Pakistan 2010 Floods (Daniel Berehulak/Getty Images)

In November 2011, a group of ministers and senior representatives of governments from Africa, Asia, the Caribbean, Latin America, and the Pacific met in Dhaka, Bangladesh, to discuss the threat of climate change and the growing vulnerability of countries to the prospect of global warming. The Secretary General of the UN, Ban Ki Moon, was also present. The conclusion of the Climate Vulnerable Forum Dhaka Ministerial Meeting was to call for more concerted action to help countries adapt to the impact of climate change and take steps to mitigate its impact by creating carbon sinks, disseminating environmentally sound technologies and establishing a balance in the energy mix by focusing on renewable and alternative energy.

The emphasis the Dhaka ministerial meeting placed on limiting global warming, in this case to 1.5 degrees Celsius above pre industrial levels and progressively reducing greenhouse gas emissions, is symptomatic of the challenges facing the response to climate change. For while reducing greenhouse gas emissions will remain an essential goal to achieve, this will be difficult in an era of economic crisis and the felt need by countries to stimulate new industries and employment at the cost of greenhouse gas emissions.

As we move further into what is already a serious situation, it would be perhaps more important to address the fact that climate change is displacing millions of people and is expected to uproot and forcibly move some 250 million people in the coming years. At a time when countries everywhere are raising barriers to immigration and making life more difficult for refugees, asylum seekers, and economic migrant workers of all kinds, the prospect of up to 250 million people moving in search of human security portends massive social, economic, political and health challenges. This is where we should be placing our attention and finding ways of preparing for what may be involved.

Accommodating displaced people will constitute, if it does not already do so, a massive challenge in terms of availability of land, of housing, of sound water and sanitation, social and health services. At ICMHD we believe that a large proportion of the people who will be displaced will move towards large towns and cities either within their own countries or in neighboring ones. Many of these towns and cities are already overwhelmed. Unplanned and poorly coordinated rural urban migration has outpaced the capacity of many of them to absorb and provide the conditions needed for healthy life. The vastly overcrowded shantytowns and slums that now characterize many cities in developing countries are not only making the protection of health difficult, but are actually producing the conditions that facilitate disease.

ICMHD believes that far more attention should be given to this part of the climate change challenge than it has received to date. This is where meaningful action is probably possible in a shorter time frame and could help avert a major global disaster.

By Manuel Carballo

Health G20: A briefing on health issues for G20 leaders

Health G20 has been created by the International Centre for Migration, Health and Development in Geneva, Switzerland and the Dasman Diabetes Institute in association with Pro-Brook Publishing. The ICMHD Executive Director, Dr Manuel Carballo, and the Director, Professor Kazem Behehani,  are editors of the publication. Pro-Brook Publishing is a specialist publisher in the global healthcare arena.

The objective of Health G20 is to promote health and development on the G20’s agenda. Underlying all economies is a healthy population, Health G20 is there to brief world leaders on key disease areas, common problems and new developments to ensure that healthcare is not left off the agenda of this powerful grouping.

Health G20 could not have been published without the assistance of the Supporters. These Supporters range from healthcare NGOs, UN agencies, commercial companies and academic institutions (See Supporters)

Asylum seeking is not new, and is in principle governed by well established and ratified international laws and principles. People have been fleeing persecutions of one kind or another for centuries and the world has seen fit to codify how to respond to this. Legislation apparently has not made it any easier.  In a recent article from Canada, Anabelle Nicoud (La Presse, February 6^th 2012 http://tinyurl.com/7qnadzb) has highlighted some of the problems asylum seekers arriving in Canada are encountering, and what in turn, the cost of these problems are to the state.  She refers specifically to the arrival in August 2011 of 492 Sri Lankans who were handcuffed on arrival and then incarcerated for about 3 ½ months during which time their cases were estimated at a cost to the state of 22 million Canadian dollars.

In Switzerland, 2012 has started out with highly publicized concerns about the growing number of asylum seekers arriving in the country (a 45% increase since 2010) and the unwillingness and/or inability of some local authorities to accommodate them. Last week, 400 residents of Pully, a small relatively well-to-do town close to Lausanne, met to protest the idea of opening an underground civil protection shelter to hold 50 asylum seekers.  Civil defense facilities have been increasingly dedicated to housing asylum seekers in Switzerland, and most recently a psychiatric institution has been partially given over to the task as well.

