Responding to Congo’s epidemic of violence against women

The rape itself was brutal enough, but the woman’s nearly severed hand shocked Susan Bartels.

It was early November and her first day working at Panzi Hospital in Bukavu, a provincial capital in the eastern Congo on the front lines of an epidemic of violence against women that — as it did in this case — starts with rape and goes on from there.

Those that don’t die of their wounds tell stories of horrific atrocities, of gang rapes, of beatings, of stabbings, of violation with gun barrels and pieces of wood; of husbands, fathers, and sons being beaten, forced to watch, or lying dead nearby. They tell of kidnappings and sexual slavery, all perpetrated on women and girls no matter their age.

Panzi Hospital stands as an oasis amidst the brutality, taking in about 10 women a day, of whom a third need major surgery. Many have their insides damaged, bleeding; many are unable to bear children; many are incontinent.

Yakin Erturk, a special rapporteur of the United Nations Human Rights Council on Violence against Women, declared in July that South Kivu Province’s sexual violence was the worst she’d ever seen. Erturk said there were 4,500 reported cases of sexual violence in the first six months of 2007, but that the actual figure is likely significantly higher. In October, Erturk told the United Nations General Assembly that the sexual violence in South Kivu amounted to war crimes and crimes against humanity.

To Bartels, the atrocities she had heard about, read about, and decided to do something about gained a human face that November day in Panzi Hospital. As she examined the woman, Bartels couldn’t tell if the wound was intentional or not, perhaps inflicted as part of the brutal “branding” practiced by some of the armed groups that plague the region. Though the hospital’s doctors discussed amputation, they eventually managed to save the woman’s hand. Had she lost it, it would have hurt her ability to work in the fields and, possibly, even to marry. 

“Women sustain injuries in the struggle to resist, but this seems so extreme,” Bartels said.

Bartels, an instructor in medicine at Harvard Medical School, emergency room
doctor at Beth Israel Deaconess Medical Center, and affiliated faculty
member of the Harvard Humanitarian Initiative (HHI), and University of Illinois gynecologist Megan App were at Panzi Hospital for two weeks in early November, the second team sent by (HHI) to help the hospital’s doctors.

HHI Panzi Project Director Julie VanRooyen said the project began in November 2006, after she met with Panzi Hospital founder Denis Mukwege Mukengere and heard about the work he does there.

“If you meet him and hear what he’s doing, you can’t go back to doing what you were before,” VanRooyen said. “Girls as young as 6; an 11-year-old repeatedly gang-raped for a period of months. It’s not just rape, it’s cassava roots, sticks, knives, guns. These women come in with shredded pelvises. … You see and hear the most awful things you can imagine. It’s really hard to get your head around them.”

Founded in 1999, the hospital was established in response to the violence that convulsed the region in the wake of the Rwandan genocide. The fighting grew into a Congolese civil war that killed more than 3 million and involved so many nations it has become known as “Africa’s World War.”

Although the political war ended in 2002, its tremors continue to be felt throughout the eastern Congo, where numerous armed groups, including militias, rebel factions, and government troops continue to be active. Many of these armed groups have been implicated in the region’s sexual violence, making the problem even harder to address.

VanRooyen said the Harvard Humanitarian Initiative plans to build the capacity of the hospital by providing high-level surgical support for the region’s doctors. HHI teams will travel to Bukavu regularly, with the goal of having one there every month. Further, VanRooyen said, the initiative is interested in broadening its work beyond the hospital, perhaps in collaboration with other humanitarian organizations. Though plans have not yet been made, the HHI is considering how to address the root causes of the violence and provide additional help to victims across the region.

Bartels and App returned Nov. 18 after two weeks in Bukavu. There, App conducted reconstructive surgery while Bartels, an instructor in medicine at Harvard Medical School, emergency room doctor at Beth Israel Deaconess Medical Center, and affiliated faculty member of the HHI, conducted training sessions for local doctors, tended patients whose ills were nongynecological, and began reviewing hospital files to better understand the region’s sexual violence.

App performed one or two surgeries each day in one of the hospital’s three operating rooms. She gave the local doctors high marks for their abilities in performing the gynecological surgery that is so often needed there, but said they weren’t as adept at handling cases where there are complications from the surgery.

The conditions at the hospital were worse than App had expected. They were crowded, with two surgeries going on at a time in each operating room, separated by only a screen. The equipment was old and liable to break, leaving patients with no options. For example, said App, the hospital has broken X-ray machines and a broken respirator. Even simple equipment was problematic, she said, telling of a clamp that broke in her hand and sutures that were the wrong size for the surgery.

“If someone needs a ventilator (respirator), they don’t have one, so that patient will die,” App said. “There’s an endless stream of women. I feel like there’s no light at the end of the tunnel.”

Bartels and App flew into the Rwandan capital of Kigali in early November and drove to the border. They crossed into the Congo on foot, met a driver from the hospital, and drove into Bukavu. A city of about 250,000, Bukavu perches on hills that line the shore of Lake Kivu and spills down onto a series of peninsulas that jut into the lake like fingers.

The two stayed in a guest house in a walled compound and traveled the dirt roads back and forth to the hospital. The trip was sometimes trying, as the daily rains turned the dirt into mud, slowing traffic on Bukavu’s hills. Though the area remains unsettled, Bartels said she didn’t feel unsafe, despite the presence of guards at both the guest house and the hospital.

The two were picked up daily before 7 a.m. and driven to the hospital in time for a morning prayer service, held for patients and hospital staff alike. After that, they went with the other doctors and nurses to “morning report,” where Mukwege talked about the new cases that had arrived.

Bartels’ lectures proved very successful, she said, with the local doctors hungry for knowledge about EKGs, cardiology, and other topics that she had prepared. Her review of the sexual violence cases showed that most of the women were not attacked at locations away from home, such as when they went for water, as Bartels had previously thought, but rather at night in their own houses, and usually by a uniformed assailant.

“Even in their own homes, they’re not safe,” Bartels said. “The brutality of it is mind-boggling.”