BMJ

Bape as a veapon oJ vav in nodevn conJIicls FaniIies and connunilies ave viclins, as veII
as individuaIs
AulIov|s) CoIeen KivIaIan and Nale Evignan
Souvce BMJ BvilisI MedicaI JouvnaI, VoI. 341, No. 7771 |4 SeplenIev 2010), pp. 468-469
FuIIisIed I BMJ
SlaIIe UBL http://www.jstor.org/stable/20766255 .
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EBITOBIALS
nuscuIosIeIelaI
pain
ave
needed, incIuding
olIev anaI
gesic dvugs
and
non-dvug
Iased lvealnenls.
Inpvoved
suppovl
Jov seIJ
nanagenenl
oJ
Iong
levn
pain
condi
lions
na
aIso veduce
vequesls
Jov
pvescviplion pain
veIieJ.
OvevaII,
lIe evidence oJ
polenliaI
visIs oJ
Iong
levn
opioid
use conIined vilI lIe IacI oJ evidence oJ eJJec
liveness is a
puIIic
IeaIlI concevn,
given
lIe
IigI pvev
aIence oJ cIvonic nuscuIosIeIelaI
pain
and lIe
vising
lvends in
opioid
use.
1 EIIioll AM, SnilI BH, Fenn KI, SnilI WC, CIanIevs WA.
TIe
epidenioIog
oJ cIvonic
pain
in lIe
connunil.
Lancel
1999:3541248-52.
2 Boudveau B, Von KM, Bullev CM, Saundevs K, Ba 6T, SuIIivan MB, el
aI. Tvends in
Iong-levn opioid lIevap
Jov cIvonic non-cancev
pain.
FIavnacoepidenioI Bvug SaJe 2009: 181166-75.
3
Bj0n AM, Jepsen F, Lavsson HJ, TIonsen HF, KieIev H, EIvenslein V, el
aI.
HospilaIizalions
Jov
Opioid poisoning
a nalion-vide
popuIalion
Iased
slud
in BennavI, 1998-2004. Addiclion 2009:104104-8.
4 McCvacIen LM, VeIIenan SC, EccIeslon C. Fallevns oJ
pvescviplion
and
concevn aIoul
opioid anaIgesics
Jov cIvonic
non-naIignanl pain
in
genevaI pvaclice.
Fvin HeaIlI Cave Bes Bev
2008:9146-56.
5 KaIso E, Edvavds JE, Moove
BA, McQua HJ. Opioids
in cIvonic
non-cancev
pain sslenalic
veviev oJ
eJJicac
and
saJel.
Fain
2004:112372-80.
6 Moove BA, McQua HJ. FvevaIence oJ
opioid
advevse evenls in cIvonic
non-naIignanl pain sslenalic
veviev oJ vandonised lviaIs oJ ovaI
Opioids.
AvlIvilis Bes TIev 2005:7B1046-51.
7 CIou B, BaIIanlne JC, FanciuIIo OJ, Fine FO, MiasIovsIi C. BeseavcI
gaps
on use oJ
Opioids
Jov cIvonic noncancev
pain Jindings
Jvon a
veviev oJ lIe evidence Jov an Anevican Fain
Sociel
and Anevican
Acaden
oJ Fain Medicine cIinicaI
pvaclice guideIine. J Fain
2009:10147-59.
8 MavleII A, O'Connov FO, Kevns BB, BecIev
WC,
MovaIes KH, Koslen
TB, el aI.
Sslenalic
veviev
opioid
lvealnenl Jov cIvonic IacI
pain
pvevaIence, eJJicac,
and associalion vilI addiclion. Ann Inlevn Med
2007:146116-27.
9
BaIIanlne JC, SIin NS.
EJJicac
oJ
Opioids
Jov cIvonic
pain
a veviev oJ
lIe evidence. CIin J Fain 2008:24469-78.
10
Savign F, Kunlze S, Walson F, Undevvood M, BilcIie O, ColleveII M,
el aI. Lov IacI
pain. EavI nanagenenl
oJ
pevsislenl non-speciJic
Iov
IacI
pain.
2009. London, NalionaI
CoIIaIovaling
Cenlve Jov
Fvinav
Cave,
vvv.ncIi.nIn.niI.gov/IooIsIeIJ/picvendev.Jcgi?IooI=nicecg
88&IIoIlpe=pdJ.
11 FauIozzi LJ, Budnilz BS.7iY. Incveasing
dealIs Jvon
opioid anaIgesics
in lIe Uniled Slales.
FIavnacoepidenioI Bvug SaJe 2006:15618-27.
12 Bunn KM, Saundevs KW, Bullev CM, Banla-Oveen CJ, MevviII JO, SuIIivan
MB,
el aI.
Opioid pvescviplions
Jov cIvonic
pain
and ovevdose a coIovl
slud.
