Health System Response to Sexual Violence Against LGBTQ Persons in African Humanitarian and Conflict Settings: A Systematic Review

Background: Sexual violence against lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons in African humanitarian and conflict settings is a neglected public health and human rights issue. Criminalisation, stigma, and discrimination frequently limit access to healthcare and psychosocial support for survivors. Objective: To synthesise evidence on health-system responses to sexual violence against LGBTQ persons in African humanitarian and conflict settings, focusing on service accessibility, quality of care, barriers and facilitators to healthcare access, healthcare worker preparedness, and policy responses. Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, CINAHL, and grey literature sources, including WHO, UNHCR, Human Rights Watch, and Amnesty International databases, was conducted for studies published between 2000 and 2024. Eligible studies addressed sexual violence, healthcare access, or health-system responses among LGBTQ populations in African humanitarian or conflict-affected settings. Study quality was assessed using CASP, ROBINS-I, and AACODS tools. Findings were synthesised narratively. Results: Of 3,847 records identified, 22 studies and reports met the inclusion criteria. Seven themes emerged: access to post-rape healthcare, quality of clinical care, psychosocial support, healthcare worker preparedness, barriers to care, facilitators of care, and policy responses. Evidence revealed limited access to inclusive services, inadequate provider training, persistent stigma and discrimination, and a lack of LGBTQ-inclusive sexual and gender-based violence protocols. Conclusion: Health systems in African humanitarian and conflict settings remain inadequately prepared to address sexual violence against LGBTQ persons. Inclusive policies, healthcare worker training, and survivor-centred care pathways are urgently needed.