In 2011 the 27 EU countries, with a total population of over 500 million people, received some 66,000 asylum seekers applications. Insignificant as this number may seem, asylum seekers have nevertheless become a major political, social and economic challenge in the EU as elsewhere. Why this should be so is not clear. Most EU countries (as well as Canada) receiving asylum seekers are ageing quickly and in need of new human resources. Theoretically these countries would benefit from employing young able bodied people who clearly want to be socially and economically integrated. Doing so would also help to cut the cost of the prolonged administrative procedures that prevent asylum seekers from quickly inserting themselves, working, paying taxes and contributing socially.

Employing asylum seekers would also help to raise self-esteem. Fleeing from persecution is never easy and most asylum seekers suffer from trauma and a perceived sense of powerlessness and loss of control.  Typically homesick, anxious and depressed because of what they have gone through and the people they have left behind, asylum seekers are fragile.  Fear of not being able to meet the often complex and unclear legal/administrative requirements of the countries they arrive in is erosive of both their physical and psychological health, which is again a cost to the state.  In the EU where of the 55,000 decisions taken on asylum seekers in the first quarter of 2011, only 1 in 4 were positive, and the administrative process can take years.

Much could be gained by if governments would recognize the potentially positive impact of quickly integrating asylum seekers in the community. The global number of asylum seekers is small and the world has already defined their rights.  People fleeing persecution and threats to their lives deserve better, and we should never lose sight of the fact that although some people are clearly more at risk than others, we are ultimately all at risk if becoming asylum seekers.

by Manuel Carballo

Alcohol abuse has been established to have far-reaching negative implications. The WHO estimates that every year alcohol consumption

source: Getty Images- Christopher Furlong

causes 2.5 million deaths and 69.4 million Disability-Adjusted Life Years (DALYs). Extreme alcohol use also leads to a number of chronic diseases and traumatic outcomes, as well as a range of health and social consequences.

Migrant populations, who have often undergone trauma and separation from their families and social networks, are both particularly susceptible and particularly vulnerable to the hazards of extreme alcohol consumption. In refugee and IDP camps, small packages of hard liquors can be purchased for as cheap as 10 US cents, offering to migrants a refuge from the difficulties of daily life or an escape from the sense of idleness that often accompanies camp life. Moreover, patterns of heavy drinking can lead to losses of productivity (i.e. choosing to drink instead of going to work in the gardens) and the draining of critically needed funds, not to mention domestic violence and social unrest.

Despite known links between alcohol abuse and issues of health, poverty, and violence, little concentrated action has been directed towards vulnerable migrant populations. This is not due to a lack of capability. An inexhaustible list of NGOs and agencies have long been working with migrant groups on related issues, yet remarkably few organizations include alcohol education or rehabilitation among their list of programs. This gap represents an unfortunate missed opportunity.

Recently, the issue of extreme drinking has been thrown into the world

Source- http://www.healthrelatedinfos.com/four-loko-banned-in-new-york-2163/

spotlight in specific reference to Four Loko, a highly-caffeinated and highly-alcoholic beverage sold in the United States. Sometimes referred to as a “blackout in a can,” the 23.4 ounce beverage contains the equivalent of six light beers and two coffees for the meager cost of 3 US Dollars. The drink has come under fire after being associated in the past month with a number of hospitalizations and the accidental death of a university student. Multiple US states have already banned the drink, and many more are considering taking similar action.

Instead of viewing Four Loko as an isolated issue, we should think of this debate as an opportunity to expand our conversation to include concerns about alcohol abuse in general. This moment has the potential to serve as a launching point for a comprehensive reevaluation of how specific governments and organizations might be uniquely poised to address extreme drinking among vulnerable populations such as migrants. Potential mechanisms to address alcohol abuse are already in place; now is the chance to capitalize on them.

The election campaign in Sweden is once again highlighting the growing controversy over migration. This morning, in a televised interview the head of the Sweden Democrats Party stated that the two foremost preoccupations of the Party are immigration and the care of the elderly. In the case of immigration, the idea is to do everything possible to curtail it, and in the case of the elderly, the aim is presumably to increase and make more efficient their care.

