Written by Dominique Vidale-Plaza, Gender Based Violence Specialist, Mukwege Foundation
While the prevention of and response to conflict-related sexual violence (CRSV) has become a hot-topic issue in recent years, victims still remain largely without access to critical, and in some cases, life-saving assistance. Survivors of sexual and gender-based violence, particularly CRSV[1], must cope with a range of physical, psychological, legal and socio-economic consequences that can last a lifetime. These myriad effects of wartime sexual violence demand a survivor-centred, multi-sectoral approach to prevention and response. The holistic model developed by Panzi Hospital and Foundation in eastern Democratic Republic of Congo (DRC), is a promising example of a survivor-centred approach to helping survivors, families and communities heal and transform their suffering.
Survivors of sexual violence often have to cope with devastating medical consequences. Sexually transmitted diseases (STDs), especially when left untreated, can result in crippling pain and a range of other debilitating conditions. Fistula[2], another medical consequence, can result from sexual trauma or be linked to obstetric complications, particularly in contexts where women or girls cannot easily access reproductive health care. The specialised treatment of traumatic and obstetric fistula, the treatment of STDs, forced or failed abortions, miscarriages and other potential consequences of sexual violence are all critical components of a holistic response to CRSV.
The new UNSC resolution 2467[3] adopted with 13 of 15 votes in favour and 2 abstentions during the Security Council’s session in April, includes for the first time, language on a survivor-centred approach to care when addressing survivors’ needs. While this addition is welcomed, the resolution noticeably omitted language calling on states to uphold sexual and reproductive rights (SRHR) following concerns from Member States, particularly the United States. One survivor from South Sudan commented that “…thousands of us have to live with STDs for life. There are thousands of raped, underaged mothers – ignoring their needs is inhumane and a crime.”
The medical consequences of sexual violence go hand-in-hand with and can lead to psychosocial consequences related to stigmatisation, lowered self-esteem, isolation and more. Given that survivors may very rarely have access to psychological care, the Mukwege Foundation advocates for the integration of psychosocial services into existing medical facilities and care programs as part of a holistic approach to responding to the needs of survivors of wartime sexual violence.
On September 28th 2009, armed forces massacred protesters and raped over one hundred women at the stadium “Stade” in Conakry, Guinea. One decade later, survivors and their families still cope with the devastating effects of trauma. In February 2017, when Dr. Mukwege and a team from Panzi Hospital visited Conakry, survivors reported persisting psychological symptoms including: severe depression, anxiety and panic attacks, sexual disfunction, among others.
In Dohuk, Iraq, where the Mukwege Foundation visited in 2018, Yazidi survivors of sexual violence perpetrated by ISIS live in displacement camps, with enormous needs for medical and psychosocial assistance but limited services available. Many survivors cope with symptoms of severe trauma and continue to wrestle with the impacts of sexual violence on their lives and those of their children and families. The reintegration of children born of ISIS perpetrated sexual violence remains challenging. In April, the Yazidi Supreme Spiritual Council announced that survivors should be welcomed back into families and communities, but although this announcement included children born in ISIS captivity, members in the community disagreed.[4]
Tatiana, a member of the Survivor Movement in the DRC, tells us more about the needs of survivors and their children in the video below.
https://www.youtube.com/watch?v=q-rPT40fj9M
The socio-economic needs of survivors and of children born of rape are significant, particularly as victims may often already be vulnerable. These challenges may become even more acute during times of conflict where violence, or the risk thereof, may lead to mass displacement or the loss of infrastructure. Mwamini, a survivor from DRC shared, “How will I meet the needs of my child, if I don’t have money, if I am stigmatised? Any parent would not be able to sleep, faced with a question like this. So, imagine yourself as a raped woman, rejected, homeless, without assistance, without work. You would see the pressure she feels and the anxiety she has about her future and the future of her child.”
Further compounding the medical, psychological and socio-economic consequences of sexual violence is the stigma survivors may face within their families, communities and even institutions. The rejection of survivors by their partners, relatives and community members can have lasting, and potentially lethal, repercussions. Stigma and other related psychosocial factors may prevent victims from seeking care and can even have an impact on survivors’ socio-economic resilience, with some survivors reporting being shunned at markets, for example. The combination of medical, psychosocial and socio-economic support can contribute to reinforcing survivors’ resilience in the face of stigmatisation and may serve to strengthen family reintegration.
Legal assistance is another crucial component of a multi-sectoral, holistic response to CRSV. Survivors see the just punishment of their perpetrators as a recognition of the violation of their rights. Although justice may mean different things for different people, this recognition and acknowledgement of the wrongs they have experienced can play a critical role in the road from victimhood to survivor-hood.
