The team's report corroborates other investigations' findings of large-scale and systematic sexual assault. There have also been many reports of women coming to hospitals in a condition which doctors would certainly suspect sexual assault. Yet the senior health officers interviewed as well as private doctors visited by the team stated that no cases of sexual assault has been filed. In other words, doctors seem to have disregarded obvious signs of sexual assault. As a consequence, there is no medical evidence of sexual assault, on which basis women could seek justice.

Profile of the survivors

Many Muslim women and girls have been the victims of most brutal forms of sexual violence in both urban and rural areas of Gujarat. Interviews conducted by women's groups have provided extensive documentation of systematic and brutal sexual violence as an integral part of mob attacks. As pamphlets circulated by the Sangh Parivar indicate, women's bodies were turned into battlefields in order to perpetrate hate and dishonour and assault the pride, dignity and integrity of the whole community.

There is, however, no official admission, either by police or by the health care machinery of the fact that sexual abuse was perpetrated at such a large scale. Nowhere do medical records of the dead or injured women mention sexual abuse. Also, there are no First Information Reports (FIRs) barring one or two cases. It is also likely that many incidents will never be made public, given the vulnerability of the victims.

There was a pattern in the sexual violence inflicted on the women. Accounts narrated by volunteers as well as women inmates of the camps indicate that women were beaten up, stripped naked, gang- raped, stabbed with iron rods, swords or sticks, and then burnt alive. The assailants cut open the abdomens of pregnant women and killed the foetuses. There were cases reported of mutilation and disfigurement – cutting off breasts, carving “Om” on foreheads, chopping of limbs, thrusting cricket bails / sticks or swords into women's vaginas. In some areas the abusers themselves stripped to further humiliate women.

The team's investigation corroborates other reports of large-scale burning of rape victims. The mobs were instructed not to leave behind any trace of evidence. They came prepared with weapons, petrol, kerosene, chemicals and gas cylinders. They shouted, “Jala do, saboot mat chhodo.” (“Burn them, don't leave any proof.”

Evidence of sexual assault was also destroyed in other ways. In some camps, volunteers reported receiving unidentified bodies without any medical records or post-mortem reports. They were forced to bury them as soon as possible.

Many women are still in a state of shock and trauma. Volunteers, as well as affected women, told the team that they were not willing to talk or complain to police. Even when some victims dared to speak out, no FIR had been lodged or arrest taken place. Hence women have lost faith in the police and other state machinery. Women also fear the adverse publicity their testimonies will draw. They are apprehensive about their names appearing in newspapers and on television. This prevents them from even complaining to health care providers.

In no camp was the team told of efforts to provide psychiatric counselling to women by government doctors or Auxiliary Nurse Midwives (ANMs). Any counselling and emotional support comes only from camp volunteers.

Assessment of specific health care needs

At one urban camp that the team visited, many women were still recovering from burn injuries. Some women who had healed only partially had gone to their relatives. All these women will need long-term care, essential for burn patients, particularly for morbidities such as deformity of limbs and other body parts. Volunteers reported that some women could not walk when they were brought to the camp; their genitals were torn as a result of gang rapes. Though many of them had received some primary treatment, there has been no long-term treatment.

Apart from the enormous pain, discomfort and psychological trauma resulting from the brutal assaults, sexual abuse can also result in Reproductive Tract Infections (RTIs), sexually transmitted diseases (STDs) including HIV and pregnancy. As the state has effectively denied that sexual assaults had even occurred, no measures had been taken for detection and further action. A strategy needs to be urgently worked out to assess the actual prevalence of RTIs/ STDs/ HIV and pregnancy. This will need the collaboration of different social action groups. Camp volunteers are overwhelmed by the overall task of running the camps, and cannot take any pro-active role in this matter.

The assessment of PTSD, and the actual provision of counselling, are the other crucial areas that have remained hitherto neglected. Women are traumatised not only by the sexual assault but also because of the killings and brutalisation of their family members, relatives and neighbours. There is an intense sense of insecurity and frustration. Many women broke down repeatedly while narrating their experience. Many were completely withdrawn, shaking and trembling, and showed symptoms like insomnia, nightmares, and lack of appetite. There is an urgent need for counseling women witnesses and victims alike.

The health care needs of survivors of sexual assault can be summarised as follows:

Treatment for the injuries of all kinds, genital as well as injuries due to stabbing, cutting, beating or burning

Assessment of problems such as damage to the genitals and other pelvic organs and pregnancies,
RTIs/ STDs including HIV

Psychiatric care and counseling, in particular, for PTSD

Reproductive health problems were very prevalent among the women in the camps, and sensitive woman gynaecologist must be part of medical relief efforts. This would also enable women who have been sexually assaulted to seek treatment without fear of stigmatisation.

Availability of services to survivors

From all accounts, it is clear that in the first few days, volunteers from the community alone organised medical help along with shelter and food.

In Amdavad city, volunteers said women were brought in stark naked and a burnt condition. A woman volunteer, a dai by training, helped some women. She reported removing objects like cricket bails and sticks from vaginas of some women, and also stitching up vaginal tears in a few women. Some women had suffered mutilation of body parts. Inmates from camps that the team visited corroborated this fact. These women had been unable to access the health services for critical medical care.

In Amdavad, many women from the camps were sent to the Civil or VS hospital, mostly for the treatment of burn injuries. Volunteers said these women received some treatment for rape-related problems. However, no medico-legal cases for sexual assault were filed.

One Muslim woman doctor from a public hospital, whom the team met in one of the camps, stated that she was not aware of such atrocities. When asked about the need for assessment of morbidities and pregnancy as an outcome of rapes, she remarked that pregnancy was not a problem as the women were already married; none of them was virgin anyway!

Dr Makwana, Chief Medical Officer, Amdavad Municipal Corporation, did not have any information on the state of women who suffered sexual abuse or on what medical treatment they received.

Future efforts to give such medical assistance will be hindered by the fact that many women who were sexually assaulted have left the camps for the homes of relatives, and do not want to be traced.

We are grateful to the camp inmates, organisers and the volunteers working in the relief camps for all the information they shared with us.

We would like to thank friends Sandhya Srinivasan, Nandita Bhatla and Ranjan De for their help in the process of editing, layout, cover design and final production of the report.