Anonymous Reporting Form for Incidents of Sexual Violence against Staff
OCHA and the NGO Forum Security Team are working to develop a more comprehensive understanding of issues affecting the safety of humanitarians, particularly as it relates to incidents of sexual violence and physical assault. Given the sensitivity of these types of incidents, we have set up this voluntary and anonymous platform for reporting in case individuals or organisations do not feel comfortable reporting by name. You may use this form to report any such incidents that have occurred in 2016.

Any information provided here will be kept confidential, and we will only share an aggregated overview of data based on the total reports received (i.e.: total number of incidents over a given time period). No information will be shared about individual incidents, and we will not contact you to ask for more information unless you indicate that you would like to speak further. Aggregated data will be used to help better understand trends and threats, and if a high number of cases are observed, the consolidated data may be used for advocacy purposes.

If you are reporting on someone else’s behalf, please do not report an incident without the explicit consent of the victim/survivor(s), and please never share someone’s name or identifying information.

If the person perpetrating the assault is a member of an NGO, UN agency (including UNMISS), or a UN Contractor, reporting is mandatory and should be reported through formal channels. If such a case is reported here, we will be required to pass this information to the relevant focal points. Likewise if there are cases of ongoing abuse or harassment, we encourage reporting through formal channels to enable follow up.

Thank you for your time and please don’t hesitate to contact connell@un.org or sec-analyst@southsudanngoforum.org if you have any questions.

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If you or a colleague needs help, post-rape medical care is available in Juba at:
• MRDCi: a western clinic located in Hai Malakal neighborhood.
• Juba Teaching, and the Primary Health Care Centers in Gurei, Nyakuron, and Munuki

Mental health support is available from Interhealth and Headington Institute. Both organizations offer critical incident care and counselling sessions by phone or skype. Interhealth offers in person counselling in Nairobi or Kenya.
ADCORD provide counselling for national staff and beneficiaries. Services are offered in their offices in Juba na Bari and in Gumbo.

For areas outside of Juba, services may vary but please feel free to contact local protection or medical actors, the Protection Cluster, or OCHA who can assist in identifying service points.

I want to report one of the following:
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I am reporting an incident that has affected:
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The incident affected staff of a:
Check all that apply
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