A little background on the situation in the DRC:
Sexual gender-based violence (SGBV) in the Democratic Republic of Congo (DRC) has become an integral part of the conflict which officially began in 1996 (and officially ended in 2003, and then again in 2007, despite the continuation of violence), and is being used extensively as a weapon of war. It has become a major source of trauma, disease and death for hundreds of thousands of women and girls. It has also become a major obstacle to social recovery and reconstruction within the country.
The last 10 years of conflict in the DRC have claimed the lives of more than 5.4 million men, women, and children of all ages. The conflict has displaced, severely injured, and disabled millions more. In doing so, it has completely destabilized the fabric of DRC’s society, and much of the mortality and morbidity has been either an indirect or direct consequence of the breakdown of economic, agricultural and healthcare systems. The conflict in the DRC has also given rise to widespread SGBV, which has reached epidemic proportions, especially in the eastern provinces. Hundreds of thousands of women and girls have been raped and mutilated, robbed of basic human rights, and deprived of their health, therefore destroying their chances of participating and benefiting in the future recovery and reconstruction of the country.
When rape is used as a weapon of war, as in the case of the DRC, the vulnerability of both women and girls increases dramatically in many ways. Rape, and the subsequent mutilation that so often accompanies SGBV in the DRC, not only traumatizes victims, but destroys their livelihoods, breaks up their families and often means rejection by their own communities. For these women and girls, the impact of rape remains long after fighting ends.
Since 1996, MONUC (the UN Mission in the DRC) has recorded over 200,000 cases of sexual violence. High as this figure is, it may only be a fraction of the true figures, as the majority of rape cases go unreported. NGOs working in the eastern provinces of DRC (North and South Kivu, Province Orientale, and Maniema) have estimated that as many as 1 in 3 women have been raped. In South Kivu alone, over 27,000 sexual assaults were reported in 2006, and 4,500 were reported in the first half of 2008. One report estimated that about 40 women are being raped every day in South Kivu. Of these women, 13% are thought to be under the age of 14, 3% die as a result of the rape and 11% are estimated to contract HIV as a result of the rape. In North Kivu, the United Nations reported that on average, 350 women per month were raped in 2007.
The conflict in DRC has eroded the health sector’s capacity to respond effectively and efficiently to the needs of rape victims. Damage to local health facilities has been extensive, and the complete lack of investment in the health sector has exacerbated the situation even more. What few health facilities exist are often in such disrepair that they don’t even have the most basic equipment, and it is presently impossible for them to respond to these women and girls in a meaningful way.
In most parts of the DRC, but especially in the war-torn regions where UNFPA and ICMHD are currently working with the support of the Pooled Fund, women and girls have no choice but to cope with massive psychological and physical injuries that prevent them from going back to their families and being reinserted in society. In order to reach out to victims of SGBV, it is necessary that healthcare services and facilities that can receive patients with dignity and respect and provide the essential care that they need, be available.
The ICMHD project described here was designed to mitigate some of the impact of SGBV, and was made possible through the Democratic Republic of Congo Pooled Fund (DRCPF). The Pooled Fund contribution to this project was allocated to UNFPA to take up the challenge of rehabilitating health facilities in three of the eastern provinces most affected by the conflict: North and South Kivu and Province Orientale.
ICMHD has been active in DRC since the 1990s and has helped to highlight the magnitude and scope of SGBV in conflict areas. In 2007, ICMHD was asked by MONUC and UNFPA to assess the situation and to prepare a strategic plan for responding to the problem. The ICMHD Accelerated Plan for Reducing and Mitigating SGBV in the DRC was adopted by UNFPA and MONUC as a basis for action in this area. In the Accelerated Plan, ICMHD included an emphasis on strengthening the capacity of the health care system to respond to SGBV by building health centres.
The following provides an outline of the progress that has been made since August 2009, and covers the acquisition of contractors, the procurement and delivery of construction materials and equipment, the coordination of engineering plans and the building of health centres.
ICMHD set out to strengthen damaged health facilities in three of the provinces affected by the conflict: North Kivu, South Kivu and Province Orientale. The objective, using a small budget, was to improve primary health facilities to an extent that they would be able to receive women and girls (and others) needing both routine and emergency care.
The challenges of this project varied considerably according to the location and the political situation in the area, although keeping in-line with the proposed schedule was a particular difficulty in all areas. Additionally, in some sites moving materials was more difficult than in others, and working with local transportation companies as well as UN partners with transport capacity, was an important part of the challenge.
In some cases, because of the condition of the existing facility, rehabilitation meant demolishing the old structure and building from scratch, while in others repairs to existing facilities could be made.
In all areas, these efforts allowed for newer and more improved facilities to become available in order to not only serve the women and girls who have been victims of rape, but also to provide services to other women who are in need of antenatal, delivery and post-delivery care, and to provide general care to the overall local population.
Rehabilitating health facilities has brought both direct and indirect benefits to the different communities. One of the important indirect benefits has been the mobilization of people around the work that had to be done. Engineers, drivers, masons, roofers, plumbers, electricians and many others brought with them a sense of urgency and commitment that if nurtured, will contribute to contribute to the recovery and reconstruction efforts, as well as to a higher standard of health for women and girls.
In almost all the locations, the type of damage suffered by health centers meant that new walls and roofs had to be constructed. This work, in combination with the better and more durable materials that were used, has produced facilities that now provide patients with a source of protection and comfort they did not previously enjoy. Stronger walls and roofs will also symbolically offer them an added sense of security that health centers should always be able to provide. As a result of these efforts, people in the area will come to recognize that they are not alone, and that the health care system in their community is there for them.
If health centers are to provide good effective service to their clients, they must have consistent access to clean and readily available water. This was one of the main priorities in almost all the centers that ICMHD rehabilitated, and required the installation of new pipes and flooring in all the health centers. Today, people coming to ICMHD-constructed health centers can expect to be treated in a facility that has clean piped water, and therefore, more hygienic conditions and a lower risk of infection. From the perspective of emergency care required by victims of SGBV, this not only means a great deal to them, but can mean the difference between safe and unsafe treatment.
Getting rid of waste material, especially contaminated material, is just as important as access to clean water. After assessments, this too became a priority in all of the health centers that were rehabilitated. In order to provide this service, furnace-driven incinerators were built on-site. Today, the incinerators on the premises of rehabilitated health centers means that potentially unsafe material can be safely dealt with, and once again the risk of infection can be reduced.
All of the health centers that were rehabilitated needed new latrines. The construction of these latrines also included building new septic tank systems and, in some cases, bringing running water to the sites. Because of local terrain and ground conditions, this task was quite complicated, but it provided the health centres with a needed means of sanitary human waste disposal, and the methods utilized at the health centers are now being taken up by people in the area.