Ann Inlevn Med 2010:! 5285-92.
Bape
as a
veapon
oJ vav in nodevn conJIicls
FaniIies and connunilies ave
viclins,
as veII as individuaIs
Bape
is
depIoed
as a
veapon
oJ vav in counlvies
lIvougIoul
lIe
vovId,
Jvon Bosnia lo
Sudan,
Fevu lo
TiIel.1
Bape
incIudes IacI oJ consenl lo sex as veII as
pvovision
oJ sex lo avoid Iavn and oIlain Iasic necessi
lies. TIe Bone Slalule oJ lIe InlevnalionaI CvininaI Couvl
vecognises
lIal
vape
and olIev Jovns oJ sexuaI vioIence
I
conIalanls in lIe conducl oJ avned conJIicl ave vav
cvines and can conslilule
genocide.2
SexuaI vioIence
sucI as Jovced
navviage,
JenaIe
genilaI nuliIalion,
and
vape
as a
pvecuvsov
lo nuvdev conslilule lovluve undev
inlevnalionaI Iav and ave IveacIes oJ lIe Oeneva Con
venlion.2
Bape,
as vilI aII levvov
vavJave,
is nol excIu
siveI
an allacI on lIe
Iod-il
is an allacI on lIe
Iod
poIilic.
Ils
goaI
is nol lo nain ov IiII one
pevson
Iul lo
conlvoI an enlive
sociopoIilicaI pvocess I cvippIing
il.
Il is an allacI divecled
equaII againsl pevsonaI idenlil
and cuIluvaI
inlegvil.2
Bape
Ias
Iong
Ieen
pevpelvaled duving
vav. Since lIe
second vovId vav, Iovevev, vape
Ias assuned
slvalegic
inpovlance,
and is nov a deIiIevale
niIilav slvaleg.3
Wonen ave nov nol
onI vaped
Iul
pIsicaII
scavved and
nuliIaled.4 In vecenl
conJIicls, vape
Ias Ieen used as a
vevavd Jov
viclov
in
IallIe,
a Ioosl lo
lvoop novaIe,
as
punisInenl
and IuniIialion Jov IolI nen and vonen,
lo incile
vevenge
in
opposing lvoops,
lo eIininale ov
cIeanse
veIigious
ov
poIilicaI gvoups,
and lo deslaIiIise
enlive connunilies
I cvealing
levvov.56
WIen
vape
is used as an inslvunenl oJ vav il is
pev
pelvaled againsl pvegnanl vonen, inJanls and
eIdevI
vonen, nen,
JIeeing veJugees,
and lIe
inlevnaII
dis
pIaced.
We do nol Inov lIe
pvevaIence
oJ
vape duving
vav Iecause no inlevnalionaI deleclion ov
vepovling ss
len
exisls,
and
vape
is oJlen nol
vepovled
Jov Jeav oJ JuvlIev
vioIence. InJovnalion on
pvevaIence genevaII
cones Jvon
Jocused sludies in individuaI counlvies. In lIe Benocvalic
BepuIIic
oJ lIe
Congo
16 000
vapes
occuvved in 2008
aIone,
and in SoulI Kivu
pvovince,
IeaIlI cenlves eslinale
lIal 40 vonen veve
vaped
in lIe
vegion daiI.'
In 2005-6,
a LiIevian
suvve
sIoved lIal
92%
oJ inlevvieved vonen
Iad
expevienced
sexuaI
vioIence, incIuding vape.'
In lIe
Uniled
Kingdon, 50-70% oJ JenaIe
asIun appIicanls
veve
vaped,
vilnessed
vape,
ov Iad a cvediIIe Jeav oJ
vape.2
OeogvapIicaI, cuIluvaI, veIigious, poIilicaI, IegaI,
and
IeIaviouvaI condilions aJJecl lIe IiIeIiIood oJ lIe
ss
lenalic use oJ
vape.44 OeogvapIicaII
venole Iocalions
aIIov
pevpelvalovs
lo
vape
vilI
inpunil.
TIe IiIeIi
Iood lIal vonen viII Ie
vaped, sIaned,
and isoIaled
is incveased in cuIluves vilI
slvong
lvadilions
vegavd
ing vivginil,
navilaI
JideIil,
and
genilaI
cIeanIiness.
BMJ 14 SEFTEMBEB 20101 VOLUME 341
CoIeenKaIanvoIunleevJovensic
pIsician,
VoIunleev
FIsician
Hunan
BigIls CIinic, HeaIlIvigIl
InlevnalionaI, 80 Maiden Lane, Suile
607, NevYovINY10038, USA
cIivaIanOIolnaiLcon
NalEvignangvaduale
sludenl,
Bepavlnenl
oJ CIinicaI and HeaIlI
FscIoIog, Univevsil
oJ FIovida,
FO Box100165, OainesviIIe, FL,
32610-0165, USA
ConpelinginleveslsNonedecIaved
Fvovenance and
peev
veviev
Connissioned: nol
exlenaII peev
vevieved.