Early campaign badge for Sweden Democrats Party- 'Keep Sweden Swedish.' (Wikipedia)

The link between these two aims may have been lost on the Sweden Democrats Party. Care of the elderly is becoming more precarious throughout much of the European region for a variety of reasons. First of all, the number of people moving in to the category typically referred to as the elderly, is growing, and doing so far more rapidly than health planners ever thought likely. The needs they are presenting with are also more complex than many people have previously thought likely. The paradox that Sweden and other European countries face, however, is that the cost of an increasingly elderly population is growing exponentially. More elderly people means that more people are living longer, and hence, contributing to the demand on national pension schemes. This changing profile of the elderly, of European demographics, and the costs of care, is emerging against a backdrop of falling birth rates and smaller numbers of people available to join the workforce, pay taxes, and contribute to social security and pension schemes. There are no two ways about this dilemma. Unless European countries can replenish their populations through massive migration, Europe’s pension schemes will come to abrupt and disastrous ends. Cutting back migration could be catastrophic for Europe, Europe’s elderly of today, and even more so, for Europe’s elderly of tomorrow.

There is of course another reason why cutting back on migration will harm the elderly. Caring for elderly people is neither easy, nor necessarily attractive. Not many people go into this type of work, and throughout much of Europe, this has become a domain in which migrants have contributed immensely. Care of the elderly has become dependent on a labour force that is often foreign-born, and that comes from countries where caring for the elderly still remains an integral and natural part of life.

The Sweden Democrats Party is right to highlight the need for care of the elderly to become more consistent, efficient, and effective. The decision by them to highlight and promote a restriction of immigration would simply make all its aims for the elderly unachievable.

Related Articles

• Factbox: Anti-immigrant Sweden Democrats party (reuters.com)
• FACTBOX-Anti-immigrant Sweden Democrats party (reuters.com)
• Swedish far-right leader: Success due to immigration backlash (cnn.com)
• Q&A: Why does Sweden’s election result matter? (cnn.com)
• Swedish election too close to call (time.com)
• The summing up of the Swedish election campaign (Cavatus’s Blog)

Manuel Carballo, Jennifer Drummond and Daniel Williams

Global attention has suddenly been focused on the gang-rape of 200 women, girls, and possibly boys in the Democratic Republic of Congo (DRC).  What action will come of these reports and the subsequent outrage remains to be seen.  Rape is not new to the DRC, nor, indeed, to any conflict situation.  In many cases mass rape in conflict is planned and organized in an attempt to undermine civil society and social cohesion, and this seems to have certainly been the case in recent wars.  The attention of the international community was especially drawn by the media to the use of rape as a tool of war during the conflict in Bosnia.  Some 40,000 women and girls (and men and boys) were kept in prison camps and other locations, repeatedly violated and often impregnated.  But Bosnia was by no means unique, and as more attention was focused on the problem it became clear that few wars have been free of mass rape.

(WOMEN'S UN REPORT NETWORK, 2008)

The situation in the DRC, however, remains somewhat distinctive by virtue of the duration of the conflict and the large number of women who continue to be raped on a daily basis by forces from inside and outside the country, including militias, rebels, and other armed groups.  A recent report in the Journal of the American Medical Association found that almost 40% of women and more than 23% of men reached in a survey in the eastern provinces of the DRC had been sexually assaulted since the start of the war.  And according to the UNFPA, there were 17,500 reported incidences of sexual violence in 2009.  Many of these rapes in the DRC have been followed by highly damaging mutilations that have left victims with massive and very difficult-to-treat physical injuries in addition to profound social and psychological scarring.

Over the coming weeks, there will no doubt be a surge of investigations into recent events and fingers will be pointed.  Hopefully there will also be a consolidated and much more rigorous response to what is now a well documented and long-standing problem.  In 2008, the International Centre for Migration, Health, and Development (ICMHD) was asked by MONUC and the UN to assess the situation and propose a course of action.  The resultant Accelerated Plan for Reducing and Mitigating Sexual and Gender-Based Violence in the DRC identified seven priority areas for action that we believe would provide a solid foundation for strengthening the fight against rape and other forms of sexual gender based violence.

