“A Biocultural Approach to Rape Committed During Armed Conflicts in Sub-Saharan Africa”
Citation: Baca, Maya, “A Biocultural Approach to Rape Committed During Armed Conflicts in Sub-Saharan Africa.” Unpublished manuscript, University of Massachusetts Boston, May 2014.
Rape has a long history of use as a weapon of war, but a short history as an internationally recognized weapon. In an age when the international community is more sensitive to the systematization of war waged against civilians, women’s loss of autonomy has become of greater concern and the international community has condemned the use of women’s bodies as another terrain on which to wage war. The historical narrative of rape has turned from a story of opportunistic rape and pillaging to one of systematic rape, in order to terrorize and create fissures in communities, “change the ethnic make-up of the next generation [and] sometimes it is also used to deliberately infect women with HIV or render women from the targeted community incapable of rendering children.” This is a form of war that can persist long after the conflict is over and the international community cannot ignore rape committed by combatants and non-combatants, alike, during armed conflicts. The effects of rape during armed-conflict—whether committed by combatants or non-combatants—can manifest psychologically, physically and socially, in unwanted pregnancies and births, as a temporary or permanent medical issue(s), and in societal responses. The effects of conflict-related sexual violence are of particular concern in Sub-Saharan Africa, because as Supervie Virginie et al., in “Assessing the Impact of Mass Rape on the Incidence of HIV in Conflict-Affected Countries,” explain, “The highest number of armed conflicts occur in Sub-Saharan Africa where many Conflict-Afflicted-Countries have a high prevalence of HIV.” Sub-Saharan Africa also has “the highest rate of STIs.”
The international community has committed resources to studying the effects of rape and providing humanitarian aid to combat sexual violence and support survivors. It is, therefore, the international community’s responsibility to understand the processes of conflict-related sexual violence, in order to provide humanitarian aid responsibly and effectively. Progress is delimited, however, by the difficulties of compiling data, during an armed conflict, on the prevalence and incidence of rape and contracting diseases from wartime rape: “For example, in the Democratic Republic of Congo (DRC), reports on the extent of conflict-related sexual violence range from 17.8% to 39.7% among women and 4% to 23.6% among men….” Taking in to consideration the issue of reporting discrepancies, this paper explores what needs to be addressed when developing services for victims of rape. It focuses on the perpetrators who committed sexual violence and the victims of sexual violence who were sexually assaulted during armed conflicts in Sub-Saharan Africa. Specifically, this essay explores the question “Who are the perpetrators and victims?” It also examines what social and epidemiological impacts of sexual violence need to be addressed in this region.
Who Are The Perpetrators and Victims?
Studies of sexual assault often look at the victims—who is victimized and how to help them—but, in order to establish a preventative program for sexual assault and provide better treatment, it is important to understand who are the people committing these assaults. Sexual violence has historically been framed as a woman’s issue and, when discussing sexual violence, people often use the passive voice, which can result in a discourse that, effectively, erases perpetrators from the conversation—for example: the male combatants raped women can turn into women were raped by male combatants which can turn into women were raped. This passive and exclusionary language disvalues the importance of knowing who are the perpetrators—but sexual violence cannot end until people stop committing sexual assault. This point is driven home by the fact that much of the material on sexual violence during an armed conflict discusses combatants assaulting women, but combatants are not the only perpetrators of sexual assault. Concurrently, a study in Cote d’Ivoire found that “violence occurs in many forms and is perpetrated by different individuals, in addition to combatants.”
While fighting sexual violence, as a tool of war, is an important effort, it is essential for policymakers and humanitarian aid workers to know the prevalence of sexual assault committed by intimate partners, strangers or acquaintances, and combatants. With this need in mind, the Cote d’Ivoire study sought to examine basic, but centrally key issues: “Since the age of 15, apart from your partner has anyone ever forced you to have sex against your will?”  The study also looked at whether partners had forced respondents to have sex one or more times. The study found,
“More than half of all women (57.1%)… reported an experience of physical and/or sexual violence since age 15… 27.7% of women… reported violence by a non-partner since age 15… Nearly 1 in 10 (9.9%) reported SV [sexual violence] perpetrated by someone other than their partner, with SV most often perpetrated by male strangers or acquaintances. Only a small percentage of women reported SV perpetrated by a combatant (0.3%)… The reported prevalence of non-partner SV was lower after the Crisis period than during or before the Crisis… the prevalence of SV by an intimate partner remained high (14.9% among women after the Crisis).
