Responding to sexual violence in armed conflict

Abstract

The global community has called for an end to rape in wartime, but the crime is less understood than typically acknowledged, and addressing it will demand local interventions. Ted Alcorn reports. During the past two decades human and women's rights groups have transformed wartime rape from a crime that was typically ignored to a priority among international lawmakers. Indicative of this is a summit convened June 10–13 by the UK “to end sexual violence in conflict”, with up to 148 countries participating. But even as governments recognise this as a global problem, research suggests that sexual violence in conflict varies according to local circumstances and might need local solutions. Sexual violence during conflict is as old as war itself but the idea that it is mutable and subject to prevention or amelioration through public policy is relatively new. In wars up until the late twentieth century, rape was treated as an inevitable if unfortunate collateral damage. When sexual crimes did capture public attention, they were typically understood as isolated incidents rather than part of a larger problem. Victims rarely reported the crimes to authorities; justice systems frequently failed to punish the perpetrators; and survivors were more likely to be ostracised by their communities than offered treatment and redress. Norms began to shift in early 1990s, at least at the level of international law, when appalling sexual violence in two conflicts drew the attention of the global community. During the dissolution of Yugoslavia, Serbian militias rounded up tens of thousands of Bosnian Muslim women and raped them systematically or sexually enslaved them, both to terrorise their people and as a policy of forced impregnation. And during the 1994 genocide against the Tutsi in Rwanda, at least 100 000 women were raped and sexually tortured by the Interahamwe militias as part of their broader campaign of ethnic cleansing. By contrast with trials held after World War 2 in which no charges of sexual violence were brought, the international tribunals established after these conflicts recognised that systematic rape and sexual torture could be war crimes—violations of human rights that went beyond the suffering inflicted on individual victims and had the intent of destroying entire communities. The UN Security Council further condemned “sexual violence as a tactic of war” in a series of resolutions passed between 2008 and 2013, and established a Special Representative dedicated to ending it, a post currently filled by Zainab Hawa Bangura of Sierra Leone. The UK's Foreign Secretary William Hague, who is co-chairing the June summit, is the issue's latest champion. His deputy Emma Hopkins, who heads the country's Preventing Sexual Violence Initiative, says ending sexual violence in conflict is in the national interest: “It's not just an issue of human rights or women's rights; it's ultimately an issue of peace and security.” In convening the summit, the UK hopes to raise awareness among policy makers, strengthen norms for punishing high-level perpetrators, and highlight practical measures for reducing the prevalence of this violence. “It's about using our diplomatic muscle to put this at the top of the international agenda, and the message it sends.” But for all of that, sexual violence in conflict remains a tenaciously difficult problem to study and therefore to address. Sexual violence in conflict cries out for attention both because of its extraordinary prevalence—the UN Secretary General's most recent report documented massive abuses in 20 countries—and the complex and long-lasting consequences for victims' physical and mental health. Each year an unknown number of people are injured and traumatised by such violence, subject to unwanted pregnancies, exposed to sexually transmitted infections, and left to cope with potentially profound challenges to their mental health. But little is understood about how sexual violence varies across settings and over time, which makes it difficult to identify the circumstances that produce sexual violence, and more importantly, means to prevent it. At the heart of the difficulty—not unique to sexual violence but especially pronounced for it—is that the crimes are ubiquitous but usually invisible unless disclosed by the victims. And because victimisation is highly stigmatised, it is vastly under-reported. Researchers thus tend to see what they look for, and not what they don't. Sexual violence committed against men is a case in point. Conventional wisdom holds that rape in wartime is perpetrated against women, and where treatment is directed towards women, little evidence emerges to contradict this. Only as researchers began surveying men did they find high rates of sexual violence among them in some settings. Chris Dolan, who directs the Refugee Law Project in Uganda and treats hundreds of male victims of sexual violence there each year, says national laws play a role in silencing male victims of sexual violence. “There are 61 countries that define rape as something that only happens to women and, of those, 37 also criminalise all same-sex activity even when it's non-consensual. So even if you're the victim, you're criminalised”, he explains. Reforming these laws is a necessary first step to unlocking further information about these crimes. Hindered by the stigma surrounding sexual violence but compelled to quantify the problem so