Cile lIisas BMJ2010:340c3270
doi10.1136/Inj.c3270
Wonen
coIIecling
Jivevood in lIe IusI ave al
IigI
visI oJ sexuaI aIuse
468
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All use subject to JSTOR Terms and Conditions
EBITOBAL
Tvaining
naleviaIs used in lIe evaIualion oJ
vape
In
addilion, veIigions
vilI
slvong
IeIieJs aIoul
appvopvi
ale JenaIe
cIolIing
and IeIaviouv incvease lIe visI lIal
vonen viII Ie
JaIseI
accused oJ
aduIlev
and
vaped
as
IuniIialion and
punisInenl.
FoIilicaI and
IegaI
cIinales
oJ levvov and IavIessness aIIov
niIilav pevsonneI
and
poIice
lo
vape
as a nallev oJ couvse. TIese Jaclovs naIe
il
unIiIeI
lIal nosl viclins viII evev
vepovl
lIeiv cvines.
TIe eJJecls oJ
vape
and sexuaI lovluve on suvvivovs ave
econonicaII, pIsicaII, pscIoIogicaII,
and
cuIluvaII
devaslaling.
Suvvivovs can Ie IeJl vilI econonic
depviva
lion, AIBS,
and
sexuaII
lvansnilled diseases.'46 Viclins
expevience
sevious acule and cIvonic nedicaI
pvoIIens,
Jovced
pvegnanc, IigIev
nalevnaI
novlaIil, niscavviage,
inJevliIil,
and cIvonic sexuaI
dsJunclion.
Because vic
lins ave oJlen
vaped
vilI a
vaviel
oJ
oIjecls-Jvon Iod
pavls
lo
guns, Inives, IollIes,
and
slicIs-lIe
ave al
visI oJ JisluIa
Jovnalion,
cevvicaI cancev, and vecuvvenl
inJeclions.2
TIe
pscIoIogicaI
eJJecls ave exlensive. Viclins
deveIop
Jeav oJ
inlinac,
seIJ
injuv, JIasIIacIs, sIeep disovdevs,9
and cIvonic
pscIosonalic pvoIIens
sucI as IeadacIes
and gaslvoinleslinaI disovdevs.1 Bape is nove
IiIeI
lo
induce posl-lvaunalic
slvess disovdev lIan evenls sucI as
voIIevies, dealIs oJ a cIose Jviend ov
JaniI nenIev, ov
naluvaI disaslevs.
TIe eJJecls oJ vape exlend lo lIe JaniI
and connu
nil.
TIe
JaniI slvuggIes
lo
accepl
lIe viclin IacI inlo
Iev Ione, ov aIandons Iev
conpIeleI,
oJlen
Ieaving
Iev cIiIdven vilIoul pvopevl
ov
suppovl, and Ieaving
Iev in
vovsening povevl.2
Men vIose pavlnevs
ov vives
Iave Ieen
vaped
ave IuniIialed and na Iecone vioIenl
lovavds lIeiv
pavlnev.'
HaIJ oJ vape viclins in Sievva Leone
vepovled lIal lIeiv veIalionsIips
vilI
JavniI
and Jviends
veve
deepI aJJecled.8
Bape is aIso an allacI on lIe cuIluve and
saJel
oJ lIe
connunil
and is acconpanied I
olIev acls oJ levvov
lIal
disvupl Iasic sevvices sucI as educalion, Javning,
connevce, and access lo IeaIlI cave. TIe lIveal oJ
vape
veslvicls cove
aclivilies,
sucI as
coIIecling
valev
and Jivevood and
vovIing
on
JaniI
Javns. TIis
vesuIls in Jevev cooIed neaIs and
endangevs JaniI
nulvilion.2
TIe inlevnalionaI
connunil
Ias nounled a con
sidevaIIe
vesponse incIuding
eJJovls lo
upIoId
inlev
nalionaI
Iav,
enIance
secuvil
in
veJugee sellings,
condenn counlvies vIeve
vape
is a slandavd
veapon
oJ vav, iniliale lviaIs oJ Iunan
vigIls aIuse,
and
incvease access lo Iunanilavian
ovganisalions
in
IigI
visI
sellings.