These findings support the need for attention to conflict-related sexual assault, since the reported prevalence of non-partner sexual violence was higher during or before the Crisis. The findings, however, also evidence that concentrating on rape as a tool of war “in all conflict-affected settings is short-sighted,” since only .3% of women reported sexual violence “perpetrated by a combatant.” It may be easier to mobilize support for wartime sexual violence, because stories of brutal mass rape that are connected to the tangible, and sometimes sensationalized, images of war can elicit a more visceral reaction than stories of rape by intimate partners or other non-combatants, which are universally more commonplace. All rape, however, no matter the context, falls on an interconnected spectrum that must be fully examined in order to ensure that the root of the problem is addressed.
The chapter “Why Domestic Sexual Violence is Invisible in Wartime,” in the Human Security Report 2012’s Sexual Violence, Education, and War: Beyond the Mainstream Narrative, illustrates this point, “Horrific accounts of savage sexual assaults by rebels, militias, and government forces, particularly in the war-affected eastern part of the DRC, have become the focus of intense media scrutiny…” but while “in the worst affected region, Nord-Kivu, 20 percent of women of reproductive age reported to have been raped in their lifetime… thirty-nine percent of women in Uganda have been victims of sexual violence in their lifetime” with police and soldiers being reported as responsible for less than 1 percent of the sexual violence. The representative sample of women in Cote d’Ivoire and statistics of sexual violence in Uganda indicate that in these regions, when deciding how to allocate humanitarian aid for sexual assault victims, the international community should take into consideration the higher prevalence of male stranger and acquaintance-perpetrated violence. In the DRC, however, “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo: A Mixed-Methods Study,” reports 83% percent of its respondents who had experienced rape identified their rapist(s) as having worn a military uniform and these women were three times more likely to have experienced gang rape than those whose attackers did not wear uniforms. This variation in reports from conflict-affected countries in Sub-Saharan Africa highlights the importance of region-specific programming (i.e. humanitarian programs designed based on the experiences of victims of sexual violence in that setting).
In regard to the identities of victims—since understanding who they are is as important as knowing who the identity of their assailants—the victimization of women is of greater prevalence than men, but men must also be acknowledged as victims in the discourse on sexual violence, in policymaking, and in the implementation of humanitarian aid programs. In the Cote d’Ivoire sample, 57.1% of women and 40.2% of men reported “an experience of physical and/or SV since age 15.” These statistics confirm the need to emphasize support for women, but they also show a need to include support for men. Many studies focus on the impact of sexual violence on women, but, while attention to sexual violence against women is certainly warranted, the same Cote d’Ivoire study explains, during the Crisis period “men were more likely than women to report physical assault from combatants (0.9% women, 4.7% men, p=0.00).” This statistic evidences a need for a particular type of program for male victims, addressing wartime rape.
Programs for children must also be designed and implemented based on the setting. In regard to the DRC, “Child rape constitutes a very small percentage of female rape cases in South Kivu, one of the worst affected conflict regions of the DRC.” A small percentage of child rape in “one of the worst affected conflict regions of the DRC” suggests that this should translate to a small percentage of child rape in general. However, as seen with the variation in perpetrators—from a majority of combatant-perpetrators in the DRC to their minority in Uganda—a study in one setting may not be representative of another. While women are the group more prevalently targeted for sexual violence, any percentage of sexual violence is not a negligible one and men and children make up a percentage of the victims of sexual violence. The demographics of victims of rape vary throughout different conflict-affected settings, making studies on who is being victimized, in an area that could potentially receive international support, a vital part of providing essential and effective humanitarian aid to victims.
The data presented here confirm that the type of sexual violence (e.g. domestic or military-related) differs with the identity of perpetrators and victims and in conflict-affected settings. As previously stated, this requires studies to be conducted in areas where sexual violence has a high prevalence, in order for personalized care to be provided for that setting based on the type of prevalent sexual violence and who is being victimized. Studies need to examine who the perpetrators are—such as combatants or intimate partners—and the demographics of the victims. Care should be provided based on the findings, while keeping in mind that there can be negative social implications related to the treatment of sexual assault. Focusing on combatant-perpetrated sexual violence, in a setting where other perpetrators are assaulting female victims, can lead to the stigmatization of victims of combatant-perpetrated sexual violence. Stigmatization is further discussed in the next section.
What is the social and epidemiological impact of sexual violence in Sub-Saharan Africa?
Rape, whether committed by combatants or non-combatants, can have a long lasting effect on the victim and community. To be truly effective, international programs for sexual violence need to address how communities receive victims of rape and create a long-term solution for providing aid to those who contract STIs or HIV or become impregnated during rape in conflict-areas. Female victims of rape often face rejection from their families or communities and providing medical services for these women could be one way to help mitigate this outcome.