(kinshasa.usembassy.gov)

The ICMHD Accelerated Plan concluded that one of the problems was the marked lack of coordination among UN agencies receiving funding to work on sexual gender based violence.  Indeed at that time it was virtually impossible to determine what was being done, where, by whom and with what funding.  In addition to calling for this to be addressed within the UN system, we called for a much more visible political commitment by national authorities to the problem and this, we are happy to say, is happening.  The Congolese government, in conjunction with UNFPA, the American Bar Association, UNDP, EUPOL and other important external organizations, has taken several steps to promote the enforcement of the 2006 amendment to the Congolese constitution which makes all forms of sexual violence punishable offenses.  Our Accelerated Plan also called for more intensified action with the uniformed services such as police and military and we, as well as others, now have programs to strengthen the awareness and capacities of national police to prevent and aid in the prosecution of rape.  Another suggestion put forth called for a strengthening of the health care system so it could better respond to the needs of survivors.  Typically, victims of rape have little or no recourse to health care and are forced to deal with their injuries on their own.  In addition, we proposed a major thrust to strengthen the national judiciary system including training and organizational reform and there is good reason to believe that progress is being made on this at different levels. Our assessment of the situation highlighted the fact that a much more robust national surveillance and reporting system was necessary if national authorities and international organizations were to be able to monitor and evaluate the situation.  Finally, because mass rape in the DRC, just as elsewhere, is facilitated by the confusion and chaos that comes with the forced uprooting of people as a result of conflict, we called for more consolidated protection of displaced women.

None of the steps we called for are simple or easy, especially on the scale needed in a country that is larger than Europe and in which police and military personnel are poorly paid and in many cases have not been paid at all in years.  But we believe that if the course of action outlined in the Accelerated Plan that we proposed were to be taken up by all partners it could provide the basis and the momentum required to reduce the number of rapes committed in the DRC and provide women and girls, who are the primary albeit not the only victims, the sense of security they deserve and have not had in over twenty years of violence.

______________________________

Manuel Carballo is the Executive Director of the International Centre for Migration, Health and Development; Jennifer Drummond and Daniel Williams are researchers at the International Centre for Migration, Health and Development

Related Articles

• UN has failed Congo mass rape victims, says investigator (guardian.co.uk)
• OXFAM Calls Out UN for Escalating Rape Victims in Congo (waronterrornews.typepad.com)
• Rape attacks on Congo villagers revealed (channel4.com)
• Margaret Aguirre: One Remote Village, 4 Days, 250 Rapes (huffingtonpost.com)
• Women for Women International Congratulates Secretary Clinton for Amplifying the Voices of Women Rape Survivors
  

The Roma have long been a pariah people. Poorly understood, highly suspect, and the subject of pervasive myths, the Roma of Europe have been persecuted and marginalised for centuries. The latest move on the part of the French authorities to forcibly displace and return over 700 Roma and destroy over 50 camps, is another example of the intolerance of European society, and the unwillingness of national authorities to look at social issues in an evidence-based way. Over the next few weeks and months, other countries in Europe may be tempted to follow the model that France has initiated. If they do, it will constitute one of the largest forced displacements Europe has seen since the Balkan War.

Jeff Pachoud/AFP/Getty Images

From a public health perspective, what is being done to the Roma in France is likely to have far-reaching repercussions. Many Roma are poor, and have become used to living in conditions of extreme deprivation. Because of this, many of them will have developed the diseases that come with chronic poverty, poor nutrition, overcrowding, and poor healthcare. Forcing the Roma to move again and returning them to locations and situations that they fled from before, will only worsen their health condition. Diseases of poverty are never resolved through forced displacement; on the contrary, they are often aggravated by it. Like refugees everywhere, many Roma will now be pushed into situations of even greater poverty, worse living conditions, and even less access to health care. They will be exposed to more disease-prone situations, and they will become all the more vulnerable to a host of old and new physical, psychological, and social problems. Unless action is taken to ensure the welfare of this population, and unless steps are taken to integrate rather than exclude the Roma, we may be on the threshold of yet another European man-made disaster.

