Carolina Fon Frías was raped by Dr. Iván Rosa — now sentenced to 12 years in prison — and dared to make her case public on Dominican Republic television. Despite the stigma, she felt compelled to speak out because, in her view, she did not receive proper attention from the healthcare system or the justice system.

Fon Frías reported the abuse to the Prosecutor’s Office, went to a hospital, and recounts spending the entire day there, “from 7 a.m. to 5 p.m., being passed around like a ball, and all protocols were skipped.” Speaking with the Centro de Periodismo Investivo (CPI) Gender Investigative Unit, she added, “When I got home, I had to get the morning-after pill from the pharmacy because they didn’t provide it. I had to make an appointment with my gynecologist and get the tests done because some tests were not performed [in the public system].”

Human rights advocates who have assisted women and minors in navigating the critical path after rape confirmed the difficulty in accessing protocol-mandated tests in the Dominican provinces of Santo Domingo, San Cristóbal, Monte Plata, San Pedro, Barahona, Bahoruco, and Santiago.

However, Dr. Luz Fermín, head of Adolescents at the National Health Service (SNS), which oversees public hospitals, said, “We have placed the HIV kit [preventive antiretrovirals] and the morning-after pill kit in our emergency rooms. I believe we have them in almost all emergency rooms.”

 “We have them in almost all our emergency rooms due to our executive director’s initiative. I must mention this because I am an obstetrician-gynecologist, and it’s my first time working in the extensive public network. I come from a primary-level hospital where the kit was available; there were hospitals without it, and we have strengthened to ensure the kits are in emergencies rooms,” she said,

Ten rape victims, mothers of raped girls, lawyers, and human rights defenders in Santo Domingo, southern, eastern, and Cibao provinces confirmed to the CPI Gender Investigative Unit that they encountered difficulties in public hospitals accessing the morning-after pill or laboratory tests used to detect sexually transmitted diseases, as the protocol dictates. They attributed the challenges to both a lack of supplies at the hospitals and a lack of information.

Challenges in Finding Information by Phone

Even women with internet access, college education, and resources to move around find it challenging to get timely information after a rape. Although, in theory, victims can access the system through almost any institution: hospitals, police, prosecution, or schools, several health centers direct women to the Prosecutor’s Office.

“The problem lies in the ignorance of the attending personnel, which complicates everything. A victim of violence can enter the healthcare system in different ways: a violence unit, the prosecution, a police station, or a school if a teacher or psychologist notices and refers. But forcing a woman to go to the Prosecutor’s Office first is impossible,” says Dr. Sheila Báez, a gender studies expert.

“The logical approach is for the raped woman, girl, or adolescent to arrive at the health system, activate the protocol, take all samples, photos, check for bruises or scratches, conduct a vaginal exam, and examine semen, ensuring the chain of custody for the evidence,” she pointed out. Subsequently, the hospital should activate protocols, including mental health and legal care, respecting the victim’s integrity.

However, some healthcare staff are unaware of the protocol. Nurses and doctors who wished to remain anonymous confirmed that emergency rooms do not always have victim care kits or the necessary information to efficiently refer patients and activate the protocol.

To prove how difficult it is for a woman in the Dominican Republic to find timely and quality information by calling different government services, the CPI Gender Investigative Unit called the National Health Service (SNS, in Spanish), Public Health, public hospitals, the Prosecutor’s Office, and the Ministry of Women. None provided clear information that a woman could go to a hospital for care, even if she chose not to report the incident.

At the SNS, when we asked which hospital in the eastern region a victim of rape could go to for assistance without reporting to the Prosecutor’s Office, the receptionist lacked the information, passing the call through several extensions without a response.

The Ministry of Women’s helpline, *212, responded similarly: “We don’t have that information at the moment, but it would be logical to go to a hospital, though we don’t have that information; sorry for the inconvenience.” Public Health responded, “I can’t tell you because all offices are closed.” It was 4 p.m.

The Prosecutor’s Office Life Line stated, “We handle gender violence, domestic violence, and sexual crimes reports. It’s advisable to report to the gender violence unit for investigation and assistance, then be sent to a hospital for antiretrovirals.” We asked, what if the woman doesn’t want to report now but needs medical care?

“It’s advisable to report so the perpetrator can be apprehended.” While this is correct from the Prosecutor’s Office’s point of view, it does not state that the person can also go to a hospital, potentially affecting some victims.

At the provincial hospital in San Juan de la Maguana and the Maternal and Child Hospital San Lorenzo de Los Mina, they also insisted that to start receiving assistance, the victim had to go to the Prosecutor’s Office or the Police so a forensic doctor could examine and activate the protocol leading to the health system.

Other major public hospitals, such as Dr. Dario Contreras University Hospital in Santo Domingo East and José María Cabral y Báez Regional Hospital in Santiago, did not answer six calls made at different times on all extensions, including citizen services.

