Differences in sexual violence against younger and older adults in complex humanitarian settings: a retrospective analysis from Médecins Sans Frontières in 2019–24

BACKGROUND

Sexual violence against older adults in humanitarian settings is poorly documented, leading to gaps in prevention and delivery of support services. This study aimed to document differences in assault characteristics between younger and older adults, by sex and displacement and disability status and region.

METHODS

This retrospective, descriptive observational, multi-country study included survivors aged 20 years or older who accessed sexual violence services supported by Médecins Sans Frontières in humanitarian settings across 11 countries between Nov 1, 2019, and Nov 1, 2024. Assault characteristics (context and circumstances of the assault and perpetrator characteristics) were compared between younger (20–49 years) and older survivors (50 years and older) stratified by sex and region using regression analyses. Among older survivors, analyses were mutually adjusted for age group, displacement, and disability status.

FINDINGS

We included data from 35 248 survivors who accessed care in the study (33 548 [95·2%] survivors were aged 20–49 years and 1700 [4·8%] were aged 50 years or older). 34 007 (96·5%) participants were female and 1241 (3·5%) were male. Rape was the most frequently reported type of sexual violence across sexes and age groups, including in older female survivors compared with younger female survivors (odds ratio [OR] 2·01 [95% CI 1·34–3·22]). Compared with their younger counterparts, older female survivors were more likely to report assault during armed attacks (OR 1·85 [95% CI 1·65–2·07]), by multiple assailants (OR 1·66 [1·50–1·84]), by armed groups (OR 1·21 [1·09–1·34]), while gathering food or wood (OR 1·51 [1·36–1·68]), and with regional variation, and less likely to report sexual violence from an intimate partner (OR 0·29 [0·23–0·36]). Older male survivors were more likely to report sexual violence other than rape (OR 2·85 [95% CI 1·51–5·07]), and to report a female assailant (OR 1·65 [1·01–2·78]). Older female survivors with disabilities were more likely to report sexual violence from an intimate partner (adjusted [a]OR 3·57 [95% CI 1·42–7·84]), and repeat assaults by the same assailant (aOR 4·01 [1·68–8·57]).

INTERPRETATION

This study reveals distinct patterns of sexual violence among older women, particularly assaults by multiple unknown armed assailants during survival tasks, and among older men, whose experiences often fall outside dominant sexual violence narratives. Disability and displacement further compound the vulnerability of older adults, influencing the type, context, and recurrence of violence. Findings underscore the urgent need for age-sensitive and disability-sensitive sexual violence support strategies in humanitarian settings.