Corentin Fohlen for The New York Times

Related Articles

• Hundreds of Roma Expelled from France: Humane Deportation or Xenophobic Slum Clearing? (humanrights.change.org)
• Roma in Europe: Persecuted and misunderstood (cnn.com)
• France pushes forward Roma deportations: ‘They are trying to get rid of us all‘ (The Guardian)
• Why do the Roma wander? (slate.com)
• A Tenuous Existence- photo essay (NY Times)
• Expulsion of Roma Raises Questions in France (NY Times)

Manuel Carballo

In the space of little more than 3 weeks, more than 5 million people in Pakistan have been displaced from their homes, their farms, their villages, their communities, and their livelihoods. Predictions are that over the course of the next few weeks, the situation could become even worse and hundreds of thousands more people could be displaced. It will be many months, or even years, before we are able to assess the full extent of the human wastage and damage done, but already a number of assumptions can be made that call for urgent action.

Mohammad Sajjad, Associated Press

The first of these assumptions is that many families will have been disrupted and that many community structures will have been disorganised. In the case of the current situation in Pakistan, this means that millions of families are being affected in ways that will make coping all the more precarious and that will limit the capacity of individuals and groups to begin the difficult, but necessary, process of recovery and reconstruction.

The second assumption is that most of the communities or locations where people are moving to, or being moved to,  are ill-prepared to deal with this influx of women, men, and children of all ages. The load this will place on the healthcare system in these locations will be huge, and it is unlikely that in the absence of massive external assistance, they will be able to respond to the needs of this new population of displaced people.

The third assumption that can be made is that within the ranks of these displaced people, many were already in poor health even before the crisis happened. Pakistan has never been a wealthy country, and as many as a third of its people were struggling to live on less than $1 per day. Malnutrition was widespread, tuberculosis was rampant, and malaria common. Maternal and infant death rates were among the highest in Asia, and life expectancy among the poor was very short. Many of the diseases and health conditions these populations suffered from, now risk being aggravated and spread to other parts of Pakistan.

Associated Press photo

From a psychosocial perspective, the process of displacement will also have affected millions of people in far-reaching ways. Many, irrespective of age or gender, will have been traumatised to such an extent that their capacity to cope will have been lessened. Losing homes, farms, communities, and local cultures will inevitably have introduced a sense of hopelessness and despair that could debilitate the capacity to cope and prepare for a new life. Tragically, there is also reason to believe that the incidence of rape and other forms of gender-based violence will have gone up as well.

All these problems will be made worse by the fact that many of the people concerned are poorly educated and unfamiliar with disease prevention principles and with the healthcare systems that hopefully will become available to them in the coming months. Unless comprehensive and well-coordinated relief and recovery programmes are put into place quickly, Pakistan could be faced with a complex range of new and worsened old health problems.

Tragically, the crisis in Pakistan may be a foretaste of things to come on an equally large scale, and over a wider geographical region. For no matter what global warming and climate change is due to, the fact remains that extreme weather conditions, including heavy and seasonally unpredictable rains, are becoming more common in some parts of the world, while in others, extreme drought and lack of water are becoming common.

K.M.Chaudary/Associated Press

The response to the crisis in Pakistan has been slow in coming. Even now, it is clear that more funding is being proposed from the World Bank, the International Monetary Fund (IMF), and regional banks, than is coming from voluntary contributions. These loans will have to be paid back, and for the foreseeable future, Pakistan will move into a process of long-term indebtedness that will undermine the country’s economy even more so, and place vast numbers of people into greater poverty.

If the international community cannot respond in a more forceful fashion than it has done to date, this will bode ill for Pakistan’s people and their health. It will bode equally ill for all the other countries and the hundreds of millions of people who could be exposed to equally disastrous climatic events in the future.

Related Articles

• Clinton Links Pakistan Floods to Climate Change (foxnews.com)
• Is the Flooding in Pakistan a Climate Change Disaster? (scientificamerican.com)
• NASA images capture extent of Pakistan flooding (photos) (news.cnet.com)
• Pakistan flood health crisis talks‎ to be held (BBC)

(Full video found here)

Vice Guide to Travel Liberia

Ted O’Reilly

VBS.tv is a free internet resource with independently-produced short documentaries addressing all topics of life. They send their correspondents all around the globe to explore various issues. In ‘Vice Guide to Liberia’ they take a close look at the variety of issues that face the post-civil war torn country of Liberia.