public attention and resources can be directed at it, advocates often overreach in their extrapolations. The founder of the Human Rights Data Analysis Group, Patrick Ball, who has spent two decades refining techniques to quantify violence for truth and reconciliation commissions in the wake of civil conflicts, is among the most careful and critical about how measurements are made. “There are enormous pressures to create numbers no matter how meaningless they are, and so people do”, Ball says. “I don't criticise this because I think it is unimportant; I am criticising it because it is transcendentally important. And if we think that it's important for us to understand what's going on in sexual violence, we should get it right.” One common misstep is to obtain data about sexual violence where they already exist, as in a hospital or relief agency, and then extrapolate those counts to geographies or conflicts for which they are not representative. The Syrian conflict demonstrates how challenging it can be to collect meaningful information where it is needed most. The deadliest ongoing war with an estimated 70 000 people killed in 2013, it has also displaced more than 8 million people and the UN concludes that “sexual violence has been a persistent feature of the conflict”. But little is known about which armed groups are committing the crimes, in what geographies, and if there is any way to intervene in the present or hold perpetrators accountable in the future. In one attempt to gather information, the Women Under Siege Project developed an online map to aggregate reports of sexual violence, with Arabic-language instructions and security measures to protect users' anonymity. But over the 3-year conflict fewer than ten people have submitted reports. “We didn't expect survivors of rape to necessarily come to the site but we thought people tracking human rights violations might do so”, says Lauren Wolfe, a journalist who manages the project. “Instead it's been much more about aggregating reports from NGOs [non-governmental organisations], from the UN, and from the media.” As a consequence, there is little reason to believe the recorded incidents are representative of violence across the country or over time. Karestan Koenen, an epidemiologist at Columbia University, NY, USA, who was invited to consult on the project told The Lancet: “The idea of crowd-sourcing sexual violence [data] is an exciting one but its epidemiological validity remains to be seen.” Even methodical population surveys, which many researchers feel are the best method for measuring the incidence of sexual violence, might be biased by the stigma attached to the crime. For example, surveys have repeatedly shown that survivors are far more likely to report a rape if it is perpetrated by a stranger than by a husband or boyfriend. In conflict and post-conflict settings, this disproportionate under-reporting of sexual violence within households can greatly inflate the share of sexual violence attributed to armed groups. The office of UN Special Representative Bangura acknowledged these weaknesses to The Lancet, saying: “The quantitative data on conflict-related sexual violence currently available does little more than serve to dramatise the issue.” Some doubt that meaningful measurements of sexual violence are even possible. But Leslie Roberts, associate professor of public health at Columbia University believes the only way forward is to develop better ways for eliciting meaningful information, despite the difficulties. “There is no public health problem we've ever been able to solve without measuring it”, he says; only then can populations at greatest risk be targeted with services, and the effectiveness of those services be assessed over time. He says he “has faith” that the field will coalesce around best-practices to reduce under-reporting—employing female interviewers and doing slow open-ended interviews, for example—and measurements will close in on the true underlying variation in rates of sexual violence. Whereas raising awareness of sexual violence in armed conflict to the level of high diplomacy has hinged, in part, on conceptualising it as a problem with commonalities across time and cultures, successful interventions to prevent it might need to vary as much as the circumstances that give rise to it. Perhaps nowhere has sexual violence been subject to more universalising impulses than the DR Congo (DRC). Convulsed by war between 1998 and 2003 and plagued by insecurity well after the formal end of the conflict, sexual violence figures prominently among the gross violations of human rights perpetrated there. Advocacy groups working to draw attention to the abuses have frequently characterised the sexual violence there as a weapon of war, with the implication that it is ordered deliberately by military leaders for strategic ends. The logical prescription for reducing this violence is to prosecute those leaders for the crimes. But the character of sexual violence in DRC and the means for preventing it may not always be this straightforward. Since 2004, Swedish social scientists Maria Eriksson Baaz and Maria Stern have done hundreds of interviews with soldiers in the DRC's national armed forces (FARDC), the group thought to be responsible for the largest share of sexual violence in the country at the time. In these conversations, they have explored how the soldiers themselves understand the violent acts they have witnessed or participated