As fighting flares up in the Democratic Republic of Congo, health workers are reporting a rise in brutal sexual violence against women. But, says Wairagala Wakabi, the international community continues to pay only lip service to the crisis in the central African country.
Medical workers are concerned about rising incidents of sexual brutality against women in the Democratic Republic of Congo (DRC), which are resulting in mounting rates of trauma, fistula, and sexually transmitted infections (STIs).
Although cases of sexual violence against women have been widespread in eastern DRC over the past decade, humanitarian workers say rape is becoming more violent and more common, yet the world continues to pay only lip service to the crisis in the central African country. Reports of gang rapes, sexual slavery, purposeful mutilation of women's genitalia, and killings of rape victims are commonplace in eastern Congo, especially in the north Kivu province, where fighting has subsisted for years.
“As the security situation unravels yet again, we are seeing trends rising and multiple forms of sexual violence—from abduction, gang rape, shooting women through the vagina and forcing family members to participate—are a spreading practice among military and militia groups”, Karin Wachter, an International Rescue Committee (IRC) gender-based violence adviser in the region, told The Lancet.
Wachter says on the one hand, the health consequences of sexual violence in DRC are the same as in other conflict zones: HIV transmission, unwanted pregnancy, and STIs, among others. “However, what is unique to the DRC is the brutality with which the attacks are carried out. As a result, women and girls suffer from debilitating damage to their reproductive systems, resulting in multiple fistulae, as well as broken bones, severed limbs, and burns. “From a public-health perspective, the psychological and social consequences of sexual violence are equally as devastating. There are serious consequences for women's and girls' mental health, including depression and suicide, as well as for the family and community members who witness or are forced to participate in the violence”, she said.
Other health workers say male relatives are often forced at gunpoint to rape their own daughters, mothers, or sisters; and that frequently, women are shot or stabbed in their genital organs after they are raped. Sometimes broken bottles or corn cobs are shoved into the women's genitalia after the rape.
According to eyewitness accounts, several groups are involved in the sexual violence, including government soldiers, guerrillas of the National Congress for the Defence of the People (CNDP) led by renegade general Laurent Nkunda, local Mai Mai militia allied to the government, and Rwandan rebel group Forces Democratiques de Liberation du Rwanda, whose members fled their country after perpetrating the 1994 genocide.
Eastern Congo has been unstable since 1996, when Ugandan and Rwandan forces helped Congolese rebels, led by Laurent Kabila, to overthrow the dictator Mobutu Sese Seko. A year later the foreign armies had turned against Kabila, choosing instead to support other rebel groups and militia against Kabila. Although peace accords that saw Ugandan and Rwandan forces exit Congo in 2003 pacified most of the country, eastern DRC, particularly north and south Kivu, have remained at war, with a myriad of militia and rebel groups taking part.
Exact figures of the violated women are impossible to establish, but even with all the shortcomings in the collection of statistics, the available figures are shocking. Indeed, returning from north Kivu in September last year Stephen Lewis, former UN Special Envoy for AIDS in Africa and current co-director of AIDS-Free World, remarked at a press conference in Kenya, “There is no precedent for the insensate brutality of the war on women in Congo. The world has never dealt with such a twisted and blistering phenomenon”.
The IRC has assisted over 40 000 rape survivors in the DRC since 2003, and recently reported 2000 cases of women held in sexual slavery for 2 weeks to 2 years. Last year, a survey by the UN Population Fund of about half the health centres in the country found that 50 000 rape cases had been reported.
At Bon Marché hospital in Bunia, more than 7400 rape victims were treated over a 4-year period, including 2708 between January, 2006, and July, 2007. At Rutshuru hospital, Médecins Sans Frontières (MSF) has provided specialised care to more than 600 victims of sexual violence since January, 2007. In Kayna town, Lubero district, where MSF run a 70-bed hospital, on average 66 victims of sexual violence were treated each month since 2004. In the south Kivu province, the UN reports that 27 000 sexual assaults were reported in 2006; in the first half of this year, 4500 cases were reported.
