'I was alive but not living ...'.

"It was April 2002. They knocked on the door of our home and we opened it up because we thought it must be the neighbors stopping by to say hello. But it wasn't the neighbors. It was six armed men. They pushed their way into our home with their guns.... They forced me to have sex with them many times." Safi (not her real name), 19, was then taken by the men to their camp in the forest where she was held for more than a year. "During that whole time, I felt like I was going crazy. I was like a person unconscious. I was alive but not living.... Every day they raped me. Before going out to steal or kill, they would rape me--sometimes one, sometimes all...." (1)

During more than five years of outright war in the Democratic Republic of Congo (DRC), rape and other forms of sexual abuse greatly increased as armed groups used sexual violence to weaken communities and force them into submission. And, despite the creation of a transitional government in 2003, conflict and sexual violence continue, particularly in the eastern DRC.

Women raped in this conflict situation have suffered many immediate, serious, and sometimes life-threatening health consequences. Safi was impregnated by one of her rapists. At a hospital in Goma where she was treated after escaping her captors, other girls and women have given birth to babies conceived during rape. But a considerable number of patients seen at the hospital, which is run by Doctors on Call for Service and receives substantial support from the United Nations Children's Fund (UNICEF), have come for surgical operations to repair a stigmatizing injury. The injury, called a fistula, is a hole torn between the bladder and the vagina or between the rectum and the vagina, leaving a woman incontinent.

Many girls and young women in the DRC are prone to developing a fistula for a number of reasons. Commonly in poor health and married before their bodies have matured, their vaginal or rectal walls may be weakened or damaged by even non-violent marital sexual intercourse. Repeated, violent rape (sometimes by insertion of sharp objects into the vagina) can exacerbate this damage, if not cause it directly. Also, girls who are impregnated during rape and give birth before their bodies have fully matured may develop a fistula as a result. Between April and September 2003, more than 150 fistula operations were performed on girls and women referred to the hospital in Goma. During that period, the hospital registered 973 female victims of sexual violence, ranging from 7-year-old girls to 80-year-old great-grandmothers. Twelve percent of the hospital's female patients had been infected with HIV, and nearly 40 percent had other sexually transmitted infections. (2)

Emergency contraception can help prevent unwanted pregnancy, and postexposure prophylaxis may help prevent HIV infection. However, the treatments are seldom available in the DRC. Even when they are available, medical workers there rarely know how to provide them. Furthermore, many rape victims do not know of the benefits of these treatments. Even if they do, such obstacles as ongoing conflict, lack of transportation, or inability to pay prevent most victims from accessing available services in time for them to be effective. (Emergency contraception should be provided within 120 hours; postexposure prophylaxis, within 72 hours.)

There are other reasons why many victims do not seek medical, let alone legal, help. They may fear retribution by their perpetrators. And, because rape carries enormous stigma in the DRC, victims try to keep it secret. Disclosure may lead to ostracism by family and community. Such fierce stigmatization and resulting isolation means that many rape victims have no way to ensure their basic survival and thus may often feel compelled to begin exchanging sex for basic necessities: food, money, shelter, or security.

A combination of factors sustains sexual violence in this setting. First, the displacement, family separation, and community disintegration resulting from conflict weaken such traditional protective mechanisms as asking family members, neighbors, chiefs, or elders for help. And war establishes violence as the norm. As a result, sexual violence by those in positions of relative power and strength--soldiers, police, teachers, and common criminals--has increased.

However, rape--rarely reported in the DRC due, in part, to an ineffective judicial system as well as gender norms that maintain women's low status and lack of power--is increasingly gaining attention. And strategies to prevent it and to alleviate its consequences are being undertaken, including:

* Neighborhood watch collaborations are being created.

* The DRC government, the United Nations, and nongovernmental agencies have joined in a national initiative to fight sexual violence.

* When populations are displaced, UNICEF staff and nongovernmental agencies try to prevent family separation, ensure speedy family reunification, and ensure that camp design does not facilitate rape.

* Post-rape kits are being supplied by UNICEF, the United Nations Population Fund, the World Health Organization, and nongovernmental agencies to a few health centers. Mobile teams are being created to care for victims when conflict areas become accessible.

These organizations and agencies are also providing training on basic principles of confidentiality, security, respect, and nondiscrimination--as well as medical and psychosocial care--to health centers, religious groups, community-based organizations, law enforcement agents, and others.

Still, the needs of Congolese women who have been raped or are at high risk of being raped remain largely unmet. Increased funding for a coordinated, multidimensional approach to preventing and responding to sexual violence in the DRC is sorely needed.

References

(1) Page K. Safi's Story: A Courageous Young Woman Moves Beyond Her Past Experience of Sexual Violence. Democratic Republic of Congo: United Nations Children's Fund, 2003.

(2) Page.

Trish Hiddleston, Head of Protection, United Nations Children's Fund (UNICEF)/ Democratic Republic of Congo