In the Democratic Republic of the Congo (DRC), "armed conflict has resulted in mass displacement and widespread sexual violence; the problem is that it hasn't always been quantified," said Dr. Lynn Lawry, senior health stability and humanitarian assistance specialist at the U.S. Department of Defense. Presenting findings from the first cross-sectional, randomized cluster study on gender-based violence in the DRC, Lawry was joined by Heidi Lehmann, director of the Gender-based Violence Unit at the International Rescue Committee, and Dr. Nancy Glass, associate professor at the Johns Hopkins School of Nursing and associate director at the Johns Hopkins Center for Global Health. "We found that sexual violence in these areas is conflict-related, prevalent, systematic, and widespread," said Lawry.

Study Finds "Female Perpetrators"

The first of its kind in the region, the population-based, quantitative study covers three districts in the DRC and a total of 5.2 million adults. It comprehensively assesses gender-based violence, including its prevalence, circumstances, perpetrators, and physical and mental health impacts.

Overall, the study found that 2.1 million women and 1.3 million men in the region had suffered sexual violence. Nearly three-quarters of all sexual violence reported was a direct result of conflict. In the study region, 20 percent of the population fought in conflicts, and 48 percent of these combatants were female.

Further, 39 percent of female survivors and 15 percent of male survivors reported female perpetrators. "These findings challenge the paradigm of male perpetrator and female victim," said Lawry. "Policymakers and donors should adjust societal paradigms of sexual and gender-based violence and also direct attention to female perpetrators and male survivors." Survivors of sexual violence in conflict, both male and female, are more at risk of later becoming perpetrators, particularly if unrecognized and untreated. To "break the cycle of violence," prevention and response programs should address the needs of survivors and combatant perpetrators of both genders.

"Community-related violence is a general crime; conflict-related violence is a war crime," Lawry said. While many efforts have focused on the Congolese military, she called for the DRC government and the International Criminal Court to also investigate and prosecute members of rebel groups, who were found to be the main perpetrators of sexual violence and other human rights abuses in this study.

Prevention: The Best Response

"Meeting the immediate consequences of violence is not enough," said Lehmann. To effectively address gender-based violence, programs must provide medical and social services, promote social empowerment, respond to emergencies, and take part in advocacy and coordination efforts.

In the DRC, programs supported by the International Rescue Committee serve approximately 350 to 400 survivors per month, 75 percent of whom report that the perpetrators are members of armed groups.

Scaling up is a major challenge. "Providing essential services alone require enormous investment, and there is no common understanding of comprehensive programming," said Lehmann. "We recognize that a program alone cannot solve all of these problems, especially in the DRC."

"Good response is about prevention," concluded Lehmann. She recommended supporting robust, long-term programming; integrating gender-based violence prevention efforts into other sectors; and investing in partnerships. "We are not going to end the violence unless Congolese women and girls are part of the conversation."

Pigs for Peace: A Holistic Approach

Health care, economic development, and social programs should be integrated "to provide a holistic and comprehensive approach" to the problem of gender-based violence, said Glass. "Rape destabilizes families and communities," she said.

Survivors rarely get immediate treatment for their injuries and trauma, or the risk of HIV, STIs, and infertility. "Many rural primary health centers and hospitals have been looted of medicines and materials by rebels and soldiers," said Glass. Conflict in the DRC has also caused health care professionals to leave unstable rural areas and poor roads and limited transportation make it unsafe and expensive to seek care.

To rebuild families and communities, "women and men need to regain their economic resources to provide for the future of their family and community," said Glass. Pigs for Peace, for example, has supplied more than 100 women — many of them rape survivors — and their families with pigs to set them on the path to recovery through psychological, social, and economic empowerment. This program aims not only to supplement household income, but to reduce the stigma of rape as survivors become productive parts of their families and communities.

Drafted by Ramona Godbole, GHI & ECSP Intern
Calyn Ostrowski, Program Associate, Global Health Initiative, 202-691-4341