The British Red Cross and the International Committee of the Red Cross (ICRC) conducted research in health care settings in four countries affected by armed conflict or other emergencies. The research focussed on the situation for adult victims/survivors. It revealed that mandatory reporting of sexual violence in these contexts can obstruct access to health care for the victims/survivors of these crimes and may expose them to increased risk of secondary violence and harm. This paper analyses and produces evidence of the various challenges of providing health care where mandatory reporting of sexual violence exists and details the negative humanitarian impacts in armed conflict and other emergencies. The report makes recommendations to States that have mandatory reporting regimes, as well as to donors, health-care providers and the Red Cross and Red Crescent Movement, on how to respond to these dilemmas and better protect the health, safety and well-being of survivors.