Making sense of sexual violence in Central Africa

[ Spring 2009 ]
Imani* was just 15 when soldiers from the rebel group Interahamwe seized her on the road. Amid a bewildering array of competing armies, local militias, and rebel factions, sexual brutality has reached unprecedented levels there, terrorizing Congolese women and girls in a way that goes far beyond that often found in conflict zones, observers say. Women are gang raped in public, taken into sexual slavery, and violated with sticks, bottles, knives, and guns. Some victims are mutilated, their limbs chopped off by machetes. Other victims see their husbands and children murdered, houses razed, and crops burned.

Working with the Harvard Humanitarian Initiative (HHI)—a University-wide program co-directed by two Harvard School of Public Health faculty members, Jennifer Leaning and Michael VanRooyen—researchers conduct studies in the midst of crisis. Their quest is to document the sexual atrocities-defined by the Geneva Conventions as war crimes-and understand their causes. Their hope is to inform policies and programs that assist survivors and, ultimately, prevent the attacks.

As part of its research agenda, HHI is reviewing hospital records of thousands of women at Panzi Hospital, in the city of Bukavu. Researchers also meet with groups of men and women from the community to explore prevailing attitudes toward women and sexual violence. Preliminary findings suggest the attacks may be poisoning Congolese society, with stigma preventing survivors from resuming normal lives. Observers are concerned that the attacks are crossing into Congolese society as soldiers demobilize.

The roots of the conflict

The Democratic Republic of the Congo (DRC), a resource-rich, culturally diverse nation in the heart of Africa, has long been a place of turmoil. In the wake of the 1994 genocide in neighboring Rwanda, Hutu refugees, including many deemed responsible for atrocities, swarmed into DRC’s eastern border region. Rebels allegedly backed by Rwanda and Uganda attacked DRC’s government in two separate wars that began in 1996 and 1998. The first toppled dictator Mobutu Sese Seko in 1997. Mobutu’s successor, Laurent Kabila, was assassinated in office in 2001. The latter clash, which involved eight nations and came to be known as “Africa’s World War,” resulted in 5.4 million deaths. A 2002 peace treaty ended the conflict, but fighting continues in the east, where rape is destroying families and communities and driving terrorized people from their land.

IN FEBRUARY OF 2009, three members of a Harvard University News Office reporting team traveled to the Democratic Republic of the Congo to shadow Harvard Humanitarian Initiative researchers: Senior Science Writer Alvin Powell, Assistant Director for Photography Justin Ide, and News Office Associate Director and Multimedia Producer Rebecca Rollins. This story is written by Powell.

“Men and women in recent focus groups say that rape is becoming more and more common in their communities. It is no longer only soldiers who rape, but also young local men who have come to regard rape as ‘normal’,” says VanRooyen.

“We can learn where women come from, what happened after their rape-whether they were rejected by their communities, which is a huge vulnerability-and which services they need most,” such as job training, says VanRooyen, an associate professor of medicine at Harvard Medical School and a division chief in the Department of Emergency Medicine at Brigham and Women’s Hospital, whose field research and practice has taken him throughout conflict areas including Somalia, Bosnia, Rwanda, and Darfur, in the Sudan.


International relief and aid organizations reached the DRC’s eastern region for years, but few data exist to guide these efforts and shape recovery and rehabilitation programs. That’s where HHI comes in.

In one pioneering project, researchers are interviewing military men. Jocelyn Kelly, a 2008 HSPH graduate who coordinates HHI’s gender-based violence research, travels to remote villages to talk with soldiers from the Mai Mai rebel group. To make these connections, HHI relies heavily on local partners with strong ties to community members and militia commanders.

“To begin to understand a conflict, we must ask questions not only of those who experience violence, but also of those who perpetrate it-and to realize that these are not necessarily two different groups,” Kelly says.

HHI’s work has caught the attention of international policymakers. In January of 2009, the Open Society Institute invited Kelly and VanRooyen to an ad hoc meeting of representatives from the U.N. Security Council member states. The pair urged the group to seek data from an array of sources, including HHI’s pioneering investigations, as they devised strategies to protect women in the DRC.

