More Vicious Than Rape

The worst perpetrators call themselves the Federation for the Liberation of Rwanda. They were the Hutu militiamen—also known as the Interhamwe—who carried out the 1994 Rwandan genocide. That bloodbath ended when the Interhamwe were forced to retreat across Rwanda's western border into Congo, where they remain to this day, deep in the forests, armed, deadly and with nowhere else they can go. But the tactic of violent rape is used by many of the other armed factions in the area, including the Congolese Army, according to relief workers and United Nations officials. "It has been used as a weapon of war for so long it's become almost a habit," says Ross Mountain, the U.N.'s humanitarian coordinator for the Congo. "All sides are doing it, and the national army is by no means immune from that." "All the armed men rape," says Doctor Mukwege. "When we see a lesion, we can tell who the perpetrator is; there are special methods of each group, types of injuries. The Interahamwe after the rape will introduce objects; a group in Kombo sets fire to the women's buttocks afterwards, or makes them sit on the coals of a fire. There's another group that specializes in raping 11-, 12-, 13-,

14-year-old girls, one that gets them pregnant and aborts them." The youngest victim of fistula from rape his hospital has seen was 12 months old; the oldest, 71.

The fistula wards at HEAL Hospital are overflowing, with two women to a bed and patients tucked into every possible corner in the 150-bed center. Doctors there say two-thirds of their hospital's fistula cases are the result of sexual violence. Since 2003, when the hospital had to be completely rebuilt after a volcanic eruption buried the town in lava, HEAL's doctors have seen 4,800 rape victims requiring medical treatment; last year alone, surgeons there performed 242 fistula-repair operations. Panzi Hospital, in the town of Bukavu, some 70 miles southwest of Goma, is an even bigger medical center specializing in fistula surgery and treating rape

victims. Its surgeons did 540 fistula repairs last year; its two fistula wards, 25 beds each, are usually full. Doctor Mukwege estimates that 80 percent of his hospital's fistula cases are the result of sexual violence, either directly from sexual assault or from rape-induced pregnancies that were forcibly aborted in the bush; the rest were normal obstetric complications. "It's an epidemic," he says.

Panzi is running at capacity, with 250 to 300 admissions a month due to rapes, most of them new cases. Other hospitals run by aid groups in eastern Congo report similar statistics; the Medecins Sans Frontieres Bon Marche Hospital in Bunia, in war-torn Ituri province, northeastern Congo, normally admits between 10 and 20 rape victims daily—a minimum of 300 a month—again, mostly new cases, according to MSF officials there. "IRC and its partners in South and North Kivu provinces registered 40,000 cases of gender-based violence [since 2003], and we're not even counting everyone," says Brian Sage, a coordinator for the International Rescue Committee, which helps support both Panzi and HEAL hospitals. "This is just the tip of the iceberg." Many more cases take place in the interior where aid workers still haven't reached. When Doctor Mukwege sent a mobile team under U.N. protection to the village of Nzingu, the group was prepared to treat 200 rape victims. Instead, 1,400 women came forward asking for medical help.

The only hope for these women is a difficult operation. It usually takes several hours, followed by a recovery period of two or three months. Even then, the doctors may have to try again. Sometimes the surgeons never manage to restore the patient's continence. "We've had a hundred fistula cases where there's no hope of recovery," says Doctor Mukwege. "We tried and tried but were unsuccessful. Psychologically, it's difficult to bear these cases. They come in here with great hope, it's very difficult for them but also for me, they come full of hope, it's so difficult to bear." Last April, he says, a 5-year-old girl was brought to him. Her tormentors had raped her and then fired a pistol into her vagina. She was operated on twice at Panzi Hospital without success before being sent to a hospital in the United States where surgeons tried twice more to repair the damage. They failed, too. She'll spend the rest of her life with a colostomy bag.