Safety should not be luck: How care becomes a pathway for women and girls

Content note: This post discusses sexual violence, coercive control, and non fatal strangulation. I have written with care and without graphic detail, but please read in the way that feels right for you.

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In many Violence Against Women and Girls (VAWG) conversations, we focus on harm, awareness, and individual professional commitment. This post is about something slightly different: the pathway itself as a safeguarding intervention. The referral route as life shaping and not simply administrative.

Safety should not be a matter of luck.

Yet for so many women and girls, safety depends on whether the person in front of them recognises harm for what it is and refuses to minimise it.

At the Test Grow and Learn launch hosted by the Cabinet Office and Islington Council, I heard about non-fatal strangulation as a prevalent form of Violence Against Women and Girls. What was thought provoking here was not violence itself, but what happened when one medical professional took it seriously; a referral was made, a clot was discovered, and a protocol was developed by a group of motivated individuals, in positions to help, that is now being mirrored by another council.

In England and Wales, this recognition has been strengthened by the introduction of strangulation and suffocation as a standalone offence, reflecting growing awareness of its seriousness and prevalence within domestic abuse and VAWG contexts (UK Government, 2022; CPS, 2022).

As I listened, I kept thinking about another harm I have witnessed: the facial scars under the eyes of street connected girls in Egypt, inflicted by the aggressor, after sexual assault to mark them as “spoiled goods”. A violence designed to be seen but rarely named in academic literature or public policy.

Missing from the Literature

When I started my PhD, the research literature offered very little on street connected girls. There were only two sightings of street girls across the work I could find during that time. I mistakenly assumed that their absence from the literature reflected their absence from the street. It did not and what I learned quickly was that it was not rarity at all; it was invisibility.

Over time, building rapport during ethnographic fieldwork and through time spent with the girls’ psychologist, I began to understand the under-eye scars so many of them carried. The scarring had been inflicted with a knife after their first sexual assault, a deliberate marking intended to announce something about them to the world. They had been marked as “spoiled goods”, no longer virgins, more available for harm and therefore less worthy of protection. However, the violence did not end with the assault, but continued through the social meaning imposed on the girl afterwards.

The violence that signals dominance

Non-fatal strangulation has its own distinct medical risks and realities. One of the reasons it matters so deeply in VAWG response is that it can produce serious internal injury, even where there are limited visible signs (IFAS, 2024; ENT UK, 2024). This is part of what makes it both medically urgent and socially dangerous.

Strangulation is also documented in sexual violence contexts, and research examining sexual assault forensic medical examinations has highlighted that non-fatal strangulation can feature within sexual assault, often alongside extreme fear and coercion (White, McLean and McManus, 2021).

As the speaker described what unfolded in Islington, I kept returning to how in this instance, care became actionable. That is was not just concern, but a pathway. A chain of decisions that made medical harm legible, and therefore treatable.

When care relies on exceptional people

During my time in Egypt, there was a moment when one girl’s facial injury became more widely visible. A blog I wrote at the time brought the scar into public attention where a reconstructive surgeon offered to repair the scarring pro bono, and a small opening appeared where girls could potentially be supported to access him.

Of course, that mattered, because it was care and generosity. It was someone refusing to accept what had been done to them.

But it also exposed the fragility of care when it is held only in goodwill and not in a recognised system.

If that one surgeon stopped offering the service, the route would disappear. It was not a pathway that could be relied on, but instead, it was a chance encounter with exceptional human decency.

Goodwill, care, and rage are often how change begins. But they must be translated into supported, recognised pathways of care. Otherwise, access belongs to those who simply get lucky, by meeting the right person at the right time.

The barrier and structural violence

There is another element of this story that shaped what was possible for the girls in Egypt, and it is both simple and devastating: many of them did not have ID. Without identity documents, they could not access proper medical care. The bureaucracy became systemic, structural exclusion.

It meant that even when someone was willing to help, the help available could become informal and precarious. A couple of stitches done quickly and quietly, in ways that could not be fully documented. It’s important to note that these conditions are not incidental. Instead, they shape what violence becomes, how visible it is allowed to be, and what forms of protection can realistically exist.

