Date Published: December 22, 2009
Publisher: Public Library of Science
Author(s): Denis Mukengere Mukwege, Cathy Nangini
Abstract: Cathy Nangini and Denis Mukwege describe their work at the Panzi Hospital in the Democratic Republic of Congo, which treats women victims of rape with extreme violence that are often perpetrated at the hands of armed groups.
Partial Text: On any given night in eastern DRC, armed groups of men will overrun a village and divide into bands of three to five, forcing themselves into houses where they seize and serially rape women and young girls. Some mutilate female genitals with guns, pieces of glass, wood, or heated plastic. Some take their victims to the forest and torture them as sex slaves for days, months, or years.
We consider rape an efficient form of biological warfare that is inexpensive to implement, effective over large areas, and does not particularly endanger the attackers. Its effectiveness relies on the perception, deeply embedded in patriarchal societies, that women’s sexuality is a prefecture of male ownership, and it is linked to the persistence of unequal gender relations and particularly to the way women’s bodies are regarded (, p. 45). Its impact is multiplied when the woman becomes pregnant and the attack is then passed on to the next generation .
The Panzi Hospital is located in Bukavu, South Kivu, a city that has been relatively secure in recent years compared with surrounding areas in the forest and in North Kivu where there are direct military clashes. In terms of sexual violence treatment, it is the best-funded hospital in South Kivu, primarily receiving funds from Communauté des Eglises de Pentecote en Afrique Centrale (CEPAC), the largest democratically governed church network in the DRC, and external NGOs. The Panzi Hospital is a referral hospital, receiving the most severe REV cases from smaller centres, owing to its expertise in surgical repair of urogenital trauma, including urological-genital and rectal-genital fistulas, simple and diverse genital and/or anal wounds, diverse genital mutilation, and other complications such as fractures of the pelvis and femur.
The war in eastern DRC has widowed a large number of women, forcing them to become heads of households without having had any preparation for this role. The war has destroyed women’s means of production and, as a result, they live below the poverty line and many rely on food aid (when available) (, p. 25). Many women and girls have also been forced into survival sex, which makes them particularly vulnerable to sexual violence. An increase in domestic violence—a common fallout of war—has also been observed, as unemployment among men and uncertainty regarding the country’s political future is on the rise (, p. 26).
It is tremendously important that access to medical care be established for as many rape survivors as possible. There are three main gaps in the provision of care: lack of health care infrastructure, an insufficient number of qualified psychotherapists, and the socioeconomic reintegration gap. A functioning health care system needs to be established to define health territories or areas that can effectively manage sexual violence cases. Such cases can be identified and treated at this level, and, if necessary, the decision to transfer patients to a superior facility can be made. In this way, the access to health care would become more evenly distributed across the province, and would, additionally, alleviate the incoming patient load on the Panzi Hospital, which treats the most severe cases. The Panzi Hospital could participate in the training of personnel and play an advisory role in the system; however, money and resources remain the biggest obstacles in establishing such a network. Medical care, while essential, is but the first milestone to be reached for a holistic recovery. Psychosocial treatment is essential to help re-establish dignity and the desire to live. However, the sheer volume of rape has created an enormous gap in psychosocial care in a region where the number of qualified psychotherapists is very limited. Given the large number of survivors and the long period of time required for healing, it is necessary to train social workers in each health region and help them get settled for the long term to allow localized provision of care.
The Panzi Hospital is one of the few establishments in the DRC maintaining detailed records of sexual violence reports. This is important not only for characterizing and assessing the consequences of the crisis, but also for understanding the underlying factors that fuel REV.
Despite the legal structures in place recognizing rape as a crime against humanity and a war crime , sexual violence remains low on the international radar. While mass rape in the eastern DRC continues to be documented widely by NGOs and the UN, this has yet to curb the use of REV and end impunity for such crimes against humanity.