KIGOMA, Tanzania – Mary Akile is still harbouring emotional suffering four years after a rape attack that inflicted both physical pain and untold mental anguish.

“I still remember how the attackers invaded my house and raped me, one after another,” says Akile, her voice cracking as she recalled the harrowing ordeal during April 2019 at Kabindi village, North Kivu Province in the Democratic Republic of Congo (DRC).

The 47-year-old mother of three, who is now living in Tanzania’s western Kigoma region, is amongst many DRC rape survivors who have suffered the horrors of war.

For decades, women and girls in the war-torn country have experienced sexual violence including rape, which has caused a myriad of problems including physical injuries, long-term psychological trauma, broken families, socio-economic exclusion and stigma.

Conflict-related sexual violence is considered a gross violation of human rights with devastating mental health consequences for the victims, medical experts said.

According to a study published in Jama, women who reported sexual assault were more likely to experience depression and twice as likely to have elevated anxiety and sleeping problems.

Scanty data  

While cumulative statistics of rape incidents in the DRC are hard to find, in 2020 the United Nations Organisation Stabilization Mission in DRC (MONUSCO) documented at least 1053 cases affecting 675 women, 370 girls, three men and five boys.

Although fear and shame engulfing communities in central and sub-Sahara Africa have for years forced rape survivors to keep mum, many of them are now publicly sharing their stories as they desperately try to unravel the emotional harm they’ve been harbouring for far too long.

This is partly thanks to reparative justice, a new paradigm for repairing emotional harm and preventing it from happening again that is premised on the need for reparations to be provided to victims.

“I feel relieved to publicly tell my story. A heavy burden has been lifted off my head, ”Akile said as she brushed a strand of dreadlocks off her face.

Rape has been used as a weapon of war by armed groups in the DRC to terrorise women and girls, forcing them to flee the country, Akile said.

The perpetrators of sexual violence are seldom punished so their victims are denied justice and don’t get compensation to rebuild their lives.

“Ever since I move to Tanzania, I feel safe and I don’t want to go back to Congo,” said Akile who designs and sells African Batik fabrics popularly known as Vitenge to eke out a living.

Impact on survivors

As part of its global initiative to enhance access to reparations for survivors of conflict-related sexual violence, Global Survivors Fund (GSF), a Swiss-based humanitarian organisation, is working with grassroots organisations in DRC and Guinea to support the healing process of the victims.

The GSF was launched in October 2019 by Nobel Laureates Dr Denis Mukwege and Nadia Murad. Mukwege is a renowned Congolese gynaecologist who has treated hundreds of rape survivors in DRC, while Murad, who was kidnapped by ISIS in Iraq, is a leading advocate for survivors of genocide and sexual violence.

GSF’s mission is to enhance access to reparations for survivors of conflict-related sexual violence around the globe, mainly by providing “interim reparative measures in situations where states or other parties are unable or unwilling to meet their responsibilities”.

In DRC, the initiative works in more than 60 villages in north and south Kivu and the central Kasai region. More than 1,093 survivors of conflict-related sexual violence have received financial compensation, vocational training, and medical and psychological care, GSF officials said.

The conflict in the mineral-rich eastern DRC, where over 120 armed groups are jostling for natural resources, has triggered a spiral of violence that has killed thousands of people and displaced many others including women and children.

Following an individual assessment, the identified survivors within the scope of our project in DRC and Guinea, received medical treatment, surgeries but also individual and physical therapies, as well as family therapies, when needed, according to  GSF.

There can be no #justice without #reparation. At GSF, we work with & for survivors of conflict-related sexual violence (#CRSV) to obtain that justice by enhancing access to their right for reparation when they need it most.
See how we do this here 👉https://t.co/KNxYvlp1DN pic.twitter.com/gRDqFMT1Fh

— Global Survivors Fund (@glsurvivorsfund) April 6, 2023

Reparations are measures taken to address human rights violations by acknowledging the damage caused, recognising the dignity of the victims and trying to restore hope for the future.

