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Democratic Republic of Congo: Rape as a Weapon in North Kivu

July 19, 2006

In the Democratic Republic of Congo (DRC), rape forms part of the daily reality for women living in the North Kivu province, where violence has reigned for several years. In 2005, Doctors Without Borders/Médecins Sans Frontières (MSF) teams admitted 1,292 women who were victims of sexual violence and as many again in the first six months of 2006. These figures are extremely disturbing; however they only reflect a very small part of reality in this eastern region. Malika Saim, MSF desk manager for the DRC, outlines the response our teams are providing to the situation. response.

 

How do you explain the extent of sexual violence in the North Kivu province?

 

"In 2004 we treated 270 rape victims in one year in North Kivu. Today this figure corresponds to the average number of cases we receive in one month. The number of rapes has not increased; instead, the accessibility to treatment has improved." —Malika Saim, MSF desk manager for the DRC

"In 2004 we treated 270 rape victims in one year in North Kivu. Today this figure corresponds to the average number of cases we receive in one month. The number of rapes has not increased; instead, the accessibility to treatment has improved." — Malika Saim, MSF desk manager for the DRC
Photo ©Spencer Platt/Getty Images
Sexual violence is embedded within the general context of violence perpetrated by the several armed groups present in this region. This violence takes many forms: rape, but also looting, crime, and armed fighting for the control of villages or roads. In this environment, where armed groups are always harassing the population, women are particularly at risk. More than three quarters of the women that we have treated have been raped by unknown armed soldiers. In the eastern regions of the DRC, while rape is etched into the general framework of violence, it's also seen as fully legitimate "additional retribution" by the armed groups.

Rape is used as a tool to terrorize the population, and the number of cases increases with each new outbreak of fighting and attacks. While young girls under 18 are particularly targeted (close to 40 percent), the most affected age group is between the ages of 19 and 45 (53.6 percent). These are the women who work in the fields in order to provide for their families. The acts of aggression against them take place mainly in the fields but also on the roads used to get there. Consequently, women limit their travel. Thus, in our supplementary feeding centers in the Kayna, mothers have preferred to find accommodation in the direct vicinity rather than returning each week to get rations for their children.

 

What is MSF's response to this violence?

 

MSF provides a wide range of services throughout the DRC, including comprehensive care for victims of sexual violence. Post-exposure antiretroviral prophylaxis treatment reduces susceptibility to HIV/AIDS and other infections.

MSF provides a wide range of services throughout the DRC, including comprehensive care for victims of sexual violence. Post-exposure antiretroviral prophylaxis treatment reduces susceptibility to HIV/AIDS and other infections. Photo ©Spencer Platt/Getty Images
On an operational level, we must adopt a cross-cutting approach and systematically try to offer specific care in all our medical programs (whether primary or secondary care). To begin with, it's essential to work with community groups and existing health facilities to increase awareness about the issue. On a medical level, early consultation after rape is vital, and must be undertaken within 72 hours. In this period of time, it's actually possible to administer to the woman an antiretroviral (ARV) prophylaxis, which makes her less susceptible to HIV infection —a very significant risk factor to take into account. Then, within five days, we offer the morning-after pill to avoid unwanted pregnancy. Medical treatment also involves prophylactic antibiotics against the most common sexually transmitted infections (syphilis, gonorrhea, and chlamydia), and tetanus and hepatitis-B vaccinations. The treatment of physical trauma such as lesions, wounds, or other injuries is also recommended. Follow-up is extensive and the total duration of medical treatment is at least six months. For every such treatment for these women, from the very outset it's essential to identify how abortion can take place. Abortion is illegal in DRC, so we have negotiated the possibility of carrying it out at a local level, with the head doctors in the health zone, but also with our practitioners.

Additionally, on a legal level and for reasons of protection, a medical certificate attesting rape is systematically produced and offered to the patient. During 2005, in our North Kivu projects, 17 percent of women accepted the medical certificate and 21 percent filed a complaint with the local authorities. Finally, we strive to guarantee our two main principles — confidentiality and free health care.

 

What is your assessment of our activities?

 

In 2004 we treated 270 rape victims in one year in North Kivu —today this figure corresponds to the average number of cases we receive in one month. The number of rapes has not increased— instead, the accessibility to treatment has improved. The message is beginning to be delivered widely. The proportion of treatments in the 72-hour period is also clearly increasing, reaching 47 percent in certain projects, like in Rutshuru.

However, several aspects are still to be improved and questions remain concerning the previous need to test —or not — the victim's serology before giving an ARV prophylaxis, the addressing of psychological suffering within medical treatment, and also the limits we apply regarding legal procedures.

But beyond these recurrent issues, this type of response in a context like that of North Kivu creates other problematic questions. For example, rape, considered a weapon of war against civilian populations, also raises the issue of its political objective. Additionally, abortion is an issue that remains completely unresolved in a country like the DRC. Abortion —carried out as a matter of course in our projects— is nonetheless forbidden in this country, as is the importing and usage of the abortion pill.

 

Tags: Democratic Republic of the Congo, Sexual Violence

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