In Egypt, sexual violence has been repeatedly documented as systemic, with deep gaps in protection, justice, and accountability (FIDH et al., 2014). In parallel, the lived experience of street connected children has been described as characterised by profound social exclusion and sustained vulnerability, including to sexual violence (Ali, 2014).

When a scar becomes protection

One of the most difficult truths I learned was that some girls refused reconstructive surgery, even when it was available. Some girls believed the marking made them less desirable, which in their view reduced their risk of further assault. The scar was both evidence of violence and, painfully, part of how they tried to manage safety on the street.

This is what sustained harm does. It reshapes what safety looks like, until the line between protection and injury becomes blurred.

Why public understanding matters

The absence of public understanding about the realities of harm street connected girls experience adds to the ongoing minimisation of VAWG. It narrows the public imagination of what violence looks like, where it happens, and who is considered worthy of urgent response.

When harm is not recognised, it becomes easier for it to sit outside our shared moral attention.

But… when harm is recognised, it becomes harder to dismiss, and easier to act on.

From motivation to systems that hold people

The Test Grow and Learn launch ended with a sentiment that stayed with me: it takes a group of very motivated people to change the world.

I believe that. And when motivation is matched with structured pathways, it becomes something even more powerful: a form of protection that does not depend on chance. What protects women and girls is when care becomes a chain of action that is repeatable, supported, funded, trained, and embedded. In other words, when the response to harm does not rely on exceptional people doing exceptional things, but on professional action that is backed by institutional commitment.

This is what I want to write about again: the people inside services and provision whose care means they notice, they act, and they refuse to fob survivors off. The people whose work ethic pushes beyond tick boxes, and into responsibility.

The true measure of a VAWG response is not whether support exists for the person who is most visible, most believed, or most likely to be helped.… It is whether support exists for the person who has the least access to care.

Safety should not be luck.

And care should not be exceptional.

It should be a pathway.

References

Ali, N. World Bank (2014) Sexual Violence against Egypt’s Street Children Can No Longer Be Ignored. World Bank Blogs (Arab Voices). 23 December. Available at: https://blogs.worldbank.org/en/arabvoices/sexual-violence-against-egypt-s-street-children-can-no-longer-be-ignored (Accessed: 29 January 2026).

Crown Prosecution Service (CPS) (2022) Strangulation and suffocation. Available at: https://www.cps.gov.uk/prosecution-guidance/strangulation-and-suffocation (Accessed: 29 January 2026).

ENT UK (2024) Guidelines for clinical management of non-fatal strangulation in acute and emergency care services. Available at: https://www.entuk.org/resources/202/guidelines_for_clinical_management_of_nonfatal_strangulation_in_acute_and_emergency_care_services/ (Accessed: 29 January 2026)

FIDH, Nazra for Feminist Studies, New Woman Foundation and Uprising of Women in the Arab World (2014) Egypt: Keeping women out: Sexual violence in the public sphere. Paris: International Federation for Human Rights (FIDH). Available at: https://www.fidh.org/IMG/pdf/egypt_women_final_english.pdf (Accessed: 29 January 2026).

Institute for Addressing Strangulation (IFAS) (2024) Guidelines for clinical management of non-fatal strangulation in acute and emergency care services (Feb 2024). Available at: https://ifas.org.uk/wp-content/uploads/2024/02/Non-Fatal-Strangulation-Guidelines_AcuteEmergency_Feb24.pdf (Accessed: 29 January 2026).

UK Government (2022) Domestic Abuse Act 2021 section 70: strangulation and suffocation circular 2022/01. Available at: https://www.gov.uk/government/publications/domestic-abuse-act-2021-section-70-strangulation-and-suffocation-circular-202201 (Accessed: 29 January 2026).

White, C., McLean, I. and McManus, J. (2021) ‘I thought he was going to kill me’: analysis of 204 case files of adults reporting non-fatal strangulation as part of a sexual assault over a 3 year period’, Journal of Forensic and Legal Medicine, 79, 102140. Available at: https://pubmed.ncbi.nlm.nih.gov/33618205/ (Accessed: 29 January 2026).