Reyna Ortiz Mora, Secretary of Women at the Dominican Medical Association (CMD), believes it is necessary to train all health personnel, whether they are related to emergencies or gynecology, because rape is a widespread issue almost comparable in incidence to diseases like dengue.

“It’s almost endemic. A significant portion of the population falls victim. We must strengthen medical staff, Primary Care Centers, and hospitals to know how to handle these patients,” said Ortiz Mora.

Even when we asked directly at the Comprehensive Units for Gender Violence, Domestic Violence, and Sexual Crimes or the Prosecutor’s Office, the response was not satisfactory. At the Santo Domingo East Unit, the receptionist said, “Bring her tomorrow at 8 a.m.” It was 4 p.m.

Doctors consulted for this story, like gynecologist Lilliam Fondeur, explained that victims should receive care as soon as possible because the longer it takes, the more likely evidence, such as blood or semen samples, is lost, and the greater the health risk to the woman.

Katherine Cabrera from the National Confederation of Rural Women has accompanied rural girls and their families to the Prosecutor’s Office seeking justice. She notes that in her experience, guardians don’t always know that they can go to a hospital for medical assistance and psychological therapy. By their knowledge of gender violence issues, she and her colleagues insist that victims receive psychological help from a state or nonprofit organization and make the necessary arrangements.

She believes that even among those who accompany victims, there is a lack of awareness about the care they should receive in hospitals after rape because “everyone knows that, but it is hardly talked about,” especially when the rapist, as in many cases, is a family member or someone close to the victim. In July 2023, Dominican media reported that the Collegiate Court of San Cristóbal sentenced a man to 20 years in prison for raping and impregnating his two underage daughters.

As they did with Dominican government agencies, the CPI Gender Investigative Unit contacted Puerto Rico’s main hospital, Centro Médico, and the Office of the Women’s Advocate’s (OPM, in Spanish) confidential line to learn their response to migrant victims of sexual assault.

Centro Médico responded that the person should go to the hospital for the necessary exams and to the Police. When asked what to do if the person did not want to report, they insisted that a complaint had to be filed with the Police. “You should go to the emergency room, and we will follow the protocol, but you must file a complaint with the Police… You must file the complaint, even if you don’t want to report.”

On the other hand, the OPM responded that regardless of migration status, the person could receive help and provided numbers for the Dominican Women’s Center (CMD), a nonprofit supporting migrants, and the Victims of Crime Support Center.

They added that if the assault was “recent,” the person could go to a hospital. Although we explained that the assistance sought was for those not wishing to report, OPM staff said, “You must file a complaint, report to the nearest station, and provide the perpetrator’s information.” However, they stated that if the person did not trust the system, the Dominican Women’s Center was the best option. They ended the call by stating that the OPM takes no action unless the person desires to do so.

Social worker Noelia Delgado Rodríguez said migrant women are more vulnerable, not only due to the dangerous journey to Puerto Rico by boat but also because of the country’s high housing costs, which often force them to live with many others in one house. “We know that overcrowding increases the likelihood of sexual assault,” she noted.

A 2019 Australian study revealed that children are more vulnerable in overcrowded homes, with sexual assault reports increasing by 23% to 46%. A 2016 Ghanaian study found that the greater the overcrowding, the higher the probability of girls and women experiencing sexual violence in impoverished communities.

Delgado Rodríguez said victims often fear reporting because their attacker wields some power over them, such as being their employer or assisting them on the journey to Puerto Rico.

Community social psychologist Ilia Vázquez Gascot said the services migrant sexual violence victims receive depend on their immediate priorities.

The psychologist explained that there are three ways to receive help in Puerto Rico. The first is to go to an emergency room, where antiviral medications and contraceptives should be administered to prevent diseases and pregnancy. “They should provide the medication there, not just a prescription,” said Vázquez Gascot.

She also explained that the emergency room must be visited within 72 hours of the incident to collect forensic evidence for a future complaint. “It doesn’t matter if the person is an undocumented immigrant,” she said, noting that the Department of Justice’s Office of Compensation and Services for Crime Victims and Witnesses has a program to cover the examination costs without considering migrant status. “The hospital could directly bill the Department of Justice for the medical evaluation.”

The second way is to file a complaint with the Police. Vázquez Gascot emphasized that a crime victim, even without regular migration status, has rights and cannot be deported. The victim can also request a protection order at a police station or court if they feel their life or safety is at risk.

The third alternative is to approach a community-based organization that helps victims of violence.

Revictimization and Resistance

In December 2021, after being drugged and raped by Dr. Iván Rosa, Carolina Fon Frías went to the La Romana Unit in the country’s eastern flank, where her ordeal began.

According to her testimony, the security guard improperly extracted confidential information from her to pass to lawyers looking for clients and often prowl near prosecutors’ offices and courts.

