(WOMENSENEWS)--Psychologist Adeyinka Akinsulure-Smith had spent several years working with trauma patients, but nothing prepared her for what she encountered in 2000 as part of a United Nations mission that sought to investigate the extent of sexual violence during Sierra Leone's civil war.
"When I first started working with victims of sexual violence, I thought sexual violence was limited to rape," said Akinsulure-Smith. "But there are so many aspects from forced penetration to being forced to watch things happen to other people to being forced to do things to other people. In war, rape can be a one-time event or it can happen many times or it can be one time with a number of people in various ways."
"The definition has expanded in my mind," she said.
Today, as a psychologist with the Bellevue/NYU Program for Survivors of Torture, a center in New York City that treats people from more than 70 countries, Akinsulure-Smith says that the deeper understanding of how rape is used as a tool of war informs her work.
She now goes "very, very slow" with clients that have directly suffered sexual violence in a conflict zone and does not expect them to be able to verbalize their experiences. "Some can never say the word 'rape.' Sometimes they can only write it down," said Akinsulure-Smith.
Like Akinsulure-Smith, many aid workers who encounter women who have been sexually violated during conflicts say they have become increasingly attuned to the nuances and extent of the crime. As a result, human rights groups and other non-governmental organizations that once considered rape a peripheral human rights and medical issue are now making it a priority.
On the medical front, organizations such as Doctors Without Borders now have built-in strategies for treating victims of sexual violence, while other relief organizations have designed local programs for women suffering from the long-term psychosocial consequences of rape. These advances emerged after the establishment of international tribunals to prosecute soldier-rapists following the conflicts in Bosnia and Rwanda. But human rights workers say that the judicial response has been too weak to prevent sexual violence from occurring in the numerous conflicts that have broken out since the mid-1990s.
Not a New Phenomenon
Sexual violence as a tool of war is not a new phenomenon. Japanese soldiers kept "comfort women" throughout the 1930s and 1940s; Russian soldiers raped German women at the end of World War II; and soldiers in Guatemala used rape against the indigenous Mayan population during a 40-year civil war that ended in 1996.
Over the past decade, soldier-rapists have employed sexual violence in such places as Kuwait, Kashmir, Sri Lanka, the Democratic Republic of Congo, Liberia, Chechnya and Sudan.
But it was the use of rape as a weapon of war in the high-profile conflicts in Rwanda and Bosnia-Herzegovina in the first half of the 1990s that served as a wake up call for the non-governmental organizations. In Rwanda, Hutu militiamen raped and sexually tortured an estimated 250,000 to 500,000 during the 1994 genocidal campaign of terror against the Tutsis. In Bosnia-Herzegovina, some 20,000 and 50,000 women were violated in an effort by the Serbs to "ethnically cleanse" the Muslims through forced pregnancy.
"During Rwanda and Yugoslavia, we didn't necessarily have the appropriate response for rape. We saw rape as a human rights issue, not a medical issue," said Christine Nadori, a program officer for Doctors Without Borders in Ottawa. "There was a real awakening," she said, in Doctors Without Borders and the NGO community that they needed to address the medical and psychosocial problems "more systematically."
This awakening coincided with steps the international community took to prosecute perpetrators of sexual violence in armed conflicts. In 1993, the United Nations Security Council established the International Criminal Tribunal for the former Yugoslavia. The next year the U.N. set up the International Criminal Tribunal for Rwanda.
Several initial indictments and the historic 2001 conviction of three Bosnian Serbs for rape as a crime against humanity raised hopes that these courts would aggressively go after the perpetrators of sexual violence. But the tribunals have not gone far enough to investigate and prosecute sex crimes, many human rights experts say.
Meanwhile, aid workers on the ground have grown increasingly aware of the many different consequences of sexual violence in war zones. The realization, for instance, that soldier-rapists often have a high incidence of AIDS, particularly in Africa, convinced medical health workers that a systematic approach was all the more imperative.
"Some forces in Africa are 80 percent HIV-positive," Nadori said. "They're killing machines."
Medical Program to Deal Directly with Sexual Violence
In 1999, during the internecine conflict in Congo-Brazzaville, Doctors Without Borders began its first medical program to respond directly to sexual violence, setting up a clinic specifically to treat rape victims.
Since then, Doctors Without Borders has integrated rape treatment into its operating procedures so that all staff members are prepared to treat women, men and children who have been sexually violated during conflict.
In addition to treating the physical injuries resulting from sexual violence, doctors and nurses working in clinics in war zones now routinely provide victims with the morning after pill as well as with prophylactic medications that can treat or prevent sexually transmitted infections, including HIV.
Doctors Without Borders also sensitizes their local staff members about the issue of sexual violence, educating them about the importance of addressing rape even in a place like Sudan, where discussing such violence is taboo. In addition, the organization takes care to make sure that there are enough women working in a clinic as well as an appropriate place where victims of sexual violence can go to disclose their stories.
"Now, people have their sexual violence glasses on. We understand that treating sexual violence needs to be just as important as providing water, food and medical care," Nadori said.
Rape as a Tool of War
Over the years, as agencies have become attuned to sexual violence, aid workers say they have also learned a great deal about the various uses and consequences rape as a tool of war may have.
Sophie Read-Hamilton, a gender-based violence strategy advisor for the International Rescue Committee, a refugee relief organization based in New York, said that during the past decade soldiers in some conflicts have used rape as a tool of "ethnic cleansing," while in other conflicts, such as in Darfur, Sudan, rape is used to terrorize people and force them to flee. And, in some wars, soldiers view women as "war booty."
Read-Hamilton said the consequences for the victims differ from country to country. In Sierra Leone, for example, rebel fighters branded the women they raped, making it difficult for their victims to blend back into society. But in Liberia, where the stigma of rape was not as great, rape victims have had a somewhat easier time coping with the trauma, she said.
"The after-effects can be different," said Read-Hamilton. "In some places like Darfur, the level of stigma and shame is so high that people can't even talk about rape."
Understanding such cultural nuances has enabled relief groups to better respond to the needs of the communities where rape occurs, said Read-Hamilton, noting that it is often important to garner the support of local women for treatment efforts. These women are often brought in and trained to serve as community liaisons.
No End in Sight
Yet, while relief experts may be better equipped to respond to victims of sexual violence, they say no end to the problem is in sight.
Although some courts have the legal authority to investigate and prosecute sex crimes and western governments are well aware that sexual violence is regularly used as tool of war, human rights experts wonder whether the international community will ever go after soldier-rapists at a rate that matches the scale of the crimes.
In Human Rights Watch's 2004 World Report, researcher LaShawn R. Jefferson wrote dejectedly about the escalation in the use of sexual violence as a tool of war and raised several questions that have yet to be answered.
"At the start of the 21st century, with some of the most horrific known examples of sexual violence during armed conflict taking place before our very eyes, we have to ask why wartime rape recurs with such alarming predictability," Jefferson wrote.
"Why are women so consistently targeted for this specific type of assault? Ultimately, can wartime sexual violence be prevented?"
Jennifer Friedlin is a writer based in New York.
For more information:
Doctors Without Borders:
Bellvue/NYU Program for Survivors of Torture:
International Rescue Committee:
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