Family and community support is an important part of the healing process for victims of rape, making it essential for those creating programs to consult studies on how rape victims are received. JT Kelly et al., in “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo,” study rejection rates in the DRC. This study surveyed a non-random sample of 225 women from a large regional hospital and two community-based NGOs. It found, “as a result of rape, 29% of women were rejected by their families and 6.2% by their communities.” Women rejected by their families were told they could not live in their husband or parents’ house. Women rejected by their community were “ostracized by peers to such a degree they [felt] forced to leave the community.” Women who were widowed were found to have experienced general isolation almost five times more often than married women; “women abandoned by their husbands were almost three times as likely to report feelings of general isolation compared to non-abandoned married women;” “Gang-raped women were roughly three times more likely to experience rejection from their family compared to women who were not gang-raped.” These statistics confirm a need to address rejection by the family and community of rape victims in programs for victims of sexual assault. Support needs to go to these victims, but, ultimately, programs need to work with communities to challenge the perception of forced sex outside of marriage as bringing “misfortune to the household,” which has led victims of rape to suffer from different forms of rejection—the same customs previously applied to adulterers.
While discussing reasons for being rejected, women often mentioned that “contamination” or a husband’s fear of contracting disease was a reason for rejection. This fear is an important link between the social and epidemiological effects of wartime rape. In order to be a militating force against the rejection of rape victims, programs need to address this fear. The statistics on medical services in the DRC, from the same study on the experience of female survivors in Eastern DRC, are devastating. The study found,
Almost half of women polled (44.6%) waited a year or more before seeking SGBV [i.e. sexual and gender-based violence] services. Fifty-five percent of women stated it took them more than a day to travel to SGBV service locations; only 4.2% of the women received SGBV services within 72 hours of the attack – a medically important window of time in which victims can be given prophylaxis for sexually transmitted infections (STIs) and HIV.
If 95.8% of women do not receive services within the “medically important window of time,” then there is a major deficiency in the amount of service locations and possibly shortcomings in the way services are promoted. It is one thing to provide sexual and gender-based violence services, but people need to know they exist and be able to reach them in order for the programs to be effective. HIV services are particularly important for victims of sexual violence, because Supervie Virginie et al. found, “the transmission probability of HIV per act of rape was four times greater than the transmission probability per act of consensual sex.” Furthermore, if a rape victim contracts a STI during the rape, the probability of their contracting HIV, later on, rises.
If women do not seek services after their assault, it is also possible that pregnancies from rape could receive no medical attention—women may not receive prenatal treatment or may not be given the option to terminate an unwanted pregnancy. The DRC study found, “Thirteen percent of women had a child from rape” and “women who did have children from rape were almost five times as likely to report experiencing community isolation than those who did not report having children from rape.” The study, however, does not provide data on whether these women seek services for their pregnancies from rape. This is another long-lasting epidemiological effect rape can have on a society. If women are not receiving prenatal vitamins or providing their babies with proper nutrition, this can have a negative effect on the development of the child, which can, in turn, effect later generations. There is also a risk, if a woman does not seek services, that she will pass along a disease, contracted during the rape, to her baby. STIs, HIV, and unwanted pregnancies from rape have an enduring impact on society and, at least in the DRC, the paucity of services that address these issues needs to be ameliorated.
Providing greater services to victims of rape, including treatment for STIs and HIV as well as services for unwanted pregnancies, could attenuate the fear-based driving force that results in the rejection of rape victims. If women had better access to medical care and these services were promoted in the community, reasons for rejecting women based on pregnancy or fear of contracting a disease could be allayed. Providing support for pregnant women could encourage support in the community and attending to treatable diseases would render the fear of infection less founded. Providing better services could also lessen the negative epidemiological effects that rape has on conflict-affected countries in Sub-Saharan Africa.
The data presented here serve to illustrate the complexity of addressing rape in conflict-affected areas. I have discussed statistics of rape, such as where domestic sexual violence is more prevalent than combatant perpetrated sexual violence, but there is a concern for misreported information and that, therefore, some of the data are a misrepresentation of reality. I am particularly concerned with the .3% of women who reported sexual violence perpetrated by a combatant in Cote d’Ivoire, since women in Eastern DRC were found to have been “three times more likely to have been gang raped than women reporting non-uniformed attackers,” but “Gang-raped women were [also] roughly three times more likely to experience rejection from their family compared to women who were not gang-raped.” If women in Cote d’Ivoire also experienced the stigmatization of gang rape, they could have been less inclined to report having experienced this type of rape. Discrepancies in reporting, however, should not discourage the international community from studying the complex issues of rape and providing support to Sub-Saharan Africa.
