A woman arrives at a health centre somewhere in the Democratic Republic of Congo (DRC). She was raped a few days ago. She does not feel well, she has pelvic pain and she fears she might be pregnant. While admitting her, the consultant asks her a series of questions: Where are you from? What religion are you? What ethnic group do you belong to? What do you do for a living? Do you have any children? Are you married? What happened? When? How? Who did it? What ethnic group did they belong to? How many of them were there? Can you estimate their age? Did they give you money or food for having sex with them? The answers to these questions are then noted down in a standardised intake and initial assessment form, one of the tools used in the Gender-Based Violence Information Management System (GBVIMS).+The GBVIMS was developed by UNHCR, UNICEF, the UN Population Fund (UNFPA), WHO and the International Rescue Committee (IRC). It is in place in several humanitarian settings, including the DRC. See http://www.gbvims.com. The consultant may be skilled enough and have enough time to obtain this information without transforming the first contact with the victim into an interrogation. Yet a legitimate reaction on the part of a person who has come seeking care would be: Why are you asking me this? especially questions about the alleged perpetrator.
Context: perpetrators in the spotlight
Rape is a crime under international law. It is also recognised by the UN Security Council as a threat to international peace and security in Resolution 1325, adopted in 2000. A central component of the UNs strategy for preventing conflict-related sexual violence is addressing impunity and identifying perpetrators. In UN Security Council Resolution 1960 of 2010, the Secretary-General is asked to provide detailed information on parties to armed conflict that are credibly suspected of committing or being responsible for acts of rape or other forms of sexual violence, and to list the parties that are credibly suspected of committing or being responsible for patterns of rape and other forms of sexual violence in situations of armed conflict on the Security Council agenda. Under Resolution 1820 of 2008, NGOs, human rights organisations, UN agencies, civil society groups and healthcare providers are specifically requested to enhance data collection and analysis of incidents, trends and patterns of rape, and Resolution 2106 (2013) requires them to contribute to more timely, objective, accurate and reliable information on sexual violence. This concern is reflected in the Comprehensive Strategy on Combating Sexual Violence in the DRC, adopted by the Congolese government in 2009.+Comprehensive Strategy on Combating Sexual Violence in the DRC, http://monusco.unmissions.org.
Numerous reports and research articles by NGOs, human rights organisations, peace institutes and academics explore the issue of sexual violence in the DRC from a variety of angles: the profiles of the perpetrators, the proportion of members of the military amongst them and their motivations. This last aspect aims to determine what objectives, other than the sole fulfilment of sexual desire by force a motivation that does not fit with the strategic rape theory, the dominant leading explanation for war rape since the conflict in Yugoslovia+Jonathan Gottschal, Explaining Wartime Rape, Journal of Sex Research, vol. 41, no. 2, May 2004. The strategic rape theory takes for granted that war time rape is a coherent, coordinated, logical and brutally effective means of prosecuting warfare. are being pursued through rape: destruction, humiliation, punishment or revenge against the enemy. Research in this area usually reaches the same conclusion, namely that more research is required to respond to the same unanswered question: to understand the motives that drive perpetrators to commit such brutal acts of violence in a systematic manner [by] comparing the experiences and attitudes of multiple militias in order to better understand how behaviors around sexual violence vary amongst groups,+Now, the World Is Without Me, Harvard Humanitarian Initiative with the support of Oxfam America, April 2010, http://www.oxfamamerica.org/publications/now-the-world-is-without-me. or to elucidate the links between soldiers perpetration of, command-structure attitude toward, and motivation for sexual violence.+Jocelyn Kelly, Rape in War: Motives of Militia in DRC, United States Institute of Peace, June 2010, http://www.usip.org/sites/default/files/resources/SR243Kelly.pdf.
Data collection during case reporting
This article considers observations made during a field visit in July 2013 to a Médecins Sans Frontières (MSF) project for victims of sexual violence based in the general hospital in Rutshuru in North Kivu. For MSF, collecting information on sexual violence is part of the daily routine of medical staff dealing with victims of this type of assault. It is generally understood at MSF that the information collected serves three main purposes: to ensure appropriate patient care, for programme monitoring and for advocacy.
Data collection and patient care
MSF has been running activities at Rutshuru hospital since 2005. When a victim of rape usually a woman arrives at the hospital, her account of the assault is noted down by a nurse in a medical file. When she has finished her description of what happened, the consultant asks her for clarification and additional information. Besides determining her medical history in order to adjust her medical care, a certain amount of information is needed to guide the victims case management. When did the incident happen? Was the victim injured in the assault? Is there a safe place for her to go? Does she intend to report the assault to the police? Has she talked about the assault with a person close to her? Can she provide for her own needs when she goes home? How does she feel?
