A/HRC/31/57 rights, including obstacles to accessing education, employment, health care and other essential services. In States that permit the modification of gender markers on identity documents abusive requirements can be imposed, such as forced or otherwise involuntary gender reassignment surgery, sterilization or other coercive medical procedures (A/HRC/29/23). Even in places with no legislative requirement, enforced sterilization of individuals seeking gender reassignment is common. These practices are rooted in discrimination on the basis of sexual orientation and gender identity, violate the rights to physical integrity and self-determination of individuals and amount to ill-treatment or torture. 50. In many States, children born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization and genital normalizing surgery, which are performed without their informed consent or that of their parents, leaving them with permanent, irreversible infertility, causing severe mental suffering and contributing to stigmatization. In some cases, taboo and stigma lead to the killing of intersex infants. E. Rape and sexual violence 51. It is well established that rape and other forms of sexual violence can amount to torture and ill-treatment.27 Rape constitutes torture when it is carried out by, at the instigation of, or with the consent or acquiescence of public officials (A/HRC/7/3). States are responsible for the acts of private actors when States fail to exercise due diligence to prevent, stop or sanction them, or to provide reparations to victims. In addition to physical trauma, the mental pain and suffering inflicted on victims of rape and other forms of sexual violence is often long-lasting due, inter alia, to subsequent stigmatization and isolation. This is particularly true in cases where the victim is shunned or formally banished from the family or community. Victims can also face difficulties in establishing or maintaining intimate relationships and a variety of other consequences, including sexually transmitted diseases, inability to bear children, unwanted pregnancy, miscarriage and forced or denial of abortion (A/HRC/7/3). Torture and ill-treatment of persons on the basis of actual or perceived sexual orientation or gender identity is rampant in armed conflict and perpetrated by State and non-State actors alike, with rape and other forms of sexual violence sometimes being used as a form of “moral cleansing” of lesbian, gay, bisexual and transgender persons (S/2015/203, A/HRC/25/65). 52. State and non-State actors alike commonly commit acts of sexual violence during international and non-international armed conflicts (S/2015/203). Sexual violence during conflict is often a product of gender stereotypes that are prevalent in societies during peacetime. Rape and other forms of sexual violence constitute violations of international humanitarian law28 and unequivocally amount to torture under international criminal law jurisprudence.29 Under international humanitarian law, torture constitutes a breach of the laws and customs of war and may be committed by both States and non-State armed groups. More recent developments in international criminal law have determined that torture can occur when the State had no role in its perpetration and where the State did not 27 28 29 14 European Court of Human Rights, application No. 39272/98, M.C. v. Bulgaria, judgement of 4 December 2003; Inter-American Court of Human Rights, Ortega et al. vs. Mexico, judgement of 30 August 2010. ICRC, “Prevention and criminal repression of rape and other forms of sexual violence during armed conflicts”, 11 March 2015. See, for example, International Criminal Tribunal for Rwanda, case No. ICTR-96-4-T, Prosecutor v. Akayesu, judgement of 2 September 1998 and International Criminal Tribunal for the Former Yugoslavia, case No. IT-96-21-Abis, Prosecutor v. Mucić et al., judgement of 8 April 2003.