Patrick Hourtane, sexual violence coordinator for MSF, told The Lancet common treatments for rape victims include provision of antiretroviral prophylaxis within 72 hours of exposure to reduce the risk of HIV infection, and prophylactic antibiotics to protect against common STIs such as syphilis, gonorrhoea, and chlamydia. Health workers also administer tetanus and hepatitis-B vaccinations and the morning after pill; and treat physical trauma such as lesions, wounds, or other injuries.
It has been estimated that the military forces in the DRC have one of the highest rates of STIs of any military group in the world, yet studies have shown only 30% of female rape cases undergo prophylactic treatment against HIV. Other health workers said the rate of rape-related fistula in DRC is unique.
Around 16 000 Congolese have recently fled their country into Uganda and 800 000 others have been internally displaced in north Kivu. Many tell tales of women who die after being violated by dozens of men, women who are abducted and held as sex slaves for months, women whose private parts are shattered by gun butts, maize corns, or bayonets after they have been raped. Similar stories are told by the people who fled several towns in Rutshuru district, such as Jomba, Bweza, Kisigari, Binza, Busanze and other areas in north Kivu (see panel).
When Laurent, 34, arrived at the Congolese border town of Bunagana, next to Uganda, he had been walking for 3 days through forests. He had fled his home at Runyonyi, which Nkunda's guerillas had ransacked. The rebels came at night and started indiscriminately torching mud-and-wattle houses in the village, raping women, shooting in the air and at those who were running away, he says.
He had witnessed several abuses at the hands of the CNDP rebels, he said, but it was the indiscriminate torching of houses and shooting that forced him to flee, minus his wife and three children, who fled into the dark of night. “People are dying over there”, said Laurent, a former primary school teacher, as he gestured towards the lush, hilly villages he was fleeing. “They sleep with your wife while you watch; and if you protest they kill you. They have guns, knives, and hammers which they use to kill people.” Laurent said a neighbour of his was forced to watch the gang rape of his 12-year-old daughter. She died. “They do it during broad daylight because there is no one to stop them.”
At Nyakibande refugee centre, 16 km inside Uganda, Beatrice clutches a 1-year-old baby to her back outside a makeshift plastic tent where she and many other families now reside. Reluctant to talk at first, she later tearfully reels off tales of the suffering which she, and other women she knows, have endured at the hands of Nkunda's rebels.
“Every woman they find they grab by force. Even if she is carrying a baby they will just grab her and violate her, and even ten men can rape one woman”, she says. Beatrice knew a woman at Chihichire, 4 km from Bunagana, who was attacked while harvesting her sorghum. Though she was carrying a 3-month-old baby on her back, this woman was raped, then beheaded. Her baby was beheaded too.
Humanitarian workers say that although there are periodic lulls in reporting, sexual violence has continued to be perpetrated throughout the past decade, and that women and girls who have suffered these atrocities will come forward long after the conflict ends.
Wachter says access to life-saving essential services remains a big problem in eastern Congo, given the enormity of the geographical area, absence of infrastructure, and limited capacity. Women often have to walk for days to reach health services, and frequently are subjected to further attacks during their journey to seek help. In some districts, several health centres are not operational because of security issues.
The latest round of fighting, which began in September 2007 and flared up last December, saw a sharp rise in the number of rape victims, with some treatment centres reporting a doubling in cases. The international response to the sexual violence has been criticised as inconsistent, inadequate, and piecemeal in fashion. Sarah Chynoweth of the Women's Commission for Refugee Women and Children also blames the UN, which has a force of 17 000 peacekeepers in Congo, and the Congo government, for doing little to stop the sexual violence.
“There is a lot of violence going on and victims do not report it because it is considered social death. A raped woman is often victimised and shunned by her husband and the community. And in Kivu the victims are afraid of the perpetrators because they are still around and most of them are armed”, says Hourtane. “We only see the tip of the iceberg.”
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