The answers to these questions help the medical staff provide the victim with better and more appropriate care. In addition to a standardised health package, which includes prophylaxis against sexually transmitted diseases and tetanus as well as hepatitis B vaccinations, treatment is provided for any injuries sustained and HIV prophylaxis and emergency contraception are offered if the assault occurred less than three days previously. MSF staff also help to find somewhere safe for the victim to live, as well as giving short-term assistance (money, food, shelter, clothes) for the duration of the treatment so that material constraints do not prevent the patient from receiving adequate followup. If deemed necessary, the patient will also be referred to the psychologist assigned to the programme.
To ensure appropriate case management, information about the perpetrator is also needed. For example, should the perpetrator be close to the victim, i.e. someone who lives with her or nearby (which is the case for 10% of victims under 13 years of age admitted to MSFs Rutshuru programme), discussions between the victim (or his/her caretaker), the consultant, the psychologist and the social worker (usually all national staff ) can help keep the victim from further harm, for instance by offering a bed in the hospital for the night or paying for the rental of accommodation while family arrangements are made, or even helping the victim to relocate permanently.
An integral part of a victims case management is the establishment of a medical certificate, upon the victims request. The certificate, which is signed by a doctor, establishes and certifies the existence of injuries or trauma and reports the victims account of the assault. However, characterising the offence or giving information on the perpetrator is not deemed part of a doctors expertise in any legal process.
Data collection for programme monitoring
From the narrative of the assault, the consultant also extracts information that will later be translated into statistics regarding the circumstances of the assault: recurrence, physical assault, place, date; the profile of the perpetrator(s) (number, civilian/non-civilian), weapons and types of weapon; and the profile of the victim (age, sex, resident/displaced person, marital situation, number of children to support). Some of this information is needed to identify patterns that may lead to programmatic changes. For example, analysing the number and frequency of assaults by location or area may indicate a need to modify service coverage. In 2006, when the number of cases admitted to Rutshuru from the Birambizo health zone rose significantly (up to 70% of total monthly admissions), MSF opened another project in Nyanzale.
Demographic data on the age and sex of victims can also be useful when aggregated. For example, by monitoring the number of males coming to the Rutshuru programme every month it became clear that sexual violence against males especially boys and teenagers was commonplace (males accounting for 3% to 5% of victims since 2010). This led to a change in the messages relayed during outreach activities, and the programme was adapted to include men as possible victims, not just as perpetrators. Identifying a significant proportion of young children in the programme enabled MSF to adapt medical examinations and psychological care to this specific group.
With regard to the perpetrators profile, the distinction between known and unknown is much more relevant than that between civilian or non-civilian for programme monitoring. Desertion from the army is extensive; attempts to reintegrate combatants into civilian life have been numerous; self-defence groups organised by local leaders arming rural young men are commonplace. In this context, what does civilian mean? The distinction can vary according to the interpretation of the victim or the staff member: some will identify a non-civilian by the fact that he was wearing a uniform or carrying a weapon or because of his alleged links with a particular armed group.
Data collection for advocacy
Within MSF, the definition of the type of data needed for advocacy purposes can be as vague as the purpose of the advocacy itself. Nevertheless, two main approaches can be distinguished. The first involves making local appeals to actors the UN, government forces, non-state actors believed to have an influence on levels of sexual violence in a given area. For example, MSF issued a press release in January 2013 describing a significant increase in the number of victims being treated in its clinic in Mugunga III camp near Goma, and appealing for action on the part of those responsible for protecting civilians and improvements to the poor security conditions in Goma camp.+DRC: High Levels of Sexual Violence in Goma Camps, Press Release, 16 January 2013, http://www.doctorswithoutborders.org/press/release.cfm?id=6566. The number of incidents was the only element used to back up this appeal, which was exclusively aimed at improving security, not naming and shaming perpetrators. The appeal was used by the MSF head of mission to open a direct dialogue with the UN mission MONUSCO, government forces and M23 rebels, and to raise concerns about insecurity in the camp.
A more global approach to advocacy is used in attempts to tackle the root causes of sexual violence in the DRC. Underlying assumptions can vary widely from one MSF team to another, depending on their particular rape theory. But the belief common to proponents of this type of advocacy is that sexual violence in the DRC has an underlying cause. Hence the insatiable quest for data in the hope that adding and cross-referencing information will reveal the reality, when in fact the only power data has is to describe it. Collecting data while caring for survivors of sexual violence is necessary to guide their case management and ensure that the programme remains relevant and effective. Speaking out can also be an effective advocacy tool, especially in the case of a specific large-scale incident perpetrated by a particular group. But the conviction that the best way to tackle sexual violence in the DRC is to understand its root causes can lead to too great an emphasis on collecting information on the perpetrators and their motives, and not enough on addressing the needs of the victims. As helping the survivors of attacks to recover should be the first priority of those responding to sexual violence, the focus should be on collecting and analysing data which enables them to do this better.
Claire Magone is Director of Studies at the Centre de réflexion sur laction et les savoirs humanitaires (CRASH), Médecins Sans Frontières.