Gender based violence: the hidden victims of war

by Dr Sundeep Chohan

In 2014, I was invited to Rwanda to work with local NGOs who were still struggling to rehabilitate the survivors of the 1994 Genocide, which had left nearly a million dead. Rwanda as a country has made enormous progress since those dark days and although the government had made very impressive efforts in rebuilding the shattered health infrastructure, there remained areas of huge need.

Whilst in Kigali, a request came from our local NGO for me to head to the Province Du Nord region to assist a community of genocide survivors who had fled there during the violence. What I saw here changed my life. The 28 survivors living in this settlement colony had all been deliberately infected by HIV during the sexual violence of the 1994 genocide. Despite the decade I had spent in the field, in some of the world's most violent regions, this was the first time I had witnessed the calculated use of HIV as a biological weapon.

‘One tactical objective of rape is to demoralise populations and a more sinister objective is to promote slow genocide when systematic rape is coupled with high rates of HIV.’
— Ishita Chowdhury, Mark M. Lanier; Rape and HIV as Methods of Waging War: Epidemiological Criminology’s Response

Looking gaunt and frail, still visibly traumatised and ravaged by the late stages of HIV, the survivors recounted their horrific stories from the genocide – stories of their deliberate and systematic infection by gangs of HIV+ve  Interahamwe militia men. It was called the ‘slow genocide’ and meant to cause as much damage to the women and their communities as possible. Ostracised, stigmatised and traumatised, twenty years on they eke out an existence whilst their health slowly fails.  These were 28 faces of the hidden side of the genocide, all victims of a crime which has barely been mentioned in the media or medical literature.

National Genocide Memorial, Kigali, Rwanda

Gender Based Violence [GBV] affected hundreds of thousands of Rwandan women at the time but the majority remained silent victims, never speaking of the horrors they faced. They dared not even tell close family, so great was the shame and trauma as well as the risk of being socially excluded. Most never received either the medical or psychological support they so desperately needed over the years that followed. The women I met simply wanted to be listened to, to tell their stories and receive comfort that someone, somewhere cared about what had happened to them. As they spoke movingly about their lives, they asked simply that we acknowledge their suffering.

It is now more dangerous to be a woman than to be a soldier in modern conflict.
— Major General Patrick Cammaert, Former UN Peacekeeping Operation commander in the Democratic Republic of Congo

Worse was yet to come, much worse. Our local contacts insisted these abuses were very much ongoing and happening on a daily basis just a short trip away across the border in the Kivu regions of the Democratic Republic of Congo. Hundreds of thousands of women were already victims of sexual GBV there and the numbers grew rapidly each day in a country that has seen several million dead since 1994. The Congolese conflict is the largest holocaust in the world since World War Two yet receives virtually no interest from the outside. With a small medical team to investigate these crimes, we entered a region that the UN had labelled the global epicentre in the use of ‘rape as a weapon of war’.

I will never forget the first Congolese GBV victim I met. A petite woman barely out of her teens, she described to us how she was assaulted repeatedly in one of the many militia rape camps in the region whilst her husband was forced to watch. The militia men then killed her husband and forced her to eat parts of him before releasing her. Several months later, she remained withdrawn, frail and barely able to communicate. For weeks after the event, she was unable to eat solid food without vomiting and even now she continued to vomit at the sight of meat.  

The town of Bukavu, South Kivu, DRC

We continued to meet victim after victim, each woman recounting a story of unspeakable horrors. Every day brought even more shocking events - there were victims who were too young to even start crawling with serious pelvic injuries. Amputations and deliberate mutilation of the breasts and genitals were common. The demand for fistula surgery had collapsed the local healthcare resources, so great in number were the women with sickening physical injuries who had been violated with machetes, guns, bottles, tree branches or whatever object the militia had close by after the women had been raped. During one phase of the war, certain combatant groups would fire weapons inside the woman as a mark of the final humiliation, leaving her to then die alone in the wilderness. Surprisingly some of these women survived and bravely made it through the war ravaged territory to the Panzi Hospital in Bukavu, which struggled to cope with the huge influx.

The use of rape during times of war is not a by-product of conflicts, but is a pre-planned and deliberate military strategy.
— Amnesty International

Despite GBV victims experiencing some of the gravest human rights abuses in the world, unfortunately it appears to be an issue which has never received the attention it really deserves from the media, public or politicians. Every conflict has its hidden victims of sexual GBV who continue suffer in silence so the medical aid and psychological support they receive is grossly inadequate. Why is it we only prepared to acknowledge those front-line causalities of any war – from the Second World War to the battlefields of Syria, we only count the dead and injured. The female GBV survivors have always been quietly silenced, not even allowed to be counted as a statistic. Grave GBV abuses are happening daily during conflicts around the world, yet when will we seek to document these and openly discuss this problem? Only when we shine a light on this issue and accept it, will we be able to allocate the required medical skills and humanitarian resources needed to assist survivors.

I had spent a decade in the field including conflict regions, yet this was never a topic that had called to me, perhaps it was a crime I didn't want to see. The women of Rwanda and Congo changed everything. It has been said that only the dead have seen the end of war, for these women and their families the war continues in their minds and bodies. Although I am still haunted by my time there, amongst the horror I saw the courage and quiet dignity of these women, a will to survive and to tell the world their story. They wanted to share their experiences with the world and asked only one thing, that I return and tell their story to anyone who would listen. Their bone-chilling story of suffering was one which must be told and so GBV Uncovered was born.  

Dr Sundeep Chohan specialises in Remote & Hostile Medicine, holds a position of a Senior Medical advisor to the UK Military and has worked in  many countries across the world affected by conflict and catastrophe. He is currently working on projects to investigate war crimes against women and deliver front-line medical care to survivors of gender-based violence in hostile and resource-poor settings.