“The situation is extremely complex,” Kelly says. “At least 21 combatant groups have been identified in the region. The profile of violence evolves over time, and it is vital that we track these changes to know how to address the most pressing problems.

“The unrestricted impunity and the competition between armed groups to be the most brutal may account for the inhuman cruelty of these rapes,” she continues. “Men may rape because there is opportunity, because they are compelled by their commanders and peers, or because there is a mandate to humiliate and morally destroy communities — or all of these. Each requires a different solution.

“We’re looking for trends in soldiers’ responses to our interviews. For instance, we can find out about the prevailing attitudes of armed men, the conversations they are already having about sexual violence, where they get their news and information, and where they go when they are seeking help. These pieces of information are critical for crafting effective programs.”

Mitigating the conflict is a job for the Congolese military and MONUC (the United Nations mission in the Congo), VanRooyen says. In June of 2008, the U.N. Security Council reframed sexual violence in the eastern DRC as a security issue, paving the way for possible war-crime prosecutions. U.N. Secretary-General Ban Ki-Moon is expected to release a report by June 30 of 2009 outlining a course of action. One possible outcome could be the redeployment of UN forces to serve a more specific protection mission for women under threat of sexual violence. “Many fine organizations deliver medical care,” says HHI Co-director Jennifer Leaning, a professor of the Practice of International Health. Leaning is an expert on human rights with experience in Darfur, Kosovo, Rwanda, and Russia. “We’re using our capacity in survey, quantitative, and qualitative research to help protect women and build the case for an international response.”

A grim picture

HHI review of Panzi Hospital medical records shows:

  • One-half of attacks occur at home
  • Victims wait an average of 16 months to seek medical care
  • One-third undergo major surgery to repair rape-related injuries
  • 6 percent report pregnancies resulting from rape
  • 12 percent worry that they have HIV/AIDS or other sexually transmitted diseases


Imani told her story during one week in February of 2009 at Panzi Hospital, a 334-bed center to which women like her have streamed since 1999. On Monday came 36 patients. On Tuesday, 9. By Friday at noon, the tally reached 69.

So far, HHI researchers have examined more than 1,000 patient records from 2006. Their ongoing review reveals that whereas women in most strife-torn countries are most vulnerable when they leave the house — to go to the market, say, or to the river for water-about half of attacks in the DRC occur at night, in the women’s homes.

“If a woman can’t feel safe at home while sleeping with her husband and children, where can she feel safe?” says HHI’s Jennifer Scott, an obstetrics and gynecology resident from Beth Israel Deaconess Medical Center, in Boston.

Women wait an average of 16 months before seeking medical care, the research team has found. Victims are as young as 3, as old as 80. Just over one in 10 have lost a child or husband. Six percent report pregnancies. About 12 percent express concern about now having HIV/AIDS or other sexually transmitted diseases.

Almost one-third undergo major surgery to repair internal injuries. A violent rape can tear the tissue separating the vagina from the bladder or anus, causing women to leak urine or feces unless the tears, called fistulas, can be repaired. Caregivers see only women who can make the journey, sometimes of hundreds of kilometers, says Panzi Hospital founder and obstetrician-gynecologist Denis Mukwege.

“Sadly, the weakest can’t get to us,” Mukwege says. “They are suffering from paralysis, from broken legs, from compound fractures.”


Speaking through a translator in Swahili at Panzi, Imani said 10 years had passed since her rape by the Interahamwe. It was, she said, only the first of four sexual assaults. The latest occurred in November of 2008, in the city of Goma.

Though Imani’s physical injuries are healing, her HIV infection will require lifelong treatment. Her psychological wounds remain deep. Orphaned by the violence, with one sister dead, Imani has lost track of other relatives. Her only family now is a little girl, born of rape, who reminds her of life’s most horrible days.

In the eyes of traditional society, both mother and child are contaminated. Imani’s marriage prospects are poor. She speaks of the life she believes she will never have: with a husband and children born of love, not violence.

“At night when I sleep, I cry,” Imani says. “You see, my life is just rape every day.”

* a pseudonym used to protect her identity
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