Healing the wounds of war at Panzi Hospital, South Kivu

When Anna (not her real name) came to Panzi Hospital in South Kivu, in the Democratic Republic of Congo, she was in her 40s and pregnant. She had been married with six children, four girls and two boys. One of the 20 armed militia roaming around the South Kivu region came to her house, tied up the males, and proceeded to rape Anna and her four daughters in front of her husband and other children. One of the boys was able to untie himself and attacked the rapist, who shot him. The four daughters were raped, then killed.

The militia took Anna, her husband and youngest son into the forest, where her husband was murdered. By the time Anna got to Panzi Hospital, she was in a fragile condition - she was malnourished, had open genital wounds from the repetitive rapes she endured while captive, and she was pregnant as a result.

When she gave birth, she decided to keep the baby, said Denis Mukwege Mukengere, gynaecologist and director of Panzi, as he recounted Anna’s story. Panzi Hospital is the only one of its kind in the country that specialises in helping victims of sexual violence.

"It is a big strain as a woman to keep a child born from rape," said Mukengere. "And the father of this child killed her husband and five of her children."

Rape as a weapon of war

Anna is just one of the 10,000 women treated at his hospital since its founding in 1999, when Mukengere saw rape and sexual mutilation cases rise rapidly as various rebel factions and DRC government troops used and continue to use rape as a weapon of war.

"The objective of the rapists is not sex. They want to destroy a person. They don’t kill, they destroy," he said.

There are a number of ways to do this, according to the numerous stories he has heard. First, most of the rape used as a weapon of war occurs in front of the community and the woman’s husband, who is also humiliated because he is forced to watch and is powerless to do anything.

"Then, once they have been raped, the [rapist] proceeds to mutilate the genitals of the woman, either by gun or knife, which provokes a fistula between the bladder and the vagina," said Mukengere.

"The objective is to destroy the woman, the woman who is already destroyed on a psychological level, on a physical level, and also risks becoming infected with HIV," he added. He said the HIV infection rate for the women who come to the hospital is about five percent. Although this seems low, most of the women treated at the hospital come from rural areas, far from cities where HIV is more widespread.

Fistula repair

When the women come to Panzi, where treatment is free, many will have waited months to save enough money to pay for some sort of transport to the hospital. Others have walked many kilometres, some with rags between their legs to catch the urine, faeces and blood that drips as a result of their injuries.

Mukengere has been practising gynaecology in the region for 20 years, but over the past six years he has dedicated himself to fistula repair and trains other doctors in the procedure. With the ravages of civil war coming to his operating table day after day, it perhaps would be easier to practise somewhere else.

"I cannot turn my head from it," he said, adding, "I would be a coward to turn away when I know I can help." He does admit that to be effective, he must concentrate on physically helping the women, and leaves the psychological repair and re-integration process to caring professionals on his staff.

"At one point, I became fragile and was affected psychologically," said the married father of five children. "It is hard if the patient is crying and you’re crying as well. And the patient is looking for support. If they see the doctor crying, they don’t have any more support," he said.

Patients need and receive psychological help at Panzi, but the physical healing is also an extremely long process, according to Mukengere.

"When you see that a woman has been shot in the vagina, with a destroyed bladder and destroyed rectum, you have to do a colostomy," he said. "The genital area needs to be cleaned up, as it has been soiled by dripping faecal matter, which takes two to three months. Then the genitals, the urinary tract and the digestive tract need to be operated on. Some women need five to six surgeries," he added. Some may never recover from their wounds.

Fistula operations are quite delicate, and if the procedure does not work the first time, the operation needs to be repeated, sometimes two or three times. Mukengere estimates that 10 percent of all fistula patients do not heal - about 150 of the 1,500 he has performed.

"Their husbands leave them, as they continue to drip urine and faeces. Nobody wants them. Reintegration is extremely difficult," he said. Part of the psychological counselling is to explain to the husbands the healing process and to help them understand and deal with the tragedy as well.

Healing

In the DRC, one non-governmental organisation reported 41,000 cases of rape, a total of 21 rape cases a day, according to Jan Egeland, the United Nations Emergency Relief Coordinator. Egeland brought it up with newly elected President Laurent Kabila in Kinshasa, who told him before the balloting that if elected he would go to Panzi Hospital and declare an offensive against sexual abuse in Congolese society.

Kabila also promised Egeland that the cultural of impunity would be over, as he would "ensure that people are immediately fired [for sexual abuse] when they are overseeing government armed forces, and government employees, [as well as] any government institution having men involved in sexual abuse. I will hold him to his promise," Egeland added.

Mukengere is optimistic that the practice of using rape as weapon of war will be abolished and the cycle of impunity will end soon. He has noticed a change not only in the media, but in Congolese society.

"In 2000 … most people did not want to hear about vaginal repair, and it was something that was not talked about. Now women understand that if they do not talk about it, they could be marginalised anyway, and they may die of fistula. It is better to talk about it so they can be helped," he said.

Civil society must come together, according to Mukengere, to condemn the rapists by imposing social sanctions on them, not punishing the victim of the tragedy. "These laws need not only to be passed, but to be enforced," he said, adding that with the help of international human-rights groups, we can say, "never again" to rape as a weapon of war.

lab/mw