Liberia was the United States’ first and only experiment with quasi-colonialism. Liberia’s constitution was written in Washington DC and its capital, Monrovia, was named after President Monroe. It was set up as a nation for freed slaves to call home after leaving America. Yet upon their arrival, the former slaves immediately enslaved the indigenous population following the same model they had learned from their time in America. This system of slavery lasted for about 140 years until the first native-born president was democratically elected. Samuel K. Doe was president from 1980 until 1990, when he was overthrown by the American-educated (and some say American-funded) rebel leaders Charles Taylor and Prince Johnson. When they captured the country’s capital they tortured, murdered and ate President Doe. After overthrowing Doe, Charles Taylor ran for president on the slogan “He killed my Ma, he killed my Pa, but I’ll still vote for him”… and he won. But as a result if his corruption, Liberia was once again in the grips of a civil war as various war lords fought for control of the nation within months of Taylor assuming power. The legacy of civil war in Liberia is astonishing; it is the fourth poorest country in the world, 50% of the population is illiterate, 70% of the female population has been raped, there is an 80% unemployment rate, and a significant portion of the population has consumed human flesh. What we see today in Liberia can be described as, without any stretch of one’s imagination, hell on earth.

The VBS crew flew to Liberia as Charles Taylor was on trial at The Hague for war crimes, to see the current state of the nation and to explore what had become of the other ex-war lords and the soldiers that fought in the wars. The film was basically split between the team’s visit to West Point, a slum on the country’s coast, and their time they spent with Joshua Blahyi, an ex-general who fought in the country’s wars. West Point is generally viewed as one of the worst slums in the world. There is no electricity or sewage system, and trash and human waste cover the streets. The health conditions in West Point are atrocious; AIDS, malaria and a plethora of other infectious diseases are everywhere. The vast majority of shops found in the slum are merely covers for heroine dens where child junkies can be found smoking both heroin and sniffing cocaine. Brothels are also a defining feature of the slum. A brief visit to one of the brothels reveals appalling health and hygiene conditions, accompanied with horrendous tales of sexual misconduct on behalf of the UN peacekeepers stationed nearby.

After visiting West Point a second time, and literally fleeing for their lives, the team avoids returning and shifts their focus to the ex-generals. The generals of these rebel forces have all assumed various nicknames throughout their time fighting in order to strike fear into the hearts of their enemies, but also to avoid recognition after the conflict was over. Of the three generals interviewed in the film, one is called General Bin Laden, one is called General Rambo, and a third is known as General Butt Naked on account of his and his soldiers attire (or lack there of) on the battle field. Joshua Blahyi aka General Butt Naked is one of the most famous people in Liberia. By his own admission, he is responsible for a minimum of 20,000 innocent civilian deaths. Yet, despite this fact, he was recently pardoned for his involvement in the wars, thanks in large part to his recent conversion to Christianity. He says in the film that despite having the option of returning to fight, he chose to stay and honor his new lifestyle, and this was a major reason for his being pardoned. General Butt Naked and his soldiers, or his ‘boys’ as he refers to them, were cannibals. They would often eat the remains of their enemies in drug-fueled frenzies. Before going into battle, they would murder and drink the blood of an innocent child as they believed this would make them impervious to bullets (this and being completely naked). Today, General Butt Naked has abandoned this name and re-assumed his name, Joshua Blahyi. He tours the country preaching in evangelical churches.

Liberia is clearly in extremely dire conditions. The reporter in the film describes it as a strange mix between heaven and hell. On the one hand, you have the awful health conditions, the slums, crime, murder, and cannibalism, while on the other hand you find churches on every street corner and massive Christian revivals held with thousands of people in attendance. The ex-soldiers are either living in a drug-induced stupor in the slums, or they are in hiding in the jungles, very well armed. According to General Rambo, if they wanted to invade the capital Monrovia, they could do so within a matter of hours. This is a very serious issue considering the fact that the UN peacekeeping troops are scheduled to leave in less than a year. One must wonder if war does indeed break out again, as it seems not unlikely that it will, what will become of Joshua Blahyi? Will he stay on the side of God and continue to preach about the ways of God or will be abandon this and return to the ways of General Butt Naked?

