The psychosocial consequences of sexual violence: MSF report eastern DRC


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"During the day I never think about this incident, but at night I suffer from insomnia and nightmares, as soon as I recall the incident. Often that moment flashes back to me in my dreams and I wake up and have to pray to try and fall asleep again." 17-year-old girl one month after she was raped in November 2003

"The unending cycle of violence against the civilian population often triggers new violence. Helplessness, frustration, and anger are often acted out in the community or in the family system. It may mean the start of a new cycle of violence," says the MSF psychologist in Baraka.

The psychosocial and emotional effects of the traumatic events associated with sexual violence are many.

The women and the men in Baraka displayed a number of signs of psychosocial problems. Some took the shape of mental health disorders whereas others surface in less obvious ways such as shame, guilt, sleeping problems, difficulties in daily functioning and withdrawal.

Women and men expressed to MSF their ongoing fear, anxiety, intrusive memories, and flashbacks, which are rooted in their experience of the fear of being killed or mutilated. Other patients have complained about a constant feeling of being ill, low appetite and disappearance of sexual desire. Acute heart palpitations are symptoms of anxiety and daily functioning is often disrupted by the fatigue caused by nightmares and other sleeping disorders.

To restore self-esteem
"One day around noon I had gone to the fields with my husband and two of my daughters. It was in May 2003 As we were cultivating, six armed men appeared all of a sudden in front of us. They caught my husband and they just killed him, right there in front of my children and me. It was not over though; two of the men violated me. One after the other, they climbed onto me. The children were crying. I lost consciousness. I was half dead. My children and I spent the night there in the fields, beside my murdered husband's body.We cried all night. At some point, some hunters appeared and helped us go back to our home. It had been looted in the meantime. Since then, I feel a lot of pain in my left leg. I can barely stand up and I suffer from vaginal pain. I often have nightmare, and so do my children - they are scared, they don't want to go back to the fields anymore." 40-year-old woman, November 2003

In the psychosocial sessions conducted by MSF, several important issues were addressed. People received an explanation for their symptoms. It turned out to be very important for most survivors that rape is considered legally as a crime punishable even in international courts. The setting of the psychosocial services enabled women to express (some for the first time) what they endured. They shared their beliefs and received acknowledgement for their suffering but also obtained re-assurance, practical advice, and dilemma counselling.

Since the objective of the psychosocial intervention was neither to heal nor to cure but to reinforce or restore coping mechanisms and self-control, the psychotherapist focused the support on the instruction of self-help mechanisms like relaxation and breathing techniques. The survivors of sexual violence also learned to mobilise their social network.

Based on the reaction of the survivors and their family members, MSF has found that despite the short intervention (mostly one session) those who received the counselling are on the road to recovery because they have broken the silence and asked for help, and are now engaged on an often terribly long road to access it.