Rebecca Singer, RN, NDTreating Sexual Violence in Liberia

Throughout Liberia's 14 years of civil war, the use of rape and sexual violence as a weapon of war was all too common. Although the war itself came to an end in August 2003 and the country has been disarmed since that time, sexual violence continues to affect Liberians. It is now estimated that 40 percent or more of women and girls in Liberia have experienced some form of sexual violence. In order to treat the overwhelming number of rape victims, Doctors Without Borders/Médecins Sans Frontières (MSF) set up treatment and counseling centers in three camps for internally displaced people north of the capital city of Monrovia as well as at Benson Hospital in the capital itself, where 60 percent of the Liberian population lives. Recently MSF teams in Nimba, a county northeast of the capital, have also begun work on issues pertaining to gender-based violence.

Rebecca Singer is a nurse from Denver, Colorado, who has spent five months working with MSF to provide treatment and support for victims of rape and other forms of sexual violence at Benson Hospital's Gender-Based Violence Clinic. Rebecca writes of her experiences thus far in Monrovia.

The majority of the people we see at the clinic were hurt during the war, but there are also many people who come to our clinic with recent accounts of sexual violence. My daily experiences indicate that sexual violence against children continues to be a common occurrence. – Rebecca Singer, RN

Currently, Benson Hospital is the only hospital in Monrovia dedicated to serving the women and children of Liberia. People come to this hospital for a number of reasons ranging from malaria and severe diarrhea, which are common diseases in the area, to pregnancy. Many of the people who come to the hospital find their way to our Gender-Based Violence Clinic, as they have heard about it from a neighbor, the police, or a social worker who made an announcement at the outpatient department. They hear that there is help for all victims of sexual violence and that they should not be ashamed about what happened to them.

A billboard created by MSF to raise awareness about free treatment for sexual violence. Photo © Rebecca Singer

Apparently, the word is spreading throughout Monrovia, despite the absence of television or a telephone system, that Benson Hospital is the place to go if "something bad" has happened to you or your child. We have plans to increase community awareness about sexual violence by advertising our services throughout greater Monrovia. So far, we have posted three billboards with an image of a man assaulting a woman. The written message is blunt, it reads, Raped? Seek Free Treatment Now. When the artist proposed the image, I was worried that it was too graphic, but my Liberian colleagues assure me that it is just strong enough.

As of now, we are seeing anywhere from 6 to 15 new patients a day, and these are the few among the many victims. The people who do make it to our clinic always wait patiently on the bench outside our office. There are mothers with small children on their backs or at their breasts, adolescent girls avoiding eye contact, and men sitting motionlessly next to their women. All are quiet.

They are waiting for their turn to enter the room marked "counseling section." When a woman, child, or man enter the room, the door is locked behind them and they can speak freely about what has happened to them or to their family member or friend that has led them to the clinic. Every day, women come in telling us that they were raped two, four, or even six years ago, and that their stomachs and backs have hurt since that time.

One woman spoke of her experience in 1992, when after running away from her village to escape war-related violence, she was raped by eight soldiers at a checkpoint. In 2003, she was gang raped again. All of the stories that emerge within these walls have become so familiar to me during these five months, yet they are all distinct. It is common to hear an account, in which rebels or soldiers came to the door, killed or beat the male head of the household, and then raped all of the women in the house. There have also been cases of sexual slavery where women were taken by military leaders, usually rebels, and forced to cook, clean, and engage in sexual acts.

The majority of the people we see at the clinic were hurt during the war, but there are also many people who come to our clinic with recent accounts of sexual violence. My daily experiences indicate that sexual violence against children continues to be a common occurrence. Approximately one-third of the patients treated here are children under the age of eighteen. We have toys and crayons and paper in the counseling room. These items usually help to break the ice. It is difficult. Lately, we have been hearing more and more cases of gang rape, random violent acts in which gangs of young boys will rape a young woman who is out alone at night. It gets dark fairly early here and in many cases people have to bathe and use the toilets outside. As my co-workers say, "it is very risky" to go out alone at night.

Rebecca Singer instructs a class of Liberian counsellors. Photo © Doris Burtscher

When the victims of sexual violence come to our clinic, we provide them with different medications that will prevent sexually transmitted infections (STIs), HIV/AIDS, or an unwanted pregnancy. We perform a medical exam and give the patient a medical certificate that could help them in a court of law if they decide to pursue a case. We also give them a hug and a place where they can come and feel safe, a place where they can try to leave their terrible experiences behind.

But for many of these victims the pain will never go away. I explain that there is no pill or tablet or injection that will take away their pain. I tell them that the heart and the head hurt because a bad thing happened and that terrible experiences makes the body hurt too. I try to describe the concept of a somatic expression of their trauma and I encourage them to talk to friends, sisters, or aunties to share the burden of their pain with others. I tell them to keep trying. This is all that I can do and I hope that they understand. Sometimes I worry that we are not doing enough. I fear that these women, children, and men will leave the clinic more hopeless than when they entered.

But then there is the woman who tells me that her pain has finally left her, or the little girl who gives me a shy smile and a hug when she comes for her return visit, or the husband who thanks me for the work we are doing for Liberian women. And these are the times when I think that we are successful in providing some hope to a healing Liberia.

Edited by Marisa Lloyd