Rape with Extreme Violence: The New Pathology in South Kivu, Democratic Republic of Congo

On any given night in eastern DRC, armed groups of men will overrun a village and divide into bands of three to five, forcing themselves into houses where they seize and serially rape women and young girls. Some mutilate female genitals with guns, pieces of glass, wood, or heated plastic. Some take their victims to the forest and torture them as sex slaves for days, months, or years. As Stephen Lewis, the former UN special envoy for HIV/AIDS in Africa has said ([1, p. 32]), ‘‘the capacity for brutality by so many perpetrators – and on the flip side, the capacity for indifference by so many witnesses – is the ugly apex of a trend gone unchecked.’’ This ugly apex has characterized the sexual violence landscape throughout history, across cultures, during times of conflict, and behind closed doors. It is in wartime, however, that rape becomes a coordinated, deliberate, en masse weapon of terror. Systematic rape is now understood as the defining tactic of modern conflicts [2]. The mass rape of hundreds of thousands of women have been reported in Europe and Nanking during the Second World War [3], Bangladesh [3], Rwanda [4], and the former Yugoslavia [4]. In both Rwanda and Yugoslavia, the International Criminal Tribunal has recognized rape as a means of ethnic cleansing and genocide [5,6]. The ongoing violence in the eastern DRC is exemplary of the use of rape to not only terrorize, displace, and demoralize, but also to deliberately incur severe sexual trauma on a level that merits analysis in and of itself. This tactic has escalated over the past ten years in eastern DRC with impunity, garnering little international attention or response. The latest figures estimate 1,100 rapes per month as assessed between November 2008 to March 2009 [7]. One of us (DM) is a gynaecologist and obstetrician who has been treating sexual violence survivors in South Kivu for a decade and as such is a first-hand witness to the brutality and scale of this kind of rape. The purely destructive and sadistic behaviour perpetrated by different armed groups signals a new pathology in South Kivu that we classify as rape with extreme violence (REV). In this article, we document the medical consequences of REV through the lens of the Panzi Hospital in Bukavu, South Kivu, one of the few established medical centres that has the capacity to treat REV cases. In the ongoing conflict of the DRC, much remains unknown and undocumented; we draw heavily on a few reports by nongovernmental organizations (NGOs) and other observers about the use and impact of rape in the DRC, and on our own extensive experience in the field.