While survivors of sexual violence usually need urgent help to rebuild their lives, the pathway to official reparation takes a long time, GSF officials said.

To mitigate the suffering, the charity and its partners are providing a number of interim reparative measures, including therapy, to transform the lives of the survivors.

Many survivors of sexual violence in DRC and Guinea live in constant fear due to the violent behaviour of the military and insecurity. But with multiple reparative measures, remarkable changes are happening and many survivors have seen a glimmer of hope that they can turn their lives around. 

A visit by Health Policy Watch to eastern DRC showed survivors of sexual violence reporting improved physical and mental health along with increased financial status and a sense of justice.

“Before, I didn’t even dare approach people to talk about what happened to me at the stadium. Thanks to the therapy, today I can talk about what happened to me. This is also the case for most of my friends,” said one survivor who preferred anonymity.

More confident

Before this initiative survivors complained that sexual violence had affected their health and social status but they are now feeling more confident thanks to the improvement in their mental and physical health.    

A study conducted by the Netherlands Institute for the Study of Crime and Law Enforcement to understand perceived changes to the quality of life of the survivors of conflict-related sexual violence in Guinea and the  DRC after they had received support from non-governmental organisations in their process of healing show their quality of life and social status within the family and community improved.

The study which examined the emotional and social-economic wellbeing of survivors and their families shows reparative measures have had a positive impact on the well-being of survivors.

According to the study, the individual and group psychological therapies in Guinea have helped survivors to regain trust in their loved ones and are now willing to tell them about their ordeals.

Global campaign

Global women’s rights movements have been waging a fierce battle for recognition and care of rape victims in war-ravaged nations. Governments, the United Nations and humanitarian organisations have been struggling to provide post-rape care including post-exposure prophylaxis against HIV transmission within 72 hours of the rape, and emergency contraception within 120 hours while conducting physical examinations on the victims.

But due to limited capacity, public health institutions usually focus on the immediate needs of rape survivors and are unable to help those struggling with the longer-term health impact of rape, especially depression, anxiety or post-traumatic stress disorder.

DRC rape survivors who lack access to mental health care complain that they are being ignored. In North Kivu, for example, sexual violence survivors feel haunted by the trauma and struggle to provide for their families, yet they hardly get badly needed care for mental health.

“I sometimes wake up in the middle of the night screaming and have scary nightmares,” said Akile. “I wish I would meet my attackers face-to-face and let  them apologise to me, that would bring a perfect relief.”     

Long-term health problems

As a public health threat affecting women and girls worldwide, sexual violence has placed survivors at risk of unintended pregnancy, unsafe abortion, sexually transmitted diseases and long-term psychological trauma, experts said.

Sylvia Kaaya, professor of psychiatry at Tanzania’s Muhimbili University of Health and Allied Sciences told Health Policy Watch that survivors of sexual violence are likely to experience post-traumatic stress disorder and recurring reproductive, gastrointestinal, cardiovascular and sexual health problems.

“During trauma, the body releases cortisol to avoid pain and inflammation, and it raises blood sugar to help the victim free from danger. However, when these physical responses persist, they may cause health problems,” she said.

Sexual abuse, notably rape, may also produce gynaecological trauma including genital injury and fistula that cause complications during childbirth. 

While timely access to clinical care is essential to prevent adverse consequences of sexual violence, experts say survivors have repeatedly been traumatised due to negative attitudes amongst healthcare providers. 

A global review of healthcare-based interventions for survivors of sexual violence shows a lack of clinical competency and prevalent negative attitudes of healthcare providers in Africa often results in poor quality of health services.

Nobel Laureate Mukwege has famously summed up the sad situation for women in his country by saying that: “In conflict zones, battles take place on women’s bodies.”

But for Akile, the root cause of this status quo is male chauvinism. “I feel sorry for fellow women in my country who cannot change this situation,” she said.

Image Credits: Alexis Huguet, Kizito Makoye.