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The 2018 Nobel Peace Prize gives the issue of sexual violence global recognition. For survivors and those closest to them, this is a moment when things can finally change. But stopping sexual violence and helping those who survive it will require long-term individual and institutional commitments — much like those at work in Congo, which is one of the world’s most dangerous places to be a woman, according to some reports.

On Dec. 10, Denis Mukwege — who has led Panzi Hospital in eastern Congo since 1999 — and Nadia Murad received the Nobel Prize for their efforts to end the use of sexual violence as a weapon of war and armed conflict.

Our recent research in eastern Congo shows that this change does not come easily for survivors of sexual violence. Support programs can help survivors economically, but the biggest hurdle they face is social stigma. Survivors of sexual violence in war are shaped by those experiences long after the initial assault. Without community involvement and support, this barrier cannot be overcome.

One hospital’s response to rampant sexual violence

At Panzi Hospital, Mukwege has treated thousands of victims of the horrific violence that the ongoing conflict has brought upon civilian populations. Sexual and gender-based violence constitute a massive challenge, particularly in the eastern provinces.

Some of this violence is perpetrated by armed groups, but there also are significant levels of violence committed by civilians, as well as domestic violence. To this day, sexual violence is one of the many dangers facing women, children and also men in eastern Congo. As many as 7,500 cases of sexual and gender-based violence were reported during a nine-month period in 2009 in North and South Kivu in eastern Congo.

Panzi Hospital has earned a global reputation for treating survivors of sexual violence and complex gynecological injuries. A holistic model of care provides services that meet the full spectrum of survivor needs: physical recovery, psychosocial and emotional support, community reintegration and legal assistance.

A number of local initiatives aim to support survivors of sexual violence by including them in the community and helping improve their livelihoods, as well as empowering women and girls to improve their lives.

But when survivors return home, where the crime happened, reintegrating into their communities can be an enduring challenge. Economically, many survivors must start from scratch and support themselves and their children through small-scale farming, often with limited technical skills and poor access to information and training.

A number of follow-up support programs under the auspices of the Panzi Foundation concentrate mainly on helping women become financially independent and capable of taking care of themselves and their children. Beneficiaries of these programs receive various types of support, including loans, livestock, seeds, school fees for children, training in income-generating activities (for example, making soap or baskets) and literacy training. But does this approach work for women who are trying to rebuild their lives after sexual assault?

A study to explore what helps women cope

To understand how best to help women who have survived sexual violence, and whether support programs make a difference, we interviewed survivors in eastern Congo and surveyed more than 1,200 women about their experiences with two Panzi Foundation support programs for survivors of sexual violence: USHINDI and Dorcas Rurale.

Sexual violence has deep physiological and psychological health effects for the survivor, but it can also destroy family and community structures. Once a survivor of sexual violence leaves the hospital after medical treatment, she may also face stigmatization and rejection by her family and community.

One consequence for a survivor of sexual violence can be outright rejection by her husband. A woman we interviewed in Kavumu in South Kivu province told us, “When they raped me, I stayed in my house for seven months, I was ashamed and couldn’t approach other people.” Another woman said that, “When he [the husband] came back, he said I simply cannot take back a wife who has been raped…”

Another woman explained how women were rejected by their families: “For us who were both raped and whose husbands were killed, we were rejected by both our native families and by the families-in-law. We had to cope with our problems — poverty, misery, illnesses — by ourselves. We were considered as useless people.”

Overall, our survey results indicate that survivors of sexual violence feel less included across various social settings, compared with other women in the community. The programs we examined seem to significantly improve the participants’ perceived economic well-being — and are particularly beneficial for survivors in this respect. Overall, women report that they feel more socially included — but survivors of sexual violence are less likely to report this effect than women who have not experienced such atrocities.

Eliminating the experience of social exclusion for sexual violence survivors is a tall order for any support program. Our findings suggest that further research and programming is needed to actively engage the families of the survivors and the larger community to reduce social exclusion and stigma associated with sexual violence. One step might be to spend more resources on community-integration activities, such as the MUSOs (Mutuel de Solidarité), or “mutual solidarity groups,” in which survivors and their partners receive some economic assistance to start income-generating activities.

Another example is village savings and loan associations (VSLAs), which can help participants start their own business. VSLAs are groups of 25 community members living in the same area, all motivated to save a small amount weekly, and to grant themselves credit from the fund of which each member has bought a share. At the end of the annual cycle for each VSLA (and MUSO), the members — survivors of sexual violence and other community members, including men — divide up the dividends according to the shares purchased and can then go on to the next cycle. This integration of survivors of sexual violence may be effective in increasing feelings of social inclusion and reducing stigma.

Gudrun Ostby is a senior researcher at the Peace Research Institute Oslo (PRIO).

Christine Amisi is a researcher at the International Center for Advanced Research and Training, a doctor at Panzi Hospital and the executive director of the Panzi Foundation DRC.

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