Extent of Violence Against Women Surfaces as Fighting Recedes

BUKAVU, Congo -- She walks slowly in padded slippers inside a hospital ward. Bohoro Nyagakon is a woman with gentle eyes and a frail five-foot frame, with a friendly 5-year-old daughter playing nearby. She is waiting in this cramped room -- with dozens of others -- to undergo a harrowing procedure: reconstruction of her vagina.
Gang rape has been so violent, so systematic, so common in eastern Congo during the country's five years of war that thousands of women are suffering from vaginal fistula, leaving them unable to control bodily functions and enduring ostracism and the threat of debilitating lifelong health problems.
Around the world, cases of ruptured vaginal tissue are usually caused by early childbirth and seen in such African countries as Ethiopia, Nigeria and Mali, where brides as young as 12 are too small to give birth. What makes the fistula cases in Congo so jarring to medical professionals here is the large number of them caused by rape.
In the past few months, as a peace agreement has taken hold and fighting has slowed, the extent of the brutality has become evident, physicians say. There are so many cases being reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat.
"There are thousands of violated ladies showing up. It's like nothing we have ever seen anywhere in the world," said Jo Lusi, head of a Congolese-run hospital in the eastern city of Goma that is working with the U.S.-based aid group Doctors on Call for Service.
"We are here repairing an organ that is so important to women and to our country and to our dignity," Lusi said. The U.N. Children's Fund is building a special ward at the hospital for women suffering from fistula and other effects of rape. "Imagine, that this is what the war in Congo has come to. What could be more terrible for our women and our families?"
Village health posts are reporting far more cases than those arriving at hospitals, because journeys from the country's interior are long and difficult, according to health care workers at the British aid agency Merlin.
"I think we are addressing the tip of the iceberg because access to health care is so limited," said David Tu, a doctor at the Bukavu branch of Doctors Without Borders-Holland. "For every one case there could be 30 more in the rural areas that we aren't hearing about."
Still, doctors say hundreds of women have arrived in recent months in Goma, Bukavu, Shabunda and several other cities in eastern Congo to wait for an operation that will deliver them from life as a village recluse -- unable to work, or to have children or sexual relations. Many local women's groups have joined to help the women make the journey by foot through miles of jungle to city hospitals. Some patients go through three or even four painful operations -- each requiring 21 days of bed rest. Each operation costs about $300 but is paid for through international donations.
In Congo, it is often said that women have paid the highest price in the war that began in 1998, pitting government forces against rebels backed by Uganda and Rwanda. Young soldiers from the dozens of factions that roam eastern Congo -- wired on cocaine, drunk from palm wine -- have turned rape into a primary weapon of war, as common as looting or setting a hut afire. Rape has even been encouraged by commanders as a way to gain control of such scarce resources as food, water and firewood, intimidating the women on a continent where women do nearly all the labor in the fields.
An estimated 3.5 million people in Congo have died in the past five years, mostly from disease and starvation. Rape has become so prevalent that some aid groups estimate that one in every three women are victims. With Congo lacking a functioning court system, no one has been punished.
But there has been a remarkable response by women around eastern Congo, who at times have launched spectacular -- and, in Africa, unheard-of -- protests to bring attention to the issue.
In March, for instance, hundreds of women stripped naked in the center of Goma and challenged thousands of dumbfounded onlookers, mostly men.
"If you are going to rape us, rape us now, because this must stop today," Mama Jeanne Banyere, head of the Federation of Protestant Women in Goma, recalled telling the crowd.
As the men stood watching, the women chanted that they would no longer accept rape in the community. They demanded health care for women suffering from fistula, who were being abandoned by husbands and ostracized by the community.
"So many women have it and so many were raped. Some were even raped by men sticking branches and guns up their vaginas," said Banyere. "We couldn't just cry. Everywhere in the country there are women crying because of this. We had to fight back."
After the protest, the health care workers at Doctors on Call for Service moved quickly to find Congolese physicians who could perform the operations for fistula patients. They predicted in April that they would need to perform only 50 such surgeries. Instead, they have done more than 150 of the operations.
Inside a ranch-style complex of wards, 55 women are housed under white tents in what used to be the hospital's garden. Girls as young as 8 and women as old as 73 sat on small wire cots wrapped in gray blankets donated by UNICEF. All had been raped and were undergoing counseling for trauma. Some said they considered killing themselves after surviving multiple rapes. Some had puddles of urine under their seats because of their condition.
A vast majority of the women in the tents were waiting for operations, sometimes a second or third procedure. About 10 more women arrive each week, doctors said.
Nyagakon, 30, was waiting for her third procedure at the Panzi Hospital in Bukavu, capital of South Kivu Province. The story of how she arrived here began on May 12, 2002, when rebel fighters demanded that she disrobe in her home. It was 8 p.m. She was eight months pregnant and had finished a long day of cooking and washing. She was resting in the sitting room of her small hut.
"Five of them came at me. I closed my eyes. They told my husband to get in another room and they held him down. They were shouting that they would kill him," she said, looking down. "Then they each had sex with me, five of them. Afterwards, I was so bruised and my mind was shutting off."
After the rebels left, her husband carried her through the banana trees under the cover of darkness and onto a boat for the five-hour ride from her town of Niabembe to Kabare, a bigger town with a hospital.
In the middle of the night, the doctors had to cut her abdomen open and remove the dead fetus.
"Afterwards my mind was really gone," she said, her eyes tearing. "I was thinking how would I survive like this."
Her husband, who teaches the Bible at a local church, took her home and was kind to her, she said. For that she felt lucky, because many husbands have left their wives after they were raped and suffered from vaginal fistula.
He could not help her, though. She stayed in bed for 10 months trying to survive the humiliation of a condition that often leaves women foul-smelling because of a tear in the bladder or the rectum. In some villages, women with fistula are told to sleep with animals. She just sat in bed crying and trying to stop the endless flow of urine and feces. Finally, a friend of her husband from a women's group at his church told him of a place in Bukavu where she could have an operation.
They left right away on the two-day journey. When she arrived, she was sad to see so many women suffering from the same affliction. "My heart was hurting," she said.
But in another way, she was happy to be among those who would not judge her or make fun of her illness. "I was feeling better because I couldn't survive this way," she said. "I was thinking I might be okay again."
Her first operation, which took nearly four hours, was unsuccessful; doctors said it was because she had suffered such severe ruptures to her bladder wall. The second operation, three months later, went far better. She can now control most of her bodily functions.
Sitting recently in her doctor's office, where drawings that depict soldiers raping a woman warn of such acts, she said she was encouraging other women to talk about what they went through.
One woman in the hospital had been shot in her vagina with a gun. Another was taken as a slave of a rebel group and gang-raped for months. Some of the women are pregnant; others are HIV-positive. The hospital has had 897 rape cases since March.
"We are good, good friends," Nyagakon said. "If I see a woman who is sad, I help her."
For now, she sat sitting in the ward with other women, who were lying listlessly on beds, some with jugs of water nearby to help them become hydrated after an operation. Others rested with bedpans nearby, waiting for surgery.
Nyagakon is awaiting her third operation. She hears on the radio of a fragile peace. She hopes that by the time she recovers, she will finally be healed and it will be safe to go home.

By Emily Wax - Washington Post Foreign Service - Saturday, October 25, 2003; Page A01