in. Eriksson Baaz and Stern—who emphasise that they can draw conclusions only about FARDC—have found very little evidence that the soldiers typically rape or perpetrate other forms of sexual violence systematically for strategic ends, or on orders from their commanders. That would require a level of discipline among the troops that poor training and morale have left them without, says Eriksson Baaz; if anything, it is the dysfunction of the military hierarchy that has created a space for opportunistic sexual violence to occur. “Many commanders live in constant fear of uprising against them, so even if they're trying to control it, they are afraid to impose sanctions against soldiers who are committing abuses.” The belief that sexual violence results from a rational decision-making process by ruthless leaders in an environment of impunity is attractive to policy makers, Stern says, because it suggests an easy fix. “If sexual violence is a strategy, then it can be hindered, prevented, stopped, which is of course very politically important.” Eriksson Baaz finishes the thought: “It gives the idea that you can control sexual violence in a similar way as chemical weapons.” Elisabeth Wood, a professor of political science at Yale University, CT, USA, also explores differences in sexual violence across conflicts and the armed groups within them. Specifically, she has broadened the study of sexual violence by turning away from it—towards conflicts in which armed groups did not seem to frequently perpetrate such crimes. From El Salvador to Sri Lanka to Israel-Palestine, she has documented armed groups engaged in conflicts where conventional wisdom holds that they would perpetrate rape, but available statistics suggest little has occurred. Although acknowledging the imprecision of existing measures of sexual violence, she says this variation suggests that some factors thought to be associated with sexual violence are not as important as imagined. Society-wide characteristics like the level of patriarchy cannot explain why two armed groups from the same community perpetrate sexual violence at different rates. An environment of impunity cannot explain why a group like the Tamil Tigers would engage in other forms of violence against civilians but rarely rape them. Whereas sexual violence was prevalent in ethnic conflicts like those in Yugoslavia and Rwanda, that dynamic cannot be the sole explanation when rape is reported infrequently in another conflict between ethnically defined populations as in Israel-Palestine. Even without a complete explanation for this variation, Woods says it gives policy makers something to aim for. “The fact that not all armed groups rape is very important because it demonstrates that those armed groups who want to prevent their combatants from engaging in rape of civilians can do so. And the fact that some armed groups do, that means we have all the more reason to hold accountable those groups that don't prevent sexual violence, or indeed those groups that actively promote it.” If there is anything certain about how the international community should respond to sexual violence in conflict, it is that perpetrators should be brought to justice and survivors should be offered medical care. But if rape in conflict is hard to measure, it is even harder to punish. This is true even in high-income countries with capable criminal justice systems, and the challenges are magnified when institutions are frayed by conflict and resources are scarce. Nowhere is this truer than DRC, which ranked last among 185 UN member states on the 2013 Human Development Index, tied with Niger. Few survivors of sexual violence bring charges and when they do, evidence to support their cases is rarely collected effectively. And if they lose—often re-traumatised by the experience—the public's overwhelming presumption is that the crime never occurred. Physicians for Human Rights (PHR) is trying to change this by strengthening the way the medical and legal sectors collaborate to gather and weigh evidence for the prosecution of these crimes. Both professions play an essential role in the judicial process, says Karen Naimer, the director of PHR's Program on Sexual Violence in Conflict Zones. “[Clinicians] are the first people to come across what constitutes evidence, so they have to start labelling it and preserving it in a way that will make it court admissible down the road.” Since 2011, PHR has convened over 400 law enforcement, health-care workers, and members of the criminal justice system to improve the ways they collect and communicate data about crimes of sexual violence. In collaboration with Congolese clinicians, PHR is also trying to standardise forensic data-collection through use of a template medical intake form. The four-page document helps practitioners undertake a full-body exam of the survivor and asks them to evaluate the consistency of the evidence with claims of physical and sexual assault. Naimer says the form is now being used in several medical facilities including one large hospital where 1766 forms were completed last year—though this likely represents only a fraction of the rapes that took place in the area during that time. Even more essential than justice, some would argue, is the need to provide survivors of sexual violence with appropriate care. In Uganda, Chris Dolan says this begins with physical treatment but extends to many other areas. “It's very hard to work on somebody's mental state when their