Vasfije of the Survivor Movement in Kosovo shares her passion and need for seeing her rapists and others brought to justice in the clip below:
https://www.youtube.com/watch?v=dhVFJUFlRHI
While UNSCR 2647 did not expressly affirm the importance of SRH services and rights – it does include a strong emphasis on holding perpetrators to account. Furthermore, the ICC has recently reinforced their focus on investigating rape and other forms of sexual violence as war crimes and crimes against humanity. But despite these examples of “justice on paper” and other important strides in strengthening policy-level responses to fight impunity, accountability for perpetrators remains elusive and few survivors have access to legal remedies.
In many countries when a person is raped, their access to services is already limited. This is exacerbated during and following periods of instability and conflict, when public systems are crippled and services are scarce, let alone integrated. Proof that this can be changed, can be found in eastern DRC, where Panzi Hospital and Panzi Foundation DRC employ a holistic approach to provide multi-sectoral assistance to survivors of sexual violence and women living with severe reproductive concerns including fistula and prolapse integrated in the general hospital. Panzi Hospital & Panzi Foundation DRC were established in 1999 and 2008 respectively, in Bukavu, DRC by Dr. Denis Mukwege. Panzi’s staff have since built up significant expertise in responding to CRSV, through providing holistic care for tens of thousands of survivors of wartime sexual violence, continuously developing their take on the one-stop centre approach, informally known as the Panzi Model.
The Mukwege Foundation works on promulgating the Panzi model in other conflict-affected countries including Guinea, Central African Republic and Iraq, and advocates for holistic, multi-sectoral assistance as a standard and a right for survivors of CRSV. To date, medical and psychological professionals from Guinea have benefited from exchange visits and training from their Panzi counterparts and survivors have begun receiving psychological assistance from Mukwege Foundation partners on the ground. The Foundation, together with colleagues from Panzi, have also visited Burundi, CAR and Iraq to begin laying the groundwork for the eventual implementation of the holistic care model in these countries.
https://www.youtube.com/watch?v=EwafpkmZhJk
The Panzi model ensures that survivors have access to a range of quality services that can be coordinated within one system. It is particularly useful in times of conflict when “survivors often do not seek care as a result of threats to their lives, stigma, community pressure or the lack of availability or awareness about services”[5]. Survivors are able to avoid undue burden in accessing care through minimising travel, costs and mitigating risks of re-traumatisation via avoiding multiple interviews and through the integration of psychological assistance throughout the circuit of care. Furthermore, this form of compassionate and survivor-centred holistic assistance within existing local facilities and services, provides sustainable care for survivors, during and after conflict, that is not susceptible to sudden cuts in funding and the short-term project-based nature of humanitarian assistance.
Tatiana, the leader of the survivor movement in the DRC, highlighted this model in her speech at this year’s Commission on the Status of Women, “The holistic care system has been set up by Panzi Hospital and the Panzi Foundation to help victims of rape and sexual violence move from victim to survivor. By its very existence, the model recognizes the victims, which is essential for their recovery. And through its holistic approach, it supports them to become leaders in their communities and change attitudes.
On this International Day for the Prevention of Conflict Related Sexual Violence, more action is urgently needed in order to ensure that survivors have access to holistic assistance. States need to accelerate the implementation of their relevant engagements, and ensure that survivors have access to the care they are entitled to. The survivors’ voices are clear; they must have access to comprehensive and holistic assistance, which necessarily includes SRH services, if they are to become empowered agents of change and peace in their communities and countries.
The Mukwege Foundation recently launched an online handbook designed to support policy makers, programme architects, and service providers in implementing the one-stop centre approach based on the Panzi Model. For more information on accessing the handbook, please contact [email protected].
[1] The term “conflict-related sexual violence” (CRSV) refers to rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, enforced sterilization, forced marriage and any other form of sexual violence of comparable gravity perpetrated against women, men, girls or boys that is directly or indirectly linked to a conflict. That link may be evident in the profile of the perpetrator, who is often affiliated with a State or non-State armed group, which includes terrorist entities, the profile of the victim, who is frequently an actual or perceived member of a political, ethnic or religious minority group or targeted on the basis of actual or perceived sexual orientation or gender identity, the climate of impunity, which is generally associated with State collapse, cross-border consequences such as displacement or trafficking, and/or violations of a ceasefire agreement. The term also encompasses trafficking in persons when committed in situations of conflict for the purpose of sexual violence or exploitation (UN Report S/2018/250 (23 March 2018))
[2] https://www.researchgate.net/publication/23277279_Sexual_violence-related_fistulas_in_the_Democratic_Republic_of_Congo
[3] http://unscr.com/en/resolutions/2467
[4] “Ali Khedhir Ilyas, a Yazidi official, said on Sunday the council encourages the women to return with their children, no matter the parentage, but added that they “cannot force the families to accept” those born of rape.” https://www.aljazeera.com/news/2019/04/yazidis-accept-survivors-isil-rape-children-190428164100751.html
[5] UN Secretary General Report on Conflict Related Sexual Violence 2018
