U.S. Troops Deploy to Central Africa to Fight Sexual Violence

Restoring stability could increase access to critical health care in the region
The U.S. government is deploying 100 troops to Central Africa to help fight the Lord’s Resistance Army (LRA), a decades-old organization notorious for rape, sex slavery, and other forms of violence against women. The troops will be armed for self-defense but will primarily advise regional military forces in hunting down the leader of the LRA, Joseph Kony, who became the International Criminal Court’s first indictee for war crimes about 10 years ago.

Since 1987, the LRA has terrorized civilian populations throughout the central African region, including parts of Democratic Republic of the Congo, northern Uganda, South Sudan, and the Central African Republic. Over the years, tens of thousands of children have been abducted to serve as child soldiers, women and girls were enslaved for sex, while tens of thousands more were disfigured or killed. Those who have been displaced by the violence continue to live in refugee and displacement camps with little opportunity for education, work, or proper health care.

While it will inevitably take time, restoring stability in the region is a prerequisite for improving physical security and developing roads and other critical infrastructure that are key to expanding people’s access to medical care. This includes access to quality reproductive health care, a goal that EngenderHealth works to achieve in both Uganda, the DRC, and throughout Africa. EngenderHealth’s Fistula Care project supports health centers in both Uganda, where the LRA originated, and the DRC, where the group continues to operate today. The project focuses on providing treatment for women living with fistula resulting from both obstetric and traumatic injury. Read a story about EngenderHealth-trained fistula surgeons in the DRC.

Some consider President Barack Obama’s deployment decision to be a positive sign that the United States will not tolerate sexual violence in Africa. The decision to deploy is consistent with legislation in Congress, the “International Violence Against Women Act” (IVAWA), which aims to establish gender-based violence as a top priority for U.S. foreign policy. IVAWA passed in the Senate Foreign Relations Committee in December 2010 but failed to pass in the U.S. House of Representatives.

Fistula in the Congo: A Response to Nick Kristof's Feb. 7 Column

It’s shocking what’s happening every day in the D.R. Congo. The sexual violence is shattering to both women and their communities. But people like Dr. Mukwege prove that we are not powerless and something can be done about it. It’s so important to support health facilities like Panzi Hospital and doctors like Denis Mukwege—who are beacons of light in a tremendously bleak environment.

EngenderHealth supports Panzi Hospital and another hospital in the Congo, HEAL Africa, through the Fistula Care project, funded by USAID. These two facilities are centers of excellence for fistula repair, drawing women from all over the country and region in need of treatment.

With USAID support, doctors and nurses at Panzi and HEAL Africa have been trained to strengthen maternal health and fistula repair services—dedicated, local professionals who will be there for the long haul. In addition, the project ensures that women have transportation to the hospital for treatment and helps them reintegrate back into their communities once they have had surgery.

Obstetric fistula also occurs when women can’t access timely emergency obstetric care—namely, cesarean sections—during long or obstructed labors. With better maternal health care, obstetric fistula cases (which still make up the majority of fistula cases in the Congo) could be averted altogether. To prevent such fistula cases in Congo and elsewhere, we work with doctors, nurses, and midwives to help them better manage complicated pregnancies and births. At the community level, the project helps rural health workers refer pregnant women with complications to hospitals that can provide comprehensive care.

Strengthening health systems by building on existing resources is the best way to both treat women with fistula and prevent new obstetric fistulas cases. And a holistic approach that improves fistula prevention—by improving maternal health care and reducing sexual violence—is crucial. In terms of providing surgical repair, it’s important to keep in mind that the vast majority of fistula surgeons live and work in the developing world. Seeing fistula cases on a daily basis, local health providers should be supported to treat and prevent fistula. It makes sense to enhance the capacity of in-country health care professionals like Dr. Mukwege who can make lasting changes, both in their country’s health system and in the lives of women and their families.


Bethany Cole
Senior Program Associate
EngenderHealth

(This post appeared February 11 as a comment in response to Nick Kristof's column in the New York Times.)

Live from MenEngage Rio: How the Privileges of Patriarchy Can Work Against Men

Posted by Eric Ramírez-Ferrero

On day four of the conference, the workshop that clearly stood out for me was, “Gender and Masculinity in Post-Conflict Settings.” In it, we examined experiences of men in war-torn societies, including post-genocide Rwanda, northern Uganda and eastern Congo, East Timor and Gaza.

One speaker used an interesting phrase, “gender against men,” to describe how strict notions of manhood are a liability to those men who fall outside of the limits it sets, men who don’t live up to the expectations inherent in “being a man.”