physical body is letting them down and causing them a huge amount of pain. So in terms of the way we approach it, we tend to start with the physical side of things, and that is what provides an opening to discuss the psychological impacts, the social impacts.” And an increasing body of evidence—including a 2013 evaluation of group psychotherapy for Congolese survivors of sexual violence—shows that effective mental health services can be delivered in low-income, conflict-afflicted areas. Heidi Lehmann, a senior director at the International Rescue Committee (IRC) who has worked for more than a decade responding to violence against women and girls in conflict and post-conflict settings, says this mentality of care must infuse every aspect of how they respond to a crisis. “The humanitarian community in particular has conceptualised sexual violence as an incident—a one-time event— and that further distances it from the reality of the multiple types of violence that face women and girls, and which are exacerbated in conflict and post-conflict settings.” In Bangui, Central African Republic, where in the first 3 months of 2014 the IRC provided care to hundreds of victims of sexual violence, they also trained health workers to undertake proactive surveillance for sexual assaults, established spaces for women to gather and promote a sense of solidarity, and audited housing facilities to improve their security. It is the strength of survivors, even under difficult conditions, that motivates Charlotte Watts, founding director of the Gender Violence and Health Centre at the London School of Hygiene and Tropical Medicine. “The thing that inspires me is the resilience and versatility of women who are in very difficult situations, and how they try and minimise the risk of violence or protect their kids. That's the stuff that I think we should be bringing out.” Ending sexual violence in conflict and beyondToday's Lancet has a special focus on sexual violence in conflict to coincide with the first Global Summit to End Sexual Violence in Conflict in London, June 10–14. War zone sexual violence and other forms of gender-based violence inflict extreme suffering and represent serious violations of human rights. These crimes leave physical, psychological, social, and economic scars on individuals, families, and communities. And shamefully, most of the perpetrators are never brought to justice. Full-Text PDF Preventing violence against women and girls in conflictAs the Global Summit to End Sexual Violence in Conflict takes place in London, UK, on June 10–13, 2014, the international community faces a propitious moment to address the horrors of sexual violence in conflict and other forms of gender-based violence. Sexual violence in conflict has occurred throughout modern history, including the targeted mass rapes and murders of women in Bangladesh's Liberation War of 1971, the systematic rape of women in the Balkans and during the Rwandan genocide in the 1990s, and current sexual abuses in the Democratic Republic of Congo (DRC) and Syria. Full-Text PDF Responding to sexual violence in conflictConflict-related sexual violence is a public health and human rights concern, as well as a matter of peace and security, and is the focus of the Global Summit to End Sexual Violence in Conflict in London, UK, on June 10–13, 2014. Sexual violence is not an inevitable consequence of conflict.1 More can be done to prevent it and to hold individuals accountable for it. Full-Text PDF Muriel Volpellier: confronting sexual violence with evidenceBack home in London, Muriel Volpellier is the lead doctor for forensic medicine at Haven Paddington, a sexual assault referral centre at St Mary's Hospital, where she conducts forensic examinations and follow-up medical care for victims of sexual assault. But today she is in Bukavu, Democratic Republic of Congo (DRC), where she arrived in April as part of the UK Foreign and Commonwealth Office's Preventing Sexual Violence Initiative. Seconded to the organisation Physicians for Human Rights, she is spending 6 months in DRC to share best practices for treating and documenting sexual assault. Full-Text PDF The challenges of research on violence in post-conflict BougainvilleThe Destiny guest house, with its plywood and pine-panelled walls, overlooks the channel between two islands. Past the flimsy gate and across the road is the shabby blue UN building, which is separated from the road by a stockade-style wooden fence. This was our residence and office base in 2011–12 when we did research in post-conflict Bougainville, Papua New Guinea, on men's sexual and other violence against women and experiences in conflict. In a country where most men and many women carry bush knives, substance misuse is severe, and disarmament post-conflict has been incomplete, our safety and that of our research colleagues was a pressing concern. Full-Text PDF Rape as a weapon of warOn Sept 25, 2012, the distinguished gynaecologist Denis Mukwege addressed the UN with a passionate plead not to forget “Africa's World War” in the eastern Democratic Republic of the Congo (DRC). For 16 years, he reminded them, Congolese women had borne the brunt of this conflict and endured rape, sexual slavery, and torture. He began his speech by saying that he regretted that he was unable to state that he was honoured to be able to address them. Honour was impossible because the “women victims of sexual violence in Eastern DRC are in dishonor”. Full-Text PDF