~Chance, a soldier in the DRC currently serving a 25 year sentence for rape

“I was hospitalized at the health centre. I was receiving an IV infusion one night when the soldiers came to pillage. They pulled out the IV catheters and then they started to rape the patients, including myself. By July, I had not had my period for seven months. I gave birth to twins. As a result of this incident, my husband has abandoned me.”

“In our village, there was a lot of suffering because of the soldiers. For this reason, we were no longer sleeping in our houses; instead we were hiding in the bush. We were in our hiding place and I was sleeping. I saw five assailants coming. They were shameful enough to rape me. I am old – around 70 years of age.”

“Because our village was at risk of being attacked, my husband and I were sleeping in our hiding place. During the night in question, 30 well-armed assailants dressed in military uniform attacked us. They killed my husband. They tied me up and the child I was carrying on my back fell to the ground. A total of nineteen assailants took turns raping me.”

“My husband and I were sleeping in our house. The children were sleeping in the house next door. The soldiers arrived and brought my daughter to our house where they raped her in the presence of my husband and me. Afterwards they demanded that my husband rape my daughter but he refused so they shot him. Then they went into the other house where they found my three sons. They killed all three of my boys. After killing them, two soldiers raped me one after the other.”

“I was walking along the road near the Kamaguana market when a boy from my neighborhood called out to me. I thought he wanted to tell me something since he was a brother of my community. I approached him and he immediately pushed me into the yard and closed the door behind me. There was a man behind the door and he beat me very badly. Then he raped me and since it was my first sexual encounter, he took my virginity.”

~Quotes from “Now the World is Without Me”, a report by the Harvard Humanitarian Initiative, April 2010

A Congolese woman recovers at a hospital in Goma, DRC. Photo: Endre Vestvik (flickr)

While Sexual Gender Based Violence (SGBV) has been experienced by women and men during conflicts throughout history, it is only in the past 10 years that SGBV has been defined as, and declared, an international human rights issue. Previously, rape was considered an incidental spoil of war, or was used as a tool to boost morale, but people are now being targeted purely for political and strategic reasons.

The accounts and estimated numbers of victims of sexual violence since the beginning of the conflict in the DRC in 1996, have been widely publicized, though the estimates do not even scratch the surface of the real situation due to overwhelming underreporting of the offenses.  Widespread human rights violations in the form of sexual violence have been reportedly perpetrated by members of all military and militia groups involved in the conflict. From the beginning of the war until 2005, over 20,000 incidents of sexual violence requiring medical attention were reported. It is important to note that these reports were of emergency cases of traumatic fistula and other extreme injuries that required immediate medical attention only, and therefore the actual numbers are presumably much higher. During 2003, South Kivu health centers reported an average of 40 rapes per day, and 13% of those occurred in girls under 14 years of age.  In 2007, the UN reported an average of 350 cases per month in North Kivu province, and 2,773 rapes were reported in one region of South Kivu. The ages of the women and girls assaulted range from 10 months to 80 years old.  In several cases, local medical centers have been raided by the military and Viagra is distributed amongst the combatants to aid in these assaults.  The rapes are frequently disgustingly brutal with most rapes perpetrated by gangs.  Families are often forced to watch or participate in the rapes, and many women are raped with pieces of wood, cassava stalks or gun barrels, among other implements. There are also many reports of women being shot in the vagina.  As a result of such brutal violence, approximately 10-12% of the survivors reporting rapes have contracted HIV as a direct result of the assault.  In addition to physical consequences, those who survive sexual violence in the context of war, are also subject to intense stigma, blame, rejection by their community and loved ones and loss of possessions, livelihoods and traditions. The fear, shame and demoralization resulting from this violence not only affects the survivor, but the entire community.

