The fear and trauma of sexual violence has sadly become a part of life for an unknown number of women, men, and children in Central African Republic (CAR) since the country descended into extreme levels of violence and lawlessness last year.
Since July 2014, Doctors Without Borders/Médecins Sans Frontières (MSF) has provided assistance and support to survivors of rape at two clinics in CAR's capital of Bangui. From July through September, 247 survivors of sexual violence received help. Most of them are women, but girls as young as eight and several men have also sought assistance and support.
They came to the clinic even though being a survivor of rape is considered taboo in Central African society.
"People are ashamed to come, but when they have the possibility of free care and support, they muster up the courage and come nevertheless," says Helene Thomas, an MSF clinical psychologist at the clinic in Bangui’s General Hospital. Radio spots played on local stations have increased awareness about the clinic and attracted more patients, who come despite the risk of stigmatization or ostracization by spouses or other family members.
The support provided at the clinics includes tests for pregnancy and sexually transmitted diseases, including HIV, as well as psychological consultations. These sessions offer patients with a safe space to share their experiences and discuss their feelings of sorrow, humiliation, and fear. Clinicians like Thomas also check for signs of depression during the consultations, which normally last a few months. Patients are encouraged to rely on their inner strength.
No one knows how many adults and children have suffered rape during the ongoing conflict. “I am convinced that we are only seeing the tip of the iceberg,” says Thomas. “There are many, many more victims out there."
One of the women who has found the courage to seek help is a 24-year-old from the city of Bambari. “It was the month of May," she remembers. "Two men from a rebel group came to my home. They asked for my husband, but he was not there, so they told me that I would have to pay,” she explains in a quiet voice, while looking down at her hands.
“They tore my clothes off, my children started to cry, and they raped me in front of them. Now, I always feel abdominal pain. In the beginning, I could not sleep, but now it is a bit better. My son, who is five years old, started to talk to me about what he saw, but I cannot talk to him about it—I do not want to hear his words."
Another soft-spoken woman cries quietly while she talks about her ordeal in January, when four armed men assaulted her. The children saw it all—including her passing out from the pain and waking up several hours later, in the middle of the night. She is waiting for the tests that will tell if she is now HIV-positive. “I cannot be with my husband. I feel numb,” she says, and talks about the continued pain she also feels in her abdomen.
It remains a rarity in CAR for survivors of rape see their perpetrators brought to justice. In some cases, the family even forces the victim to live with the rapist out of shame about what happened.
“I just recently worked with a family who had forced their 15-year-old daughter to live with the boy who had raped her," says Thomas. "She had attempted to take her own life and was referred to us by a social worker. We tried to intervene, and explained to the family that no one should be forced to live with their rapist; that rape is a crime, and that the rapist should be brought to justice."
As horrifying as these experiences of sexual assault are, consultations can have a positive impact. “There is almost always a change for the better,” says Sylvie Nadege Gonekra, a midwife at the clinic in Bangui’s General Hospital. “After a few consultations, I notice a change on most patients’ faces."
“Some of the women will remain traumatized for life—but if, for example, we can get the family to be very supportive of the victim, then there is a chance," says Thomas. "The assault will never be forgotten, but they can pull through and end up having a life without severe psychological trauma."