The first frontline clinic to offer treatment for both medical and psychological injuries of victims of physical and sexual abuse has opened in Papua New Guinea, a country that researchers say is potentially the worst place in the world for gender violence.
The Médecins Sans Frontières project, named the 9 Mile clinic, which opened in the capital city Port Moresby on 10 May, has already treated 43 victims of family and sexual violence, the level of which is unmatched by anything seen in the career of project head Paul Brockmann.
"The use of violence as a response is simply more shockingly common here than in any other places where I've worked," Brockmann told Guardian Australia.
Separate studies conducted in the 1990s found that 67% of Papua New Guinean women had been abused by their spouse (almost 100% in the Highlands regions) and more than half of women interviewed had been raped. In the same study, 60% of men interviewed said they had participated in a gang rape.
"[Gender violence] is probably the number one social problem facing the country," said Lowy Institute's Director of the Myer Foundation Melanesia Program Jenny Hayward-Jones.
"The problem of gender violence is probably more severe in PNG than almost any country in the world, or is at least very similar to the West of Africa."
The 9 Mile Clinic is the third that MSF have set up in the country. Since opening on 10 May they have treated 43 survivors of violence.
Staff have treated more than 13,000 patients in PNG's second biggest city, Lae, since opening a centre there in 2007, which they recently handed control of to the PNG department of health.
The MSF projects train local staff to offer five basic first response treatments: emergency medical care for injuries, psychological first aid, prophylaxis for HIV and medicine for other sexually transmitted infections; emergency contraception; and vaccination to prevent hepatitis B and tetanus.
Brockmann said the goal was to have a clear package of medical services that was easy to explain. The psychological first aid incorporates lessons learned at the Lae project.
Brockmann said they were the only organisation offering counselling in an integrated service with medical treatment. It is a way of offering psychological care to patients who were unlikely to come back for long-term trauma counselling after a first visit to get their injuries treated medically.
"So we've combined that and we're offering a psychological first aid which is not counselling. It's basically a stabilisation, a normalisation," he said.
Martha Pogo, a PNG Health Extension Officer who has come to Port Moresby after two years at the Lae project, said this service fills a gap in PNG's health system, and some patients are now returning for follow ups.
"After the first visit they feel like 'oh, I'm feeling good, I'm feeling better. There are people here to talk to, I've never had time to speak to someone, I've never had the opportunity to receive such medical care.' These are the comments we have received," she told Guardian Australia.
Pogo has seen the results of violence up close in her time at the MSF clinics.
"One lady who came in to the clinic had been beaten by her husband when she was two or three months pregnant," she said.
"Beaten, kicked and punched all over, including on the abdomen. She lives just a few houses away, but she couldn't come in straight away because she had a miscarriage after the incident and she was bleeding. She was so weak, she was crawling. When she could stand up and take one step at a time she walked right into the room and was seen by me. She was grateful she could walk in and get help because she didn't have the strength to walk to the bus stop."
At a third centre in Tari, in the notoriously violent PNG highlands, patients presented with injuries from weapons like bush knives, axes, spears and arrows.
"There is more of a culture of violence in the highlands regions of the country," said Hayward-Jones.
"In coastal provinces … there's not at all that same culture or that same tradition of violence as you grow up."
Hayward-Jones said the traditions of violence appear to be spreading as people move across the country seeking employment, inter-marry across regions, and as foreign-owned projects create wealth inequality, and with it jealousy.
The violence doesn't just stop with the medical treatment. Brockmann acknowledged there were cases of victims facing retribution from family members when they returned home after seeking treatment.
"It does sometimes occur that a patient will go home and someone will say 'where were you', and there will be more violence based on them not being a home," he said.
It's one of the many areas where the PNG system falls down. The medical needs are being seen to, but the victims are not being protected by police and social welfare authorities.
"Those services very much need to be available as well," said Brockmann.
"They, in my view, are lagging a bit behind the model we've demonstrated for medicine, but I think there's a will to respond now that maybe was not so strong a decade ago or even five years ago."
Hayward-Jones said the services provided by MSF and other NGOs and church groups working in the country are vital.
"It's by no means enough, but it's certainly a massive contribution because the state of PNG is just not equipped to provide the support for women and other victims that they need, and the health system is extremely weak," she said.
MSF plans to extend the project to urban health centres, into large city hospitals and more remote locations, and Brockmann called for other agencies to stop talking and start taking action.
"Start providing care, in the medical, law and justice, and social welfare protection fields, or this ongoing problem will continue," he said.
"These are cycles of violence that we can interrupt if we respond robustly to the needs of survivors now in multiple sectors."