© Unjin Lee / afrol News- Two Congolese rape survivors, both HIV positive, in a small clinic in Luvungi

One of the most immediate barriers keeping sexual violence survivors from healing in these combat situations is the lack of prosecution for offenders. This impunity is often the result of a failed judicial system and state, as well as the cultural bias and stigma associated with rape within the society, especially in the case of the rape of men and boys.  This stigma, as well as the fear of further violence if the survivor seeks medical care or reports the incident, leads to a dangerous silence that serves to perpetuate impunity. Furthermore, sexual violence is often not reported, especially in the eastern regions of the country, because most rural areas have little to no police presence, and many of the existing police forces are not properly trained to accept reports of sexual violence.  Additionally, many of these crimes are perpetrated by men and women in uniform. Further barriers to accountability include the failure to prevent attacks, inadequate support of effective prosecution efforts, and difficulty in documentation procedures due to an inability to collect timely evidence in conflict situations.

Excerpt from public records on sexual violence http://www.womensrightscoalition.org/site/advocacyDossiers/congo/tablesexualviolence_en.php

Since the beginning of these atrocities, and amidst all reporting that did take place, 2009 saw the first 5 men to ever be convicted and sentenced for the crime of mass rape. Currently, there are only about 300 inmates incarcerated in the North Kivu capital of Goma that have been accused or convicted of rape.  The lack of accountability and culture of impunity, and the publicity surrounding the impunity, only serves to propagate these brutal crimes and to further the psychological impact on survivors and their communities.  Additionally, this same culture of impunity has been cited as one of the main reasons behind a recent increase in rapes perpetrated by civilians. While sexual violence in the East is still largely militarized, a recent study by the Harvard Humanitarian Initiative has shown a marked increase in civilian sexual predators. In 2004, for example, less than 1% of rapes were perpetrated by civilians, compared to 38% in 2008.

In an effort to aid in the provision of justice for survivors of sexual violence, ICMHD is currently involved in a security sector reform project to train members of the national police force to work with the reporting and prosecution of sexual violence. This training program not only addresses practical skills such as investigatory and interview techniques, but also addresses the culturally-related thoughts and actions concerning sexual violence against both women and men. Protection of those who report and testify is a main focus of these training modules, as well as the need to treat all perpetrators as equals regardless of social or military status. The education of those mandated to protect civilians is merely one step in the fight against sexual violence and impunity. The civilian population must be educated in the same manner. To be able to create behavioural change, it is absolutely necessary that the burden of shame be placed on the perpetrator and not on the survivor. Only with justice that can be ‘seen’ will healing for survivors begin. Without justice that can be seen, the rampant sexual violence currently being endured will continue.

References and Links

Harvard Humanitarian Initiative Report   Now, The World Is Without Me: An Investigation of Sexual Violence in eastern Democratic Republic of Congo

“Our Bodies- Their Battle Ground: Gender-based Violence in Conflict Zones.” IRIN. United Nations Office for the Coordination of Humanitarian Affairs. September 2004. Retrieved from http://www.irinnews.org/pdf/in-depth/GBV-IRIN-In-Depth.pdf.

Couldrey, Marion and Tim Morris, Eds. “Sexual Violence: Weapon of War, Impediment to Peace.” Forced Migration Review. Refugee Studies Center. January 2007     Retrieved from      www.fmreview.org/sexualviolence.htm

“DRC: Special Report on War and Peace in the Kivus.” IRIN. United Nations Office for the Coordination of Humanitarian Affairs. August 6, 2004. Retrieved from http://www.reliefweb.int/rw/rwb.nsf/AllDocsByUNID/255867dccca8df71c1256ee8003eec46.

“No End to War on Women and Children. North Kivu, Democratic Republic of the Congo.” Amnesty International. Amnesty International Publications. September 29, 2008. Retrieved from http://www.amnesty.org/en/library/asset/AFR62/005/2008/en/bbe6934a-9f60-11dd-9e51-afa0a8282a50/afr620052008en.pdf.

“DRC: Rape cases soar in South Kivu.” IRIN. United Nations Office for the Coordination of Humanitarian Affairs. June 3, 2009. Retrieved from http://www.irinnews.org/report.aspx?ReportID=84685

DRC: Behind Bars for Rape. Retrieved from http://www.irinnews.org/Report.aspx?ReportId=89761

DRC:Getting Away With Rape. Retrieved from http://www.irinnews.org/Report.aspx?ReportId=89802

Analysis: Rethinking Sexual Violence in DRC. Retrieved from
http://www.irinnews.org/Report.aspx?ReportId=90081