I have asserted that the international community should take a holistic perspective when developing services for victims of sexual violence. Developers need to consider who are the perpetrators of rape, who are the victims, and in what settings are certain types of rape perpetrated. They also need to consider the families and communities of rape victims in their programming, in order to decrease the prevalence of rejection. Of equal importance is the need for more studies on the perpetrators of rape in conflict-affected areas and the social systems that explicitly or permissively support them.
Bartels, SA, et al. “Patterns of Sexual Violence in Eastern Democratic Republic of Congo: Reports From Survivors Presenting to Panzi Hospital in 2006.” Conflict and Health. 2010 May 5; 4:9. doi: 10.1186/1752-1505-4-9.
Hossain, Mazeda, et al. “Men’s and Women’s experiences of violence and traumatic events in rural Cote d’Ivoire before, during and after a period of armed conflict.” BMJ Open. 2014 Feb 25; 4(2):e003644. doi: 10.1136/bmjopen-2013-003644.
Hossain, Mazeda, et al. “War and Sexual Violence – Mental Health Care for Survivors.” The New England Journal of Medicine. 2013 June 6; 368:2152-2154. doi: 10.1056/NEJMp1304712.
Human Security Report Project. Human security report 2012: sexual violence, education, and war: beyond the mainstream narrative. Vancouver: Human Security Press, 2012.
Kelly, JT, et al. “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo: A Mixed-Methods Study.” Conflict and Health. 2011 Nov 2; 5:25. doi: 10.1186/1752-1505-5-25.
Outreach Programme on the Rwandan Genocide and the United Nations. “Background Information on Sexual Violence used as a Tool of War.” http://www.un.org/en/preventgenocide/rwanda/about/bgsexualviolence.shtml.
Supervie, V, et al. “Assessing The Impact Of Mass Rape On The Incidence Of HIV In Conflict-Affected Countries.” AIDS. 2010 Nov 27; 24(18):2841-7. doi: 10.1097/QAD.0b013e32833fed78.
Ted Talk “Jackson Katz: Violence Against Women—it’s a men’s issue” http://www.ted.com/talks/jackson_katz_violence_against_women_it_s_a_men_s_issue#t-242827.
 Outreach Programme on the Rwandan Genocide and the United Nations, “Background Information on Sexual Violence used as a Tool of War,” http://www.un.org/en/preventgenocide/rwanda/about/bgsexualviolence.shtml.
 V Supervie, et al., “Assessing The Impact Of Mass Rape On The Incidence Of HIV In Conflict-Affected Countries,” AIDS. 2010 Nov 27; 24(18):2841-7. doi: 10.1097/QAD.0b013e32833fed78, 1-2.
 Ibid., 2.
 Mazeda Hossain, et al., “Men’s and Women’s Experiences of Violence and Traumatic Events in Rural Cote d’Ivoire Before, During and After a Period of Armed Conflict,” BMJ Open, 2014 Feb 25; 4(2):e003644. doi: 10.1136/bmjopen-2013-003644, 1-2.
 Ted Talk “Jackson Katz: Violence Against Women—it’s a men’s issue,” http://www.ted.com/talks/jackson_katz_violence_against_women_it_s_a_men_s_issue#t-242827.
 Hossain, et al., “Men’s and Women’s Experiences of Violence and Traumatic Events in Rural Cote d’Ivoire Before, During and After a Period of Armed Conflict,” 6.
 Ibid., 3.
 Ibid., 5, 6.
 Ibid., 6.
 Human Security Report Project, Human security report 2012: sexual violence, education, and war: beyond the mainstream narrative (Vancouver: Human Security Press, 2012), 34.
 JT Kelly, et al., “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo: A Mixed-Methods Study,” Conflict and Health, 2011 Nov 2; 5:25, doi: 10.1186/1752-1505-5-25, 3.
 Hossain, et al., “Men’s and Women’s Experiences of Violence and Traumatic Events in Rural Cote d’Ivoire Before, During and After a Period of Armed Conflict,” 5.
 Ibid., 6.
 Human Security Report Project, Human security report 2012: sexual violence, education, and war: beyond the mainstream narrative (Vancouver: Human Security Press, 2012), 73.
 Kelly, et al., “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo,” 4.
 Ibid., 4.
 Ibid., 4.
 Ibid., 4.
 Ibid., 5.
 Supervie, et al. “Assessing The Impact Of Mass Rape On The Incidence Of HIV In Conflict-Affected Countries,”1-2.
 Ibid., 6.
 Kelly, et al., “Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo,” 5.
 Ibid., 4.