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Abstract
BackgroundThe epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC.MethodsMedical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤18 yrs) and adult patients.Findings440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6–12], p<0.001), and less frequently by military personnel (13% vs 48%, OR 0.14 [95%CI 0.075–0.26], p<0.001). Delayed presentation for medical care (>72 hours after the assault) was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2–4.0], p = 0.007). Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3–4.4], p = 0.006). Nine (2.9%) pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34).InterpretationWorld media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.
Highlights
Violent conflict in the Democratic Republic of the Congo (DRC) over the past decade has been associated with a large-scale epidemic of rape [1,2]
The alarming brutality and scale of sexual violence in some areas of eastern DRC has resulted in thousands of cases of traumatic genital injury and gynecologic fistulae among adult female victims, together with devastating psychological and social consequences [1,2,3,4]
Sexual violence committed during these conflicts has been recognized as systematic and politicallymotivated: sexual assault was declared a crime against humanity by International Tribunal for the Former Yugoslavia (1996), and an act of genocide by the International Tribunal for Rwanda (1998) [5]
Summary
Violent conflict in the Democratic Republic of the Congo (DRC) over the past decade has been associated with a large-scale epidemic of rape [1,2]. The alarming brutality and scale of sexual violence in some areas of eastern DRC has resulted in thousands of cases of traumatic genital injury and gynecologic fistulae among adult female victims, together with devastating psychological and social consequences [1,2,3,4]. Much attention has focused on military personnel using sexual violence as a deliberate tactic to terrorize, displace, and demoralize local communities [1]. The epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC
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