe.

Sexual violence is an appalling phenomenon in any jurisdiction but the international traveller who experiences sexual violence may face particular added challenges of being isolated from social supports, language barriers and lack of familiarity with local forensic and sexual assault health services. There is a pressing need for interdisciplinary mixed-methods research, which reports data from multiple jurisdictions on sexual violence in international travellers. The extent to which patterns of sexual violence in international travellers differ from those occurring during domestic travel is unknown and would benefit from targeted research. Efforts should be made to engage with sexual assault treatment services, sexual health clinics, the travel industry and the media using targeted public health campaigns to raise the profile of this issue and to encourage disclosure among victims of this despicable crime.

Authors’ contributions

G.T.F. was responsible for study conception, research and preparation of the first draft of the manuscript. W.M.Z.B.M.K. was responsible for literature review and editing of the draft manuscript. A.H. was responsible for critical manuscript editing. All authors read and approved the final version of the manuscript.

Data availability

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Conflict of interest

The authors have no conflicts of interest to declare.

References