TIvee inlevnalionaI
pviovilies
Iave Ieen
pvoposed
lo
idenliJ
and venove sexuaI
inequaIil
and
Iias:
lo
deveIop
a uniJied inlevnalionaI
vesponse
lo Ian lIe use oJ
vape
as a
veapon
oJ vav and
inpIe
nenl
slvalegies
oJ
pvevenlion
and
avaveness: and lo
eIininale
inpunil I inpIenenling accounlaIiIil
and veslilulion Jov lIe cvines.2
EJJeclive
vesponses
lo
vape
as a
veapon
oJ vav
I
lIe nedicaI and
pscIoIogicaI
connunilies incIude
suppovling nandalov vepovling, incveasing
scveen
ing, Ieaving
vilness lo lIe
pvoJound
Iunan cosl oJ
vape I invesligaling
and
docunenling evidence,
and
adIeving
lo slandavd lvealnenl
pvolocoIs
vilI
eavI
and inlense nenlaI IeaIlI
suppovl.
Bape duving
avned conJIicl is nol
sinpI
aIoul niIi
lav pevsonneI, poIice,
ov levvovisls. BeJove
2004, vape
assaiIanls in lIe Benocvalic
BepuIIic
oJ lIe
Congo
veve
pvinaviI
aJJiIialed vilI lIe
niIilav: Iovevev,
aJlev
2004,
civiIian
vapes
incveased 17-JoId vIiIe
vapes I
avned conIalanls decveased
I
770/o. TIis
pallevn suggesls
a
disluvIing acceplance
oJ
vape
anong
civiIians.
Bape
is lIe vesuIl oJ lIe IacI oJ
dedicaled socielaI allenlion lo lIe
saJel, vespecl,
and
pvospevil
oJ vonen in
peace line,
as veII as in vav.
1
BeIIan
C. SexuaI vioIence as a
veapon
oJ vav.
UniceJ, 1996. vvv.
uniceJ.ovg/sovc96pI/sexvioI.Iln.
2 CIiJJovd C.
Bape
as a
veapon
oJ vav and ils
Iong-levn
eJJecls on
viclins and
sociel.
SevenlI OIoIaI ConJevence VioIence and
lIe Conlexls oJ
HosliIilI-13.2008 Ma 5-7, Budapesl, Hungav.
vvv.inlev-discipIinav.nel/plI/IIv/vcce/vcI7/CIiJJovd%20papev.
pdJ.
3
Annesl
InlevnalionaI. Lives IIovn
apavl.
Cvines
againsl
vonen
in lines oJ conJIicl
Slop
vioIence
againsl
vonen.
Annesl
InlevnalionaI FuIIicalions. 20045-64.
4
OingevicIT, Leaning J. TIe use oJ
vape
as a
veapon
oJ vav
in lIe conJIicl in
BavJuv, Sudan. US
Agenc
Jov InlevnalionaI
BeveIopnenl/OTI.
20046-56.
Illp//pIsiciansJovIunanvigIls.
ovg/IiIvav/docunenls/vepovls/lIe-use-oJ-vape-as-a-veapon.pdJ.
5 OollscIaII J. ExpIaining
vavline
vape./SexJIes 2004:41129-36.
6
Annesl
InlevnalionaI.
Slop
vioIence
againsl
vonen.
Bape
as a
looI oJ vav a Jacl sIeel. 2007.
vvv.anneslusa.ovg/vonen/
vapeinvavline.IlnI.
7 Hunan
BigIls
WalcI.
Slopping vape
as a
veapon
oJ vav in
Congo.
2009.vvv.Ivv.ovg/en/nevs/2009/09/18/slopping-vape
veapon-vav-congo?pvinl.
8 Anovilz L, Beis C, Lons KH,
Vann
B, Mansava B, AIinsuIuve-SnilI
AM,
el aI. FvevaIence oJ vav-veIaled sexuaI vioIence and olIev
Iunan
vigIls
aIuses
anong inlevnaII dispIaced pevsons
in Sievva
Leone./AM 2002:287513-21.
9 Buvnan AM, Slein
JA, OoIding JM, SiegeI JM, Sovensen
SB, FovslIe
AB, el aI. SexuaI assauIl and nenlaI disovdevs in a
connunil
popuIalion./ConsuIl
Oin
FscIoI 1988:56843-50.
10
OoIding JM. SexuaI assauIl
Iislov
and
pIsicaI
IeaIlI in
vandonI
seIecled Los
AngeIes
vonen. HeaIlI
FscIoI 1994: 13130-8.
11 Novvis FH.
EpidenioIog
oJ lvauna
Jvequenc
and
inpacl
oJ
diJJevenl
polenliaII
lvaunalic evenls on diJJevenl
denogvapIic
gvoups./ConsuIl
Oin
FscIoI 1992:60409-18.
12 BavleIs S, VanBooen M, Leaning J, Scoll J, KeII J. Nov, lIe vovId
is vilIoul ne an
invesligalion
oJ sexuaI vioIence in easlevn
Benocvalic
BepuIIic
oJ
Congo. OxJan, 2010.
vvv.oxJan.ovg/en/
poIic/nov-vovId-vilIoul-ne.
BMJ 14 SEFTEMBEB 20101 VOLUME 341 469
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