International Activity Report 2003

Republic of Congo
2003

International staff:

National staff:

MSF has been working in Republic of Congo since 1997

Tika Bika Viol – I say no to Rape! A simple slogan, a shattering subject. The grassroots campaign Tika Bika Viol!, led by MSF, transformed the streets of the Congolese capital Brazzaville for a week in March 2003, in response to the sexual violence that has altered the lives of untold thousands of women in Congo for many years.

The vast public education drive attacked the lack of public awareness of rape that has served to hide, and sometimes abet, the persistent problem in the country. Tika Bika Viol! grew out of MSF's ongoing work providing medical care and psychological support to rape victims in the capital city.

While MSF also has other types of projects in the country – emergency assistance for people displaced by con. ict in the south and treatment for those suffering from sleeping sickness – it was the rape care and prevention work that took center stage in early 2003.

"To rape someone is to kill someone," B., 19-year-old victim

"Rape? Men like it." The phrase rings out in the warm air of the Nkeoua market neighborhood on the outskirts of Brazzaville. A theater group sets up a simple set on a flatbed truck; members of the MSF team begin discussions with small groups of men. The subject is provocative, but the uncomfortable glances and silences also speak of the weight of oppression young women bear after nightfall. On the improvised stage, the actors play out the terrible – yet everyday – story of a young girl who meets the wrong man. Facing the inevitable, the young actress cries and pleads. The crowd groans, the tension is palpable and the rape scene is harsh. Everyone in the audience tries to direct the difficult sequence. Laughter, cries, shouts of rage – then jaws clench and eyes turn away. The young woman is left alone with her humiliation. The silence reveals a collective discomfort. Instinctively, women approach the truck in small groups to support the young actress, who struggles to recover. They know this story all too well.

This street play proved to be the most powerful part of Tika Bika Viol!. The campaign touched the raw nerve of rape that is one of the country's grim not-so-secrets. Although it involved an international colloquium attended by a variety of national and international organizations, as well as first lady Madame Antoinette Sassou, the heart of Tika Bika Viol! was its grassroots education. Over 300 life-size wooden figures of women haunted the streets; street theater, banners and buttons promoted discussion of the taboo subject. Taxis sported bumper stickers and helped get the message to outof- the-way spots and filling stations around the city. The campaign helped put a taboo topic out in the open and fostered discussion of the devastating consequences of this unfortunately common occurrence.

A disturbing phenomenon, encouraged by impunity

In Congo, crimes of sexual violence, including rape, were often perpetrated by fighters from all sides during the country's civil war, which flared up between 1998 and 2000. They continue to be carried out by armed men during times of upheaval in Brazzaville. But now these crimes are mainly committed by civilians, with 60% of victims being very well acquainted with their rapist. Women, children and the elderly are at risk of being raped in their homes, on the street, and when carrying out daily activities such as fetching water. To make matters worse, rape goes virtually unpunished in the country: not a single rapist was convicted in 2002.

The Tika Bika Viol! campaign was the natural outgrowth of MSF's sexual violence program, begun in March 2000 at Makélékélé hospital in Brazzaville. MSF provides emergency medical care for rape victims, including treatment for injuries sustained during rape, medication to prevent pregnancy and preventive treatment for sexually transmitted diseases including HIV. To prevent unwanted pregnancy and to block the spread of HIV, women should receive medical attention within 72 hours. In addition to medical assistance, MSF national and international staff provide psychological treatment and follow-up, essential for traumatized survivors. More than 600 people have been treated in the sexual violence program in Makélékélé. In January 2003, the project was expanded to Talangaï hospital in the northern part of Brazzaville.

Many victims of sexual violence are unaware of the free services provided by MSF and the urgency of receiving treatment. Tika Bika Viol! helped spread the word about both the problem and the MSF program. Three weeks after the Tika Bika Viol! campaign, the 300 wooden silhouettes installed on all of Brazzaville's main roads were still standing. Not a single one had been stolen, and neighborhood residents had put them back in place if they fell over. The determined-looking women had been transformed from an image of the rape problem itself into a symbol of the rejection of sexual violence.

Other programs: helping those affected by displacement and disease

A year of armed conflict between government forces and Ninja rebel factions was followed by a ceasefire in March 2003. Beginning in October 2002, tens of thousands of people displaced by the con. ict were trapped outside the city of Brazzaville, pinned between the conflict zone and government barricades; many others remained unreachable in the forest of the Pool region. MSF intervened with health clinics and a supplementary feeding program. In May 2003, MSF gained access to the Pool region and began surgical, medical and nutritional programs at the reference hospital in Kinkala, along with measles vaccinations in outlying villages. In June, MSF started mobile clinics, nutritional assistance and support to Mindouli hospital, also in Pool. As of July 2003, aid to displaced people still waiting to go home continued.

MSF continued assistance to refugees from Democratic Republic of the Congo as well as local residents in the northeast town of Bétou; in addition to providing basic medical care, MSF has also constructed a new operating room and outpatient ward in Bétou's health center. MSF provides artemisinin-containing combination therapy (ACT) to malaria patients in the region. MSF has also been actively fighting human African Trypanosomiasis in Congo since 2000, supporting treatment centers in Plateaux and more recently Bouenza and Cuvette Est provinces, conducting mass screening and researching new protocols. Commonly known as sleeping sickness, this neurological disease is caused by a parasite transmitted by the tsetse fly and is fatal if left untreated. It is endemic in 36 African countries and affects an estimated 500,000 people. The Plateaux project closed in May 2003, having screened 58,417 people and treated 913. Since opening in September 2002, the Bouenza project has screened 45,125 and treated 575. Work in Cuvette Est began in June 2003.

In February 2003, an outbreak of the Ebola virus in Cuvette caused the death of more than 120 people. Ebola hemorrhagic fever is deadly in 50-90% of cases. In collaboration with the World Health Organization and the national Ministry of Health, MSF provided essential medical supplies such as isolation kits. A similar outbreak in the region last year killed 66 people.

© 2009 Doctors Without Borders/Médecins Sans Frontières (MSF)