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Shattered Lives: Eastern DRC
Responding to Sexual Violence in Masisi
March 4, 2009
DRC 2008 © Pascale Zintzen
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In the midst of the conflict in Kivu, MSF strives to provide medical care to victims of sexual violence. Rape is widespread, but access to patients is a challenge. With the help of a network of women working in villages, the word is spreading and more victims are seeking care. Yet, fighting, geographic isolation and the fear of disclosing the rape prevent many women from seeking care in Masisi, a district in North Kivu.
In the Kivu region, eastern DRC, ongoing fighting has left hundreds of thousands in need of emergency health care. The already weak health system deteriorated even further with the escalation of violence in September 2008. Health centers have been looted and abandoned as health staff have fled for their safety. As in many other violent conflicts, widespread sexual violence adds to the terror and the needs of a population already traumatized by war.
A study by the UN Population Fund (UNFPA) of nearly half the health centers in the country found that 50,000 rape cases had been reported. however, UNFPA acknowledged that the numbers reflect a fraction of the total, as many cases of sexual violence are not reported13. In 2008, MSF alone treated 6,700 victims of sexual violence in North and South Kivu. “Rape is widespread, practiced by all sides of the conflict”, said Dr. Bertrand Draguez, MSF medical director. “The collapse of all legal structures makes any prosecution impossible”. Many families headed by males often settle violent crimes against women and girls outside the courts. Some ‘resolve’ rape cases by accepting money from the perpetrator or his family, or by arranging to have the perpetrator marry the victim14.
Reaching Rape Victims Amid Conflict
MSF has been in the Kivu region since 1992, providing emergency medical care in hospitals, health centers and mobile clinics. MSF teams treat gunshot wounds and burns, perform emergency surgery, respond to epidemics like cholera and measles, give psychological support to people traumatized by the conflict and provide care to victims of sexual violence.
In august 2007, MSF started providing emergency medical care in Masisi district, covering a population of 337,000, including residents and displaced people. The number of women suffering from sexual violence astounded the team soon after they arrived. “At the beginning, we tried to listen to people and find out where it was worse, so that we could target the work”, said Ann Khoudiacoff, who supervised MSF medical activities in Masisi. “But it soon became clear that it was a problem of catastrophic proportions, and it happens everywhere”. Care for victims of sexual violence was then included in MSF emergency medical activities in the area.
In Masisi town, where a population of 23,000 has swollen to more than 34,000 with the arrival of people fleeing the violence, MSF supports the general hospital and the health center. With 175 beds, the hospital offers emergency medical care including surgery, maternity and pediatric services, cholera treatment and medical care for victims of sexual violence. To ensure privacy during medical consultations in the hospital, a special room was adapted to receive rape victims. Through mobile clinics, MSF teams reach remote villages in the district, where the population is trapped by the conflict and unable to reach health care facilities.
The situation in North Kivu remains extremely volatile. The ability of the people and of MSF teams to move around is restricted because of the insecurity of the area. Reaching victims is a huge challenge. In 2008, MSF teams in Masisi treated an average of 45 new victims of sexual violence every month – a small proportion of the number of women believed to have been raped. Out of those who sought medical care, only 20% arrived within 72 hours. Seventy-five percent arrived after five days, too late to receive both preventive treatment for HIV and emergency contraception. The main reasons for the delay are lack of access and awareness: one-third simply could not reach the facility any earlier and two-thirds did not know that services were available.
To improve awareness of the availability of medical care, a network of women was trained as focal points on sexual violence in their villages. “The first thing we did was to go to the villages and invite all mothers to come to a talk on sexual violence”, said Anna Halford, MSF project coordinator in Masisi. “We explained the medical consequences, what we offered and that it was free. We then asked them to elect a woman they would feel comfortable with to be the focal point for sexual violence in their villages”. Today, the network comprises 59 women – called mamans conseillères (mama counsellors) - based in 11 villages, and it is still growing. Their role stretches beyond their own villages, as they visit other communities to spread the message about sexual violence. When they are approached by victims of sexual violence, the mamans explain the need for medical care and try to persuade them to go to the hospital. Sometimes, rape survivors come to the hospital on their own, having heard in their villages about the availability of care. To get to this point, the MSF team had to break through some well-established perceptions of rape. “They said it happened every day, in the villages, when they went to the fields, everywhere so they didn’t consider it something that needed attention. We had to engage in open discussions in the villages and do a lot of sensitization to show that a woman victim of sexual violence needs medical care”, said Khoudiacoff, the medical supervisor.
A community health education team also organizes training for primary and secondary school teachers on the medical impact of sexual violence and the health care available for victims at the hospital in Masisi. They work with the local radio station to disseminate their messages and organize awareness raising activities in the hospital.
Though awareness is increasing and more victims are arriving at the hospital spontaneously, for many, getting to the facility is too difficult. Depending on the village they come from, patients must walk anywhere between two and 12 hours through unsafe routes to reach Masisi hospital. “They just can’t get to the hospital”, Halford said. “You can’t ask a woman who has been continuously raped for three days to leave her six children behind and walk four hours crossing two territories to reach the hospital. Besides, they can’t leave their villages without raising suspicion. They don’t dare”. Although care is provided through the mobile clinics, they can only cover a limited number of villages at any one time. Despite the insecurity and the complete collapse of the justice system, a medical-legal certificate is issued for every rape survivor. If the patient doesn’t want to keep a copy for safety reasons, MSF can safely store it. Today, few victims consider denouncing perpetrators. But if they want to do so in the future, they can retrieve their medical certificates and use them in court. “The level of impunity is appalling”, Halford said. “It is so shaming to be raped here, that women just don’t want to press charges. They are too scared. It is like a conspiracy that makes revealing a case of rape the worst possible thing. They just want to cover up”.
MSF teams also provide free primary and more specialized care by supporting hospitals and mobile clinics in and around Kabizo, Kayna, Kirotche, Kitchanga, Masisi, Mweso, Nyanzale and Rutshuru.
Read the full report: Shattered Lives