In post-conflict settings, such men might include those who have been the victims of sexual violence. The speaker from Uganda showed a moving video documenting the experience of one Congolese man (his identity was protected) who candidly described the horror of being held prisoner by the forces fighting in eastern Congo: Over a period of days, he was repeatedly gang-raped by soldiers. Though the physical trauma was beyond daunting, this man also knew that his perpetrators’ intention was to humiliate him, to diminish him, to demonstrate their power over him by putting him “in his place”—as a “woman.”

This sounded disturbingly familiar. We know that, ultimately, rape is about power, even when both the perpetrator and victim are men. As an anthropologist, I also found it fascinating how gender definitions are used to make sense of those who have power and those who don’t. It’s not merely academic - it plays out daily in the most devastating ways: In these and other post-conflict settings, men who aren’t willing to fight—to take up that traditionally “male” role –are feminized and subject to the same reign of terrors as women.

Unfortunately, the humiliation of male victims of sexual violence is further compounded when they seek counseling and care. The limited systems available (in this case United Nations missions) to support survivors of rape are closed to men. Indeed, support workers’ own definition of rape has excluded men as possible victims, and even those who did “get it” conceded that, “We have programs for women at-risk and for those who traumatized by sexual violence, but we have nothing for men.”

The same speaker explained that this is in part a result of what he called “patriarchal feminism” – a one-sided concept wherein only women are vulnerable. He went on to say that this is quite damaging for women, too, because it limits them to the role of victims rather than as agents of change. He seemed to be saying that many efforts to promote women’s equality actually reinforce traditional visions of womanhood and manhood (thus the “patriarchy”).

I agree with the speaker that, inadvertently, some “empowerment” efforts may reinforce rather than change norms. But the term “patriarchal feminism” sounds like plain old patriarchy to me, because there is no doubt that pervasive and age-old ideals of what women and men should be and do really DO oppress women! Yet this workshop made clear that we all need to be more conscientious of and concerned by how the meanings of “manhood” affect men, too. Clearly, they continue to benefit men in power, but they render other men even more vulnerable and sometimes invisible—and in the worst cases, beyond the safety net of services and support.

Dr. Denis Mukwege: Finding Hope Where There Is Little

The ongoing conflict in the Democratic Republic of the Congo (DRC) has devastated women’s health and lives in many ways. Women continue to be brutalized by rape and sexual violence—the prevalence of which is considered to be the world’s worst. And due to the threat of violence, women have limited mobility, and many are unable to get the basic or emergency obstetric care they need, resulting in unnecessary maternal deaths and injuries. But one man, Dr. Denis Mukwege, is helping to bring hope in the DRC by healing women with fistula, a devastating vaginal injury.

As a founder and director of Panzi Hospital in Bukavu, Dr. Mukwege and his team offer a safe space where women suffering from fistula—which can be caused by sexual violence as well as by injuries sustained during prolonged childbirth—can be surgically repaired. Panzi Hospital is the first of its kind in the area. As the conflict in the DRC has escalated, so too has the number of fistula survivors. Dr. Mukwege and the Panzi staff have risen to the challenge: More than 3,500 women are treated annually at Panzi, and over 500 fistula repair surgeries were performed from 2006 to September 2008.

Dr. Mukwege is all too familiar with the complex situation in the DRC. Growing up there, he knew he wanted to be a doctor from a young age, when he accompanied his father, who was a pastor, on visits to members of the community who were ill. After he became an obstetrician-gynecologist, he fully recognized how desperately maternal and reproductive health services were needed.

In recognition of his dedication, he was awarded the United Nations Prize in the Field of Human Rights in 2008. A fierce advocate for women, Dr. Mukwege is also committed to preventing sexual violence, addressing the psychosocial factors that lead to gender-based violence. He often speaks out about how and what men need to do to stop it.

The Fistula Care Project, funded by the U.S. Agency for International Development and led by EngenderHealth, will assist in training doctors and nurses in obstetric care and help Panzi Hospital continue its work in fistula repair in the region.

Listen to an interview with Dr. Mukwege on National Public Radio.

An inspiring speaker, in the coming weeks Dr. Mukwege will appear with playwright Eve Ensler at several events across the United States as part of the “Turning Pain to Power” tour by the V-Day Campaign, a global movement to stop violence against women and girls. A conversation with Dr. Mukwege and Eve Ensler will be held at the 92nd Street Y in New York on February 11. Tickets are available online.