Refugees with Communication Disabilities, in Rwanda - Understanding the need for accessible Sexual and Reproductive Health Education (SRHE) and Sexual and Gender-Based Violence (SGBV) services

Principal Investigator: Dr Julie Marshall

Project Fact File

Start DateApril 2018
End DateDecember 2018
Funded by

Elrha’s Humanitarian Innovation Fund – a grant making facility supporting organisations and individuals to identify, nurture - and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. The Humanitarian Innovation Fund is a programme of Elrha and is funded by aid from the UK Government and the Swedish International Development Agency (SIDA) and Ministry of Foreign Affairs (MFA). Visit for more information. Visit for more information about Elrha’s work to improve humanitarian outcomes through research, innovation, and partnership.

Speech Pathology Australia

Manchester Metropolitan University

Project TeamDr Julie Marshall
External Providers and CollaboratorsUNHCR Rwanda
Helen Barrett, Communicability Global

Principal Investigator

Meet Dr Julie Marshall

Dr Julie Marshall

Reader in Communication Disability and Development

Phone +44 (0)161 247 2581

Project Details


Rwanda is host to over 161,000 refugees mainly from DRC and Burundi, including many people with disabilities (PWD). PWD are under-identified in humanitarian contexts and many fail to access support they need. Those who are identified often have visible impairments. Up to 50% of PWD may have a communication disability (CD) (sometimes referred to as speech and language difficulties) and many people with communication disabilities (PWCD) go unidentified. This is partly because CDs are often associated with other diagnoses (e.g. intellectual disability) and are frequently invisible.

Refugees are commonly acknowledged to be at higher risk of Sexual and Gender Based Violence: (SGBV) sometimes referred to as gender based violence (SGBV) than others in a community, due to community breakdown, family separation and risky behaviours undertaken to survive. PWD are 3-4 times more likely to suffer sexual abuse and vulnerability increases further if s/he has a CD. Having a CD likely makes the reporting of SGBV challenging or impossible.

A recent literature review by Barrett & Marshall (2017) suggests that there is limited research about PWCD who are refugee-survivors of SGBV; there are no data available on the size/nature of the challenges facing refugee-survivors of SGBV with CD in accessing support; and there is extremely limited reporting of Sexual and Reproductive Health Education (SRHE) and support services specifically adapted for refugee-survivors of SGBV with CD. This project builds on a seed-funded project started in 2016.

Aims and Objectives


The aim of this consultation, which has been carried out collaboratively between MMU, UNHCR Rwanda and Communicability Global, is to understand:

a) Current processes for accessing sexual and reproductive health education/ Sexual and Gender Based Violence (SRHE/SGBV) response and prevention services;

b) Availability and appropriateness of SRHE/SGBV response and prevention services;

c) Needs/opportunities for the provision of (more) inclusive SRHE and SGBV response and prevention services

- for refugees with communication disabilities, in Rwanda.


  1. Carry out a literature review looking at SRHE for people with disabilities, and how refugees with communication disability may benefit from accessible SRHE.
  2. Carry out approximately 12-15 meetings with SRHE and SGBV prevention and response service providers.
  3. Build the capacity of SGBV frontline workers to carry out semi-structured interviews and assist in translation.
  4. Carry out exploratory interviews with refugees with communication disabilities /carers, to understand their experiences of life in the refugee setting, and/or their experiences of and needs for SRHE/SGBV services for people with communication disabilities.
  5. Carry out a final project workshop with key stakeholders in Rwanda. 


This project is a consultation and forms the first stage of the Humanitarian Innovation process (see the Humanitarian Innovation Guide) by looking at what services exist currently, how fit for purpose they are for refugees with communication disability, to begin to generate ides about solutions to improve services. The methodology draws on qualitative research methods, including participant interviews and focus group discussions

  1. We carried out a literature review  which led to the review  and synthesis of findings from 31 papers, across four topic areas:
    • communication disability
    • SRHE
    • sub-Saharan Africa locations
    • refugee-related terms.
  2. We carried out focus group discussions (FGDs) with 12 groups of service-providers/stakeholders  to find out about their provision of services and understanding about communication disability
  3. We carried out  individual interviews with 21 refugees with communication disabilities and their carers, to find out about their experiences of life in the refugee setting as a person with a communication disability (PWCD)/carer, how they keep themselves / their family member with CD safe, and their experiences of using services.

We synthesized findings from these 3 sets of data with the findings from our 2016 project, Supporting Refugee Survivors of SGBV with Communication Disability: and ran a stakeholder workshop to:

  1. Get feedback on our findings so far, 
  2. identify gaps and opportunities in relation to provision of inclusive SRHE/SGBV response services;
  3. identify and map potential solutions.


The four data sets and the workshop led to agreement that:

Further detailed findings will be contained in publications, under development.

Please see the one page briefing note for more information. 


Related Links

Supporting refugee-survivors of GBV with communication disability

Understanding Sexual and Gender-Based Violence against Refugees with a Communication Disability

Vulnerability of refugees with communication disabilities

VIDEO: SGBV lecture given by Dr Julie Marshall and Helen Barrett on 25 September 2017

Julie Marshall & Helen Barrett (2018) Human rights of refugee-survivors of sexual and gender-based violence with communication disability, International Journal of Speech-Language Pathology, 20:1, 44-49

Other Links

Women’s refugee commission GBV against refugees with disabilities toolkit

WRC ‘I see that it is possible’ report on GBV and disability

UNHCR information: SGBV

Refugees with hearing and communication disability