“My issues with the system started with security. The guy, very cunningly, asked, ‘sharp weapon, knife, or firearm,’ and I said ‘rape.’ He wanted to know my complaint. Later, a lawyer approached, sat next to me, asked, ‘Are you the one who was raped?’ and offered her services. The only person I had spoken to was security because not even my family knew. I had spoken to someone in Santo Domingo and my lawyer in Santiago,” said Fon Frías.

Lawyers also prowl outside the Santo Domingo East unit, constantly receiving calls and being approached by relatives of perpetrators and victims seeking help.

Carolina’s second revictimization occurred when she narrated her rape to formalize the complaint. “Finally, someone came to see me, writing down what she wanted while others came in to listen. It was shocking and frustrating. I wondered where my dignity was. I acted out of inertia, and she interrupted me, raising her eyebrows and making sounds. I got irritated and told her to write whatever she wanted,” said Fon Frías.

She had to finish her story to someone else because the first person took a lunch break.  “Then another part of the ordeal began: She questioned if I was a lawyer because I requested what my lawyer advised, like camera footage and medical exams, which she dismissed saying my lawyer wasn’t a prosecutor. When I told her who my lawyer was, she reacted immediately and said a forensic doctor would see me for evaluation.”

With the forensic doctor came the third revictimization. “This person dared to say how if I was raped, I didn’t have scratches, questioning everything I said. I was sensitive and didn’t want to speak because I had so much inside. It was late afternoon; I arrived at 10 a.m. For the exam, the forensic doctor told me to get on a dirty, broken stretcher in a small room, wearing gloves, saying she saw nothing wrong, questioning why it didn’t hurt, and being rough.

“The forensic doctor said she couldn’t report because she lacked a blue liquid to see tearing, arguing there were none, and couldn’t take photos. I was about to cry and said, ‘Why then open my legs and touch me?’ I also told her, ‘I need it, my lawyer asks for it, and if not, he will come for it,’ she asked, ‘Who is your lawyer?’ When I told her, she reacted,” said Fon Frías.

Then, the fourth ordeal began: the public health system. From the Prosecutor’s Office, they accompanied her home to get her underwear, an essential piece of evidence and took her to a Public Health facility for a semen sample. She says the forensic doctor did it precariously due to a lack of materials, using wood and cotton. They took the sample, but she did not receive medical attention and was told to return the next day.

“No one saw me at Public Health that day because the staff had left. They gave me a name and phone number for the next day. Later I learned they were supposed to give me a document, a process I never had. I went home; they should have given me the morning-after pill, but they didn’t. I bought and took it myself,” said Fon Frías.

The next day, she went to a Public Health office and faced more revictimization from the receptionist. “I was asked to disclose everything and sent to a room with four or five people going about talking. I thought it was normal. It was all to get antiretrovirals. Then they sent me to someone to get instructed on the exams, went to the lab, and marked HIV. My lawyer asked, ‘Did you get the exams?’ I said I was told HIV, and he said other STD tests should be done.”

She found the required STD tests online with her cell phone and requested them. They agreed, but she believed they weren’t done. “When I went to get the results, they were not in the book, and after speaking with someone else, they came back with the marked results, saying they had forgotten they had them. They didn’t do the tests.” She continued her medical process with her private gynecologist.

As her case dragged on for months without the Public Prosecutor’s action, she reported it to the media, starting a process leading to a sentence still subject to appeal. At the time of publication of this story, the aggressor was under house arrest, according to Fon Frías.

After sharing her case, 20 women supported Fon Frías, claiming they had also suffered abuse from the doctor.

Getting some justice has been a long road of conflicts with the Public Prosecutor’s Office, the Public Health system, the Judiciary, and social stigmas around rape in the Dominican Republic.

About 25 women formed a support group to encourage each other, share information on violence processes, and cover the information gaps encountered when dealing with the Police, Public Prosecutor’s Office, hospitals, and even their lawyers. “We encourage each other, share if a document is needed, what’s missing, how it was in our case, and understand each other because sometimes we have different moods and don’t want to talk,” said Fon Frías, finding solace in these small gestures of support.

Where to Seek Help in the Dominican Republic

Reports can be made to the Línea Vida by calling 809-200-1202. If possible, it is recommended to go to specialized gender violence units; if unavailable in your province or municipality, you can go to any Prosecutor’s Office.

The Ministry of Women offers psychological and legal assistance services, as well as a helpline for victims at *212.

There are NGOs that provide free or low-cost support to victims of gender violence, including sexual assault, such as the Patronato de Ayuda a Casos de Mujeres Maltratadas at (809) 533-1813 or WhatsApp (849) 340-1813.

Where to Seek Help in Puerto Rico

Options for seeking guidance or support after sexual abuse or assault in Puerto Rico include Tu Paz Cuenta, from Taller Salud (787-697-1120); the San Juan Municipality helpline 939-CONTIGO (939-266-8446); Proyecto Matria’s helpline: 787-489-0022; and the Centro de Salud Justicia’s helpline (787-337-3737). All operate 24/7.