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DRC: Reaching Survivors of Sexual Violence in Ituri

25 April 2016

The MSF project in Mambasa is initially expected to last six months, at which point its work will be evaluated and adapted according to need. Photo: Natacha Buhler/MSF

Viviane, an MSF team supervisor, trains the head nurse at the Molokai health center on the protocols of caring for victims of sexual violence and STIs. The most important message is that sexual violence is a medical emergency and victims should be cared for as quickly as possible after the assault. Photo: Natacha Buhler/MSF

Alongside its medical work, MSF carries out activities to raise awareness of sexual violence and STIs. The patients who come to the health centers are just the tip of the iceberg. Photo: Natacha Buhler/MSF

The rate of sexual violence and sexually transmitted infections is extremely high in Mambasa. In March alone, MSF teams cared for 123 victims of sexual violence and treated 907 cases of STIs in nine different health areas, which likely represents just a fraction of the real number of people who've been sexually assaulted. Photo: Natacha Buhler/MSF

The Mambasa region has abundant natural resources. Elephants and many animals on the brink of extinction can be found in and around the Okapi Wildlife Reserve, in addition to gold and diamond mines and loggers. Photo: Natacha Buhler/MSF

The region's original inhabitants are the pygmies, although many others have come to the territory to exploit its wealth. Different groups of Mai-Mai militiamen and poachers, who continue to destabilize the area, can be found in the forests that cover the region. Photo: Natacha Buhler/MSF

Marguerite (name changed) arrived at the Biakato health center two days after being assaulted. She is 70 years old. She was sleeping in her house in the fields when three armed men broke down her door and dragged her outside. They beat and raped her. Her neighbors found her naked and unconscious in the forest the next day. Photo: Natacha Buhler/MSF

Marie (name changed) used to go to the gold and diamond quarries every week to sell drinks. One day, she encountered a group of Mai-Mai who threatened to kill her if she didn't agree to join them. She was held captive by them for a year before she managed to escape. When she returned her husband rejected her because she was four months pregnant. She gave birth on April 13 to a little boy, who she has named Alain. Photo: Natacha Buhler/MSF

MSF teams spend a day or two at each health center training and supporting local teams. They also remain in daily contact with the head nurses in order to monitor patients. Not only do the teams ensure that victims of violence receive adequate medical and psychological care, they also refer them to other organizations who can help with their reintegration. Photo: Natacha Buhler/MSF

Since February 2016, three MSF teams have regularly visited nine health centers in Mambasa, Bella, Nia Nia, and PK51 in Ituri province, offering medical and psychological aid to victims of sexual violence, as well as treatment for sexually transmitted infections. Photo: Natacha Buhler/MSF

In response to high levels of sexual violence in the Ituri region of eastern Democratic Republic of Congo (DRC), Doctors Without Borders (MSF) has launched a project in Mambasa to provide medical and psychological care to survivors.

Driving along the red mud road, the MSF Land Cruiser passes through a cloud of white, yellow, and orange butterflies. On either side of the road is thick forest. The trees are packed so closely together that visibility is limited to a couple of feet.

It is not far from the Okapi Wildlife Reserve, and among the trees are animals on the brink of extinction, elephants, and villages inhabited of pygmy people who are the original inhabitants of this region. The trees also hide gold and diamond mines, both official and unofficial; smugglers of hardwood; poachers; armed Mai-Mai militiamen; and many other men carrying weapons.

The MSF staff in the vehicle represent one of three medical teams circulating between the towns of Mambasa, Nia-Nia, Bella, and PK51. At each stop, they provide care for victims of sexual violence and people suffering from sexually transmitted diseases.

Their work is part of a project launched this past February. They have already been very busy. "In March alone, our teams took care of 123 victims of sexual violence and treated 907 people for sexually transmitted diseases," said Mame Anna Sane, MSF medical team leader.

"These are very big numbers. That is almost four people raped per day—and that is just the ones coming to health facilities. Rape is so taboo that many people don’t come for help, so the real numbers are likely much higher."

Each of the three MSF teams is made up of a nurse, a psychologist, and a health promoter. Together, they provide support to nine health facilities in the region by training local staff members in the provision of medical and psychological care for survivors of sexual violence.

The MSF teams also supply the necessary medicines and work with local communities to raise awareness about sexual violence, encouraging victims to seek medical care promptly. Rape survivors need to come for help within 72 hours of an assault for treatment to be effective. MSF teams also educate people about the symptoms of sexually transmitted infections so that people recognize them and come for treatment.

Taking Care of the Survivors

The work with local communities is showing results, and there is evidence that rape survivors are coming forward more promptly.

When an MSF team is visiting the Biakato health center, a 70-year-old woman who survived a gang rape is brought in by a group of relatives and neighbors. Two days earlier, she was asleep at home when three armed men broke down her door. They dragged her out of the house and into the forest, where they beat her and then raped her one by one.

They left her in the forest, naked and unconscious. At the health center, she will receive psychological support and treatment for HIV and other sexually transmitted diseases. Her daughter is with her—but not all patients have family members to support them.

Marie, 37, is in the maternity ward at Biakato health center. She has just given birth to a baby boy and she is alone. Almost two years ago, as she went to sell drinks in a mine near her home, Marie was kidnapped by a Mai-Mai group. They kept her prisoner for more than a year and raped her repeatedly.

She only managed to escape when the Congolese army attacked the camp where she was being held. She returned to her husband, but he rejected her because she was four months pregnant from one of the rapes.

A Medical Emergency

"Our work involves changing mentalities to get rid of the taboo around [reporting] sexual violence, and to be able to offer proper care to every victim. [This mean working on] the mentality of the local population, but also of the authorities," Sane said. "Of course there is a criminal and legal aspect to sexual violence, but for us, it’s first of all a medical emergency."

MSF’s project in Mambasa will last six months and then be reassessed. It is already clear, however, that the need for medical and psychological care for survivors of sexual violence in the Ituri region are far greater than expected.