Enough is Enough: Sexual Violence against Women and Girls as a Weapon of War must End by Medecins Sans Frontieres / Doctors Without Borders 4:23pm 11th Mar, 2004   Medecins Sans Frontieres (MSF), Canada's briefing paper for March 8, International Women’s Day.    “The day before yesterday I went to the bush to look for wood. There were three government soldiers with guns. One of them saw me and he asked: “Where are you going?” I said I was looking for wood. Then he told me: “You are assigned to me for the day.” I was very afraid. He forced me to go far into the bush and he undressed me. Then he raped me. When I got dressed afterwards he took 50 Liberian dollars from me. I came back to the camp and yesterday I felt very sick. My stomach is very painful, but I don’t have any money to go for treatment.” Woman, 27 years old, living in a camp for displaced people in Monrovia, Liberia, June 2003    RAPE AS A WEAPON OF WAR    Wars leave women and girls particularly vulnerable. Women, girls and even young children are all too often raped, abducted and forced into sexual slavery as social and economic structures fall apart. When forced to flee their homes, women and girls frequently become separated from their families and are left open to attack. They may be forced to trade sex for protection, or simply food or shelter.    The incidence of rape and sexual violence in these situations not only increases but often becomes systematic. Rape becomes a weapon of war, with women and girls the targets.    Seen this way, sexual violence is not only a consequence or side effect of war and displacement. It is, instead, a deliberate tool of war, used to destabilize and threaten a part of the civilian population, often a particular group. Women and girls are singled out because the harm and humiliation inflicted on them not only hurts them but also deeply harms and humiliates their families and often the entire community. Unfortunately, too often when even the war might have finished, rape has not.    MSF was first confronted with this in their programmes in the 1990s. In Bosnia, systematic rape was used as part of the strategy of ethnic cleansing. Women were raped so they could give birth to a Serbian baby. In Rwanda, systematic rape of Tutsi women took place during the genocide. Between 300,000 and 500,000 female survivors of the genocide are estimated to have been raped.    With the AIDS pandemic, rape has now become a lethal weapon. Immediate medical care, including the availability of post exposure prophylaxis (PEP), is now a matter of life and death. More must be done to treat and support the victims of sexual violence and to prevent it from happening in the future. Silence, indifference and inaction have been the answer for too long. Enough is enough.    IMPUNITY MUST STOP    Unfortunately, impunity is often the norm. While some progress has been made in recognising rape and other acts of sexual violence as war crimes (rape is now specifically mentioned in the Statute of the International Criminal Court©ˆ), the international and national response so far remains unclear and inadequate.    Local, national and international actors must take all necessary measures to address impunity and help prevent such acts. Counselling sessions with rape survivors have also highlighted the importance to the healing process of having rape declared a punishable crime, even in international law. The present lack of justice remains unacceptable and sexual violence will continue unless political and military decision-makers finally decide to act.    (1. In article 7 (1) g- of the ICC Statute rape, sexual slavery, enforce prostitution, forced pregnancy enforced sterilization and sexual violence is considered crimes against humanity).    CONSEQUENCES OF RAPE: WOMEN AND GIRLS ARE SCARRED    Medical    The medical consequences of sexual violence are devastating. The physical injuries can be life threatening and many rape victims are at risk of contracting sexually transmitted diseases, including HIV/AIDS. This risk is significantly increased during rape because forced sexual intercourse results in injuries and bleeding, thereby facilitating transmission of the virus.    Unwanted pregnancies as a result of rape can force women to seek medically unsupervised abortions. MSF has seen cases of pelvic inflammatory infections and septisemia arising from such procedures. Other reproductive health problems include interruptions or abnormalities to the menstrual cycle or delayed conception.    Psychological    Being raped leads to long-lasting trauma and suffering. Sometimes this takes the shape of mental health disorders whereas at other times it surfaces in less obvious ways such as shame, guilt, sleeping problems, difficulties in daily functioning and withdrawal. Many women report ongoing fear, anxiety, intrusive memories and flashbacks, which are rooted in their experience of the fear of being killed or mutilated. Other patients have complained about a constant feeling of being ill, low appetite and disappearance of sexual desire. Decreased sexual desire or pain during sex is particularly common and very damaging to family life and relationships.    Acute heart palpitations are symptoms of anxiety and daily functioning is often disrupted by the fatigue caused by nightmares and other sleeping disorders.    Social-economic    On top of the physical and psychological trauma caused by sexual violence, the raped woman is often stigmatised by the community and sometimes even rejected by her husband. These women, isolated and ashamed, are then forced to find their own way and live in poverty. It is imperative that the stigma of rape is removed so that they can regain their livelihoods and their full place in society.    MSF’s RESPONSE    Dealing with sexual violence is difficult and there are many obstacles, including cultural, to treating and supporting victims appropriately. Working in emergency or semi-emergency settings where there may not be even basic health care, let alone a private space for treatment and counselling, only adds to these obstacles. But we have a responsibility to provide care.    MSF is striving to provide comprehensive and quality care to victims of sexual violence in confidential settings. We treat the victims’ wounds, offer emergency contraception and provide treatment for the prevention of sexually transmittable diseases. This includes HIV, for which we administer antiretroviral drugs to prevent post-rape infections. These drugs are effective only when taken within 72 hours after of the rape, one reason why immediate medical assistance is so vital.    Given the fact that sexual violence is often a taboo, it is as important to have education activities in place to raise awareness about the issue and the fact that medical treatment is available. In some projects, MSF also organizes the psychosocial counselling. Here, women are enabled to talk about – often for the first time – what they endured. They share their beliefs and receive acknowledgement for their suffering. The objective of the psychosocial interventions is to reinforce or restore coping mechanisms and self-control.    MSF is providing care and support to victims of sexual violence in a number of countries where we work. Below is a selection of four projects where MSF has been providing assistance to victims of sexual violence. The dominance of African countries does not mean that sexual violence does not happen elsewhere. It does, however, reflect the fact that it is extremely difficult to support victims of sexual violence in countries like Chechnya, Pakistan and Afghanistan were the taboo and stigma is even greater and where women risk being expelled or possibly killed once the family finds out.    Click on the link below to view country reports. Visit the related web page
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