A/68/297 vulnerable to sexual violence. 61 They face a heightened risk of sexual exploitation and trafficking, as well as increased domestic violence and abuse from family members. Health facilities that lack qualified health professionals, patient referral mechanisms and psychological counselling may be unable to identify and respond to these forms of conflict-related sexual violence. This is especially true when health services are restricted to sexual violence perpetrated by armed groups. 62 The stigma associated with sexual violence and HIV and the absence of adequate protection mechanisms may also contribute to negative physical and mental health outcomes. Stigma, abandonment by families and communities, and retribution from perpetrators create an atmosphere that perpetuates gender-based violence and leads to the exclusion and disempowerment of survivors. The failure to provide services that promote the safety and respect the confidentiality of survivors undermines their full participation in society, particularly in post-conflict reconstruction efforts. D. Children 46. Children are particularly vulnerable in conflict due to poor hygiene and food insecurity. 63 Malnutrition, in particular, undermines children’s immunity and resistance to preventable and communicable diseases, such as diarrhoea or malaria. 64 The breakdown of disease surveillance and vaccination systems also contributes to the vulnerability of children to ill-health and hinders their right to health. 65 47. Conflict may also have a devastating psychological impact on a child’s wellbeing and development. Distressing experiences, abuse and chronic stress may increase the risk of trauma, particularly where children are separated from their families. Mental health needs of children may, however, be left unaddressed due to the unavailability of psychosocial services. 66 48. Conflict may also result in children adopting new roles and responsibilities, which may increase their vulnerability to sexual violence and exploitation. 67 Health facilities in conflict often lack child-appropriate services for survivors of sexual violence, particularly for boys. Exposure to sexual violence increases the risk of further violations for girls. For example, marriage to the perpetrator is often seen as __________________ 61 62 63 64 65 66 67 13-42297 UNFPA, “HIV/AIDS, gender and conflict situations”, p. 1. Available from www.unfpa.org/hiv/ docs/factsheet_conflict.pdf. Human Security Research Group, Human Security Report 2012: Sexual Violence, Education and War: Beyond the Mainstream Narrative (Vancouver, Human Security Press, 2012), pp. 34-35, 45. International Bureau for Children’s Rights (IBCR), Children and Armed Conflict: A Guide to International and Humanitarian Law (Montreal, 2010), p. 160. Flavia Bustreo and others, “Improving child health in post-conflict countries: can the World Bank contribute?” (Washington, D.C., World Bank, 2005). Ibid.; IBCR, p. 160. M. Hasanović and others, “Psychological disturbances of war-traumatized children from different foster and family settings in Bosnia and Herzegovina”, Croatian Medical Journal, vol. 47, No. 1 (2006), pp. 86-87. Watch List on Children and Armed Conflict, “Caught in the middle: mounting violations against children in Nepal’s armed conflict” (New York, 2005), pp. 30-31. 15/24